P.196 Antiplatelet, anticoagulant, or endovascular treatment for stroke prevention in blunt cerebrovascular injury: Retrospective review, systematic review and meta-analysis

Background: Ischemic stroke occurs following trauma-related blunt cerebrovascular injury (BCVI) in up to 20% of cases. Preventative treatment includes antiplatelets, anticoagulants, and/or endovascular treatment (ET), but the optimal choice remains unclear. The objective of this study was to compare the ischemic stroke rate between these three treatments. Methods: Following PRISMA guidelines, we queried the OVID Medline, Embase, Web of Science, and Cochrane Library databases from September 2019 to inception to identify studies reporting treatment-stratified outcomes in BCVI patients. Meta-analysis was performed to compare outcomes between the treatment groups, using odds ratios. Retrospective review of our institutional experience with BCVI outcomes was performed and added to the meta-analysis. Results: Analysis of seven comparative studies of antiplatelets (n=334) versus anticoagulation (n=325) found no significant difference in ischemic stroke rate (OR 1.27, 95%CI 0.40-3.99), but a decrease in hemorrhagic complications (OR 0.38, 95%CI 0.15-1.00). Analysis of seven comparative studies of antiplatelets/anticoagulants (n=805) versus ET (n=235) also found no significant difference in stroke rate (OR 0.71, 95%CI 0.35-1.42). Conclusions: Antiplatelets and anticoagulants were similarly effective in reducing ischemic stroke risk in BCVI, but antiplatelets were better tolerated in this trauma population. The addition of endovascular treatment did not further reduce stroke risk compared to antiplatelets or anticoagulants alone.

Completion Arteriogram Following Carotid Endarterectomy Yields Lower Perioperative Stroke Rate

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%.

The association of stroke rate with low density lipoprotein and statin exposure in patients with atrial fibrillation (AF)

Background There are limited data on the association between cholesterol levels and stroke risk in atrial fibrillation (AF). Objective To quantify the association of stroke rate in AF with low-density lipoprotein (LDL) levels and statin use. Methods Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients aged ≥66 years, diagnosed with AF between 2009–2019. We used cause-specific hazard regression to determine the association of statin use with stroke rate. We developed a second cause-specific regression model for patients with at least one lipid profile measurement in the year before AF diagnosis to study the association of LDL levels with stroke rate, while adjusting for statin use. LDL levels were modeled using restricted cubic splines (RCS). Both models were adjusted for age, sex, heart failure, hypertension, diabetes, stroke or transient ischemic attack, and vascular disease at baseline, plus anticoagulation as a time-varying covariate. Results We studied 261,659 qualifying patients (median age 78 years, 49% female), of whom 3,954 (1.5%) developed a stroke during one-year follow-up. A total of 142,834 (54.6%) patients were treated with statins and 145,775 (55.7%) had lipid measurements before AF diagnosis. The adjusted RCS analyses (see Figure) indicated increasing hazard ratios (HRs) for stroke with increasing low-density lipoprotein (LDL) values above 1.5mmol/L. Statin use was associated with a lower stroke rate relative to non-users (hazard ratio 0.87, 95% confidence interval 0.81–0.93, p-value <0.0001). Conclusion LDL levels above 1.5mmol/L were independently associated with higher stroke rates in patients with AF, while statins were associated with lower stroke rates independent of anticoagulation. This suggests that LDL measurements may improve stroke risk stratification in AF, while statins may offer an underutilized pathway to lower stroke risk in AF. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): 1) Heart and stroke foundation of Canada HR for Stroke and LDL level

The Effect of Concurrent Resistance Training on Upper Body Strength, Sprint Swimming Performance and Kinematics in Competitive Adolescent Swimmers. A Randomized Controlled Trial

This study aimed to examine the effect of 9 weeks of concurrent resistance training (CRT) between resistance on dry land (bench press (BP) and medicine ball throw) and resistance in water (water parachute and hand paddles) on muscle strength, sprint swimming performance and kinematic variables compared by the usual training (standard in-water training). Twenty-two male competitive swimmers participated in this study and were randomly allocated to two groups. The CRT group (CRTG, age = 16.5 ± 0.30 years) performed a CRT program, and the control group (CG, age = 16.1 ± 0.32 years) completed their usual training. The independent variables were measured pre- and post-intervention. The findings showed that the one-repetition maximum bench press (1RM BP) was improved only after a CRT program (d = 2.18; +12.11 ± 1.79%). Moreover, all sprint swimming performances were optimized in the CRT group (d = 1.3 to 2.61; −4.22 ± 0.18% to −7.13 ± 0.23%). In addition, the findings revealed an increase in velocity and stroke rate (d = 1.67, d = 2.24; 9.36 ± 2.55%, 13.51 ± 4.22%, respectively) after the CRT program. The CRT program improved the muscle strength, which, in turn, improved the stroke rate, with no change in the stroke length. Then, the improved stroke rate increased the swimming velocity. Ultimately, a faster velocity leads to better swim performances.

