International Journal of Stroke: Podcast Series

As COVID-19 continues to ravage health systems across the world we are still asking ourselves what are the risks for stroke patients that have contracted   COVID-19. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke, spoke to Dr James Siegler from Cooper Neurologic Institute, Cooper University Hospital, Camden, New Jersey in the USA about the retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019, across 31 hospitals in four countries. Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event recorded from the 1st of Feb  until the 16th of June 2020.

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The International Journal of Stroke is the flagship publication of the world Stroke Organisation, please consider becoming a member.  

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Patients with acute ischemic stroke on dabigatran treatment may become eligible for thrombolysis with rt-PA. In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Pawel Kermer from Krankenhaus Sanderbusch; Neurology, Sande Germany. 

Read the article link here

Mobile stroke units, otherwise known as MSUs have recently been introduced in the care of patients suspected of having an acute stroke, leading to shortening in the time to thrombolytics, but how does the clinical effectiveness in terms of functional outcome and survival among patients treated in MSU and/or conventional care compare? 

Carmen Lahiff-Jenkins; Managing Editor of the International Journal of Stroke spoke to the very impressive Dr Nida Fatima from the Department of Neurosurgery, Massachusetts General Hospital, Boston, USA who was the corresponding author for the Mobile Stroke Unit versus Standard Medical Care in the Management of patients with Acute Stroke: a systematic review and meta-analysis. 

Anecdotal reports and clinical observations have recently emerged suggesting a relationship between COVID-19 disease and stroke; highlighting the possibility that infected individuals may be more susceptible to cerebrovascular events

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke (IJS) spoke to Kieron South and Craig Smith from the University of Manchester, two authors of the article Preceding Infection and Risk of Stroke: An Old Concept Revived by the COVID-19 Pandemic published in IJS.   

Unfortunately, at the time of recording there was some difficulty with the internet, another COVID-19 affect, and so some of the discussion with Craig Smith is a little hard to hear. Please be patient with us. It can be difficult to get good internet working from home. 

If you enjoy our podcast series with stroke practitioners and researchers from around the world, please do write a review, as we have it on good advice this helps others to find us. 

IJS is the flagship publication of the World Stroke Organisation (WSO). The WSO is doing every thing we can to support our professional membership at this difficult time. Please stay tuned for our upcoming conference details in November. Also, we produce weekly webinars and educational content for our stroke community, please consider becoming a member. 

Clinical assessment scores in acute ischemic stroke are only moderately correlated with lesion volume since lesion location is an important confounding factor. Many studies have investigated grey matter indicators of stroke severity but the understanding of white matter tract involvement is limited in the early phase after stroke. Carmen Lahiff-Jenkins, Managing Editor for the International Journal of Stroke spoke to Dr Deepthi Rajashekar from the Biomedical Engineering Graduate Program, Department of Radiology, University of Calgary and Professor Michael Hill Cumming School of Medicine, University of Calgary and Foothills Medical Centre. Both are authors of the manuscript Structural integrity of white matter tracts as a predictor of acute ischemic stroke outcome published recently in IJS. This study aimed to measure and model the involvement of WM tracts with respect to 24-hours post-stroke National Institutes of Health Stroke Scale (NIHSS) and have found that white matter tract integrity and lesion load are important predictors for clinical outcomes after acute ischemic stroke as measured by the NIHSS and should be integrated for predictive modelling.

Access the article here

In health research we often hear, and pay lip service to the term ‘patient centred‘. Many of us would probably be hard pressed to devise entirely patient centred studies. "Take Charge’ is an impressive, novel, community-based self-directed rehabilitation intervention that helps a person with stroke to take charge of their own recovery. 

In a previous randomised controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders. 

This current study confirms that Take Charge; a low cost, person-centred, self-directed rehabilitation intervention after stroke – improved health-related quality of life and independence.

Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke and spoke to Dr Harry McNaughton who conducted the study from the Medical Research Institute of New Zealand in the Stroke/Rehabilitation Research Department at Wellington Hospital.

Dr McNaughton and team tested the same intervention in three doses (zero, one or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We spoke to him about how this trial came about and how these really astounding results could change the way we look at some rehabilitation interventions. 

This podcast is sponsored by the World Stroke Organisation  

Controversy and great interest exists regarding cardiovascular and cerebrovascular risk and it’s relationship to sleep duration. Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Jingwei Li from the George Institute for Global Health about the paper ‘Secondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial’ other wise known as the SAVE trial.

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You can access the article here.

The thrombolysis in cerebral infarction scale otherwise known as the (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer dependent, so this means it may not result in the best prediction of patient outcome and can also provide an inconsistent reperfusion grading. 

Carmen Lahiff Jenkins Managing Editor of the International Journal of Stroke spoke to Drs Haryadi Prasetya and Manon Kappelhof from Amsterdamn University Medical Centre two of the author group who submitted the article qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients. In this podcast we look at the authors investigations into  qTICI and eTICI using image processing techniques based on the TICI methodology to develop better quality reperfusion grading. 

The International Journal of Stroke is the flagship publish of the World Stroke Organisation 

qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients 

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic characterized by high morbidity and mortality. Clinical factors that can identify patients at risk for worse outcomes can help in developing risk stratification models for judicious use of healthcare resources. A team of researchers from Italy and the USA performed a pooled analysis of published studies, for assessing the impact of CVD in patients with COVID-19. They found CVD was associated with 2.5-fold enhanced risk of severe disease. 

Carmen Lahiff-Jenkins, IJS Managing Editor spoke to Dr Gaurav Aggarwal from the Department of Medicine, Jersey City Medical Center, Jersey City, USA. Dr Gaurav Aggarwal is the submitting author for Cerebrovascular Disease is Associated with an Increased Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19): which is a pooled analysis of published literature 

On March 11th, 2020 the World Health Organization declared the COVID-19 infection a pandemic. We are currently in the throws of that global infection and the big question everyone is racing to ask and answer is the risk of ischemic stroke higher in patients with COVID-19 infection. We spoke to both Drs based in the United States Adnan Quereshi from the University of Missouri, Department of Neurology, and Vishal Jani from the Creighton University School of Medicine, Immanuel Medical Centre Omaha Nebraska, who is the corresponding author for the article “Management of Acute Ischemic Stroke in Patients with COVID-19 Infection: Report of an International Panel”

This important paper is from a team of doctors on the front line from the USA, Egypt, Turkey, Iran, Italy Taiwan, Pakistan, Poland, France and China and more presents a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection.