Archive for February, 2010

By Ed Susman

SAN ANTONIO, TX – Both carotid artery stenting and carotid endarterectomy appear to have similar results in preventing strokes among patients with carotid stenosis whether they are symptomatic or asymptomatic, researchers said at the 2010 International Stroke Conference.

“I’m excited to say that we have 2 good options to treat carotid stenosis,” said Wayne Clark, MD, Oregon Stroke Center at Oregon Health Sciences University, Portland, Oregon.

In the Carotid Revascularisation Endarterectomy Versus Stenting Trial, about 7.2% of the patients who were randomised to undergo angioplasty and stenting experienced a perioperative (within 30 days) event of myocardial infarction, stroke, or death compared with 6.8% of the patients who underwent extracranial carotid artery endarterectomy.

Dr. Clark said the difference between those 2 groups was not significant. The 117 sites in Canada and the United States enrolled 1,321 symptomatic patients and 1,181 asymptomatic patients into the study.

Dr. Clark said that in the mean 2.5 year follow-up, about 5.2% of the patients undergoing stenting experienced 1 of the endpoint events compared with 4.5% of the surgery patients, again a nonsignificant difference.

“At experienced centres, both procedures appear to have low periprocedural complications and excellent longer-term results for symptomatic and asymptomatic men and women,” Dr. Clark said during his late-breaking presentation at the conference.

The researchers did note some differences between the groups, including a finding that older patients — those aged older than 70 years — appeared to have better outcomes with surgery, while younger patients did better with the stenting procedure.

Periprocedural strokes occurred more often in the patients who underwent stenting (4.1%), compared with 2.3% of those who underwent surgery (P = .01). On the other hand, myocardial infarctions were more frequent among those undergoing surgery (2.3%), compared with 1.1% of the patients who received stents (P = .03).

About 35% of the patients in the study were women, Dr. Clark said. He said that despite attempts to recruit minority patients, just 9% of the cohort came from minority populations.

Funding for this study was provided by the National Institutes of Health and Abbott.

- MFP Wire Services
- 02-27-2010

By: Ed Susman

SAN ANTONIO, TX – Patients with acute mild ischaemic stroke did not achieve better outcome if they were treated with aspirin/dipyridamole or clopidogrel, researchers said at the 2010 International Stroke Conference.

The researchers reviewed data from the Prevention Regimen for Effectively Avoiding Second Strokes study, looking for evidence of a difference between the treatments in functional outcome or the prevention of second strokes. Prevention Regimen for Effectively Avoiding Second Strokes failed to meet its primary endpoint of showing that the combination product was noninferior to clopidogrel.

“Treatment with combined aspirin/dipyridamole versus clopidogrel in 1,360 patients with acute mild ischaemic stroke did not differ in effects on functional outcome, death, bleeding, or serious adverse events,” said Philip Bath, MD, University of Nottingham, Nottingham, United Kingdom, during his poster presentation at the conference.

In the study, researchers enrolled 20,332 patients to assess antiplatelet and blood pressure-lowering strategies for secondary prevention of stroke. Of that group, 672 patients were randomised within 72 hours of ischaemic stroke symptoms to the combination of aspirin 25 mg twice a day and extended-release dipyridamole 200 mg twice a day. Another 688 patients were assigned to receive clopidogrel 75 mg/day.

In the subgroup analysis, the primary outcome was functional outcome at 30 days; secondary outcomes included recurrence and death at up to 90 days. Analyses were adjusted for baseline prognostic variables and blood pressure treatment assignment, Dr. Bath said. The average age of the patients in the substudy was 67 years, and the average National Institutes of Health Stroke Scale score was 3, indicating mild residual symptoms from the cerebrovascular event.

When the researchers scrutinised outcomes, the risk of dying or becoming dependent upon others to complete the activities of daily living did not differ between the 2 groups (P = .75). Patients taking aspirin and dipyridamole had a 44% reduction in recurrence and a 29% decrease in recurrence of vascular events, but neither of the differences achieved statistical significance, Dr. Bath said.

“Administration of both treatments was practical and well tolerated,” he said.

Funding for this study was provided by Boehringer Ingelheim.

- MFP Wire Services
- 02-27-2010

By: Ed Susman

SAN ANTONIO, TX – Patients who are assessed a National Institutes of Health Stroke Scale score of “0″ — indicating normal functioning — might be misdiagnosed as not having had a stroke, researchers said at the 2010 International Stroke Conference.

“An National Institutes of Health Stroke Scale score of 0 does not equal the absence of stroke,” said Sheryl Martin-Schild, MD, Tulane University Stroke Center, New Orleans, Louisiana, during her poster presentation at the conference. “While the National Institutes of Health Stroke Scale examination is a useful tool for identifying stroke, not all stroke symptoms are captured as deficits on the National Institutes of Health Stroke Scale examination.”

Dr. Martin-Schild and colleagues examined the records of 83 patients who were admitted to the stroke centre with neurological conditions suspected of being a stroke, but were given an National Institutes of Health Stroke Scale score of 0. She found that 20 of these patients had persistent neurological symptoms that did not resolve.

Three-fourths of these patients were discharged to their homes, but 10% of them were sent to skilled nursing facilities. Their mean age was about 54 years and 35% of them were women. About 45% of these patients complained of headaches.

The doctors found that 17 additional patients appeared to have experienced a transient ischaemic event that was followed by a stroke. These patients were aged about 69 years, and 41% were women. Their major complaints were headaches and vertigo and limb weakness.

The remaining 46 patients were classified as having experienced a clinical transient ischaemic attack that produced brain infarction that was identified on magnetic resonance imaging scans. This group of patients had a mean age of 63 years and 54% were women. Their major complaints were limb weakness and sensory disturbances.

Overall, Dr. Martin-Schild said the most common complaints were headache, vertigo, ataxia, confusion, and blurred vision. The scans indicated that patients in these National Institutes of Health Stroke Scale = 0 classification appeared to have had impacts with the posterior circulation. “Specifically, the cerebellum, was most commonly infarcted in this group,” she reported.

Dr. Martin-Schild said that relying on the National Institutes of Health Stroke Scale score could cause future detriments to the patients:

· Some of the unscored symptoms were subtle, but others were potentially disabling.

· Axial ataxia is not evaluated on the National Institutes of Health Stroke Scale examination.

· A missed infarction could be a missed opportunity to institute appropriate preventative measures.

- MFP Wire Services
- 02-27-2010