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Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology

The study examined 2,416 people who had experienced an ischemic stroke. In 549 patients, TIAs were experienced prior to the ischemic stroke and in most cases occurred within the preceding seven days: 17 percent occurring on the day of the stroke, 9 percent on the previous day, and 43 percent at some point during the seven days prior to the stroke.

This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.

Hemophilia Drug Used to Staunch Cerebral Bleeding
A report showed that large doses of the drug, recombinant activator factor VII (rFVIIa), given to patients within four hours of a stroke caused by cerebral bleeding resulted in a significantly increased chance of survival and less disabling brain damage than found in patients who were not given the treatment. (rFVIIa) is used in the US to treat hemophilia patients since it improves the blood's clotting ability, stanching the uncontrolled bleeding that is characteristic of this illness. Applied to the treatment of stroke, the drug is used to stop active bleeding in the brain.

Although, only 10 percent to 15 percent of strokes are caused by burst blood vessels, more than 60 percent of patients who suffer hemorrhagic strokes die within a year. despite the best treatments available now. The report appeared in the February 24, 2005 issue of the New England Journal of Medicine.

Stroke Risk Greatest in Black Southerners
A comparative study showed that not only is the chance of black Southerners to suffer a fatal stroke much higher than for Southern whites, but it is also higher than for other black Americans. The data analyzed from 1997-2001 National Center for Health Statistics suggested that the rate of stroke deaths among black men in the south was 51 percent higher than it was among black men in other parts of the country. And black men in the South had roughly four times the risk of dying of a stroke as white men living outside the South. Leading theories in the literature for the racial and geographic differences are that Southerners are more likely to smoke, be overweight, have high blood pressure, and be in poor general health. The research findings were presented at the 2005 American Stroke Association’s International Stroke Conference.

Insufficient Attention Paid to Treating Mini-Strokes
People who suffer a "mini-stroke", or transient ischemic attack (TIA), receive less aggressive medical attention in terms of testing, treatment and education than patients with full-blown stroke, according to a report presented at the 2005 American Stroke Association’s International Stroke Conference. Since about a third of people who suffer from a mini-stroke will have a major stroke within five years unless they receive preventive therapy, the failure to treat TIA as a medical emergency may undermine efforts to prevent disabling or even fatal strokes later on. The report was based on a study of the comparative treatment received by 91 TIA patients and 94 stroke patients.

Mortality From Most Fatal Type of Stroke
Experimental Miniature ‘Corkscrew’ Shows Dramatic
Results in Halting Ischemic Strokes, Reversing Damage
An experimental device — the Concentric MERCI Retrival System — is showing dramatic results in halting ischemic strokes in progress and in some cases reversing the damage they cause. In the largest test of the new technique, doctors extracted blockages from dozens of patients around the country who otherwise would have likely died or suffered serious brain damage. In some cases, the procedure immediately restored the patients’ ability to move and talk. The device, a spring-like nickel and titanium wire, is used intra-arterially and works like a miniature corkscrew in gently pulling blood clots from the brain.

It is transported to the area of blockage through an extremely small tube (catheter) that is inserted into an artery in the groin and snaked through the arteries of the body until it reaches the clot. The wire springs into a coiled corkscrew shape when deployed from the end of the catheter, embedding itself in the clot. After it snags the clot, it is pulled back into the tube and a miniature balloon inflates, temporarily blocking blood from flushing the clot back into the brain. The device is then withdrawn — removing the clot and restoring blood flow.

Currently the only way to stop an ischemic stroke once it has started is to give patients the clot-busting drug tPA (tissue plasminogen activator). The window of opportunity for using tPA intravenously is only three hours, so many ischemic stroke patients arrive too late for it to be effective. When used intra-arterially, tPA can be effective for up to six hours, but some patients, such as those on certain blood-thinning medications, still are not good candidates for the treatment.

In the clinical trial of the Concentric MERCI (Mechanical Embolus Removal for Cerebral Ischemia) Retrieval System, led by the University of California at Los Angeles, doctors at 25 centers around the country tried the technique on 114 patients who could not undergo tPA treatment. Use of the device restored blood flow in 61 of the patients (54 percent). Of those, 23 have no disability or minor disability, such as handwriting problems. An initial report on the safety and efficacy of the device was presented Feb. 5, 2004, at the American Stroke Association's 29th International Stroke Conference.

Risk of Rupture for Most Small Aneurysms Appears Low
Findings from the largest-ever international study of unruptured brain aneurysms suggest that the risk of rupture for most unrepaired small aneurysms (less than 7 millimeters in size) is small. The International Study of Unruptured Intracranial Aneurysm (ISUIA) was sponsored by the National Institute of Neurological Disorders and Stroke (NINDS) and included more than 4,000 patients at 61 sites in the United States, Canada, and Europe. Results of the study appear in the July 12, 2003 issue of The Lancet.

