American Heart Association

Monthly Archives: May 2017

Author Interview: Colin Derdeyn, MD

Colin Derdeyn

Colin Derdeyn

A conversation with Colin Derdeyn, MD, Chair and Departmental Executive Officer of the Department of Radiology, University of Iowa Carver College of Medicine, about the late complications of stenting for intracranial atherosclerotic disease and the challenges posed by new stroke treatments.

Interviewed by José G. Merino, MD, Associate Professor of Neurology, University of Maryland School of Medicine.

They will be discussing the paper, “Nonprocedural Symptomatic Infarction and In-Stent Restenosis After Intracranial Angioplasty and Stenting in the SAMMPRIS Trial (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis),” published in the June 2017 issue of Stroke.

Dr. Merino: Good afternoon. Can you tell us what prompted this secondary analysis of the SAMMPRIS data?
Dr. Derdeyn: From SAMMPRIS, we learned that there’s potentially great value for dual antiplatelets and statins, along with aggressive risk factor management for patients with intracranial atherosclerotic disease (ICAD).  We also learned that in this setting, there is a much higher complication rate from stenting than we thought, mainly due to a lot of perforator strokes, particularly in the basilar territory, and that the procedure is associated with a risk of intracranial hemorrhage, perhaps due to reperfusion. These short-term complications limit the value of stenting for ICAD.

Some Interesting Late-breaking Abstracts

European Stroke Organisation Conference (ESOC)
May 16–18, 2017

May 18, 2017
Should you restart anticoagulation after a cerebral haemorrhage? And other questions.

There are few things as devastating as a large ischaemic stroke in a patient who you had previously advised not to take anticoagulation.

As a stroke physician, I’ve been asked questions about whether I should give anticoagulation to a patient who has had an intracerebral haemorrhage (ICH). Many people who have had an ICH are at high risk of having an ischeamic stroke. At the late-breaking trials session of ESOC, there was some useful evidence that will help me sleep after these consults.

What Causes Lacunar Stroke, and How Should You Treat It?

European Stroke Organisation Conference (ESOC)
May 16–18, 2017

May 17, 2017
What if I told you that nearly 1/4 of ischaemic strokes weren’t caused by emboli at all? With the focus on retrieving clots with clever devices, and preventing them from forming with anticoagulants, it’s easy to forget that some ischeamic strokes have quite a different cause.  Lacunar strokes are caused by small vessel disease: an intrinsic disease of the small deep perforating arteries. Small vessel disease also causes vascular dementia, and is likely to  play a role in gait disturbance and falls.

At ESOC, there was an excellent session on SVD, which gave plenty of practical advice and food for thought.

Untangling Post-stroke Dementia

European Stroke Organisation Conference (ESOC)
May 16–18, 2017

May 16, 2017
It was refreshing to see a full hall at the ESOC session about the impact of stroke and cognition. In stroke research, it is easy to get distracted by exciting and dramatic things (such as thombectomy working for people who wake up with stroke) and forget some of the other things that are just as important to our patients. Fortunately, the relationship between stroke and cognitive impairment is now firmly on the research agenda.

We know that stroke increases the risk of dementia, but it’s difficult to say just HOW much. The existing data is quite confusing; if you look at patients who have had a large stroke, many will have cognitive impairment, but again many will be unable to take part in cognitive tests. The picture is quite different if we only look at patients with a mild stroke or TIA, as far fewer will have cognitive impairment. The problem is that many studies are only able to recruit patients with milder stroke. To make the problem worse, patients with severe stroke will not survive, so if you are not careful, it can seem that patients with milder stroke are more likely to have dementia at one year.

A Session for the Ages

European Stroke Organisation Conference (ESOC)
May 16–18, 2017

May 16, 2017
The 3rd European Stroke Organization Conference (ESOC) session titled “Official Welcome and Large Clinical Trials” kicked off what was to be a spectacular conference with one of the most impactful 90 minutes I have ever witnessed. The session in the Grand Hall of the Prague Conference Center was standing room only and, after a warm introduction, incorporated 8 presentations from large clinical trials each lasting 8 minutes. The conference itself drew over 4,200 participants, challenging the International Stroke Conference in impact and attendance. This is a remarkable achievement for a conference in its third year of existence.