Episode 054 -- International Stroke Conference News

Inspire Cafe Podcast

I had the honor of appearing on Kathy De La Torre's The Inspire Café podcast. She started the podcast to understand what makes a person resilient. She explains her motivation like this:

I am fascinated with the stories of human resiliency…. What makes these people tick?  What became their turnaround, ah-hah moment or the trigger that caused them to pivot, shift their thinking and turn away from their dark moment and face the light?  The idea of people actually putting into practice of making lemonade out of their lemons, turning a negative into a positive, is remarkable.

This week, I talk with Kathy in detail about my stroke, stroke in general, and why I started this show. It's the latest version of my origin story.

I'm truly humbled to be on Kathy's show, especially when I look at the other folks she's interviewed.

So after you listen to Strokecast, head on over to The Inspire Café in your favorite podcast app and listen to episode 69.

News from ISC19

Neurologists, researchers, and other stroke professionals from around the world got to spend several days in tropical Hawaii in February to learn to more effective treat and prevent strokes at the International Stroke Conference 2019. And presumably to work on their tans and surfing skills in the off hours. A lot of research, reports and news came out of the conference or at least around it.

Here are the 10 Topics

Opioid epidemic fueling a rise in infection-related stroke

• AHA/ASA News Room
• Study Highlights:
  
  • The opioid epidemic is fueling a steep rise in infection-related stroke hospitalizations.
  • Injecting opioids, such as heroin, can introduce bacteria into the body which travels through the bloodstream to infect heart valves. Clumps of infected tissue can break off and travel to the brain, resulting in stroke.

Safety Window for tPA Extended Up to 9 Hours for Ischemic Stroke

• Neurology Today
  • "In the primary outcome measure, 37 percent of patients treated with tPA in the nine-hour window—including those with so-called "wake up" strokes—achieved a modified Rankin Scale (mRS) score of 0–1 at 90 days compared with 29 percent of patients who were treated with placebo in the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) trial (p=0.045), said Henry Ma, MD, PhD, director of physician training at Monash University in Melbourne, Australia.
  • In the secondary outcome measure—achieving a mRS score of 0–2 at 90 days—the milestone was achieved by 51 percent of the patients treated with tPA compared with 43 percent of the patients on placebo therapy (p=0.022), Dr. Ma said in his late-breaker oral presentation.

  • "EXTEND is the first positive thrombolysis trial in an extended time window using automated penumbral imaging," he said. "The current guideline for thrombolysis in acute ischemic stroke is less than 4.5 hours from stroke onset. But advanced imaging studies from our group and others suggest that the ischemic penumbra can exist up to 24 hours after onset and its salvage can lead to improved outcome."

No Loss of Thrombectomy Benefit in Late Stroke With Transfer

• Medscape
  • For patients with a large-vessel ischemic stroke in the late window who were found to have salvageable brain tissue on imaging, transfer from a primary stroke center to a thrombectomy-capable hospital did not affect the benefit of thrombectomy, latest results from the DEFUSE 3 trial show.

Home-Based Telerehabilitation for Stroke Patients Is as Effective as the Clinic

• Neurology Today
  • "In our presentation we showed that telerehabilitation is non-inferior to in-clinic rehabilitation and improves arm motor status," said Steven C. Cramer, MD, FAAN, professor of neurology, anatomy and neurobiology, and professor of physical medicine and rehabilitation at the University of California, Irvine.

Cilostazol Prevents Recurrent Strokes in Japanese Study

• Neurology Today

  • Dual antiplatelet therapy that includes cilostazol appears to reduce strokes in patients who have had a previous stroke and are at high risk of experiencing another, researchers reported here at the 2019 International Stroke Conference.

  • In a late breaker presentation, Kazunori Toyoda, MD, PhD, deputy director general of the Hospital of the National Cerebral and Cardiovascular Center in Suita, Osaka, Japan, said that the combination of cilostazol plus either aspirin or clopidogrel was superior in preventing another stroke than either clopidogrel or aspirin alone.