Coiling Produces Better Outcomes
Than Clipping in Treating Ruptured Brain Aneurysms
Endovascular coil embolization — an interventional neuroradiology technique to treat cerebral hemorrhage from a ruptured aneurysm — substantially reduces the risk of subsequent severe disability or death in comparison with surgical clipping in patients judged to be treatable by either procedure. Interim results of this international multicenter clinical trial — the International Subarachnoid Aneurysm Trial (ISAT) — proved so conclusive, that the study was halted. Study results were published in the October 26, 2002 issue of The Lancet.

Significantly Lower at High-Caseload Hospitals
A study of subarachnoid hemorrhage (SAH), the most fatal form of stroke, shows that patients admitted to high-volume SAH centers have a 40 percent lower in-hospital mortality rate than patients admitted to low-volume centers. This is the most comprehensive study to date evaluating the volume-mortality relationship in SAH cases. The authors of the study attributed this finding, in part, to differences in the availability of specialized personnel, equipment and protocols at low- and high-volume SAH centers. The study defines low-volume hospitals as having fewer than 10 SAH admissions per year and high-volume centers as having more than 35 SAH admissions per year. The large difference in hospital mortality provides compelling evidence that surviving a SAH is more likely if a patient is admitted to a high-volume hospital. The study was published in the November 2003 issue of the Journal of Neurosurgery.

Aspirin as Effective as Ticlopidine in
African American Antiplatelet Stroke Prevention Study
Results from the African American Antiplatelet Stroke Prevention Study (AAASPS), a large multicenter trial of 1,809 African American stroke patients from more than 60 sites in the United States, show that aspirin is as effective as ticlopidine for prevention of a second stroke in this population. Originally scheduled to run until October 2003, the AAASPS was stopped in July 2002, after analyses suggested that there was less than a 1 percent chance that ticlopidine would be shown to be superior to aspirin if the study were carried to completion. (University Hospital participated in this study.)

Beauty Parlor Sinks Linked to Potential Stroke Risk
Researchers in the Department of Physical Medicine and Rehabilitation at UMDNJ-New Jersey Medical School found that the neck extension required for a salon sink shampoo results in altered blood flow to the brain, which may be a risk factor for stroke. This is the first scientific study to look at the previously reported phenomenon of individuals experiencing a stroke during or immediately after getting a salon shampoo. Study subjects also experienced pain and dizziness, warning signs for a stroke, particularly in elderly individuals. The study appears in the June 2002 issue of the American Journal of Physical Medicine and Rehabilitation.

Hormone Replacement Therapy Linked to Increased Risk of Stroke
Research performed as part of the Women's Health Initiative — a long-term study sponsored by the National Institutes of Health (NIH) — links estrogen and progestin therapy (combined hormone therapy, or HT) with increased risk of stroke, among other things. The research involving more than 16,600 women ages 50 to 79 was halted early (July 2002) after more than five years because the risks apparently posed by HT — including small but significant increased risks of stroke, blood clots and heart disease — were determined to outweigh the benefits. The Women’s Health Initiative is looking at ways to prevent heart disease, breast and colon cancer, and osteoporosis. The report is published in the Journal of the American Medical Association, July 17, 2002.

Anti-Cholesterol Drugs After Heart Attack Appear to Reduce Stroke Risk
Starting on anti-cholesterol drugs within days of having a heart attack might halve the risk of going on to suffer an ischemic stroke, according to a study reported in the September 2002 journal Circulation. The study of more than 3,000 patients also seems to counter fears that taking statins early following a heart attack could increase the risk of hemorrhagic stroke.

Strong Association Between Cigarette Smoking and Aneurysm Rupture
Neurosurgeons have revealed that cigarette smoking is a significant risk factor for aneurysm rupture. In a study, "Natural History of Unruptured Intracranial Aneurysms: Probability of and Risk Factors for Aneurysm Rupture," published in the September 2000 issue of the Journal of Neurosurgery, neurosurgeons investigated the long-term natural history of unruptured intracranial aneurysms, finding a significant association between cigarette smoking and increased size of an unruptured lesion and subsequent aneurysm rupture.

Heart Disease, Stroke 2-4 Times More Likely Among Adult Diabetics
The prevalence of heart disease and stroke is two to four times greater in U.S. adults with diabetes than those without diabetes, according to a report by the Centers for Disease Control and Prevention. From 1999-2001, adults with diabetes were 3.7 times as likely as adults without diabetes to report a history of coronary heart disease, 3.6 times as likely to report a history of stroke, and 2.2 times as likely to report a history of another heart condition, the CDC analysis found. The agency said increased efforts are needed to improve the use of preventive care practices such as antihypertensive treatment and aspirin, particularly among adults with diabetes. In addition, it said efforts to prevent diabetes and to reduce the prevalence of cardiovascular disease risk factors, such as hypertension and high cholesterol, could substantially decrease the burden of heart diseases and stroke.

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