World Stroke Organization #MondayTips
Every Monday, WSA Social Media Leader Rodrigo Guerrero publishes a #MondayTip on the WSA WorldStrokeEd Twitter account, covering a specific stroke related topic. You can find a compilation of our #MondayTips here!
;
#MondayTip
ICH & antithrombotics
👉Incidence: 0.3-0.9%/y
👉Worst outcome vs other ICH etiologies
👉Mortality: OAC>antiplatelets> no AT
👉Women received ⬇️ reversal agents , but no diffs in neurological deterioration, walking at 3m, mortality at 1y.
From @HanneKChr at #WSC2022
#MondayTip
☝️Two pillars of #secondary stroke #prevention:
🏛️#treatment of the main cerebrovascular #riskfactors
🏛️#identification of the underlying cause
From https://journals.lww.com/co-neurology/Abstract/2022/02000/Precision_medicine_in_secondary_prevention_of.9.aspx
#MondayTip
☝️In #LVO patients, #TNK conferred similar benefit & safety as #rTPA
#AcT trial sub analysis #WSC2022
514 LVO (+)
78,2% EVT
~baseline characteristics
👉90d mRS 0-1: TNK 32.7% vs rTPA 29.1%, p=0.38
🔐Initial eTICI≥2b: 9.4 vs 10.2%
🩸No differences in safety outcomes
#MondayTip
Stroke & Heart Failure
☝️Up to 20% of pts w/MI &⬇️EF have a LV thrombus
☝️Do not relay only on TTE for dx LVT➡️use🫀MRI
☝️High recurrence! use S2I2N0-3
🧠HFrEF/noAF: anticoagulation⬇️43% stroke/⬆️2x major 🩸
☝️In LVT➡️DOAC better than VKAs
From @SposatoL at #WSC2022
#MondayTip
Why ⬇️hematoma expansion (HE) has not led to 📈outcomes?
-HE might not be a reasonable 🎯
-Small ⬇️in HE is insufficient
-⬇️HE offset by treatment side-effects
-Most🩸has ocurred
-Inclusion of low risk of ↗️HE pts
-🩸large enough/strategic 📍
-Not the only mechanism
Este #Mondaytip es para nuestros colegas y amigos de habla hispana
Y es para recordarles los factores de #riesgo que provocan casi un 90% de los #ACV #stroke y que se pueden manejar 💪🏽
@WStrokeCampaign @WorldStrokeOrg @SIECV_IASO @ALATAC
#MondayTip
🩸Etiologies in #multiple intracerebral hemorrhages #ICH and suggested investigations
#vascular #neoplastic
🧠https://link.springer.com/article/10.1385/NCC:4:3:267
#MondayTip
📸Imaging features of #intracranial #arteriopathies ⭕️
#ICAD #vasculitis #MRI #RCVS
#OpenAccess
👉https://practicalneurology.com/articles/2019-jan/intracranial-atherosclerotic-disease?c4src=search:feed
#MondayTip
Why is so important to check for #carotid stenosis in ischemic #stroke patients?
Bc trials have shown a great benefit of #revascularization therapy such as #endarterectomy
#NASCET https://www.nejm.org/doi/full/10.1056/nejm199108153250701
#ECST https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext
Look at that risk reduction!👇🏻
#MondayTip
☝🏼Identifying #AF is important in 2ry stroke #prevention as anticoagulation is superior to antiplatelet agents in⬇️ stroke risk of patients w/AF
☝🏼 Detection of #paroxysmal AF in cryptogenic #stroke depends on type of #monitoring used
From https://cp.neurology.org/content/4/5/386
#MondayTip
🩸The #Heidelberg #Bleeding Classification
Classification of bleeding events after ischemic stroke and reperfusion therapy
#openacces
https://www.ahajournals.org/doi/10.1161/strokeaha.115.010049
#MondayTip
💊Dual Antiplatelet Therapy is currently part of evidence based management in minor #stroke and #TIA
☝🏼Check this summary from @StrokeAHA_ASA of the 3 main #DAPT trials
#CHANCE #POINT #THALES
#openaccess
https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031763
#MondayTip
☝️#MRI sequences are useful in dating ischemic #stroke as hyperacute, acute, subacute or chronic
ie:
🧠ADC low: < 1 week
🧠FLAIR (+): >6-12hr after onset
🧠CE-T1w: parenchymal enhancement typically 1week-2months
#openacces
👉https://pubs.rsna.org/doi/10.1148/rg.325115760
#MondayTip
Based on best evidence today, in patients w/ AF who suffer a #stroke while on #DOAC:
☝️Change to another DOAC is not associated to ⬇️recurrent ischemic stroke or bleeding
👉Add-on antiplatelets significantly⬆️the risk of bleeding
#RENOExtend
https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.038239
#MondayTip
Some #NIHSS Pitfalls:
☝🏼0 does not equal “No Stroke”‼️
👉Items with poor reliability (LOC, gaze, facial palsy, ataxia)
🧠 Emphasis on 🗣 and following commands may result in higher score for dominant hemispheric strokes
⏬ sensitivity for posterior circulation
#MondayTip
The↗️burden of stroke & dementia emphasizes the need for new, well-tolerated, cost-effective 1ry prevention strategies to⬇️the risks worldwide, and specifically LMICs
@WorldStrokeOrg Multilevel community interventions for 1ry stroke prevention
https://journals.sagepub.com/doi/10.1177/1747493019873706