| Timely treatment, new techniques,
lifestyle behaviors and genetics are key topics of stroke research in 2010 The American Heart Association/American Stroke Association has been compiling an annual list of the top 10 major advances in heart disease and stroke research since 1996. This year, for the first time, two separate lists have been compiled that highlight the top ten research advances in each respective area. Stroke research highlights in 2010 noted by the association include (in no ranking order): 1. "Time is brain": Clot-dissolving treatment for acute ischemic stroke found beneficial in the first 4.5 hours after onset, potentially harmful later A combined patient analysis of eight trials of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke reinforced prior findings of a strong time-to-treatment effect, with greatest benefit in the first few hours after onset, and, for the first time, demonstrated increased mortality from late treatment beyond 4.5 - 6 hours after onset. Pooled analysis of the ECASS, ATLANTIS, NINDS and EPITHET trials - Lancet, May 15, 2010; www.thelancet.com; Lancet 2010;375(9727):1695-703; Funding: There was no funding source for this study. 2. New mechanism of emboli clearance from the brain vasculature discovered This study identified an entirely new way by which brain blood vessels are kept open by the body in the face of clots - extravasation. Clots that are not able to be dissolved are sometimes pushed out through blood vessel walls into the surrounding tissue, restoring nourishing flow in blood vessels. Lam, et al; Nature, May 27, 2010;www.nature.com.Nature 2010;465:478-482; Funding: No funding sources were listed. 3. Carotid endarterectomy and carotid artery stenting directly compared The large CREST trial compared head-to-head the two major methods to reopen narrowed carotid arteries carrying blood flow to the brain: carotid endarterectomy and carotid stenting. Overall, both techniques had similar rates of success and complication, but among younger patients, under 70 years of age, stenting appeared advantageous while among older patients endarterectomy appeared advantageous. Those findings were also supported in a preplanned meta-analysis of individual patient data from three randomized controlled trials. CREST - New England Journal, July 1, 2010;
www.nejm.org; N Engl J Med
2010;363(1):11-23; Funding: National Institute of Neurological Disorders and Stroke
(NINDS). 4. Million-person milestone, emerging research shows quality initiatives improve outcomes In an analysis of the first one million stroke patients
enrolled in the national Get With the GuidelinesR - Stroke quality improvement
program at nearly 1400 hospitals across the United States, quality of care on
10 performance measures improved substantially from 2003 to 2009. More than 80
percent of patients were receiving defect-free care by 2009, up from less than
half in 2003. Smith, et al - Circulation, Sept. 27,
2010; http://circ.ahajournals.org;
Circulation. 2010;122:1496-1504. 5. International study identifies the ten major risk factors for stroke In the worldwide INTERSTROKE study, 10 simple risk factors were found to be associated with 90 percent of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the worldwide burden of stroke. INTERSTROKE Investigators - Lancet, June 18, 2010; www.thelancet.org; Lancet 2010;376,112-123; Funding: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, Boehringer Ingelheim. 6. Ultrasound detection of silent emboli identifies patients at high risk of stroke This international, multicenter, prospective study confirms that detection of silent, microclots traveling to the brain on transcranial Doppler ultrasound identifies a subgroup of patients with asymptomatic narrowing of the carotid artery who are at high risk for stroke and might benefit from surgery or stenting. ACES - Lancet Neurology, July 2010; www.thelancet.org;Lancet Neurol;9(7):663-71; Funding: British Heart Foundation. 7. Robot-assisted therapy beneficial for long-term arm impairment after stroke This randomized trial suggested that robot-assisted therapy can improve the rehabilitation of arm function after stroke compared with ordinary care, though no more than intensive therapist care. Lo, et al - New England Journal of Medicine, May 16, 2010; www.nejm.org; N Engl J Med. 2010;362(19):1772-83; Funding: Veterans Affairs Cooperative Studies Program and Rehabilitation Research and Development Service. 8. Genetic findings important in understanding, treating aneurysms Two new studies looked at the genetics and treatment of aneurysms. Saccular intracranial aneurysms are located in the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. This multicenter genome-wide association study in Europe and Japan identified three new and confirmed two previously suspected chromosome sites as harboring genes predisposing to the formation of intracranial aneurysms. Vascular Ehlers-Danlos syndrome is a rare, genetic, severe disease that causes arterial dissections and ruptures that can lead to early death. This randomized trial found that treatment with a beta-blocker medication to lower mechanical stress on arterial walls prevents dissection and hemorrhages in Ehlers-Danlos patients. Yasuno, et al - Nature Genetics, May 2010;
www.nature.com; Nat Genet;2010;42(5):420-5;
Funding: Yale Center for Human Genetics and Genomics,Yale Program on Neurogenetics,
US National Institute of Health, Howard Hughes Medical Institute. 9. Lowering blood pressure early reduces brain hemorrhage growth One out of six strokes is due to bleeding into the brain, intracerebral hemorrhage, a major cause of death and disability. Two pilot trials found that aggressively lowering blood pressure, starting within six hours of stroke onset, is feasible and can reduce hemorrhage expansion. Larger trials have been launched to determine if this improves patient final outcome. ATACH Investigators - Critical Care Medicine,
Feb. 2010; www.ccmjournal.org;
Crit Care Med. 2010;38(2):637-48; Funding: - 10. Physical activity, even moderate in degree, reduces stroke risk A large study found leisure-time physical activity, even in modest degree, is associated with lower stroke risk in women. In particular, walking was generally associated with lower risks of total, ischemic, and hemorrhagic stroke. Sattelmair, et al - Stroke, April 6, 2010;
http://stroke.ahajournals.org; Stroke 2010;41(6):1243-50; Funding: National Institutes
of Health. |