International Stroke Conference, Feb. 1-3, 2012

The American Heart Association's International Stroke Conference

The American Heart Association's annual International Stroke Conference was held from Feb. 1 to 3 in New Orleans and attracted more than 18,000 participants from around the world, including neurologists, neurosurgeons, neurointerventionalists, neuroradiologists, endovascular specialists, emergency medicine specialists, nurses, pharmacists, clinical practitioners, and basic researchers. The conference featured presentations focusing on the latest advances in the prevention, diagnosis, and management of stroke and cerebrovascular disease.

In one study, Heather Fullerton, M.D., of the University of California in San Francisco, and colleagues found that some common infections in healthy children increased the risk of stroke.

"We wanted to evaluate why these strokes occur in generally healthy children and to understand the mechanism of disease, as children who experience stroke have a high risk of recurrence. Most previously healthy children with a first stroke are found to have a disease of the blood vessels to the brain, and we wanted to get a better understanding as to why this was happening," Fullerton said. "We found that infection is a risk factor for stroke in children. This appears to be an effect of acute infections, acting as the trigger of a stroke, rather than an effect of chronic infections. Children are at highest risk for a stroke in the first few days of an acute infection."

Fullerton recommended that pediatricians and family practitioners should not counsel patients on this potential risk. She noted that, as the risk of stroke in childhood is so rare, warning parents would cause much alarm and offer little benefit.

"The results of this study are really for understanding why these strokes occur in generally healthy children, so that we can develop methods for preventing recurrent strokes," Fullerton concluded.

Abstract No. 39

In another study, Jessica Kepplinger, M.D., of the University of Technology in Dresden, Germany, and colleagues found that sleep apnea was common in individuals with acute ischemic stroke.

"We found an overall high frequency of sleep apnea (91 percent) in our study population of acute stroke patients, which underlines the importance of this stroke risk factor," Kepplinger said. "When we looked at patients with clinically silent infarcts or chronic microvascular changes, severe sleep apnea, which is defined by an apnea-hypopnea-index of ≥30 events per hour of sleep, was more common than in patients who did not have one of these neuroimaging findings; however, this was not statistically significant, perhaps due to the small sample size."

Further analyses showed that patients who had higher apnea-hypopnea-index values, as a clinical surrogate of sleep apnea severity, were more likely to have silent strokes. In addition, the investigators also found that, in patients who had either clinically silent infarcts or chronic microvascular changes, the severity of sleep apnea increased the risk of having impaired physical functioning at hospital discharge.

"We want to highlight the importance of sleep apnea as a stroke risk factor and that it may not only lead to clinically-apparent but also silent infarcts," Kepplinger added. "Further investigations are needed in these at-risk populations, especially concerning possible treatment. Currently, we plan a multinational prospective randomized study of early noninvasive ventilatory correction in acute stroke patients with sleep apnea."

Abstract No. 3434

Daniel J. Miller, M.D., of the Henry Ford Hospital in Detroit, and colleagues found that atrial fibrillation was associated with the cause of stroke in approximately 20 percent of patients who experienced stroke of unknown cause.

"The presence of atrial fibrillation in patients with a history of stroke or transient ischemic attack carries a risk of recurrent stroke of approximately 10 percent per year when treated with aspirin alone. Specialized treatment can reduce that risk," Miller said.

The investigators evaluated 156 patients who had experienced a stroke or transient ischemic attack of unknown cause. Patients wore a cardio outpatient monitor with electrocardiography (ECG) leads to report any events over a 21-day period.

"We found a 19.5 percent detection rate of atrial fibrillation, primarily proximal atrial fibrillation, over the 21-day period. Approximately one-fifth of patients with transient ischemic attack or stroke had proximal atrial fibrillation," Miller noted. "We also found five different risk factors that increased the risk of atrial fibrillation, including female gender, dilated left atrium, decreased heart pump function, increased National Institutes of Health Stroke Scale score, and premature atrial complex (PAC) on ECG. The presence of PAC on ECG actually increased the risk of atrial fibrillation by 13.7 percent."

Abstract No. 150

AHA: Stroke Victims Not Getting to Hospital Any Faster

FRIDAY, Feb. 3 (HealthDay News) -- Stroke victims are not getting to the hospital any faster than they did in 2005, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 191
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AHA: Rivaroxaban Tied to Lower Brain Bleed Risk in A-Fib

THURSDAY, Feb. 2 (HealthDay News) -- A once daily oral dose of rivaroxaban (Xarelto) significantly lowers the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) at moderate to high risk of stroke, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 152
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AHA: Apixaban Beats Aspirin for Stroke Prevention in A-Fib

THURSDAY, Feb. 2 (HealthDay News) -- Apixaban is more effective than aspirin in reducing the risk of repeat stroke and systemic embolism in patients with atrial fibrillation (AF) who are unsuitable for vitamin K antagonists (VKA) therapy, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 3776
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AHA: Incidence of Repeat Blockage of Carotid Artery Low

THURSDAY, Feb. 2 (HealthDay News) -- Rates of restenosis and occlusion do not differ between patients who received carotid artery stenting (CAS) or carotid endarterectomy (CEA) for the treatment of carotid stenosis, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 3
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AHA: Anemia May Triple Stroke Mortality

THURSDAY, Feb. 2 (HealthDay News) -- Having anemia can triple the risk of dying within a year after having a stroke, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 147
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AHA: Stem Cell Therapy May Aid Ischemic Stroke Recovery

WEDNESDAY, Feb. 1 (HealthDay News) -- Stem cell therapy has a nonsignificant effect on improving functional recovery after subacute ischemic stroke, and may have a role in regenerative therapy following stroke, according to two studies presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract - Prasad
Abstract - Bhatia
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AHA: Thrombolysis Shows Potential After Wake-Up Stroke

WEDNESDAY, Feb. 1 (HealthDay News) -- Selected patients with wake-up stroke (WUS) who receive thrombolysis have outcomes comparable to those treated with thrombolysis within 4.5 hours of stroke onset, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 56
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AHA: Faster Pre-Stroke Memory Decline for Stroke Decedents

WEDNESDAY, Feb. 1 (HealthDay News) -- Individuals who die from stroke have faster pre-stroke memory decline than stroke survivors or stroke-free adults, according to a study presented at the American Heart Association's International Stroke Conference, held from Feb. 1 to 3 in New Orleans.

Abstract No. 31
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