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Medical Management vs Mechanical Thrombectomy for Mild Strokes
Although mechanical thrombectomy (MT) is the standard of care for anterior circulation acute large-vessel occlusion (LVO), it is not known whether MT benefits patients with National Institutes of Health Stroke Scale scores less than 6. Goyal and colleagues evaluated 364 patients with mild deficits and acute LVO treated with MT or best medical management in a retrospective pooled multicenter study over a 5-year period. The patients treated with MT experienced higher odds of asymptomatic intracerebral hemorrhage (ICH) and lower rates of 3-month functional independence compared with patients treated with best medical management. In a meta-analysis that included 843 patients from 4 studies, MT was associated with higher odds of symptomatic ICH, but no other differences, suggesting a clinical trial in this patient population is warranted.
Pediatric Endovascular Recanalization Outcomes
Randomized clinical trials show efficacy of endovascular recanalization for stroke treatment in adults, but it is not clear whether these results can be applied to pediatric patients with stroke with large-vessel occlusion. Sporns and coauthors found that endovascular recanalization appeared to be safe with positive interventional and neurologic outcomes in this pediatric population. The study findings showed that the rate of recanalization, complications, and neurologic outcomes were comparable with those in adult trials and therefore support endovascular recanalization in children with acute, large-vessel occlusion. Editorial perspective is provided by Fox and Dlamini.
Brain Volumes, Mood, and Cognition in Professional Fighters
Although imaging studies of repetitive head trauma and resulting structural brain changes have been conducted, the association between the structural brain changes and altered brain functions is not well understood. Lee and colleagues used a population-based cohort from the Professional Fighters Brain Health Study, examining volumes of brain structures and cognitive and mood assessments of 476 active and retired professional fighters and healthy age-matched control participants. Repetitive traumatic injury in fighters with the imaging findings of cavum vergae (CV) and increased cavum septum pellucidum/cavum vergae (CSPV) length correlate with decreased volumes of various brain structures and impaired cognitive measures (processing and psychomotor speed). Cavum septum pellucidum/cavum vergae identified in fighters with repetitive traumatic injury can be viewed as a risk factor for clinically significant injury.
Continuing Medical Education
Benefits of Rivaroxaban Plus Aspirin in Reduction of Ischemic Stroke
The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized clinical trial enrolled 27 395 patients with systemic atherosclerotic disease and showed the combination of low-dose rivaroxaban plus aspirin to be significantly superior to aspirin for prevention of ischemic strokes. Less is known about the efficacy of rivaroxaban plus aspirin on different stroke subtypes. Perera and coauthors, in a secondary analysis of 291 COMPASS patients who experienced an ischemic stroke, found that low-dose rivaroxaban plus aspirin is associated with significant reductions in cardioembolic stroke and embolic strokes of undetermined source.
Highlights. JAMA Neurol. 2020;77(1):1. doi:10.1001/jamaneurol.2019.3178
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