Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,483 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective 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. Did your doctor somehow miss the recovery protocol that Pedro Bach-y-Rita used to recover fully back in 1958 with only a partial brain?
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.
We
investigated whether the signal change on fluid-attenuated inversion
recovery (FLAIR) can serve as a tissue clock that predicts the clinical
outcome after endovascular thrombectomy (EVT), independently of the
onset-to-admission time.
Methods:
Consecutive
patients with acute stroke treated with EVT between September 2014 and
December 2018 were enrolled. Based on the parenchymal signal change on
FLAIR, patients were classified into FLAIR-negative and FLAIR-positive
groups. The clinical characteristics, imaging findings, EVT parameters,
and the intracranial hemorrhage defined as Heidelberg Bleeding
Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular
hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were
compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3
months was considered to represent a good outcome.
Results:
Of
the 227 patients with EVT during the study period, 140 patients (62%)
were classified into the FLAIR-negative group and 87 (38%) were
classified into the FLAIR-positive group. In the FLAIR-negative group,
the patients were older (P=0.011), the onset-to-image time was shorter (P<0.001), the frequency of cardioembolic stroke was higher (P=0.006), and the rate of intravenous thrombolysis was higher (P<0.001)
in comparison to the FLAIR-positive group. Although the rate of
complete recanalization after EVT did not differ between the 2 groups (P=0.173),
the frequency of both any-intracranial hemorrhage and Heidelberg
Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive
group (P=0.004 and 0.011). At 3 months, the percentage of
patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%)
was significantly related to the FLAIR signal change (P=0.047), while the onset-to-image time was not significant (P=0.271).
A multivariate regression analysis showed that a FLAIR-negative status
was independently associated with a good outcome (odds ratio, 2.10 [95%
CI, 1.02–4.31], P=0.044).
Conclusions:
A
FLAIR-negative status may predict the clinical outcome more accurately
than the onset-to-admission time, which may support the role of FLAIR as
a tissue clock.
We
investigated whether the signal change on fluid-attenuated inversion
recovery (FLAIR) can serve as a tissue clock that predicts the clinical
outcome after endovascular thrombectomy (EVT), independently of the
onset-to-admission time.
Methods:
Consecutive
patients with acute stroke treated with EVT between September 2014 and
December 2018 were enrolled. Based on the parenchymal signal change on
FLAIR, patients were classified into FLAIR-negative and FLAIR-positive
groups. The clinical characteristics, imaging findings, EVT parameters,
and the intracranial hemorrhage defined as Heidelberg Bleeding
Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular
hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were
compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3
months was considered to represent a good outcome.
Results:
Of
the 227 patients with EVT during the study period, 140 patients (62%)
were classified into the FLAIR-negative group and 87 (38%) were
classified into the FLAIR-positive group. In the FLAIR-negative group,
the patients were older (P=0.011), the onset-to-image time was shorter (P<0.001), the frequency of cardioembolic stroke was higher (P=0.006), and the rate of intravenous thrombolysis was higher (P<0.001)
in comparison to the FLAIR-positive group. Although the rate of
complete recanalization after EVT did not differ between the 2 groups (P=0.173),
the frequency of both any-intracranial hemorrhage and Heidelberg
Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive
group (P=0.004 and 0.011). At 3 months, the percentage of
patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%)
was significantly related to the FLAIR signal change (P=0.047), while the onset-to-image time was not significant (P=0.271).
A multivariate regression analysis showed that a FLAIR-negative status
was independently associated with a good outcome (odds ratio, 2.10 [95%
CI, 1.02–4.31], P=0.044).
Conclusions:
A
FLAIR-negative status may predict the clinical outcome more accurately
than the onset-to-admission time, which may support the role of FLAIR as
a tissue clock.
Well shit, the answer is to write up protocols and modify them as needed. But we also need to know exactly the time parameters that provide 100% recovery for each type of intervention. Without that we will never provide correct solutions. https://www.medpagetoday.com/meetingcoverage/isc/70827?
Stroke docs struggle with message after DAWN, DEFUSE 3, new guidelines
Note that this study was
published as an abstract and presented at a conference. These data and
conclusions should be considered to be preliminary until published in a
peer-reviewed journal.
LOS
ANGELES -- Time is brain has been a hard-fought mantra in acute stroke
care. Decades after introduction of IV thrombolysis, the still-slow
climb in rates of use show just how difficult.
