Utah Department of Health Targets High Stroke Death Rate. "Stroke: It's A Time Bomb" Awareness Campaign Begins Today

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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The Tenth Annual TAPS Conference

Psychiatric Bulletin ◽

10.1192/pb.20.1.48 ◽

1996 ◽

Vol 20 (1) ◽

pp. 48-49

Author(s):

Hugh Freeman

Keyword(s):

Mental Illness ◽

National Health ◽

Mentally Ill ◽

Central Place ◽

Psychiatric Services ◽

Group Meeting ◽

Health Targets ◽

Department Of Health ◽

Severely Mentally Ill ◽

National Differences

From a group meeting in one room at Friern Hospital, the annual conferences of TAPS (Team for the Assessment of Psychiatric Services) have grown after ten years to overflowing a large hall, with participants from many countries. Dr Rachel Jenkins of the Department of Health, in introducing the meeting, emphasised that mental illness now had a central place in national health targets. The reduction of suicide was a special objective, particularly as it is now estimated that one in six of the severely mentally ill eventually kill themselves. She pointed out that although this conference was focused on deinstitutionalisation, there had been very little research on why such major national differences in this process had occurred.

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Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease

Stroke ◽

10.1161/strokeaha.120.030550 ◽

2020 ◽

Vol 51 (9) ◽

pp. 2620-2629 ◽

Cited By ~ 1

Author(s):

Vikram S. Kashyap ◽

Peter A. Schneider ◽

Mazin Foteh ◽

Raghu Motaganahalli ◽

Rasesh Shah ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Carotid Artery ◽

Death Rate ◽

Technical Success ◽

Protocol Population ◽

Procedural Success ◽

Intent To Treat ◽

Treat Population ◽

Stroke Death

Background and Purpose: Transcarotid artery revascularization (TCAR) is comprised of carotid artery stent placement with cerebral protection via proximal carotid artery clamping and reversal of cerebral arterial flow. The aim of the present study was to evaluate the safety and efficacy of TCAR performed by a broad group of physicians with variable TCAR experience. Methods: The ROADSTER 2 study is a prospective, open label, single arm, multicenter, postapproval registry for patients undergoing TCAR. Patients considered at high risk for complications from carotid endarterectomy with symptomatic stenosis ≥50% or asymptomatic stenosis ≥80% were included. The primary end point was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary end points included technical success and individual/composite rates of stroke, death, and myocardial infarction (MI). All patients underwent independent neurological assessments before the procedure, within 24 hours, and at 30 days after TCAR. An independent clinical events committee adjudicated all major adverse events. Results: Between 2015 and 2019, 692 patients (Intent to Treat Population) were enrolled at 43 sites. Sixty cases had major protocol violations, leaving 632 patients adhering to the Food and Drug Administration-approved protocol (per-protocol population). The majority (81.2%) of operators were TCAR naïve before study initiation. Patients underwent TCAR for neurological symptoms in 26% of cases, and all patients had high-risk factors for carotid endarterectomy (anatomic-related 44%; physiological 32%; both 24%). Technical success occurred in 99.7% of all cases. The primary end point of procedural success rate in the Intent to Treat population was 96.5% (per-protocol 97.9%). The early postoperative outcomes in the Intent to Treat population included stroke in 13 patients (1.9%), death in 3 patients (0.4%), and MI in 6 patients (0.9%). The composite 30-day stroke/death rate was 2.3%, and stroke/death/MI rate was 3.2%. In the per-protocol population, there were strokes in 4 patients (0.6%), death in one patient (0.2%), and MI in 6 patients (0.9%) leading to a composite 30-day stroke/death rate of 0.8% and stroke/death/MI rate of 1.7%. Conclusions: TCAR results in excellent early outcomes with high technical success combined with low rates of postprocedure stroke and death. These results were achieved by a majority of operators new to this technology at the start of the trial. Adherence to the study protocol and peri-procedural antiplatelet therapy optimizes outcomes. Longer-term follow-up data are needed to confirm these early outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02536378.

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Stroke death rate annual decrease reversal and prescription decrease of antihypertensive drugs stimulating the angiotensin II formation

American Journal of Hypertension ◽

10.1016/s0895-7061(02)02564-5 ◽

2002 ◽

Vol 15 (4) ◽

pp. A106

Author(s):

A FOURNIER

Keyword(s):

Angiotensin Ii ◽

Death Rate ◽

Antihypertensive Drugs ◽

Stroke Death

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Abstract W P9: SAMMPRIS, WASID, and the Non-Linearity of Stroke Risk: Is There Room for Further Trials of Intervention for Intracranial Stenosis?

Stroke ◽

10.1161/str.45.suppl_1.wp9 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nancy T Kung ◽

Dushyant Damania ◽

Minal Jain ◽

Anunaya Jain ◽

George E Koch ◽

...

