Stroke - ICAD

Stroke - ICAD

Etiology
- hypoperfusion
- artery-artery occlusion
- branch artery disease (BAD)

Observations
- MC east Asian; 2nd Brazil
- recurrence of stroke in ICAD is around 30% in one year
- asymptomatic ICAD vs no ICAD has the same stroke risk

Blood pressure trials
WASID 
- BP > 160/90 inc risk TIA/stroke

SAMMPRIS 
- BP > 140/90 inc risk TIA/stroke

Management trials
*BMM - best medical management

WASID
- warfarin vs ASA, no difference

SAMMPRIS
- BMM is supererior to stenting

CASSISS
- BMM is the same as stenting 3 wks after stroke

BASIS
- balloon angioplasty leads to restenosis frequently

PRINCE
- ticagrelor & ASA vs clopidogrel & ASA
> ticagrelor group had lower bleeding risk

CHANCE 2
- ticagrelor & ASA vs clopidogrel & ASA
> ticagrelor group is more effective

COMPASS
- rivaroxaban w/ or w/o ASA, no difference

CAPTIVA
- clopidogrel & ASA vs ticagrelor & ASA vs rivaroxaban & ASA
- being studied

Clinical trials - Statin and stroke

Clinical trials - Statin and stroke 


Clinical Trials
Statins
CARE
- pravastatin dec 31% incidence of stroke

LIPID
- pravastatin dec 19% incidence of stroke

SPARCL
- Stroke Prevention by Aggressive Reduction in Cholesterol Levels
- atorvastatin dec 16% incidence of stroke

PCSK9 Inhibitor
FOURIER
- evolocumab dec incidence of stroke

ODYSSEY
- alirocumab dec incidence of stroke

SPIRE 1&2
- bococizumab no difference in incidence of stroke

Pediatric stroke

Pediatric stroke

Basics
- pediatric description + family history
- trauma, evaluate dissection

Neuroimaging
CTA H&N w/ significant artifacts, consider sedation
- If dilation & tortuosity, consider connective tissue disorder
> genetic consult, renal US (for FMD), echo (for structural abnormalities)

Migraine - Preventive treatment

Migraine - Preventive treatment

Antihypertensives
Antidepressants
Anticonvulsants
CGRP antagonists
Other

Other
- Riboflavin
- Magnesium

Clinical trial - EVT for BAO

Clinical Trial - Endovascular Treatment for Basilar Artery Occlusion

Considerations
- 1% of all strokes; 6-8% of EVT
- Symptoms: impaired consciousness, quadriparesis, pupillary abnormality, vertigo, and hearing loss
- Mortality rate 36%, and only 32% achieved positive clinical outcomes
- Location: top is embolus, mid is stenosis

Clinical trials (EVT vs BMM)
BEST (2020)
- no difference in function or mortality

BASICS (2021)
- no difference in function or mortality

ATTENTION (2022)
- better function and mortality

BAOCHE (2022)
- better function, but no difference in mortality

Movement Disorders - Rockstars

Movement Disorders - Rockstars

Dr. Alberto J. Espay
Fellowship: Dystonia Medical Research Foundation (Electrophysiology of Movement Disorders)
Master's Degree: University of Toronto (Clinical Epidemiology and Health Care Research)
Fellowship: University of Toronto (Movement Disorders)
Residency: Indiana University (Neurology )
Medical Degree: Central University of Venezuela
Bachelor's Degree: Liceo de Aplicación

Dr. Michael S Okun
Fellow in Movement Disorders and Stereotactic Surgery for Movement Disorders (Emory University, 2000-2002)
Residency - Neurology (University of Florida, 2000)
Residency - Internal Medicine (University of Florida, 1997)
Medical Degree (University of Florida, 1996)

Dr. Joseph Jankovic
MD from University of Arizona College of Medicine (06/1973 - Tucson, Arizona United States)
Internal Medicine Residency at Baylor College of Medicine (06/1974 - Houston, Texas United States)
Neurology Residency at The Neurological Institute, Columbia University (06/1977 - New York, NY United States)

