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:

Thursday, March 2, 2017

Patent Foramen Ovale Closure Device Shows Long-Term Benefit vs Medical Management in Stroke Prevention

So this seems to argue that closing a PFO is better than medical drug treatment. Challenging all these previous studies. When will your doctor tell you about this?

Stroke Rounds: PFO Closure Works Long-Term Only for Some


Landmark Study Finds Expensive Catheter Procedure to Close Hole in Heart No More Effective Than Medical Therapy to Prevent Strokes


AAN Nixes Routine PFO Closure


By Alex Morrisson
HOUSTON, Tex -- February 28, 2017 -- After a decade of follow-up, the use of patent foramen ovale (PFO) closure device appears to reduce the risk of stroke recurrence significantly better than medical treatment alone, according to a study presented here at the 2017 International Stroke Conference (ISC).
In the final analysis of the Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) study, of the 499 patients assigned to be implanted with the Amplatzer PFO Occluder, 18 stroke-related events occurred compared with 28 events among the 481 patients treated medically -- a relative risk reduction of 45% (P = .046).
“These analyses support the hypothesis that PFO closure is preventing PFO-related recurrent strokes,” reported David Thaler, MD, Tufts University School of Medicine, Boston, Massachusetts. “PFO closure cannot prevent strokes from non-PFO related causes.”
The final results of the Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) awaited US Food and Drug Administration (FDA) regulatory decision. The data, which was first collected in 2003 was completed in 2015, was analysed by an FDA Advisory Panel in 2016. Dr. Thaler trial said the low rate of events required longer follow-up. The device was approved in Europe in 1998. The FDA approved the device in October 2016.
The researchers enrolled patients from 69 sites in the United States and Canada from 2003 to 2011. Patients who were believed to have PFO-related strokes were randomised between having the device implants and guideline-driven medical management. Patients were eligible if they experienced cryptogenic strokes within the last 9 months, were found to have a PFO, and were aged 18 to 60 years.
The composite endpoint was the occurrence of non-fatal ischaemic stroke, fatal ischaemic stroke or death within 45 days of randomisation. The definition of stroke for the study was neurological deficit due to cerebral ischaemia observed on imaging scans or stroke symptoms that lasted longer than 24 hours.
“In the RESPECT trial, PFO-closure with the Amplatzer PFO Occluder was more beneficial than medical management alone in the intention-to-treat population for the primary outcome,” Dr. Thaler concluded.
[Presentation title: PFO Closure Reduces Long Term Recurrence of Ischemic Stroke: Final Primary and Secondary Population Results From the RESPECT Multicenter Trial. Abstract 71]

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