Keyword(s):

Sample Size ◽

Death Rate ◽

Time Window ◽

Recurrent Stroke ◽

Recruitment Rate ◽

Significant Benefit ◽

Intracranial Stenosis ◽

Complication Rates ◽

Unruptured Intracranial Aneurysms ◽

Stroke Death

Background: SAMMPRIS concluded that aggressive medical management (AMM) was superior to early percutaneous transluminal angioplasty and stenting (PTAS) plus AMM for patients with symptomatic severe intracranial stenosis. WASID and SAMMPRIS have shown that the risk of recurrent stroke after the initial event is early, non-linear, and markedly diminishes over one year irrespective of treatment. We therefore investigated the feasibility of demonstrating benefit for a new endovascular intervention (nEI) for these patients within this narrow time window. Methods: We compared 1-year stroke/death rates in patients treated with AMM versus a hypothesized nEI. The 1-year stroke/death rate for AMM was derived from the SAMMPRIS trial. A minimal 30-day stroke/death rate for a nEI was set to 3% using data from endovascular treatment of unruptured intracranial aneurysms. The subsequent stroke/death rate over the ensuing 11 months was varied above and below the rates achieved in SAMMPRIS, and the sample size for a future 1-sided superiority trial was calculated at 0.05 alpha and 80% power. Results: For a nEI with the same 31-365 days stroke/death rate as SAMMPRIS AMM (5.3%) but an improved 30-day stroke/death rate of 3%, a total of 1,484 subjects would be required to show significant benefit over AMM. At the SAMMPRIS recruitment rate of 187 patients/year, it would take 7.9 years to recruit 1,484 patients. Varying the 31-365 days stroke/death rate for nEI from 3% to 8%, and keeping 0-30 days stroke/death rate constant at 3%, (1 year total nEI stroke/death rate ranging from 6% to 11%), the total sample size required to show significant benefit at 1 year over AMM (1 year stroke/death rate of 12.2%) would be 518 and 17,600 respectively. This trial would take approximately 2.8 years and 94.1 years to recruit the eligible subjects at the SAMMPRIS rate, respectively. Conclusion: Identification of higher-risk subgroups, demonstration of decreased 30-day endovascular complication rates, and enhanced recruitment strategies will be necessary before institution of trials of new endovascular interventions for symptomatic intracranial stenosis.

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Completion Arteriogram Following Carotid Endarterectomy Yields Lower Perioperative Stroke Rate

Vascular and Endovascular Surgery ◽

10.1177/15385744211048310 ◽

2021 ◽

pp. 153857442110483

Author(s):

Nicholas J. Madden ◽

Keith D. Calligaro ◽

Matthew J. Dougherty ◽

Krystal Maloni ◽

Douglas A. Troutman

Keyword(s):

Carotid Endarterectomy ◽

Death Rate ◽

The Body ◽

Stroke Rate ◽

Stent Deployment ◽

Technical Problems ◽

Perioperative Stroke ◽

Patch Angioplasty ◽

Intraoperative Revision ◽

Stroke Death

Introduction: Completion imaging following carotid endarterectomy (CEA) remains controversial. We present our experience performing routine completion arteriography (CA). Methods: A retrospective review of our prospectively maintained institutional database was performed for patients undergoing isolated CEA. Results: 1439 isolated CEAs with CA were performed on 1297 patients. CEA was for asymptomatic lesions in 70% (1003) of cases. There were no complications related to arteriography. An abnormal arteriogram documented significant abnormalities in the internal carotid artery (ICA) and prompted revision in 1.7% (24/1439) of cases: 20 unsatisfactory distal endpoints of the endarterectomy (12 residual stenoses, 7 intimal flaps, and 1 dissection), 3 kinks or stenoses within the body of the patch, and 1 thrombus. Of the 20 distal endpoint lesions, stent deployment was used in 17 cases and patch revision in 3 cases. The other 4 cases were treated by patch angioplasty (3) or thrombectomy (1). None suffered a perioperative stroke. The overall 30-day stroke, death, and combined stroke/death rate for the 1439 patients in our series was 1.5% (22), .5% (7), and 1.9% (27), respectively. The combined stroke/death rate for asymptomatic lesions was 1.1% (11/1003) and for symptomatic lesions was 2.5% (11/436). Of the 22 strokes in the entire series (all with normal CA), 15 were non-hemorrhagic strokes ipsilateral to the CEA; 14 were confirmed to have widely patent endarterectomy sites by CT-A (13) or re-exploration and repeat arteriography (1). The occluded site was re-explored and underwent thrombectomy, but no technical problems were identified. The remaining strokes were hemorrhagic (4 reperfusion syndrome and 1 surgical site bleeding) or contralateral to the CEA (2). Conclusion: Although not all patients in this series who underwent intraoperative revision due to abnormal CA might have suffered a stroke, performing this simple and safe study may have halved our overall perioperative stroke rate from 3.2% to 1.5%.

