Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 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:

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's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Monday, January 2, 2017

AHA names top 10 research advances of 2016

You will notice none of these have anything to do with stroke rehabilitation or stopping the 5 causes of the  neuronal cascade of death in the first week.  All because we have NO strategy or stroke leadership with a plan to get every stroke survivor to 100% recovery. LEADERS tackle the hardest problems they don't run away from them.  
http://www.healio.com/cardiology/practice-management/news/online/%7B0df12108-ce73-488e-b0b0-e0770ad56920%7D/aha-names-top-10-research-advances-of-2016?s
The American Heart Association, which funds many heart- and stroke-related research studies, compiled a list of the top 10 research advances in heart and stroke science in 2016.(This seems to be their strategic vision which to my eyes seems worthless - 87 pages of blather -No specifics.)

This year, some of the top breakthroughs according to the AHA(American Heart Association) were the results of the SAMMPRIS, HOPE-3 and SPRINT trials, advancements in the treatment of severe stroke, and much more.

1. Preventing second stroke in high-risk groups
Results from the SAMMPRIS study, published in JAMA, showed that a subgroup of patients at higher risk for recurrent stroke did not benefit from aggressive medical management.
While previous research showed that treating high cholesterol, high BP and blood sugar and changes in lifestyle can often be better for stroke patients than a stent, patients who had an old stroke central to a blockage in smaller arteries, had a new stroke, or were not on a statin at the time they joined the study, require treatments with new therapies, the AHA stated in a press release.

2. New, advanced treatments for women with MI
A study published in Circulation: Cardiovascular Imaging suggested that differences found between men and women who had experienced chest pain or MI incidence could lead to new and better treatment for women.
Through CV imaging, the researchers observed differences in plaque type, size and ways in which the plaque “broke.” Although women were at higher risk for CV incidence than men in the study, men had larger-size plaques. Further research of these differences could lead to better treatment for chest pain and MI incidence, the AHA stated.

3. Advancements in valve replacements in the elderly
A recent study from The New England Journal of Medicine used data on the survival and stroke rates of elderly patients with severe aortic stenosis at intermediate risk for surgery to compare the outcomes of surgery vs. transcatheter aortic valve replacement.
Open-heart surgery and TAVR showed similar outcomes in this cohort, suggesting that it may be safe to expand TAVR to patients at less surgical risk.

4. Options for carotid artery treatment
Narrowing of the carotid arteries have historically been treated with a carotid artery endarterectomy. However, the results of the CREST study, published in The New England Journal of Medicine, suggest that a less invasive stent is a viable treatment for narrowed neck arteries, the AHA stated.
At 10 years, there was no significant difference between patients who received endarterectomy or stenting in periprocedural stroke, incidence of MI or death, or subsequent stroke.

5. Simultaneous management of BP and cholesterol
The HOPE-3 study, whose findings were published in three articles in The New England Journal of Medicine, showed that reducing BP and cholesterol is more beneficial to patients at intermediate CV risk than doing either alone, the AHA stated in the release.
Compared with placebo, patients treated with statins had lower CV, MI and stroke risks, and the findings supported the notion that Asian and Hispanic populations benefit from statin therapy.

6. Lifestyle habits could alter genetic CV risks
Research published in the New England Journal of Medicine suggests that people with high genetic CV risk can potentially “stack the deck” in their favor if they adopt favorable lifestyle habits, according to the release.
In participants at high genetic CV risk from four cohorts, favorable lifestyle was associated with almost 50% lower 10-year CVD incidence vs. unfavorable lifestyle including smoking, obesity, lack of exercise and poor diet.

7. Disparity in counseling women and minorities with HF
Women and minority patients who are eligible for an implantable cardioverter defibrillator are often insufficiently counseled about device use, according to at 21,000-patient study published in Circulation.
Four out of five patients with HF who are eligible for ICD counseling did not receive it, with higher rates among women and minorities. Among those who received counseling, women and minority individuals were less likely to receive an ICD.

8. Syncope as sign for pulmonary embolism
Data from the PESIT study, published in The New England Journal of Medicine, which studied 560 patients who were admitted to the hospital for syncope, showed that having a set of criteria for testing patients for pulmonary embolism could be a life-saving preventative measure.
While syncope is not typically considered a major sign of PE, researchers found that PE was present in approximately one in six patients (18%) with syncope, the AHA stated in the release.


9. Stent retrievers successfully treat severe stroke
A meta-analysis published in The Lancet showed that patients with severe acute ischemic stroke treated promptly with stent retrievers had favorable outcomes, the AHA stated.

10. Two studies impact heart disease prevention
Two studies published in 2016 added much to the understanding of heart disease risk and how to prevent it, according to the AHA.
The first study, an analysis of the SPRINT trial published in JAMA, showed that lowering BP below 120 mm Hg systolic/90 mm Hg diastolic compared with 140 mm Hg systolic/90 mm Hg diastolic resulted in lower rates of death and CV events in patients aged 75 years and older. The findings could have implications for BP targets in geriatric populations.
Also in 2016, researchers identified a gene variant conferring lower risk for CHD and published their findings in The New England Journal of Medicine.
The ANGPTL4 gene governs the action of lipoprotein lipase (LPL), which is capable of breaking down triglycerides, which can contribute to CHD, the AHA stated.
Those with the variant had lower triglyceride levels, higher HDL levels, and lower CAD risk compared with those without it. The findings could lead to better control of triglyceride levels and new ways to treat and prevent CHD, according to the release.

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