Top Advances in Stroke for 2011

Updated:Mar 7,2012
scinews_topadvancesSTROKE2011

The American Heart Association’s mission is “building healthier lives, free of cardiovascular diseases and stroke.” The Stroke Council is uniquely dedicated to advancing the science of stroke prevention, treatment, and recovery through research and education. The Stroke Council develops scientifically-based publications, meetings, professional education, and training programs and supports the American Stroke Association’s work in translating stroke-related science into effective initiatives and products for the public, healthcare professionals, healthcare facilities, and policy makers. Each year the Stroke Council leadership acknowledges top research in stroke for the past year.  These are the Stroke Council’s selections for 2011.
 
AHA/ASA Stroke Council Top Research of 2011

1Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke
Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes

Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV, Olson DM, Hernandez AF, Peterson ED, Schwamm LH. Circulation. 2011 Feb 22;123(7):750-8. Epub 2011 Feb 10.
Abstract

Stroke_Jauch-Ed“This important publication by Fonarow and colleagues is yet another significant paper to emanate from the Get With The Guidelines®-Stroke dataset.  This study is a call to action for the stroke healthcare community to improve our evaluation and treatment times when stroke patients arrive in the Emergency Department.  Door-to-needle times of less than 30 minutes are commonplace in other countries so every effort to decrease our door-to-needle times must be undertaken if we are to give our patients every benefit of tPA use.” 
 
-- Edward C. Jauch, MD, MS, FAHA, FACEP, Chair, Stroke Council
 
 
2Stenting Versus Aggressive Medical Therapy for Intracranial Arterial Stenosis
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis S, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM., Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride L, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ, SAMMPRIS Trial Investigators (2011). Stenting versus aggressive medical therapy for intracranial artery stenosis. N Eng. J Med 365, 993–1003. doi: 10.1056/NEJMoa1105335.
Abstract

broderick_Joseph-200x200“The results of the SAMMPRIS trial have taught us three important lessons:  The challenges of intracranial revascularization are greater than those of revascularization of extracranial carotid stenoses (previous trials of intracranial revascularization also tell us this), attentive and aggressive medical therapy is an important and effective approach to prevention of stroke in high-risk populations, and the CMS and the FDA will play critical roles in the advancement of cost-effective medicine.” 

-- Joseph P. Broderick, MD, FAHA, Vice-Chair, Stroke Council
 
 
3Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality
Xian Y, Holloway RG, Chan PS, Noyes K, Shah MN, Ting HH, et al. Association between stroke center hospitalization for acute ischemic stroke and mortality. JAMA. 2011;305:373–380.
Abstract

Saver-Jeffery“This study demonstrated that acute ischemic stroke patients have lower mortality rates if they receive their care at certified Stroke Center hospitals. The authors studied 31,000 patients admitted with acute ischemic stroke in New York State. After adjusting for patient case-mix differences, care at Stroke Centers was associated with a reduction in 30-day mortality from 12.5% to 10.1%, a 2.4% absolute and 19% relative risk reduction.” 

 -- Jeffrey L. Saver, MD, FAHA, Immediate Past Chair, Stroke Council
 
 
4Body-Weight–Supported Treadmill Rehabilitation after Stroke
Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK, Cen S, Hayden SK; LEAPS Investigative Team. N Engl J Med. 2011 May 26;364(21):2026-36.
Abstract

cramer_Steven-200x200“In the Locomotor Experience Applied Post-Stroke (LEAPS) trial, Pam Duncan and colleagues found that treadmill training starting 2 months after stroke, treadmill started 6 months after stroke, and a home exercise program started 2 months after stroke each improved functional walking ability at 1 year post-stroke, with no difference between the three groups.  This trial teaches us that a majority of patients can experience functionally important gains in walking--which are directly linked to social participation--when therapy is initiated months after stroke onset.”

-- Steven C. Cramer, MD, Chair, Stroke Rehabilitation, Prevention And Recovery Committee 
 
 
5Bihemispheric Brain Stimulation Facilitates Motor Recovery in Chronic Stroke Patients
Lindenberg R, Renga V, Zhu LL, Nair D, Schlaug G. Neurology. 2010 December 14; 75(24): 2176–2184. doi: 10.1212/WNL.0b013e318202013a.
Abstract

cramer_Steven-200x200“Lindenberg and colleagues, working in the lab of Gottfried Schlaug, found Class I evidence that bihemispheric transcranial direct current stimulation provided across five sessions to patients an average of 2.5 years after stroke improves arm motor function.  This study emphasizes the importance of pairing a restorative intervention with training to maximize treatment effects.” 

