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:

Friday, May 19, 2017

European Stroke Organisation - ESOC Day 3 Highlights 18 May 2017

I see nothing here that helps survivors recover better. Nothing on rehab, nothing on hyperacute interventions. I would say this conference was totally fucking useless.
Oops, once again not following Dale Carnegie, 'How to Win Friends and Influence People'.
Exciting new data from the late breaking sessions ensured a fitting finale to ESOC 2017. Highlights from the late breaking sessions are provided below.

SPACE 2 Study - A Comparison of Stenting, Endarterectomy and Best Medical Management
This study augments the volume of evidence demonstrating minimal differences between carotid endarterectomy (CEA) and carotid stenting (CAS) and a low overall rate of procedural complications in patients with asymptomatic carotid stenosis. Prof Tilman Reiff (University Hospital Heidelberg, Germany) presented results from this study in patients with an asymptomatic carotid stenosis, adding to the growing evidence of the relative risks and benefits of these interventions.

· Key findings from the SPACE 2 study

o In 400 patients randomised to CEA vs CAS there was a low rate of periprocedural stroke (<30days), with only 5 events (2.5%) in each arm.

PRASTRO-1 Study - A Comparison of Prasugrel and Clopidogrel (Standard of Care)
The PRASTRO-1 study, demonstrated no significant advantage of prasugrel over clopidogrel in patients with non-cardioembolic stroke. The study compared prasugrel to clopidogrel to determine whether the newer platelet inhibitor, which is felt to be less liable to patient resistance, has equivalent efficacy to the current standard of care. Prof Kazunori Toyoda (Suita- Osaka, Japan) presented the study's results from 3,747 patients with non-cardioembolic stroke.

· Key findings from the PRASTRO-1 study

o There was no significant difference between drugs for the primary outcome of ischaemic stroke, myocardial infarction, or other vascular death (RR 1.05, 95% CI 0.76-1.44), with an equal rate of 'any stroke' in both groups (RR 0.99, 95% CI 0.72-1.36).

o Although event rates were similar, the study did not demonstrate 'non-inferiority' of prasugrel at the pre-defined threshold (RR=1.35).

General or Local Anesthesia During Endovascular Therapy (EVT)?
There is uncertainty regarding the effect of the anesthetic approach during endovascular therapy for ischaemic stroke. Observational studies suggest that general anesthesia (GA) during EVT is associated with worse outcomes compared to conscious sedation (CS). The results of the GOLIATH and ANSTROKE randomised studies should help physicians choose the best strategy for their patients.

· The GOLIATH Study assessed whether GA caused greater infarct growth and worse outcomes during EVT compared to CS. A total of 128 patients were included in the study results presented by Prof Claus Simonsen (Aarhus University Hospital, Denmark).

o Key findings of the GOLIATH study:

§ There was no difference in acute infarct size between groups (median acute infarct volume 10.5 mls with GA and 13.3 mls with CS, p=0.26). Final infarct volume was higher with conscious sedation (38 mls with CS and 22 mls with GA, p=0.04).

§ EVT under GA did not result in worse outcome. The odds ratio for better outcome was 1.91, 95% CI 1.03 to 3.56.

· The ANSTROKE Study compared GA and CS in 106 patients undergoing endovascular therapy for acute ischaemic stroke. The study was conducted at the Sahlgrenska University Hospital in Sweden.

o Key findings of the ANSTROKE study:

§ There was no difference in the numbers of patients who were independent at 3 months (42.2% with GA vs. 40% with CS, p=1.0).

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