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Trends in the Stroke Death Rate Among Mississippi Adults, 2000–2016

Preventing Chronic Disease ◽

10.5888/pcd16.180425 ◽

2019 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Vincent L. Mendy ◽

Rodolfo Vargas ◽

Marinelle Payton ◽

Jennifer N. Sims ◽

Lei Zhang

Keyword(s):

Death Rate ◽

Stroke Death

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The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack

Vascular ◽

10.1177/1708538118799225 ◽

2018 ◽

Vol 27 (1) ◽

pp. 51-59 ◽

Cited By ~ 2

Author(s):

Rodolfo Pini ◽

Gianluca Faggioli ◽

Mauro Gargiulo ◽

Enrico Gallitto ◽

Laura M Cacioppa ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Death Rate ◽

Stroke Risk ◽

Death Risk ◽

Carotid Revascularization ◽

Postoperative Stroke ◽

Tertiary Hospitals ◽

Ischemic Attack ◽

Few Data ◽

Stroke Death

Objective Carotid stenosis with crescendo-transient-ischemic-attack (cTIA) requires a prompt intervention to reduce the stroke risk. Few data are reported in literature about cTIA suggesting a different perioperative risk compared with patients with single TIA (sTIA). This study aimed to compare the outcome of carotid endarterectomy (CEA) in patients with TIA (single/crescendo) and evaluate the outcome risk-factors. Methods Data from two tertiary hospitals for vascular treatment were analyzed from 2007 to 2016. All patients with TIA subjected to CEA were considered, comparing the 30-day postoperative stroke and stroke/death in patients with cTIA and sTIA, particularly in the urgent (≤48 h) setting. Results On a total of 3866 CEA, 888 (23%) were performed in symptomatic patients and 515 for TIA: 365 (71%) patients with sTIA and 150 (29%) with cTIA. When compared with sTIA, cTIA patients were younger and less frequently affected by coronary disease, dyslipidemia, and chronic pulmonary disease; however, contralateral carotid occlusion was more common (20% vs. 10%, P = .004; 56% vs. 46, P = .03; 16% vs. 7%, P = .01; >80 years 26% vs. 16%, P = .01 and 2% vs. 10%, P = .001; respectively). Postoperative stroke and stroke/death were significantly higher in cTIA compared with sTIA (5.3% vs. 1.6%, P = .02 and 6.0% vs. 2.2%, P = .03; respectively). Urgent CEA was performed in 58% ( n: 87) cTIA and in 11% ( n: 56) sTIA( P<.01). The urgent setting did not influence the stroke and stroke/death rate of CEA for sTIA (3.6% vs. 1.3%, P = .21 and 3.6% vs. 1.9%, P = .44, respectively), but was associated with lower rate of events in cTIA (1.1%vs. 11.1%, P = .01 and 2.3% vs. 11.1%, P = .03, respectively). This beneficial effect in patients with cTIA treated within 48-h was confirmed also by multivariate analysis (OR: 0.09, 95% CI: 0.76–0.01, P=.02). Conclusions cTIA subjected to CEA have a higher stroke and stroke/death risk compared with patients with sTIA. The urgent setting seems to reduce the stroke/death rate cTIA; for sTIA with a stable neurological condition, the timing of CEA did not influence the outcome.

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Carotid endarterectomy may be required in addition to best medical treatment for some patient subgroups with asymptomatic carotid stenosis

Vascular ◽

10.1177/1708538114560463 ◽

2014 ◽

Vol 23 (1) ◽

pp. 62-64 ◽

Cited By ~ 6

Author(s):

Kosmas I Paraskevas ◽

Andrew N Nicolaides ◽

Frank J Veith

Keyword(s):

Medical Treatment ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Death Rate ◽

Cerebrovascular Event ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Best Medical Treatment ◽

Patient Subgroups ◽

Stroke Death

Several guidelines recommend carotid endarterectomy for patients with severe asymptomatic carotid stenosis to reduce the risk of a future cerebrovascular event, as long as the perioperative stroke/death rate is <3%. Based on improvements in best medical treatment, it was argued that currently best medical treatment alone should comprise the treatment-of-choice for asymptomatic carotid stenosis patients and that no intervention is warranted in these individuals. While it is true that best medical treatment should be used for the management of all asymptomatic carotid stenosis patients, emerging evidence suggests that best medical treatment alone may not prevent disease progression and the development of symptoms in some asymptomatic carotid stenosis patient subgroups. This article analyzes the results of two recent independent studies demonstrating that medical therapy alone may not be adequate for stroke prevention in some asymptomatic carotid stenosis patient subgroups. These results suggest that besides best medical treatment, additional carotid endarterectomy should be considered for specific asymptomatic carotid stenosis patients.

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