Dr. Kailash Bhatia
Neurogenetics and movement disorders (UCL)
Neurology degree (University of Bombay1988)
Doctor of Medicine (University of Bombay1988)
Doctor of Medicine (University of Bombay1986)
Bachelor of Medicine/Bachelor of Surgery (University of Bombay1982)

Dr. Anthony E. Lang 
Medicine and Neurology at the University of Toronto
Fellowship with Professor C.D. Marsden at UCL

Dr. Bastiaan R. Bloem
MD degree at Leiden University (1993), and PhD (1994)
Neurology training (1994‐2000) also at Leiden University
Movement disorders fellowships at The Parkinson's Institute, Sunnyvale, California (with Dr J.W. Langston), and at UCL

Dr. Francisco Cardoso
Escola de Ciências Medicas de Alagoas, in Maceio, Brazil
Doctorate from the Federal University of Minas Gerais, where he also completed his residency. Subsequently, Dr. Cardoso undertook a clinical fellowship in movement disorders at the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston, Texas.

Dr. Alfonso Fasano
MD from the Catholic University of Rome, Italy, in 2002 and became a neurologist in 2007. After a two-year fellowship at the University of Kiel, Germany, he completed a PhD in neuroscience at the Catholic University of Rome.

Dr. José Fidel Baizabal-Carvallo
MD in Mexico
IM and neurology at the National Institute of Medical Sciences and Nutrition, “Salvador Zubirán” in Mexico City
Fellowships in cerebrovascular disorders and Parkinson´s disease at the University of Paris in France and a fellowship in Movement Disorders in la Pitié-Salpêtrière Hospital in Paris, France. He also completed a fellowship in movement disorders and deep brain stimulation at Baylor College of Medicine in the Texas Medical Center in Houston, Texas, mentored by Prof. Joseph Jankovic

Dr. Sanjay Pandey
Medicine and neurology (Mumbai University)
Fellowship in PD and movement disorders (NINDS)

Clinical trial - ICH & NSGY

Clinical trial - ICH & NSGY

Trials
Clinical management
FAST (2008)
- factor VII for ICH
- reduces growth, but does not affect mortality or functional outcome

PATCH (2016)
- Platelet transfusion in ICH for antiplatelet is worse than standard

Minimal invasive surgery 
MISTIE (2016)
- MIS & tPA increased asymptomatic bleeding

MISTIE III (2019)
- MIS no benefit for moderate and large ICH

Surgical treatment
STICH (1998)
- surgical treatment for ICH does not have benefit

STICH II (2013)
- surgical treatment for ICH does not have benefit

Clinical trial - alteplase (tPA)

Clinical trial - tPA

Trials
EXTEND (2019)
- tPA within 9h w/ mismatch
- worse mortality and no functional improvement

Clinical trial - EVT

Clinical trial - endovascular thrombectomy

Trials
Timing
DAWN (2018)
- EVT 6-24 h after stroke w/ mismatch
- EVT better functional outcome

DIFFUSE 3 (2018)
- EVT 6-16 h after stroke w/ mismatch
- EVT better functional outcome

Additional thrombolytic
DIRECT-MT (2020)
- EVT w/ & w/o tPA has no significant difference

MR CLEAN-NO IV (2021)
- EVT w/ & w/o tPA has no significant difference

Clinical trial - tenecteplase

Clinical trials - tenecteplase

TNK versus tPA

Trials
TAAIS (2012)
- TNK better reperfusion and clincial outcomes

ATTEST (2015)
- no difference

NOR-TEST (2017)
- no difference

EXTEND-IA TNK (2018)
- TNK before EVT better reperfusion and clincial outcomes

EXTEND-IA TNK (2020)
- TNK 0.25 mg/kg same benefit 0.4 mg/kg

AcT (2022)
- no difference

TRACE-2
- no difference for non-elegible EVT

Subscribe to: Posts (Atom)