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

Wednesday, August 2, 2017

Aspiration Not Better For Stroke Thrombectomy Outcome Contact aspiration no better than stent retrievers

No clue what this means or how this gets you 100% recovered.
https://www.medpagetoday.com/Cardiology/Strokes/66989?
  • by Reporter, MedPage Today/CRTonline.org
Contact aspiration failed to show any real advantage over stent retrievers during revascularization for a ischemic stroke in the anterior circulation, the French randomized ASTER trial showed.
Successful revascularization -- defined as modified Thrombolysis in Cerebral Infarction (mTICI) scores 2b or 3 at the end of all endovascular treatments -- reached 85.4% with contact aspiration versus 83.1% with stent retriever use (OR 1.20, 95% CI 0.68-2.10), reported Bertrand Lapergue, MD, PhD, of Foch Hospital in Suresnes, France, and colleagues.
Outcomes were similar between groups, too, for National Institutes of Health Stroke Scale (NIHSS) score improvement at 24 hours (-4.8 versus -5.2 points, P=0.68) and functional independence at 90 days (45.3% versus 50.0%, OR 0.83, 95% CI 0.54-1.26).
ASTER's first-line results were previously reported at this year's International Stroke Conference and are now published online in the Journal of the American Medical Association.
"First-line contact aspiration was not superior to first-line stent retriever in achieving successful revascularization at the end of the endovascular procedure," Lapergue's group concluded.
However, the authors maintained that this was a superiority trial designed to demonstrate a 15% absolute increase in successful revascularization by thrombus aspiration. "A smaller yet potentially clinically significant difference in revascularization rate cannot be fully excluded," they said.
"Theoretically, contact aspiration could result in a higher rate of an mTICI score of 3 compared with stent retriever because use of a stent retriever requires that it be passed through the clot and therefore might result in a higher rate of distal emboli (as was found in an in vitro study), but there were no significant differences between groups in the secondary outcome of an mTICI score of 3 or in the frequency of embolization to a new vascular territory in this study."
The trial randomized eligible patients with acute ischemic stroke in the anterior circulation to treatment with contact aspiration (n=192) or stent retriever therapy (n=189) before urgent mechanical thrombectomy at eight comprehensive stroke centers in 2015-2016. Those who were eligible also received IV thrombolysis prior to arrival at the angiographic suite.
The study group had a mean age of 69.9 years and 45.7% were women. Average baseline NIHSS score was 16.2 and a median 227 minutes elapsed from symptom onset to arterial puncture.
Baseline differences emerged in age, admission systolic blood pressure, prestroke mRS score, and site of occlusion.
Rescue treatment resulting in switching or combining therapies was required in 32.8% of the contact aspiration versus 23.8% of stent retriever groups (OR 1.57, 95% CI 0.99-2.47). There were numerically more symptomatic intracranial hemorrhages at 24 hours with stent retriever use (6.5% versus 5.3%), as well as new ischemic strokes in different vascular territories (8.5% versus 5.3%).
The study was sponsored by Fondation Ophtalmologique Adolphe de Rothschild with an unrestricted research grant from Penumbra.
Lapergue had no disclosures listed.
Co-authors reported several relationships with industry.

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