Seven presentations highlighted during Late-Breaking Science Oral Abstracts

MainArticlePost_largeREVSeven abstracts were presented February 12 during the Late-Breaking Science Oral Abstract session.

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Aspirin is not effective for primary prevention of stroke in elderly Japanese patients with vascular risk factors. Lead author Shinichiro Uchiyama, MD, Tokyo Women’s University, reported a subanalysis from the Japanese Primary Prevention Project.

The open label study followed 14,464 patients with vascular risk factors for stroke over a median of about five years. Patients were randomized a group taking 100 mg of aspirin daily or a group taking no aspirin in addition to their standard medications. Researchers found a nonsignificant reduction in the incidence of ischemic stroke (p=.061), offset by a nonsignificant increase in the incidence of intracranial hemorrhage (p=.078) associated with aspirin. There was no difference in the cumulative rate of fatal or nonfatal stroke between the two groups.

“There is always the question of how well you can extrapolate a Japanese stroke population to Western populations,” said session moderator Steven Greenberg, MD, PhD, John J. Conway endowed chair in neurology at Massachusetts General Hospital and professor of neurology at Harvard Medical School, Boston. “But these results suggest no evidence of benefit to aspirin for primary stroke prevention.”

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The VERiTAS Study of large vessel flow measures in the posterior circulation to predict subsequent vertebrobasilar (VB) stroke showed stronger results. Patients with low flow in the large VB vessels as measured by quantitative MRA had a hazard ratio of 18 for a subsequent VB stroke. Low-flow status emerged as a significant predictor of VB stroke (p=0.04). Results were presented by lead author Sepideh Amin-Hanjani, MD, professor and program director of neurovascular surgery, the University of Illinois at Chicago.

“This was a small study, 72 patients, but very exciting,” Dr. Greenberg said. “These low-flow patients are the people whose risk of a subsequent event is so high that they might benefit from even a risky procedure to reopen flow. VB flow could be a good way to select patients for trials. Stay tuned for follow-up.”

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The ongoing controversy over the management of patients with cryptogenic stroke and patent foramen ovale (PFO) moved closer to resolution. Lead author David Kent, MD, MS, professor of medicine and director of Predictive Analytics and Comparative Effectiveness (PACE), Tufts Medical Center, Boston, presented a pooled analysis of 2,303 patients across three PFO closure trials. Individual trials showed no significant difference between closure and medical therapy. The meta-analysis showed a hazard ratio of 0.41 for recurrent stroke (p=.0433) following closure. PFO closure had no impact on the composite primary outcome of stroke, transient ischemic attack or death.

“There is intriguing evidence in the larger numbers,” Dr. Greenberg said. “We are beginning to see convincing evidence that there is a lower recurrent stroke risk with closure. Also of note, this study was not industry-sponsored; it was an independent analysis.”

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MR CLEAN, the first trial of thrombectomy with second-generation devices, reported the number-needed-to-treat. Clinicians need treat only three to five patients for every less disabled outcome and seven patients per nondisabled outcome. The analysis was presented by lead author May Nour, MD, PhD, fellow and clinical instructor in neurology and radiology, University of California, Los Angeles.

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Mohamed Labib, MD, CM, neurosurgeon at the University of Ottawa presented early results for a standardized process for evacuating intraparenchymal hemorrhage. The process, Minimally invasive Subcortical Parafascicular Access for Clot Evacuation (MiSPACE), showed a statistically significant improvement in GCS and no fatalities in 35 patients across 10 centers.

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Madeleine Hunter, an undergraduate at Columbia University, New York, showed a strong association between increased P-wave terminal force in EKG lead V1 (PTFV1) and cryptogenic and cardioembolic stroke independent of any history of atrial fibrillation and heart failure.

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Jesse Dawson, MD, clinical reader, University of Glasgow, United Kingdom, presented preliminary data from an early trial of vagus nerve stimulation for patients with upper limb weakness after stroke. The treatment is based on vagus nerve stimulation used for epilepsy. Although the small study was not powered to detect significant improvements in the primary endpoint (the Upper Extremity Fugl-Meyer score), the possible response of some subjects showed promise. A confirmatory study is under way in the U.S.

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