Flu-like Illness Linked to Stroke, Cervical Dissection

• Medscape

  • Having an influenza-like illness (ILI) is associated with an increased risk of ischemic stroke on the order of 40%, regardless of sex, race, or geographical setting, new research suggests.

  • "The study shows that influenza-like illness increases the risk of stroke, particularly in the first 30 days," study author Amelia Boehme, PhD, assistant professor, Epidemiology and Neurology, Columbia University, New York City, told Medscape Medical News.

e-Cigarettes Linked to Increased Stroke, MI Risk

• Medscape

  • Among more than 400,000 respondents older than 18 years from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey, almost 66,800 reported having ever used e-cigarettes.

  • Study results showed a 71% higher risk of experiencing a stroke, a 59% higher risk for an MI, and a 40% higher risk for angina or coronary heart disease (CHD) for the e-cigarette users compared with nonusers. Users also had twice the rate of smoking regular cigarettes.

Marijuana, cocaine could play role in stroke increase among young adults

• AHA Website

  • The vast majority of strokes occur in people over 65, but the number of younger adults having strokes is rising. New research suggests growth in illegal drug use could be playing a role.

  • Past research has shown higher cardiovascular death rates for young adults who used cocaine or marijuana. But the new study, presented this week at the American Stroke Association's International Stroke Conference in Honolulu, investigates trends in illegal drug use among 18- to 54-year-olds who had a stroke.

  • Researchers looked at 20 years of drug tests and self-reported data involving more than 2,200 young adults who had a stroke in greater Cincinnati and northern Kentucky. While alcohol and cigarette use in the stroke victims remained stable over the two-decade study period, drug use rose dramatically, from 4.4 percent in 1993-1994 to 30.3 percent in 2015.

Countries with Dirty Air have more stroke deaths

• AHA/ASA Newsroom

  • In a nationwide study, counties with dirtier air had higher rates of stroke deaths and shorter life expectancies, according to preliminary research to be presented in Honolulu at the American Stroke Association’s International Stroke Conference 2019, a world premier meeting for researchers and clinicians dedicated to the science and treatment of cerebrovascular disease.

  • Researchers examined the average yearly levels air pollution (PM2.5) that contains fine inhalable particles. Produced by diesel engines and the burning of coal, biomass and kerosene, this type of air pollution has previously been shown to enter the circulatory system and harm health.

Fluctuating blood pressure after stroke could mean higher risk of death

• AHA Website

  • A new study, presented this week at the American Stroke Association's International Stroke Conference in Honolulu, delved deeper into the topic by researching whether increased blood pressure variability after a stroke is associated with risk of death.

  • Researchers looked at data from 1,947 patients who had four to five blood pressure readings in the 24 hours after a stroke. After adjusting for various factors, they found that patients with more variation in their systolic blood pressure, the top number in the measurement, had a higher risk of death within 90 days.

  • Dr. Adam de Havenon, the study's lead author, said the results reinforce the importance of blood pressure variability as a risk factor for poor outcomes after a stroke.

Hack of the Week

On the rare occasion I really clean the living room, I find random pills under the couch. The get there after making a run for it as I move them from prescription bottles to pill organizers.

Bowl Cozys solve this problem for me.

A bowl cozy is a curved lightly bowl shaped quilted piece of fabric. Their main use is for eating soup. You put your hot bowl of soup in it and then you can pick it up without burning your hands. You can find them on Amazon, Etsy, and at street fairs around the country. You can also finds patterns so you can make your own.

When I fill my pill organizer, I start by pouring pills into a bowl cozy. Then I can put them in the organizer chambers one by one. Then I put the lefty overs back into the pill bottle and move on to the next med.

And I don't lose pills anymore.

Where do we go from here?

• Review the articles linked above for more details and to form your own analysis. 
• What do you think of this type of discussion? Let me know in the comments below.
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