American Heart Association

Monthly Archives: August 2021

Article Commentary: “Marijuana Use and the Risk of Early Ischemic Stroke”

Burton J. Tabaac, MD
@burtontabaac

Dutta T, Ryan KA, Thompson O, Lopez H, Fecteau N, Sparks MJ, Chaturvedi S, Cronin C, Mehndiratta P, Nunez Gonzalez JR, et al. Marijuana Use and the Risk of Early Ischemic Stroke: The Stroke Prevention in Young Adults Study. Stroke. 2021.

As stroke is becoming a more prevalent etiology of death for young adults 25 to 45 years old, there is naturally a growing interest focused on modifiable risk factors for stroke prevention. The focus of this publication is aimed at drug use, namely marijuana, and if it plays a role as a causative or contributing factor to ischemic stroke. There is well documentation in the literature to support tobacco smoking and cocaine use as risk factors for stroke, yet a causal relationship for marijuana remains less clear. This article grows even more prescient given the rapidly growing rise of marijuana use in the United States, especially amongst 18- to 25-year-olds.1

To date, there exist few epidemiological studies to evaluate the association between marijuana use and acute ischemic stroke, with some reports suggesting conflicting findings indicating no association with stroke risk; the potential for a dose response effect has been postulated. As more states and local governments pursue the decriminalization and legalization of marijuana, further clarification to delineate the potential risk of stroke becomes ever more paramount to public health interest. The authors of this paper investigated a large population-based case control study of ischemic stroke in young adults to assess whether self-reported marijuana use was associated with early-onset ischemic stroke, and evaluated for a dose-response temporal relationship.

By |August 12th, 2021|clinical|Comments Off on Article Commentary: “Marijuana Use and the Risk of Early Ischemic Stroke”

Neurons Over Nephrons? The Impact of Blood Pressure Reduction in Acute Intracerebral Hemorrhage and Renal Function

Faddi G. Saleh Velez, MD

Qureshi AI, Huang W, Lobanova I, Hanley DF, Hsu CY, Malhotra K, Steiner T, Suarez JI, Toyoda K, Yamamoto H, on behalf of Antihypertensive Treatment of Cerebral Hemorrhage 2 Trial Investigators. Systolic Blood Pressure Reduction and Acute Kidney Injury in Intracerebral Hemorrhage. Stroke. 2020;51:3030–3038.

Since the National Institute of Neurological Disorders and Stroke (NINDS) trial in 1995, the rapid management of acute stroke became the cornerstone for all emergency departments and stroke units around the globe. Further scientific progress led to the broadening of the therapeutic window with the later inclusion of endovascular therapies up to 24 hours; therefore, the use of advanced imaging that requires contrast administration exponentially increased and, with it, the concern of contrast-related acute kidney injury (AKI), mainly in patients with an already affected kidney function. In 2017, Brinjikji et al. published a systematic review and meta-analysis concluding that initial contrast administration had no statistically significant association with an increase in risk of AKI in stroke patients independently of pre-existent kidney disease (odds ratio [OR]=0.63; 95% confidence interval [CI] 0.34–1.12). However, little attention has been placed on the risk of kidney injury in patients with intracerebral hemorrhage (ICH) in which aggressive blood pressure management is performed.

By |August 10th, 2021|clinical|Comments Off on Neurons Over Nephrons? The Impact of Blood Pressure Reduction in Acute Intracerebral Hemorrhage and Renal Function

Author Interview: Dr. Tharani Thirugnanachandran on “Anterior Cerebral Artery Stroke: Role of Collateral Systems on Infarct Topography”

Dr. Tharani Thirugnanachandran
Dr. Tharani Thirugnanachandran

A conversation with Dr. Tharani Thirugnanachandran, MBChB, stroke researcher, Monash University, Victoria, Australia.

Interviewed by Dr. Andy Lim, MBA, emergency physician, Monash Medical Centre, Victoria, Australia.

They will be discussing the article “Anterior Cerebral Artery Stroke: Role of Collateral Systems on Infarct Topography,” published in Stroke.

