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Even hospitals schooled in enhanced stroke treatment are lagging in efficient brain scanning. Also this week, rivaroxaban vies for indication expansion and peripheral arterial disease has new treatment options.
Clock Often Ticks Too Long Before Stroke Brain Scan
The mantra in stroke care is "time is brain," but imaging acute stroke patients to determine stroke type is not happening as quickly as it should, researchers found.
According to an analysis of 40,777 patients from hospitals participating in the Get With the Guidelines -- Stroke program from 2003 to 2009, only 41% were imaged within 25 minutes, the American Heart Association recommended time, according to Adam G. Kelly, MD, from the University of Rochester in Rochester, N.Y., and colleagues.
Patients who received imaging within the recommended time frame were more likely to receive thrombolytic therapy (63% versus 38%), researchers reported online in Stroke: Journal of the American Heart Association.
Patients who were less likely to receive imaging within 25 minutes included women, nonwhites, those who did not arrive at the hospital by ambulance, and those with certain known risk factors for stroke such as diabetes, a prior history of stroke, over 75 years old, and peripheral vascular disease.
Rivaroxaban Maker Seeks FDA Approval for VTE
Janssen has filed paperwork with the FDA requesting that the oral anticoagulant rivaroxaban (Xarelto) be approved to treat patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) and prevention of recurrent venous thromboembolism (VTE).
The request is backed up by data from the EINSTEIN studies, the latest of which, EINSTEIN-PE, was presented at the American College of Cardiology meeting in March.
EINSTEIN-PE compared rivaroxaban with enoxaparin followed by a vitamin K antagonist in patients with acute symptomatic PE with or without symptomatic DVT.
Thrombus Aspiration No Risk in PCI
A post-hoc analysis of the PASSION trial at 2 years follow-up found that thrombus aspiration did not increase rates of adverse cardiac events in STEMI patients given stents, according to a study published in Catheterization and Cardiovascular Interventions.
In the original trial, 619 STEMI patients were randomized to paclitaxel-eluting or bare-metal stents, with thrombus aspiration performed in just over half of the participants.
This new analysis, by Maarten A. Vink, MD, and colleagues from the Netherlands, found that the most significant variables associated with undergoing thrombus aspiration at P<0.001 were previous MI (OR 7.62), visible thrombus (OR 6.42), TIMI flow 0/1 (OR 2.97), and age (OR 1.03).
Other significant variables were diabetes, anterior MI, positive family history, proximal tortuosity, calcified lesion, and proximal lesion.
Leg Occlusions Get Nonsurgical Option
The Enabler-P balloon catheter system enabled the successful crossing of 32 out of 37 chronic total occlusions of the superficial femoral artery and popliteal artery, according to a first-in-man study published in the Journal of Endovascular Therapy.
The Enabler-P balloon anchors against the vessel wall proximal to the lesion and supports controlled advancement of a standard nonhydrophilic guidewire. The interventionalist is able to manually retract, advance, or torque the wire at all times.
In this safety and effectiveness study called APOLO (Accessing Peripheral Occluded LesiOns), all but one of the 32 cases successfully crossed were successfully recanalized, reported Thomas Zeller, MD, from Herz-Zentrum Bad Krozingen in Germany, and colleagues.
Saving Limbs with Stem Cells
Stem cells harvested from patients' own bone marrow have shown the ability to reduce the need for lower limb amputation as a result of peripheral arterial disease, a phase II study found.
A total of 77 critical limb ischemia patients from 18 centers in the U.S. were randomized in a 2:1 ratio to stem cell therapy or placebo, reported Richard J. Powell, MD, from Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues in Molecular Therapy.
At six months, about half of the patients who received a placebo died, required an amputation, or saw their leg wounds worsen compared with one-quarter of those who received the stem cell therapy. Many in the stem cell group showed significant improvement in blood flow in the ischemic limb, researchers reported.
'Stroke' the Salt Shaker Lightly
Over a 10-year period, Participants in the Northern Manhattan Study whose salt intake was greater than 4,000 mg per day had a 2.6-fold increased risk of stroke compared with those whose intake was less than 1,500 mg per day, which is the recommended allowance from the American Heart Association.
Overall, the mean salt consumption was 3,031 mg per day and only 12% consumed less than 1,500 mg per day, reported Hannah Gardener, ScD, from the University of Miami, and colleagues online in Stroke: Journal of the American Heart Association.
However, they found that for each 500 mg per day increase in salt consumption there was a 17% increased risk of stroke. Gardener and colleagues said their results are consistent with other studies showing that salt intake is associated more with stroke than with cardiovascular disease.
Ambitious Oral Anticoagulation Registry
Boehringer Ingelheim, makers of dabigatran (Pradaxa), a new oral anticoagulant approved for the prevention of stroke in patients with nonvalvular atrial fibrillation, has launched a registry to understand the long-term use of antithrombotic agents in this patient population.
GLORIA-AF will follow newly diagnosed afib patients from 50 countries, with the intentions to be completed in 2020, according to the company.
From the American Heart Association: