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Intravenous thrombolysis for ischemic stroke gets an assist from ultrasound energy, and a disparity exists between rich and poor nations in getting cardiovascular research seen by the medical community.
Ultrasound and tPA Team Up
Adding pulsed-wave ultrasound to tissue plasminogen activator (tPA) appeared to be safe and effective in patients with ischemic stroke stemming from a proximal intracranial occlusion, a first-in-human pilot study showed.
Twenty patients received a standard dose of intravenous tPA followed by 2 hours of pulsed-wave ultrasound delivered by an operator-independent device. All of the patients tolerated the full treatment, with no serious adverse events tied to the device. There were no cases of symptomatic intracerebral hemorrhage.
At 2 hours, 40% and 10% of the patients achieved complete and partial recanalization, respectively. At 90 days, one-quarter of the patients had an excellent neurological status indicated by a modified Rankin scale score of 0 or 1.
"Sonothrombolysis using a novel, operator-independent device, in combination with systemic tPA, seems safe, and recanalization rates warrant evaluation in a phase III efficacy trial," Andrew Barreto, MD, of University of Texas Health Science Center at Houston, and colleagues reported in Stroke: Journal of the American Heart Association.
Medical Tx Still Beats Wingspan Stent Over Long Term
After more than 2.5 years, aggressive medical treatment alone remained superior to medical treatment plus stenting with the Wingspan stent in high-risk patients with intracranial artery stenosis.
The final results of the SAMMPRIS trial -- reported in The Lancet -- are consistent with the 30-day results, which showed a higher rate of stroke or death in the stenting group (14.7% versus 5.8%) and caused the trial to be stopped early.
Colin Derdeyn, MD, of Washington University in St. Louis, and colleagues looked at the longer-term results of the trial, which included 451 patients with a recent transient ischemic attack or stroke stemming from a 70% to 99% blockage in a major intracranial artery.
The primary outcome was a composite of the rate of stroke or death within 30 days, ischemic stroke in the territory of the qualifying artery beyond 30 days, or stroke or death within 30 days after a revascularization procedure of the qualifying lesion. Through a median of 32.4 months, the rate was 15% in the medical treatment group and 23% in the stenting group.
"Our findings lend support to the use of aggressive medical management rather than percutaneous transluminal angioplasty and stenting with the Wingspan system in high-risk patients with atherosclerotic intracranial arterial stenosis," the researchers wrote.
National Wealth Tied to Research Dissemination
Cardiovascular research coming out of less wealthy nations is not disseminated as widely as that from richer parts of the world, according to a study in the International Journal of Cardiology.
Stephan Winnik, MD, of the University Heart Center Zurich, and colleagues looked at a random sample of abstracts submitted for presentation to the European Society of Cardiology congress in 2006. All abstracts were tracked for acceptance for presentation at the meeting, as well as full-text publication and citation through December 2011.
After taking into account differences in research quality and infrastructure, the wealth of a researcher's nation -- based on per-capita gross domestic product -- was significantly associated with each outcome, such that research coming from poorer nations was less likely to be accepted, published, or cited.
"We anticipate that our findings will increase the awareness and may improve the understanding of potential challenges faced by investigators from less wealthy nations in the dissemination of their research, and may help to determine potential solutions to address these concerns," the authors wrote.
Air Pollution Cleared of Afib Connection
Poor quality air may not be associated with a greater risk of atrial fibrillation (Afib) after all, an Italian study suggested.
A prior study of 176 patients with known heart disease demonstrated a significant relationship between exposure to particulate matter and Afib. But the patients lived over a large geographic area (within 50 kilometers, or about 31 miles, of the air monitoring station), and there could be smaller-scale variations in air quality.
Gianfranco Cervellin, MD, of the University Hospital of Parma in Italy, and colleagues explored the potential link between air pollution and Afib by looking at all emergency department visits for acute-onset Afib at their hospital over a 2-year period. All 975 patients with Afib lived within just 10 kilometers (about 6 miles) of the air monitoring station.
Contrary to the findings of the other study, there was no significant association between Afib and concentrations of nitrogen dioxide, ozone, or particulate matter, the researchers reported in a letter to the editor in the Canadian Journal of Cardiology.
"Our analysis indicates that the correlation between air pollution and a complex and multifactorial disorder like atrial fibrillation remains elusive," they wrote.