Patients treated with thrombectomy needed less time to complete both tests and finished Part A without errors more frequently than control patients. “Our results suggest that thrombectomy improves executive function at three months after stroke, when compared to medical treatment alone,” concluded Dr. López-Cancio and colleagues.
PFO Closure May Affect the Size and Location of Recurrent Strokes
The size and location of recurrent strokes among patients with patent foramen ovale (PFO) differ between patients who had their PFOs closed with a device and patients who only received medical therapy. Those who received medical therapy alone tended to have large strokes more often than those who underwent closure with the device. The former also tended to have strokes that were more often in superficial locations consistent with PFO-related stroke, according to a study.
These findings were not statistically significant in the intent-to-treat analysis, but were significant when the researchers analyzed patients based on treatment received.
To gain further insights into the clinical efficacy of PFO closure, David E. Thaler, MD, PhD, of Tufts University School of Medicine in Boston, and colleagues analyzed the mechanisms of recurrent strokes during long-term follow-up in the RESPECT trial. The trial randomized 980 subjects to PFO closure with the Amplatzer PFO Occluder or medical management from August 2003 to December 2011. The investigators included follow-up data through August 14, 2015, in their analysis.
The study included patients ages 18 to 60 who had cryptogenic stroke and PFO. In the intent-to-treat population, 18 recurrent strokes occurred in the closure group and 24 occurred in the medical-management group. In the medical-management group, 79% of the recurrent strokes were cryptogenic, compared with 56% in the device group. Infarct size was large in 79% of the medical-management group, compared with 56% of the device group. Infarct location was superficial in 61% of the medical-management group, compared with 53% of the device group.
“These data support the hypothesis that the Amplatzer PFO Occluder prevents PFO-related recurrent stroke,” concluded the researchers.
Intracerebral Hemorrhage Location Predicts Dementia
Intracerebral hemorrhage is associated with a high risk of subsequent dementia, according to a prospective study. In addition, risk factors for dementia after intracerebral hemorrhage include the location of the brain bleed, older age, stroke severity, and findings that are associated with cerebral amyloid angiopathy.
“The incidence of new-onset dementia is high after intracerebral hemorrhage, with a strong influence of lobar location,” said Solène Moulin, MD, of Lille University Hospital in France, and colleagues. “Among patients with lobar intracerebral hemorrhage, prognostic factors suggested a strong implication of underlying cerebral amyloid angiopathy that might predict future risk of dementia.”
To assess the incidence, prognostic factors, and possible mechanisms of dementia after intracerebral hemorrhage, Dr. Moulin and colleagues enrolled consecutive adults with spontaneous intracerebral hemorrhage into a prospective cohort study. The investigators included 218 patients who did not have dementia in the first six months after stroke (108 males; median age, 67.5).
The investigators found that 20% of the subjects had dementia at one year after stroke, and 63 patients developed dementia during an average follow-up of 5.4 years.
Prognostic factors of new-onset dementia included lobar location (hazard ratio [HR], 2.21), older age (HR, 1.06 per year), increasing cortical atrophy (HR, 2.7), presence of disseminated superficial siderosis (HR, 7.10), and higher number of lobar cerebral microbleeds (HR, 3.40).
Migraine With Aura Heightens Risk of Cardioembolic Stroke
People who experience migraine with aura have a twofold increased risk of ischemic stroke, compared with patients who have migraine without aura, according to an analysis of data from the Atherosclerosis Risk in Communities (ARIC) study. This increased risk was the same for men and women. In addition, investigators found that migraine with aura increased the risk of cardioembolic stroke, compared with other subtypes of ischemic stroke.
Prior studies have identified migraine with aura as a risk factor for stroke. To study specific subtypes of ischemic stroke that are associated with migraine with aura, Souvik Sen, MD, MPH, a neurologist at the University of South Carolina School of Medicine in Columbia, and colleagues analyzed data for 12,758 participants, ages 45 to 64, who completed their third clinical visit in the study. A total of 817 people had an ischemic stroke.
The investigators used a Cox proportional hazards model to analyze the association between migraine with aura and incidence of stroke, compared with migraine without aura. They used survival analysis to evaluate the incidence of each subtype of stroke in the two groups.
“If we are going to prevent people with migraines with aura from having a stroke, it’s important to know what types of stroke they’re having and then be vigilant about it,” Dr. Sen said.