Deans' stroke musings: How to Establish the Outer Limits of Reperfusion Therapy

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, September 2, 2021

How to Establish the Outer Limits of Reperfusion Therapy

If you didn't get to 100% recovery it is your responsibility to initiate research that will get there. This thinking small has to stop.

How to Establish the Outer Limits of Reperfusion Therapy

Lawrence R. Wechsler

Ashutosh P. Jadhav

Tudor G. Jovin

and on behalf of the XIth Stroke Treatment Academic Industry Roundtable

Originally published2 Sep 2021https://doi.org/10.1161/STROKEAHA.121.035022Stroke. ;0:STROKEAHA.121.035022

Abstract

Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments(I'm sure your definition of effective is not what your patient would consider effective. Did they get to 100% recovery? NO? Then it wasn't effective! Your fucking tyranny of low expectations is showing.) for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the “outer limits” of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy(100% recovery is the only consideration! If that is not your goal, GET THE HELL OUT OF STROKE!). The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.