The time-focused message is butting up against the DEFUSE 3 and DAWN trials,
showing that a mechanical thrombectomy treatment window out to 16 and
even 24 hours still can benefit imaging-selected patients, and
newly-released American Heart Association/American Stroke Association guidelines officially promoting that extended window.
A subanalysis of DEFUSE 3 presented after the main results at the International Stroke Conference
(ISC) here showed just how unimportant time was for thrombectomy
outcomes when patients presented beyond 6 hours were selected with
perfusion imaging.
Whereas the likelihood of good functional outcome (modified Rankin
Scale score 0-2) dropped precipitously as time at presentation increased
from 6 hours to 16 in that trial among patients in the medical
treatment-only arm, the mechanical thrombectomy arm saw exactly the same likelihood of functional independence at hour 6 as at 16.
The discussion immediately turned to how to manage the interpretation.
"How do we as practitioners manage the messaging around it? Because
it could foster some complacency a little bit. You don't want any
complacency," said Bruce Ovbiagle, MD, of the Medical University of
South Carolina in Charleston, who chaired a press conference where the
findings were presented. "We've been pushing that for a long time. We
don't want to dilute our message in any way."
"We certainly don't want to give the message that it's okay to delay
treatment, that it's okay to delay coming to the hospital," agreed
Maarten Lansberg, MD, of Stanford University in Stanford, California,
who presented the substudy. "The message here is time is still
important; it is not too late when it's 6 hours. Even at 16 hours and
probably up to 24 hours, there is still a subset of the population
that's going to benefit."
Gregory Albers, MD, also of Stanford, presented the main DEFUSE 3 results
at ISC, and said that the extended-window thrombectomy studies provide
the next evolution in stroke beyond a simple time is brain mantra.
That mantra gained urgency with the approval of tissue plasminogen
activator (tPA) in 1996 with just a 3-hour window. But as imaging
developed in the 1990s, it also became clear that strokes developed
uniquely -- some patients who came in immediately after symptom onset
had massive infarcts whereas others remained small hours after onset.
In 2006, the first DEFUSE trial tested tPA out to 6 hours with MRI to
predict response. Albers' group developed the RAPID software to see how
much brain tissue is salvageable, which has been used in thrombectomy
trials to select patients for that treatment.
"With DAWN and DEFUSE [3], the world is moving from a time clock to a
tissue clock," commented Jeffrey Saver, MD, of the University of
California Los Angeles But, he clarified, "it's not longer just a time
clock, it's also a tissue clock."
Although imaging can find patients all along the time spectrum who
still have salvageable tissue that would stand to benefit, it's still
important to rush at every point along the line.
"The
time is still critical because a smaller percentage of the people you
check with that perfusion imaging will have that good brain," J Mocco,
MD, of Mount Sinai Hospital in New York City, said in panel discussion
at the DEFUSE 3 press conference. "But once you use the imaging to
select the patient, it's completely reasonable that they would have a
consistent treatment effect, because you've selected the ones that are
going to have that benefit."
After the imaging, "we still want everyone, even at 12 hours, to move
as fast as they can," Ralph Sacco, MD, of the University of Miami and
president of the American Academy of Neurology, told MedPage Today.
"In other studies, it is clearly shown that the longer it takes to open
the vessel, the worse the outcome. So we need to keep that message
going that time is brain, and that minutes count, and we need to get
these vessels open pretty quickly."
"The only good thing I think for the public is, when you wake up with
a stroke and you're out of that 6-hour time window, because last known
well was when you went to bed, there is now hope," he added.
The changing maxim also opens up more opportunities for research,
noted Ovbiagele. "What is it about these patients who, for whatever
reason, their strokes are developing more slowly as opposed to the
people who are developing rather quickly? People tend to say it's
collaterals; we continue to study that. But I think you have 50% [of
patients] with this who come in not eligible ... others somehow are
going slowly. I think it will be important for us to think about this."
DEFUSE 3 was funded by the National Institute of Neurological Disorders and Stroke.
Lansberg disclosed no relevant relationships with industry.
Albers
disclosed relevant relationships with iSchemaView, Medtronic outside
DEFUSE 3, and a patent licensed to Stanford University for automated
detection of arterial input function and venous output function voxels
in medical imaging.
Mocco disclosed a relevant relationships with Penumbra.
