Stroke and COVID with Dr James Seigler

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Patients with acute ischemic stroke on dabigatran treatment may become eligible for thrombolysis with rt-PA. In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Pawel Kermer from Krankenhaus Sanderbusch; Neurology, Sande Germany.  Read the article link here    

Mobile stroke units, otherwise known as MSUs have recently been introduced in the care of patients suspected of having an acute stroke, leading to shortening in the time to thrombolytics, but how does the clinical effectiveness in terms of functional outcome and survival among patients treated in MSU and/or conventional care compare?  Carmen Lahiff-Jenkins; Managing Editor of the International Journal of Stroke spoke to the very impressive Dr Nida Fatima from the Department of Neurosurgery, Massachusetts General Hospital, Boston, USA who was the corresponding author for the Mobile Stroke Unit versus Standard Medical Care in the Management of patients with Acute Stroke: a systematic review and meta-analysis.   

Anecdotal reports and clinical observations have recently emerged suggesting a relationship between COVID-19 disease and stroke; highlighting the possibility that infected individuals may be more susceptible to cerebrovascular events Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke (IJS) spoke to Kieron South and Craig Smith from the University of Manchester, two authors of the article Preceding Infection and Risk of Stroke: An Old Concept Revived by the COVID-19 Pandemic published in IJS.      Unfortunately, at the time of recording there was some difficulty with the internet, another COVID-19 affect, and so some of the discussion with Craig Smith is a little hard to hear. Please be patient with us. It can be difficult to get good internet working from home.  If you enjoy our podcast series with stroke practitioners and researchers from around the world, please do write a review, as we have it on good advice this helps others to find us.  IJS is the flagship publication of the World Stroke Organisation (WSO). The WSO is doing every thing we can to support our professional membership at this difficult time. Please stay tuned for our upcoming conference details in November. Also, we produce weekly webinars and educational content for our stroke community, please consider becoming a member. 

Clinical assessment scores in acute ischemic stroke are only moderately correlated with lesion volume since lesion location is an important confounding factor. Many studies have investigated grey matter indicators of stroke severity but the understanding of white matter tract involvement is limited in the early phase after stroke. Carmen Lahiff-Jenkins, Managing Editor for the International Journal of Stroke spoke to Dr Deepthi Rajashekar from the Biomedical Engineering Graduate Program, Department of Radiology, University of Calgary and Professor Michael Hill Cumming School of Medicine, University of Calgary and Foothills Medical Centre. Both are authors of the manuscript Structural integrity of white matter tracts as a predictor of acute ischemic stroke outcome published recently in IJS. This study aimed to measure and model the involvement of WM tracts with respect to 24-hours post-stroke National Institutes of Health Stroke Scale (NIHSS) and have found that white matter tract integrity and lesion load are important predictors for clinical outcomes after acute ischemic stroke as measured by the NIHSS and should be integrated for predictive modelling.   Access the article here

In health research we often hear, and pay lip service to the term ‘patient centred‘. Many of us would probably be hard pressed to devise entirely patient centred studies. "Take Charge’ is an impressive, novel, community-based self-directed rehabilitation intervention that helps a person with stroke to take charge of their own recovery.  In a previous randomised controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders.  This current study confirms that Take Charge; a low cost, person-centred, self-directed rehabilitation intervention after stroke – improved health-related quality of life and independence. Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke and spoke to Dr Harry McNaughton who conducted the study from the Medical Research Institute of New Zealand in the Stroke/Rehabilitation Research Department at Wellington Hospital. Dr McNaughton and team tested the same intervention in three doses (zero, one or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We spoke to him about how this trial came about and how these really astounding results could change the way we look at some rehabilitation interventions.  This podcast is sponsored by the World Stroke Organisation  

Controversy and great interest exists regarding cardiovascular and cerebrovascular risk and it’s relationship to sleep duration. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Jingwei Li from the George Institute for Global Health about the paper ‘Secondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial’ other wise known as the SAVE trial. If you enjoy this podcast series then please help spread the word, please share with your colleagues and write a review on the streaming service.  You can access the article here.  

The thrombolysis in cerebral infarction scale otherwise known as the (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer dependent, so this means it may not result in the best prediction of patient outcome and can also provide an inconsistent reperfusion grading.  Carmen Lahiff Jenkins Managing Editor of the International Journal of Stroke spoke to Drs Haryadi Prasetya and Manon Kappelhof from Amsterdamn University Medical Centre two of the author group who submitted the article qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients. In this podcast we look at the authors investigations into  qTICI and eTICI using image processing techniques based on the TICI methodology to develop better quality reperfusion grading.  The International Journal of Stroke is the flagship publish of the World Stroke Organisation  qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients 

