Deans' stroke musings: Stroke Rounds: Lesion Site Affects Reperfusion Benefit With Clot Grabber

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, January 28, 2016

Stroke Rounds: Lesion Site Affects Reperfusion Benefit With Clot Grabber

If the ICA is blocked is it even a stroke since that is prior to entering the Circle of Willis? And if the Circle of Willis is complete then that wouldn't cause problems. Is this problem even defined correctly?
http://www.medpagetoday.com/Cardiology/Strokes/55888?xid=nl_mpt_cardiodaily_2016-01-28&eun=gd3r
The magnitude of functional outcome benefits from reperfusion with endovascular thrombectomy may depend on the site of occlusion, a meta-analysis showed.
Reperfusion was associated with 3.5-fold higher odds of a good functional outcome (0-2 on the modified Rankin Scale) at 90 days among patients with internal carotid artery (ICA) occlusions and 6.2-fold higher among those with proximal middle cerebral artery (MCA) occlusions versus persistent occlusion.
Reperfusion had no significant association with good functional outcome in distal MCA lesions (OR 1.4, 95% confidence interval 0.8-2.6), although there was a link in the M2 occlusion subset (OR 2.2, 95% CI 1.0-4.7), Robin Lemmens, MD, PhD, of University Hospitals Leuven in Belgium, and colleagues reported online in Neurology.
"The association between reperfusion and good clinical outcomes is stronger in patients with proximal(closer) occlusions compared to distal(farther) occlusions," the group concluded. "Our results, however, do not indicate that patients with distal MCA occlusions do not benefit from endovascular therapy."
"In contrast, the results underscore the need for additional clinical trial data to determine the effect of endovascular therapy in this subgroup," they continued.
Indeed, the study "is not going to change my practice," Haitham Dababneh, MD, of Doctors Hospital at Renaissance in Edinburg, Texas, told MedPage Today. He likewise called for better data from randomized controlled trials, noting differing baseline characteristics between groups in the meta-analysis and the fact that there were fewer patients with distal strokes than proximal strokes.
For now, "it's hard to compare apples to oranges," Dababneh said.
As for the reason why patients with distal MCA occlusions might show less benefit from reperfusion, the authors suggested that those individuals "have less brain tissue at risk of infarction (i.e., less brain tissue that can be salvaged with reperfusion) compared to patients with more proximal MCA or ICA occlusions."
Lemmens and colleagues pooled patient-level data from four large endovascular trials -- SWIFT, STAR, DEFUSE 2, and IMS III -- for a total of 710 patients in their analysis.
Panagiotis Papanagiotou, MD, of Hospitals Bremen-Mitte in Germany, told MedPage Today that clinicians should focus on careful patient selection, perhaps with advanced imaging techniques.
Papanagiotou, who was an investigator for SWIFT, added that the improvement of endovascular techniques -- such as "direct thrombus aspiration to achieve higher recanalization rates" -- may also be helpful for the treatment of distal lesions.