Deans' stroke musings: Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, January 29, 2020

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

This is why I think you really need to have a discussion with your doctor as to why this needs to be done. If your Circle of Willis is complete it would seem to make more sense to just close up the artery completely rather than risk more brain damage. My right carotid artery was completely closed for at least 10 years before collaterals appeared and I suffered no cognitive impairment from that lack of blood source. Push your doctor hard on that question. Will they guarantee no adverse events from the procedure they do?

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

By Eric Ramos

BARCELONA, Spain -- January 26, 2020 -- Patients with new silent cerebral infarctions during revascularisation procedures for carotid artery disease appear to have worse cognitive impairment than patients who do not develop new lesions, according to a study presented here at The International Conference of the European Society of Cardiology (ESC) Council on Stroke.

Patients who developed new ischaemic lesions scored significantly worse on the Mini Mental State Examination (MMSE) at their follow-up visit, compared with MMSE scores taken right before and after the procedure.

“Patients undergoing carotid artery angioplasty and stenting have high risk of stroke or transient ischaemic attack intra-procedurally,” explained Alexandros Evangeliou, MD, Hippokration General Hospital, Thessaloniki, Greece. “Even though ischaemic brain lesions are detected on post-procedural imaging, most of these patients do not have neurological deficits.”

To clarify the association between intra-procedural ischaemic lesions and cognitive impairment, the researchers examined the neurological outcomes of 31 patients aged 56 to 78 years who successfully underwent carotid artery angioplasty and stenting for carotid artery disease.

All patients underwent a neurological clinical examination, and Mini-Mental-State-Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS) questionnaires were administered before and after surgery, and at the follow-up visit. Cerebral diffusion-weighted MRI was performed before and after revascularisation.

After a median follow-up time of 9 months, 8 (25.8%) patients showed new ischaemic lesions on MRI.

There were no differences in NIHSS scores before and after the procedure or at the follow-up visit. The authors noted that this was expected because the NIHSS score is used to quantify stroke severity in clinically evident strokes, not silent ones.

However, the MMSE score at the follow-up visit (24.7 ± 5) was significantly lower than scores recorded before the revascularisation procedure (27.2 ± 2.7; P = .049) and after (28.3 ± 1.53; P = .029).

“The MMSE score correlated with MRI imaging and can be used in this setting to assess prognosis,” said Dr. Evangeliou.

[Presentation title: Evaluation of Silent Cerebral Infarction Prognosis in Patients With Carotid Artery Disease Undergoing Carotid Artery Revascularization Procedure]