 -- Steven C. Cramer, MD, Chair, Stroke Rehabilitation, Prevention And Recovery Committee
 
 
6Fluoxetine for Motor Recovery After Acute Ischaemic Stroke (FLAME): A Randomised Placebo-controlled Trial
Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C, Bejot Y, Deltour S, Jaillard A, Niclot P, Guillon B, Moulin T, Marque P, Pariente J, Arnaud C, Loubinoux I. Lancet Neurol. 2011 February; 10(2): 123–130. Published online 2011 January 7. doi: 10.1016/S1474-4422(10)70314-8.
Abstract

cramer_Steven-200x200“The Fluoxetine for motor recovery after acute ischemic stroke (FLAME) study from Francois Chollet and colleagues was a double-blind, placebo-controlled trial that found that daily Fluoxetine was superior to placebo for improving arm motor function when started 5-10 days after an ischemic stroke, in a manner that was unrelated to any effects of depression.  The brain undergoes great changes in the weeks following a stroke; this is a landmark study as it provides strong evidence that targeting these brain changes can improve patient outcomes.”

 -- Steven C. Cramer, MD, Chair, Stroke Rehabilitation, Prevention And Recovery Committee
 
 
7Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral Ischemia
The Carotid Occlusion Surgery Study Randomized Trial
Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP; COSS Investigators. JAMA. 2011 Nov 9;306(18):1983-92.
Abstract

Stroke_Derdeyn-Colin“There are two main conclusions from the COSS trial.  First, surgery did not reduce the risk of stroke compared to medical management.  Second, the risk of stroke owing to reduced blood flow remains high in medically treated patients, and new treatments for these patients need to be developed.  In addition, follow up of selected COSS patients for a study of the effects of revascularization on cognition is ongoing.  We may find that surgery does not reduce stroke risk, but improves cognitive status at 2 years.” 

-- Colin Derdeyn, MD, FAHA, Chair, Stroke Statements Oversight Committee
 
 
8Apixaban in Patients with Atrial Fibrillation
Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, Flaker G, Avezum A, Hohnloser SH, Diaz R, Talajic M, Zhu J, Pais P, Budaj A, Parkhomenko A, Jansky P, Commerford P, Tan RS, Sim KH, Lewis BS, Van Mieghem W, Lip GY, Kim JH, Lanas-Zanetti F, Gonzalez-Hermosillo A, Dans AL, Munawar M, O'Donnell M, Lawrence J, Lewis G, Afzal R, Yusuf S; AVERROES Steering Committee and Investigators. N Engl J Med. 2011 March 3; 364(9): 806–817. Published online 2011 February 10. doi: 10.1056/NEJMoa1007432
Abstract

Apixaban versus Warfarin in Patients with Atrial Fibrillation
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L; ARISTOTLE Committees and Investigators. N Engl J Med. 2011 Sep 15;365(11):981-92. Epub 2011 Aug 27.
Abstract

kasner_Scott-200x200“Atrial fibrillation is well known to cause stroke, and warfarin has been the mainstay of preventative therapy for decades.  However, warfarin is challenging to use for many reasons, including enormous variability in the right dose for each individual patient, numerous interactions with food and other medications, and the need for blood monitoring.  Apixaban, an oral inhibitor of factor Xa, was shown in a head-to-head randomized clinical trial to be superior to warfarin, resulting in a relative 21% lower risk of stroke and systemic embolism, 31% less major bleeding, and 11% lower mortality. Warfarin is also unfortunately underused in clinical practice, and another randomized trial compared apixaban to aspirin in patients who were deemed unsuitable for warfarin therapy.  That trial demonstrated that apixaban reduced the risk of stroke or systemic embolism by 55% without an increased risk of bleeding compared to aspirin.  The blockbuster results from these two studies will likely forever change the landscape of anticoagulant therapy for atrial fibrillation.” 

-- Scott Kasner, MD, FAHA, Member, Stroke Council 

 


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