American Heart Association

Monthly Archives: June 2019

Recovery Post-Stroke: Proportional or Not?

Kathryn S. Hayward, PhD, PT

Hawe RL, Scott SH, Dukelow SP. Taking Proportional Out of Stroke Recovery. Stroke. 2019;50:204–211.

In this entry, I discuss a recent publication by Rachel Hawe and colleagues (1) regarding the potential biases of the mathematical properties of the proportional recovery rule and how this may impact application in the field of stroke recovery. Proportional recovery is the idea that most individuals post-stroke (“fitters” to the rule) will recover 70% of their potential on a given outcome (see paper for rule equation). The authors cite multiple studies that have demonstrated proportional recovery for upper limb motor impairment using a single outcome (Fugl Meyer Upper Limb assessment, out of 66 points), and recent work extending this rule to lower limb, aphasia and hemispatial neglect recovery outcomes.

The principal mathematical concept discussed as a limitation of the proportional recovery rule is mathematical coupling. This concept refers to when one variable directly or indirectly contains all or a part of another. For example, in the case of proportional recovery of the upper limb post-stroke, the initial score on Fugl Meyer Upper Limb assessment is part of both the independent and dependent variables of the proportional recovery rule.

ESOC 2019 Session: Intracerebral Haemorrhage I

European Stroke Organisation Conference
May 22–24, 2019

Andrea Morotti, MD

This interesting session dedicated to intracerebral hemorrhage (ICH) started with a pragmatic talk on rare causes of intracranial bleeding, discussing the diagnostic accuracy of neuroimaging in the acute phase, by Floris Schreuder.

Christian Weimar presented the main strengths and limitations of currently available tools to stratify ICH prognosis.

The pathophysiology and management of perihematomal edema was illustrated by Kevin Sheth, with a focus on edema measurement with advanced neuroimaging.

ESOC 2019 Session: Endovascular Treatment – Clinical Practice

European Stroke Organisation Conference
May 22–24, 2019

Elena Zapata-Arriaza, MD

The annual European Stroke Organisation Conference was held May 22 to 24 in Milan. There were countless sessions with a high scientific quality. In particular, the scientific communications session “Endovascular Treatment – Clinical Practice,” held on May 22, revealed interesting findings. Among all the refreshing results, I would like to highlight the following:

Dr. Georgios Tsivgoulis, from the National & Kapodistrian University of Athens, showed interesting data about a systematic review and meta-analysis of bridging therapy (BT) versus direct mechanical thrombectomy(MT) in stroke patients with large vessel occlusion (LVO). The mentioned systematic review included 38 studies with a sample of 11.798 patients. The main conclusions of the study exposed that pretreatment with IVT does not increase complication nor results in measurably delayed reperfusion in LVO patients treated with MT. In addition, their results, also showed a potential benefit on functional outcome and mortality in patients receiving BT compared to direct MT.