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.

Thursday, June 11, 2020

Stroke Thrombectomy's Benefits Hold Strong in Developing World

Oh God, congratulating themselves on their tyranny of low expectations. Never do they talk about failure to get 100% recovered. 'Good outcome' and 'likelihood' are NOT GOOD ENOUGH. Talk to survivors sometime without your bias of accepting and promoting the failures of the status quo. Pushing failures in the developed world down to the developing world, not my idea of success.

Stroke Thrombectomy's Benefits Hold Strong in Developing World

Brazilian trial affirms value of endovascular therapy

A thrombectomy device removes a blood clot
The benefits of stroke thrombectomy could be reproduced in a resource-limited healthcare system, a randomized trial in Brazil showed.
Within the public health system there, adding endovascular treatment to standard care for large vessel occlusion strokes resulted in less disability as shown by a better distribution of modified Rankin scale (mRS) scores at 90 days (common OR 2.28, 95% CI 1.41-3.69).
Moreover, 35.1% of thrombectomy recipients had good outcomes (0-2 mRS scores) at that point, compared with 20.0% of controls receiving standard care alone (difference 15.1 percentage points, 95% CI 2.6-27.6), reported Raul Nogueira, MD, of Grady Memorial Hospital in Atlanta, and collaborators.
Rates of 90-day mortality were 24.3% and 30.0% for the thrombectomy and control arms (HR 0.73, 95% CI 0.45-1.19), the group reported in their paper published in the June 11 issue of the New England Journal of Medicine.
"While there was a lower overall likelihood of good outcome and higher mortality rates as compared to previous trials in high-income countries, the overall benefit of thrombectomy as shown on the shift across all modified Rankin Scale scores was similar," commented Amrou Sarraj, MD, of UTHealth McGovern Medical School in Houston.
"Additionally, the likelihood of achieving functional independence largely mirrored the MR CLEAN trial," according to Sarraj.
And that was despite differences at every step of stroke care compared with the high-income countries where trials were conducted, Nogueira's group noted.
Lack of such confirmatory data from developing nations might have been one reason that "[d]espite its apparent efficacy, the use of thrombectomy has remained limited in many regions of the world or has been delayed in adoption," Nogueira's group wrote.
"Further work is still needed in these countries to bridge the remaining gaps, but the results help further open the doors for millions of people with limited healthcare system resources to receive this life-saving treatment. It is a major step in the right direction in these countries," Sarraj told MedPage Today.
The RESILIENT trial represented a collaborative effort by the Brazilian government and academic physicians to evaluate whether the treatment should be incorporated into the country's Universal Public Health Care System. In Brazil, thrombectomy costs over $8,000 more per patient upfront than medical therapy alone.
The study randomized acute stroke patients to standard care with or without thrombectomy at 18 Brazilian sites in 2017-2019 -- well before the COVID-19 pandemic wreaked havoc on the health system there. Participants had to have a proximal intracranial occlusion in the anterior circulation and be treated within 8 hours of symptom onset.
From 20 sites initially considered for the trial, 12 certified stroke centers ended up making the cut and participating. Only one center had had prior experience with endovascular stroke treatment, though all trial operators were fellowship-trained neurointerventionalists with at least five thrombectomies (at any center) under their belt, Nogueira and colleagues said.
During the roll-in phase of the trial, hospitals that had no previous experience with thrombectomy were required to perform three to five such procedures and have them evaluated. The 79 patients treated during this period were not included in the primary analysis.
Notably, RESILIENT leaders had intended to include 690 study participants. An interim analysis, conducted after 174 people reached 90-day follow-up, favored early efficacy of thrombectomy, and thus enrollment was stopped.
In the final intention-to-treat analysis, 221 individuals were randomized. NIH Stroke Scale scores were a median of 18. Patients had a median age of 66 years, and just over half of participants were women. Around 70% of both groups received IV alteplase (Activase).
In the thrombectomy arm, 82.0% of patients achieved substantial reperfusion. Median time from arrival in the emergency department to the start of IV alteplase was 34 minutes. Time from arrival to arterial puncture was 116 minutes.
Symptomatic intracranial hemorrhage (ICH) was observed in 4.5% of either group. Asymptomatic ICH occurred in 51.4% of thrombectomy patients and 24.5% of controls -- higher than previously seen in other studies, Nogueira's group noted.
"Because most of our follow-up imaging at 24 hours to determine whether there had been an intraparenchymal hemorrhage was performed with CT, it was difficult to distinguish contrast staining from hemorrhagic conversion, and this may have resulted in the overestimation of the number of minor hemorrhages," the authors noted.
Nevertheless, RESILIENT provides "high-level evidence" that thrombectomy may have benefits in developing countries, Sarraj told MedPage Today.

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