Dr. Lim: Dr. Thirugnanachandran, on behalf of the Blogging Stroke team, it is a pleasure to welcome you to this author interview regarding your publication in Stroke that explored the role of leptomeningeal anastomoses in influencing infarct topography after anterior cerebral artery stroke. Can I start by asking you to give us a brief summary of what you did?

Dr. Thirugnanachandran: Thank you, Dr Lim. Anterior cerebral artery stroke is far less common than middle cerebral artery stroke. So comparatively less attention has been given to it in the literature. Much of our current understanding about it has come from older works taken postmortem or poststroke. In contrast to prior studies, our study was able to give us an insight into what happens to this arterial territory at stroke onset with the use perfusion imaging and a computer model.

By |August 6th, 2021|author interview, clinical, diagnosis and imaging|Comments Off on Author Interview: Dr. Tharani Thirugnanachandran on “Anterior Cerebral Artery Stroke: Role of Collateral Systems on Infarct Topography”

Predicting Outcomes of Mechanical Thrombectomy for Patients With Large Permanent Ischemic Core

Farah Aleisa, MD

Panni P, Gory B, Xie Y, Consoli A, Desilles J-P, Mazighi M, Labreuche J, Piotin M, Turjman F, Eker OF, et al. Acute Stroke With Large Ischemic Core Treated by Thrombectomy: Predictors of Good Outcome and Mortality. Stroke. 2019;50:1164–1171.

The HERMES meta-analysis demonstrated the benefit of second-generation endovascular recanalization therapies (primarily stent retrievers) over medical therapy alone among patients with acute ischemic stroke due to large vessel occlusions.1,2,3 The utilization of brain imaging to exclude patients with a large core of infarcted brain tissue in this pooled analysis was based on selection of patients with an initial Alberta Stroke Program Early CT Score (ASPECTS) of 6 or more.4,5 However, we don’t have large studies looking for the benefits of mechanical thrombectomy (MT) with large core ischemic stroke (ASPECTS <6). The available subgroup analyses in the literature concerning thrombectomy for large core stroke reported rates of symptomatic intracerebral hemorrhage ranging from 16% to 31%.6-10 This study was done to address the uncertainties regarding the associated benefits and risks of MT for patients who had large core ischemic stroke by recognizing the clinical and imaging factors associated with good clinical outcomes.

The data in this study was collected from the multicentric stroke registry for acute ischemic stroke patients treated with MT. Baseline large ischemic core was defined as diffusion-weighted imaging (DWI)–ASPECTS of ≤5. The degree of disability was assessed by the modified Rankin Scale at 90 days. Outcomes included good outcome (modified Rankin Scale score of ≤2) and mortality (modified Rankin Scale score of 6).

By |August 4th, 2021|clinical, outcomes|Comments Off on Predicting Outcomes of Mechanical Thrombectomy for Patients With Large Permanent Ischemic Core

Article Commentary: “Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19”

Ericka Teleg, MD

Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok JG, Williams JH, de Lemos JA, Decker-Palmer MR, et al. Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19: An Analysis From Get With The Guidelines-Stroke. Stroke. 2021.

The COVID-19 pandemic has caused a shift in stroke systems and has changed the way stroke approach and management are put in place. The impact of this is that time is still brain. Time and stroke outcomes still matter more so during this time. From a patient’s perspective in experiencing and reporting symptoms to the way emergency room systems tackle stroke during the pandemic, remain a challenge.

The objective of this study was to analyze characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke pre-COVID-19 and during COVID-19 time. This study is important as it allows us to be able to navigate the time-sensitive nature of stroke during COVID-19. With the COVID-19 restrictions and concern for infection and transmission, several studies have demonstrated no difference in diagnostic and treatment times pre-COVID 19 versus the COVID-19 era. On the other hand, some studies showed a decline in stroke presentations. One reason emphasized in this article is underreporting of symptoms due to fear of COVID-19 exposure in-hospital.

By |August 2nd, 2021|clinical, outcomes, treatment|Comments Off on Article Commentary: “Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19”