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February 26, 2021
New data from an observational study provide some support for antiplatelet therapy in patients with moyamoya disease, a rare arteriopathy characterized by progressive stenosis of the distal internal carotid artery and other basal cerebral arteries.
Patients with moyamoya disease prescribed antiplatelet therapy, tracked through the Korean National Health Insurance Service (NHIS) database, had a significantly lower risk of death than those who didn’t receive antiplatelet therapy (HR 0.77; 95% CI 0.70-0.84). The largest reduction in mortality was seen in patients who were prescribed the phosphodiesterase inhibitor cilostazol (HR 0.57; 95% CI 0.49-0.68).
Based on their findings, “antiplatelet therapy generally, and cilostazol particularly, shows observational evidence of potential benefit as medical treatment for patients with moyamoya disease,” write Woo-Keun Seo, MD, PhD (Samsung Medical Center, Seoul, South Korea), and colleagues in their study published Feb
February 12, 2021
In an international pragmatic study testing a strategy of shortened dual antiplatelet therapy (DAPT) for patients who receive a drug-eluting stent, nearly one in five clinical outcome events were missed by site investigators, according to an analysis from the GLOBAL LEADERS Adjudication Substudy (GLASSY).
Overall, the diagnostic accuracy of clinical events reported by site investigators was modest, while the concordance was generally weak between investigator-reported MIs, strokes, bleeding events, and stent thromboses and those captured by the formal clinical event committee (CEC).
“We did see that relying exclusively on investigator-reported events is very suboptimal, as events were reported by investigators which were not confirmed by the central process and, also vice versa, that the central process detected a considerable number of events which were not reported originally by the investigators,” said senior author Marco Valgimigli, MD, PhD (Cardiocent
February 09, 2021
Patent foramen ovale (PFO) closure in conjunction with optimal medical therapy can reduce both the number of migraine days and the frequency of attacks compared with medicine alone, according to a new pooled analysis.
The findings are unlikely to have an effect on clinical practice, as regulatory bodies have not approved any PFO closure device for the treatment of migraine. However, the procedure is now an option for the prevention of PFO-associated stroke.
“What this [study] will do is increase people s interest and whet their appetite for the next clinical trial, but it s not going to have an immediate practical, clinical effect,” senior study author Jonathan Tobis, MD (University of California, Los Angeles), told TCTMD. “People aren t going to go out and start closing PFOs for migraine. I hope if anything it will stimulate interest in the patient population to participate in the RELIEF PFO trial [because] this shows the good justification for why PFO cl
(UPDATED) For patients with acute ischemic strokes caused by large-vessel occlusions, forgoing IV thrombolytics before mechanical thrombectomy may be a viable option, according to the results of two trials published online this week in
JAMA.
In the DEVT trial, taking patients directly to the cath lab resulted in noninferior 90-day functional outcomes compared with the guideline-recommended approach of administering IV alteplase before the intervention, lead author Wenjie Zi, MD (Xinqiao Hospital and The Second Affiliated Hospital, Chongqing, China), and colleagues report.
And in the SKIP trial, which was initially presented at the International Stroke Conference last year, functional outcomes were similar with the two strategies. The trial, however, did not establish the noninferiority of skipping IV thrombolytics, a result attributed to higher-than-expected rates of recanalization and favorable outcomes.