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic characterized by high morbidity and mortality. Clinical factors that can identify patients at risk for worse outcomes can help in developing risk stratification models for judicious use of healthcare resources. A team of researchers from Italy and the USA performed a pooled analysis of published studies, for assessing the impact of CVD in patients with COVID-19. They found CVD was associated with 2.5-fold enhanced risk of severe disease.  Carmen Lahiff-Jenkins, IJS Managing Editor spoke to Dr Gaurav Aggarwal from the Department of Medicine, Jersey City Medical Center, Jersey City, USA. Dr Gaurav Aggarwal is the submitting author for Cerebrovascular Disease is Associated with an Increased Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19): which is a pooled analysis of published literature 

On March 11th, 2020 the World Health Organization declared the COVID-19 infection a pandemic. We are currently in the throws of that global infection and the big question everyone is racing to ask and answer is the risk of ischemic stroke higher in patients with COVID-19 infection. We spoke to both Drs based in the United States Adnan Quereshi from the University of Missouri, Department of Neurology, and Vishal Jani from the Creighton University School of Medicine, Immanuel Medical Centre Omaha Nebraska, who is the corresponding author for the article “Management of Acute Ischemic Stroke in Patients with COVID-19 Infection: Report of an International Panel” This important paper is from a team of doctors on the front line from the USA, Egypt, Turkey, Iran, Italy Taiwan, Pakistan, Poland, France and China and more presents a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection.

Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. The Sleep SMART trial is the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/TIA reduces recurrent vascular events or death, and improves functional recovery. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of spoke to Professor Devin Brown from the department of Neurology, University of Michigan in the USA about this trial and its design and potential to influence how we use sleep tools to potentially improve clinical outcomes after TIA. The International Journal of Stroke is the flagship publication of the World Stroke Organisation, please consider becoming a member.  Music is Kool Kats by Kevin McLeod  

Researcher Peter Knapp talks to the International Journal of Stroke Managing Editor on the review the Frequency of anxiety after stroke which is a timely updated systematic review and meta-analysis of observational studies in this area.

In 2017, for the first time, stroke, became the second most common cause of both death and disability in the world.  In New Zealand (NZ) the situation is even more dire as was previously shown through a series of population-based Auckland Regional Community Stroke Studies (ARCOS) population-based studies. The number of stroke survivors have tripled over the last three decades, and there are also significant ethnic disparities in stroke, with the risk of stroke in Māori and Pacific people two to three times greater than in NZ Europeans. In 2011-2012, the age-adjusted incidence of stroke in NZ was the fourth highest in high-income countries.  Carmen Lahiff-Jenkins Managing Editor of the International journal of Stroke spoke to Professor Valery Feigin from the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand he is also the submitting author for the article Measuring stroke and transient ischaemic attack burden in New Zealand: protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V) now online in the International Journal of Stroke.    To become a member please click here   Music is Kool Kats by Kevin McCloud 

Informal caregivers in stroke: life impact, support and psychological well-being - a Swedish Stroke Register (Riksstroke) study In 2016, the Swedish Stroke Register, Riksstroke, conducted a long-term follow-up survey on caregivers to patients with stroke three and five years earlier. Items on psychological well- being were adapted from the 36-item short-form health survey (SF-36) and poor outcome was defined using the SF-36 reference material. Survivor degree of dependency was indicated by the caregiver as independent, partially dependent or completely dependent.  The caregiver situation varies greatly with degree of survivor dependency which makes generalizations of caregiver needs difficult. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke discussed the results of this investigation with Dr Stefan Sennfalt who emphasized the need for integrating support aimed specifically at caregivers to survivors of stroke with a large degree of dependency.  The International Journal of Stroke is the flagship publication of the World Stroke Organisation. Please consider becoming a member. World Stroke Organization Music is Kool Kats by Kevin MacLeod 

In this podcast World Stroke Organization members from Japan demonstrate the importance of professional and patient collaboration in influencing stroke policy. We spoke to people from Australia to Japan and followed the journey of this important legislation from the 14 stakeholder groups to the Japanese Diet. 

In 2015 discussions began among key researchers in the field of stroke rehabilitation and recovery. This resulted in the Stroke Recovery and Rehabilitation Roundtable who met in Philadelphia, in the USA and resulted in the publication of 6 papers in the International Journal of Stroke and the Neurorehabilitation and Neural Repair journals. We are now on the second round table and things are heating up significantly in the rehabilitation and recovery space. The second published SRRR series incorporates themes of cognitive impairment, knowledge translation, an exemplar of a next generation of stroke recovery treatment trials, kinematic and kinetic movement quantification.  A major goal of the Stroke Recovery and Rehabilitation Roundtable SRRR is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In the paper, a stroke recovery trial development framework: Consensus based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable describes key issues for the next generation of stroke recovery treatment trials and presents the Stroke Recovery and Rehabilitation Roundtable Trials Development Framework (SRRR-TDF). An exemplar is presented to demonstrate the utility of this framework to guide the GO, NO-GO decision-making process in trial development. The International Journal of Stroke is the flagship publication of the World Stroke Organization. Please do consider becoming a member and help us to fight the global burden of stroke! Visit our website here. Find the article here! Music Kool Kats by Kevin Mcleod 

