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Latest news and Developments

December 2018

New Focus Trial Collaboration results: "Fluoxetine 20 mg given daily for 6 months after an acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function." Link to Lancet Full article 5th December 2018

ARISTOPHANES Study: In this largest observational study to date on NOACs and warfarin, the NOACs had lower rates of stroke/ Systemic emboli and variable comparative rates of Major Bleed versus warfarin. The findings from this study may help inform the discussion on benefit and risk in the shared decision-making process for stroke prevention between healthcare providers and nonvalvular atrial fibrillation patients Link to Stroke Article 8 Nov 2018

November 2015:Mechanical Thrombectomy

Currently in the UK and I am sure Worldwide, delivering Mechanical thrombectomy is the current focus of attention and the challenge is to deliver robust clinical pathways to allow it to be offered to stroke patients quickly and safely. Here is an interesting paper from 2012 and here is Consensus statement from the European Stroke Organisation. It will be interesting times ahead. Here is an interesting read the PISTE or Pragmatic Ischaemic Stroke Thrombectomy Evaluation study run by Keith Muir. For those not aware of the typical selection criteria it will be those age >18 years with NIHSS ≥ 6 and No Major Contraindication and Eligible for IV rtPA who will be given standard IV rtPA 0.9mg/kg and then either MRA/CTA/DSA looking for ICA-T, MCA M1 or M2 occlusion and then randomized to receive completion of alteplase or Additional mechanical thrombectomy IA Device selected as per Neurointerventionalist. Assessment will be early major neurological improvement as per NIHSS and mRS at 3m.

I know large teaching centres are getting on with their plans and are at varying stages. It is going to be a significant amount of additional work for a tertiary centre in a time when there is no money to go around. Do we need to go down the route of the cardiology PCI model. Should I be asking my cardiology colleagues to go north.

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