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2/13/2015 Overview Non-endovascular treatment of Acute Ischemic Stroke International Stroke Conference Stroke prevention Update 2015 Stroke rehabilitation Nerissa U. Ko, MD, MAS University of California, San Francisco Recent

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2/13/2015 1

International Stroke Conference Update 2015

Nerissa U. Ko, MD, MAS University of California, San Francisco Recent Advances in Neurology February 13, 2015

Nothing to disclose

Overview

Non-endovascular treatment of Acute

Ischemic Stroke

Stroke prevention
Stroke rehabilitation

ACUTE STROKE Clot buster use rises most among 80 and older stroke patients

Michelle P. Lin, M.D., M.P.H., University of

Southern California, Los Angeles, Calif.

Researchers analyzed the health records of

nearly 6 million patients admitted to U.S. hospitals between 2000 and 2010 for strokes treated with IV tPA

Study participants were 35 percent 80 years

and older, 37 percent 65 to 79 years of age, and 28 percent were 18 to 64.

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Clot buster use rises most among 80 and older stroke patients

They found that tPA administration rate increases

from 2000 to 2010 were:

0.47 to 3.55 percent for the oldest group studied;
0.92 to 3.87 percent for 65 to 79 year olds; and
1.02 to 3.61 percent in patients ages 18 to 64.
Among age >80, those treated at an urban

hospital and teaching hospital were more likely to receive tPA.

Women, Blacks, Hispanics and Medicaid holders

were less likely to receive tPA.

Many mild stroke patients considered “too good to treat” may actually benefit from tPA

Stroke patients with mild symptoms might be

eligible but often don’t receive tPA because they are deemed “too good to treat”, but many of these patients don’t fare well after stroke

Using the Get With The Guidelines database from

Boston’s Massachusetts General Hospital, researchers analyzed 2,745 consecutive stroke admissions (01/2009 - 07/2013) to identify which “too-good-to treat”-patients should be considered for tPA because of their risk of poor health or death.

Many mild stroke patients considered “too good to treat” may actually benefit from tPA

238 stroke patients arrived in time to receive tPA but

did not receive it because their symptoms were too mild or they were rapidly improving

89 did not do well and might have benefitted from tPA.

– Only 62 percent were discharged home – 27 percent went to inpatient rehabilitation facilities – 8.4 percent to skilled nursing facilities – more than 2 percent either died or went to hospice.

Risk factors for having poor outcome: elderly; more

severe strokes; Hispanic;stroke that affects both hemispheres

Patients with “wake-up strokes” may be candidates for tPA treatment

Andrew D. Barreto, M.D., The University of Texas

Health Science Center at Houston, TX.

N=40 moderate severity wake-up stroke patients

with a broad range of stroke severities and disabling deficits.

Patients received tPA an average of 2.6 hours

after waking up with stroke symptoms.

None of the patients treated had intracerebral

hemorrhage, resulting in neurological worsening.

50% made full recoveries at 90 days.

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STROKE PREVENTION

Atrial fibrillation and Cryptogenic stroke

To help determine if an implantable cardiac

monitor (ICM) is effective, researchers analyzed 1,247 cryptogenic stroke patients who received an ICM device post stroke

Atrial fibrillation detection rate in the study

population was 12.2 percent at 182 days; this was 37 percent higher than what was found in a recent randomized controlled trial (CRYSTAL AF) at the same time.

Atrial fibrillation and Cryptogenic stroke

Half of the patients with detected atrial

fibrillation had an episode that was at least 3.4 hours in duration.

Among the patients with atrial fibrillation, 25

percent had an episode that was longer than 11.8 hours.

ICMs may have even greater clinical utility in

detecting AF in real-world practice than in clinical trials.

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Atrial fibrillation and Cryptogenic stroke

Scientists analyzed data from previous studies

to determine if detecting atrial fibrillation with an ICM in cryptogenic stroke patients is cost- effective compared to standard of care.

ICM was associated with fewer recurrent

strokes and increased quality of life

While stroke-related costs were lower in the

ICM group, overall costs were higher than in the standard of care group

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2/13/2015 1

International Stroke Conference Update 2015

Nerissa U. Ko, MD, MAS University of California, San Francisco Recent Advances in Neurology February 13, 2015

Nothing to disclose

Overview

Ischemic Stroke

ACUTE STROKE Clot buster use rises most among 80 and older stroke patients

Southern California, Los Angeles, Calif.

nearly 6 million patients admitted to U.S. hospitals between 2000 and 2010 for strokes treated with IV tPA

and older, 37 percent 65 to 79 years of age, and 28 percent were 18 to 64.

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Clot buster use rises most among 80 and older stroke patients

from 2000 to 2010 were:

hospital and teaching hospital were more likely to receive tPA.

were less likely to receive tPA.

Many mild stroke patients considered “too good to treat” may actually benefit from tPA

eligible but often don’t receive tPA because they are deemed “too good to treat”, but many of these patients don’t fare well after stroke

Boston’s Massachusetts General Hospital, researchers analyzed 2,745 consecutive stroke admissions (01/2009 - 07/2013) to identify which “too-good-to treat”-patients should be considered for tPA because of their risk of poor health or death.

Many mild stroke patients considered “too good to treat” may actually benefit from tPA

did not receive it because their symptoms were too mild or they were rapidly improving

– Only 62 percent were discharged home – 27 percent went to inpatient rehabilitation facilities – 8.4 percent to skilled nursing facilities – more than 2 percent either died or went to hospice.

severe strokes; Hispanic;stroke that affects both hemispheres

Patients with “wake-up strokes” may be candidates for tPA treatment

Health Science Center at Houston, TX.

with a broad range of stroke severities and disabling deficits.

after waking up with stroke symptoms.

hemorrhage, resulting in neurological worsening.

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STROKE PREVENTION

Atrial fibrillation and Cryptogenic stroke

monitor (ICM) is effective, researchers analyzed 1,247 cryptogenic stroke patients who received an ICM device post stroke

population was 12.2 percent at 182 days; this was 37 percent higher than what was found in a recent randomized controlled trial (CRYSTAL AF) at the same time.

Atrial fibrillation and Cryptogenic stroke

fibrillation had an episode that was at least 3.4 hours in duration.

percent had an episode that was longer than 11.8 hours.

detecting AF in real-world practice than in clinical trials.

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Atrial fibrillation and Cryptogenic stroke

to determine if detecting atrial fibrillation with an ICM in cryptogenic stroke patients is cost- effective compared to standard of care.

strokes and increased quality of life

ICM group, overall costs were higher than in the standard of care group

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REHABILITATION