Risk factors and treatment of oxygenator high-pressure excursions during cardiopulmonary bypass

Introduction: A high-pressure excursion (HPE) is a sudden increase in oxygenator inlet pressure during cardiopulmonary bypass (CPB). The aims of this study were to identify factors associated with HPE, to describe a treatment protocol utilizing epoprostenol in severe cases, and to assess early outcome in HPE patients. Methods: Patients who underwent cardiac surgery with cardiopulmonary bypass at Sahlgrenska University Hospital 2016–2018 were included in a retrospective observational study. Pre- and post-operative data collected from electronic health records, local databases, and registries were compared between HPE and non-HPE patients. Factors associated with HPE were identified with logistic regression models. Results: In total, 2024 patients were analyzed, and 37 (1.8%) developed HPE. Large body surface area (adjusted Odds Ratio (aOR): 1.43 per 0.1 m2; 95% confidence interval (CI): 1.16–1.76, p < 0.001), higher hematocrit during CPB (aOR: 1.20 per 1%; (1.09–1.33), p < 0.001), acute surgery (aOR: 2.98; (1.26–6.62), p = 0.018), and previous stroke (aOR: 2.93; (1.03–7.20), p = 0.027) were independently associated with HPE. HPE was treated with hemodilution ( n = 29, 78.4%), and/or extra heparin ( n = 23, 62.2%), and/or epoprostenol ( n = 12, 32.4%). No oxygenator change-out was necessary. While there was no significant difference in 30-day mortality (2.7% vs 3.2%, p = 1.0), HPE was associated with a higher perioperative stroke rate (8.1% vs 1.8%, aOR 5.09 (1.17–15.57), p = 0.011). Conclusions: Large body surface area, high hematocrit during CPB, previous stroke and acute surgery were independently associated with HPE. A treatment protocol including epoprostenol appears to be a safe option. Perioperative stroke rate was increased in HPE patients.

Relationships between measures of boat acceleration and performance in rowing, with and without controlling for stroke rate and power output

Purpose Boat acceleration profiles provide a valuable feedback tool by reflecting both rower technique and force application. Relationships between measures of boat acceleration and velocity to inform interpretation of boat acceleration profiles in rowing were investigated here. Methods Thirteen male singles, nine female singles, eight male pairs, and seven female pairs participated (national and international level, age 18–27 y). Data from each stroke for 74 2000-m races were collected using Peach PowerLine and OptimEye S5 GPS units. General linear mixed modelling established modifying effects on velocity of two within-crew SD of boat acceleration variables for each boat class, without and with adjustment for stroke rate and power, to identify potential performance-enhancement strategies for a given stroke rate and power. Measures of acceleration magnitude at six peaks or dips, and six measures of the rate of change (jerk) between these peaks and dips were analyzed. Results were interpreted using rejection of non-substantial and substantial hypotheses with a smallest substantial change in velocity of 0.3%. Results Several boat acceleration measures had decisively substantial effects (-2.4–2.5%) before adjustment for stroke rate and power. Most effect magnitudes reduced after adjustment for stroke rate and power, although maximum negative drive acceleration, peak drive acceleration, jerk during the mid-drive phase, and jerk in the late recovery remained decisively substantial (-1.8–1.9%) in some boat classes. Conclusion Greater absolute values of maximum negative drive acceleration and jerk in the late recovery are related to improved performance, likely reflecting delayed rower centre-of-mass negative acceleration in preparation for the catch. Greater absolute values of peak drive acceleration, first peak acceleration, and jerk in the early and mid-drive are also associated with improved performance, likely reflecting propulsive force during the drive. These proposed mechanisms provide potential strategies for performance enhancement additional to increases in stroke rate and power output.