American Stroke Association, Feb. 11-13

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The American Stroke Association's International Stroke Conference

The annual American Stroke Association's International Stroke Conference was held from Feb. 11 to 13 in Nashville, Tenn., and attracted nearly 4,000 participants from around the world, including cerebrovascular research and practice experts. The conference featured more than 1,500 presentations that emphasized basic, clinical, and translational medicine, and provided insight into the prevention, management, and treatment of strokes.

In one study, Italo Linfante, M.D., of Baptist Hospital in Miami, and colleagues evaluated effects of recanalization and symptomatic intracranial hemorrhage (sICH) on 90-day mortality (mRS) and factors associated with mortality despite successful recanalization.

Using the North American Solitaire Stent Retriever Acute Stroke registry, the investigators evaluated 354 stroke patients in 24 centers treated within less than or equal to eight hours of symptom onset, from March 2012 to February 2013. Of the 354 patients, 256 (72.3 percent) were recanalized successfully, including 234 patients who had 90-day mRS recorded. While the investigators found that mortality was significantly lower with successful recanalization, there was no statistical difference in sICH occurrence. However, the investigators found that mortality was higher in patients who developed sICH.

"Failed recanalization is associated with higher 90-day mortality, whereas proximal large vessel occlusion, high National Institutes of Health Stroke Scale, and use of rescue therapy are independent predictors of mortality among successfully recanalized cases," the authors write.

Several authors disclosed financial ties to Modest, Covidien, and/or Stryker.

Abstract No. LB P14

In another study, Susan Linder, P.T., of the Cleveland Clinic, and colleagues compared the effectiveness of two different approaches to aerobic exercise training paired with upper extremity rehabilitation in improving motor outcomes in stroke patients. The investigators hypothesized that aerobic exercise could potentially prime the central nervous system after stroke.

The investigators evaluated three groups of patients. The first group was put on a motor-assisted stationary bike, which helped some patients with deficits from stroke. The first group also received standard upper extremity rehabilitation. The second group was put on a stationary bike with no motor assistance and received standard upper extremity rehabilitation. The third group only received standard upper extremity rehabilitation.

"We found that the two groups of patients who underwent an aerobic exercise regimen with or without motor assistance on a stationary bike had better motor outcomes compared to those who only received standard upper extremity rehabilitation," Linder said. "These findings support our hypothesis that aerobic exercise may potentially prime the central nervous system and improve motor outcomes."

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In another study, Laura Lehman, M.D., of Boston Children's Hospital, and colleagues found that the rate of posttraumatic stress disorder (PTSD) in parents following childhood stroke is similar to that seen in parents of children with other critical illnesses. Specifically, the investigators found that 24 percent of parents of children who have experienced a childhood stroke have PTSD, while 22 percent of children have anxiety following childhood stroke.

"We had a small sample size of nine children in which none met all criteria for PTSD but 22 percent had clinically significant levels of anxiety. PTSD in the parents and anxiety in the children may affect the child's compliance with medical therapies such as physical, occupational, and speech therapy which could affect the functional outcome in the child," Lehman said.

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Waleed Brinjikji, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues found that a new device, HydroCoil, significantly improved healing of ruptured aneurysms compared to a standard device. In addition, the investigators also found the new device to be associated with a significantly lower rate of occurrence.

"We think that one of the reasons the HydroCoil had better outcomes than the bare platinum coil in the ruptured aneurysms is that a ruptured aneurysm can have a little bit more of a complex or irregular shape, the expansion of the hydrogel likely allows for filling of some of these irregular outpouchings and rupture sites," Brinjikji said in an American Stroke Association news release. "The advantage of the HydroCoil is that it will expand to fill in that irregular shape."

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Chuanhui Dong, Ph.D., of the University of Miami Miller School of Medicine, and colleagues found that keeping systolic blood pressure readings below 140 mm Hg helps reduce the risk of stroke in healthy people aged 60 and older. The findings challenge a controversial report published last year in the Journal of the American Medical Association suggesting physicians should aim for blood pressure readings of 150/90 mm Hg or lower for patients 60 and older who do not have diabetes or chronic kidney disease.

