American Heart Association

Monthly Archives: January 2020

A CHANCE for Double Antiplatelet Therapy in Minor Stroke: That’s the POINT

Elena Zapata-Arriaza, MD
@ElenaZaps

Pan Y, Elm JJ, Li H, Easton JD, Wang Y, Farrant M, et al. Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack: A Pooled Analysis of Clopidogrel in High-Risk Patients With Acute Non-Disabling Cerebrovascular Events (CHANCE) and Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trials. JAMA Neurol. 2019;76:1466-1473.

Double antiplatelet therapy (DAT) with Clopidogrel plus Aspirin for TIA and minor ischemic stroke has been widely supported by several clinical trials, allowing its indication in clinical practice guidelines. However, differences in DAT employment duration between studies may increase bleeding risk by canceling the benefit for ischemic events recurrence.

To clarify the optimal DAT duration after TIA or minor ischemic stroke, the authors from the CHANCE and POINT trials performed a pooled analysis of both randomized clinical trials. Primary efficacy outcome was defined as a major ischemic event (ischemic stroke, myocardial infarction or death from ischemic vascular causes), and primary safety outcome was major hemorrhage.

By |January 10th, 2020|clinical|0 Comments

Article Commentary: “Stent Design, Restenosis and Recurrent Stroke After Carotid Artery Stenting in the International Carotid Stenting Study”

Reyes de Torres Chacon, MD

Müller MD, Gregson J, McCabe DJH, Nederkoorn PJ, van der Worp HB, de Borst GJ, et al. Stent Design, Restenosis and Recurrent Stroke After Carotid Artery Stenting in the International Carotid Stenting Study. Stroke. 2019;50:3013–3020.

Several studies in recent years have linked the type of stent used during carotid artery stenting (CAS) to the early recurrence of stroke in the early days (peri-procedural period). However, there are currently no data on the relationship between the type of device and the incidence of stroke and restenosis of the stent in the long term.

This study analyzes the restenosis rate and incidence of new strokes among patients treated with CAS using open-cell stent versus closed-cell stent during follow-up, at least 4 years.

By |January 8th, 2020|clinical|0 Comments

Meet the Blogger: Lin Kooi Ong, PhD

Lin Kooi Ong

Name: Lin Kooi Ong, PhD (Medical Biochemistry)
Hometown: Bandar Sunway, Selangor, Malaysia
Current Position: Lecturer, Monash University Malaysia; Conjoint Fellow, The University of Newcastle

Q: What made you interested in a career in stroke?

A: I am fascinated about the brain, and I also want to contribute to people’s lives. I have family members and friends who suffer from stroke and neurodegenerative disorders. I feel that this is a rewarding career to investigate how the brain works and how to fix it when it fails.

By |January 7th, 2020|clinical|0 Comments

Author Interview: Prof. Adnan Siddiqui, MD, PhD, on the COMPASS Trial

Prof. Adnan Siddiqui
Prof. Adnan Siddiqui

An interview with Prof. Adnan Siddiqui, MD, PhD, Professor of Neurosurgery and Radiology, University at Buffalo, about aspiration thrombectomy versus stent retriever thrombectomy as a first-line approach for large vessel occlusion strokes.

Interviewed by Dr. Robert Regenhardt, MD, PhD, Fellow, Massachusetts General Hospital. 

They will be discussing the article “Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial,” published in The Lancet.

Dr. Regenhardt: The endovascular thrombectomy (EVT) trials from the last few years have revolutionized the approach to the treatment of acute stroke from large vessel occlusion (LVO). For most patients enrolled in these trials, stent retriever devices were used for EVT. Indeed, the current stroke guidelines specifically recommend the use of stent retrievers for EVT to treat eligible patients. Therefore, the robust, randomized COMPASS trial may lead to practice changes at many institutions, encouraging interventionalists to perform a direct aspiration first pass technique (ADAPT). Would you mind describing your approach and experience with ADAPT?

Prof. Siddiqui: At Buffalo, we were some of the original stenting for stroke trialists. Dr. [J] Mocco was part of that group, and he took that with him after he completed his fellowship at Buffalo. We realized the value of putting a stent across a clot, like cardiologists do for STEMIs. However, when you drop a stent into someone, you need to put them on aspirin and Plavix. And, unlike in the heart, most of the time there is no underlying plaque. The lesion causing the occlusion often is an embolus that traveled from somewhere else to the brain. As part of that original stenting for stroke trial, towards the end, we were using a stent called Enterprise. Enterprise came in a long size and you could actually partially deploy it and drag it back. Lo and behold, we would retrieve the stent and out came the clot. And so that was the genesis of the whole stent retriever concept, and that caught on like wildfire.

Meet the Blogger: Richard Jackson, MD

Richard Jackson

Name: Richard Jackson, MD
Hometown: Radford , VA
Current Position: Glens Falls Hospital Stroke Director

Q: What made you interested in a career in stroke?

A: My father was a general neurologist who believed that a generalist could treat anyone with the right resources and knowledge. He even starting the tPA program in my hometown. I, too, became a generalist, but I realized after three years that with the rapidly changing treatments and a large need in most communities, my current level of knowledge would not be enough in the near future. 

Q: What has been your career path into this field?

A: I started out as a generalist and created programs in Botox and confusion locally, but starting a primary stroke center showed me that to treat people on that size scale, specialized training would be required. The need, coupled with a previous interest in vascular neurology and neuroimaging, helped shape the decision to return to fellowship.

By |January 3rd, 2020|clinical|0 Comments