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:

Wednesday, July 26, 2017

PESA: 3-D vascular ultrasound detects plaque burden for CV risk prediction

What is your doctor doing to determine your CVD risk due to plaque? Mine did nothing, never did find my 80% blocked right carotid artery. You'll have to demand answers since your doctor probably is just 'winging it' with no protocols to follow for anything to do with your stroke recovery or prevention of your next stroke or heart attack.
Valentin Fuster, MD
Valentin Fuster
A 3-D vascular ultrasound detected elevated plaque burden in middle-aged men, especially within the femoral territory, according to a study published in the Journal of the American College of Cardiology.
The technology “is a feasible, reproducible and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, said in a press release. “This novel method is valid for imaging superficial peripheral atherosclerosis burden from early to advanced stages of disease and can be applied to identification of individuals at risk, targeting or monitoring treatment.”
Ultrasound in low-risk participants
The PESA study was an ongoing observational prospective cohort study in which researchers analyzed data from 3,860 participants (mean age, 46 years; 63% men) without prior CVD. Most participants (79.4%) were low risk. A baseline visit included 3-D vascular ultrasound (Philips iU22) of the femoral and carotid territories, 12-lead ECG and other tests. Participants were followed up at 3 and 6 years.
A random sample (n = 32) was selected from the cohort to assess reproducibility of volume measurement and plaque detection with 3-D vascular ultrasound.
Global plaque burden was more evident in men (63.4 mm3; interquartile range [IQR], 23.8-144.8) vs. women (25.7 mm3; IQR, 11.5-61.6; P < .001). Plaque burden was more common in the femoral territory (64 mm3; IQR, 27.6-140.5) compared with the carotid territory (23.1 mm3; IQR, 9.9-48.7; P < .001), and it increased with age (P < .001).
Similar results were found for plaque presence.
Plaque burden
Femoral disease burden had a stronger link to sex, age, dyslipidemia and smoking vs. carotid disease burden. Hypertension and diabetes did not show significant territorial differences.
Plaque burden was associated with higher CV risk independent of territories affected or number of plaques (P for trend < .01).
“Our results suggest that the ability of global plaque burden to predict cardiovascular risk is likely to be improved by adding evaluation of the femoral arteries at early stages of cardiovascular disease,” the researchers wrote.
“[A] question is how important it will be to include femoral plaque measurement in addition to carotid measurement,” J. David Spence, MD, MBA, professor of neurology and clinical pharmacology and director of the Stroke Prevention and Atherosclerosis Research Centre at the Robarts Research Institute at Western University in London, Ontario, wrote in a related editorial. “Our experience has been that whereas carotid imaging is very comfortable for both the patient and the technologist, it is more difficult to deal with the disrobing (and sometimes the hygiene issues) involved in assessing the femoral arteries.” – by Darlene Dobkowski
Disclosures: The study was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III and Banco Santander. The authors report no relevant financial disclosures. Spence reports serving as an officer for Vascularis Inc.

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