In the new study, the researchers found that, compared to those with systolic readings below 140 mm Hg, the risk of first stroke was 2.4 times greater in Hispanics with readings of 140 to 149. For blacks with readings of 140 to 149, the risk of a first stroke was two times higher than in those with readings under 140 mm Hg. In women with systolic blood pressure readings of 140 to 149, the risk of a first stroke was nearly twice as high compared to those with readings under 140 mm Hg. Among men, those with levels of 140 to 149 were 34 percent more likely to suffer a stroke than those with systolic levels below 140 mm Hg.

"Hypertension is the most established and modifiable risk factor for stroke, one of the leading causes of death and disability," Dong said in an American Stroke Association news release. "Reduction in systolic blood pressure below 140 is important in primary stroke prevention, even among those over 60 without diabetes or chronic kidney disease."

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Yasumasa Yamamoto, M.D., of Kyoto Katsura Hospital in Japan, and colleagues evaluated how home blood pressure (HBP) predicts post-stroke cognitive decline as well as stroke recurrence. Specifically, the investigators assessed 250 patients with non-cardio-embolic ischemic stroke who were treated as an inpatient and then tracked in an outpatient clinic using HBP as measured in the early morning and just before going to bed.

"Higher HBP, especially bedtime HBP, strongly predicts subsequent development of post-stroke cognitive decline," the authors write.

Abstract No. LB P13

ASA: Low Vitamin D Levels Tied to Poor Stroke Prognosis

THURSDAY, Feb. 12, 2015 (HealthDay News) -- Low vitamin D levels are linked to an increased risk of severe stroke and poor health in stroke survivors, new research finds. The study was scheduled to be presented Wednesday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

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ASA: Worse Stroke Outcomes in Dehydrated Patients

THURSDAY, Feb. 12, 2015 (HealthDay News) -- People who aren't well-hydrated when they have a stroke are about four times more likely to have a worse outcome than people who've had more fluids, a new study suggests. The research is scheduled to be presented Thursday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

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ASA: Cancer Risk Higher for Older Stroke Survivors

THURSDAY, Feb. 12, 2015 (HealthDay News) -- Older adults who survive a stroke may have a higher-than-average risk of developing cancer in the next few years, according to a study scheduled to be presented Thursday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

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ASA: Ultrasound of Optic Nerve Could Aid Stroke Prognosis

THURSDAY, Feb. 12, 2015 (HealthDay News) -- The optic nerve may provide clues to a stroke patient's survival, a new study indicates. The findings were scheduled to be presented on Wednesday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

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ASA: Driving Errors Up in Recent Stroke Survivors

WEDNESDAY, Feb. 11, 2015 (HealthDay News) -- In two small studies, drivers who survived a recent stroke were more likely than other drivers to make serious driving errors, and stroke survivors were also more likely to get into collisions when in a simulated driving test environment. The researchers were scheduled to present their findings Wednesday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

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ASA: Rapid Endovascular Therapy Beneficial in Ischemic Stroke

WEDNESDAY, Feb. 11, 2015 (HealthDay News) -- For patients with ischemic stroke, rapid endovascular therapy is associated with improved outcomes, according to two studies published online Feb. 11 in the New England Journal of Medicine. The research was published to coincide with the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn.

Abstract - Campbell
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Abstract - Goyal
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ASA: Hospitals Embracing 'Drip and Ship' Stroke Protocol

WEDNESDAY, Feb. 11, 2015 (HealthDay News) -- More community hospitals are giving tissue plasminogen activator (tPA) medication to stroke victims, improving their chances of survival and recovery, new research indicates. The findings are to be presented Wednesday at the American Stroke Association's International Stroke Conference, held from Feb. 11 to 13 in Nashville, Tenn., and published simultaneously Feb. 11 in Stroke.

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