In 2015 discussions began among key researchers in the field of stroke rehabilitation and recovery. This resulted in the Stroke Recovery and Rehabilitation Roundtable who met in Philadelphia, in the USA and resulted in the publication of 6 papers in the International Journal of Stroke and the Neurorehabilitation and Neural Repair journals. We are now on the second round table and things are heating up significantly in the rehabilitation and recovery space. The second published SRRR series incorporates themes of cognitive impairment, knowledge translation, an exemplar of a next generation of stroke recovery treatment trials, kinematic and kinetic movement quantification.  The second Stroke Recovery and Rehabilitation Roundtable’s “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, this group focused on measurement of the quality of upper limb movement. The group came to agreement on the recommended protocols for measurement which should be conceptually rigorous, reliable, valid and responsive to change. The taskforce is urging the clinical and research community to consider adopting these recommendations. The recommended measurement protocols include four performance assays (2D planar reaching, finger individuation, grip strength and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. The paper, ‘Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable’ describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment.  The International Journal of Stroke is the flagship publication of the World Stroke Organization. Please do consider becoming a member and help us to fight the global burden of stroke! Vist the WSO page here! You can find the article here! Music Kool Kats by Kevin Mcleod 

In 2015 discussions began among key researchers in the field of stroke rehabilitation and recovery.  This resulted in the Stroke Recovery and Rehabilitation Roundtable who met in Philadelphia, in the USA and resulted in the publication of 6 papers in the International Journal of Stroke and the Neurorehabilitation and Neural Repair journals. We are now on the second round table and things are heating up significantly in the rehabilitation and recovery space. The second published SRRR series incorporates themes of cognitive impairment, knowledge translation, an exemplar of a next generation of stroke recovery treatment trials, kinematic and kinetic movement quantification.  Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care.  An international 10-member Knowledge Translation Working Group collaborated over a six month period. The process was informed from well distributed surveys to all stakeholders. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. The taskforce recommends that health care providers, managers, and organizations determine whether the priorities identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke. The International Journal of Stroke is the flagship publication of the World Stroke Organization. Please do consider becoming a member and help us to fight the global burden of stroke! Visit our website here You can find the article here! Music Kool Kats by Kevin Mcleod 

In 2015 discussions began among key researchers in the field of stroke rehabilitation and recovery.  This resulted in the Stroke Recovery and Rehabilitation Roundtable who met in Philadelphia, in the USA and resulted in the publication of 6 papers in the International Journal of Stroke and the Neurorehabilitation and Neural Repair journals. We are now on the second round table and things are heating up significantly in the rehabilitation and recovery space. The second published SRRR series incorporates themes of cognitive impairment, knowledge translation, an exemplar of a next generation of stroke recovery treatment trials, kinematic and kinetic movement quantification.  Cognitive impairment is an important target for rehabilitation as it is common following stroke, is associated with reduced quality of life and interferes with motor and other types of recovery interventions. Cognitive function following stroke was identified as an important, but relatively neglected area during the first Stroke Recovery and Rehabilitation Roundtable leading to a Cognition Working Group being convened as part of SRRR II. There is currently insufficient evidence to build consensus on specific approaches to cognitive rehabilitation. However, this group presents recommendations on the integration of cognitive assessments into stroke recovery studies generally and define priorities for ongoing and future research for stroke recovery and rehabilitation. A number of promising interventions are ready to be taken forward to trials to tackle the gap in evidence for cognitive rehabilitation. However, to accelerate progress requires that researchers coordinate efforts to tackle multiple gaps along the whole translational pathway.  Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke spoke to Dr Michael O’Sullivan from the Centre for Clinical Research, Faculty of Medicine, University of Queensland, in Brisbane, Australia.  The International Journal of Stroke is the flagship publication of the World Stroke Organization. Please do consider becoming a member and help us to fight the global burden of stroke! Click this link to visit our membership page Find the article here Music Kool Kats by Kevin Mcleod 

Dr George Ntaois on 'Oral anticoagulation versus antiplatelet/placebo for stroke prevention in patients with heart failure and sinus rhythm: systematic review and meta-analysis of randomized controlled trials' Previous meta-analyses of randomized controlled trials of oral anticoagulation in patients with heart failure and sinus rhythm reported reduced stroke risk and increased bleeding risk compared to antiplatelets or placebo. However, the effect estimates may be subject to imprecision, as all included trials were prematurely terminated, stroke was not the primary outcome and overall results were primarily driven by a single trial which accounted for >80% of all strokes. Current guidelines do not provide strong recommendations about the role of oral anticoagulants in heart failure patients with sinus rhythm.    Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to George Ntaios the Department of Medicine, University of Thessaly, Larissa, Greece.  Dr Ntaios and his team wanted to provide a more accurate estimate of the effect of oral anticoagulation on stroke risk in heart failure patients with sinus rhythm by systematic review and meta-analysis of available randomized controlled trials including the recently published evidence. Link to article here Music by Kevin McLeod