Heme Iron Intake and Risk of Stroke; A Prospective Study of Men

 

Abstract

Background and Purpose—Intake of iron, especially heme iron, has been associated with several diseases. However, epidemiological studies of heme iron and nonheme iron intake in relation to risk of stroke are lacking. The aim of this study was to examine the associations between heme iron and nonheme iron intake and stroke incidence in men.
Methods—The population-based prospective Cohort of Swedish Men included 38 859 men, aged 45 to 79 years, who had no history of stroke, coronary heart disease, or cancer at baseline. Hazard ratios and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards regression models.
Results—During an 11.7 years follow-up, 3097 incident cases of stroke, including 2482 cerebral infarctions and 450 intracerebral hemorrhages, were registered. The hazard ratios of total stroke and cerebral infarction for the highest compared with the lowest quintiles of heme iron intake were 1.16 (95% CI, 1.03–1.31; P trend=0.037) and 1.15 (95% CI, 1.00–1.31; P trend=0.089), respectively. The incidence rates of total stroke per 10 000 person-years were 72.6 in the lowest quintile and 84.4 in the highest. The association was confined to men with body mass index <25 kg="kg" m="m" sup="sup">2

A superb study and a highly relevant one...
The technology, infrastructure and the medical services have decreased the fatality in stroke. while this does lead to independence for ADL and professional activities also in some cases, many stay dependent, putting a burden on the family and the society.
What we have to do is not just to improve the post-event medical facilities, but to improve the pre-event medical system so that stroke does not happen. That would be our true victory....and sadly no business for me, an interventional neuroradiologist.

Remarkable Decline in Ischemic Stroke Mortality Is not Matched by Changes in Incidence [Original Contributions]:
Background and Purpose—
In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Age–sex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium.
Methods—
Data for all IS deaths (1980–2010) in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age–sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann–Kendall tests were used for trend evaluation.
Results—
IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age–sex groups. A remarkable decline in IS mortality after 2000 was observed in all age–sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age–sex groups. In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly.
Conclusions—
The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance.

A very interesting article.....I have thought of doing IAT for such 'distal  MCA' occlusions often but somehow always found noninvasive management better -either IVT  or medical management as indicated...
The problem for me is the smaller infarct volume and relatively preserved clinical status of such patients, at least in my practice, and the complication rate associated with the IAT.
But of course 50+ % success rate is reasonably good....but in our center we have fairly good clinical  outcomes in such patient with IVT...
I am still not impressed in spite of this article...

Is Intra-Arterial Thrombolysis Beneficial for M2 Occlusions? Subgroup Analysis of the PROACT-II Trial [Brief Report]:
Rahme, R et al, Stroke ASAP Dec 2012
Background and Purpose—
The role of endovascular therapy for acute M2 trunk occlusions is debatable. Through a subgroup analysis of Prolyse in Acute Cerebral Thromboembolism-II, we compared outcomes of M2 occlusions in treatment and control arms.
Methods—
Solitary M2 occlusions were identified from the Prolyse in Acute Cerebral Thromboembolism-II database. Primary endpoints were successful angiographic reperfusion (TICI 2–3) at 120 minutes and functional independence (mRS 0–2) at 90 days.
Results—
Forty-four patients with solitary M2 occlusions, 30 in the treatment arm and 14 in the control arm, were identified. Successful reperfusion (TICI 2–3) was achieved in 53.6% and 16.7% of patients in the treatment and control arms, respectively (P=0.04). A favorable clinical outcome (mRS 0–2) was observed in 53.3% and 28.6%, respectively (P=0.19). Baseline characteristics were similar between the 2 groups.
Conclusions—
Intra-arterial thrombolysis may lead to a 3-fold increase in the rate of early reperfusion of solitary M2 occlusions and could potentially double the chance of a favorable functional outcome at 90 days.
Clinical Trial Registration—
This trial was not registered because enrollment began before July 1, 2005.

Aneurysm come in all shape and sizes and at all locations.

This one was in a 42 years old female patient with Grade I SAH and a ruptured right PcomA aneurysm.

The anatomy was odd with a bulbous, rather blister like proximal part, then a narrowing, then the body, again a narrowing then a teat like portion. The Pcom, of course, had to arise from the aneurysm; specifically it came at the site of first narrowing mentioned.

The aneurysm was directed laterally and posteriorly and had a curved structure rather.

The proximal bulbous portion measured 2.67 mm in diameter with equal neck and the distal narrower portions 2 mm.

So, I used an Echelon and Xpedion –ten system- to access the aneurysm.

Then i was in a fix as to how to go about fixing the aneurysm.

I put in a 2x6 3D AXIUM in the mid part of the aneurysm beyond the Pcom origin. The coil loops did try to go in the distal teat but somehow the entire coil could be fit in there.

Angio showed complete cessation of flow within that portion, with contrast stasis in the teat and the Pcom stayed patent.

However in the native images, still some space appeared within the coil mesh, so I took an AXIUM 2x4 Helix coil and pushed in.

The loops went into the first coil and then started to come into the proximal portion. Somehow, the loops in this part stayed horizontal thus restructuring the inflow zone and contrast flowing into the pcom.

But the last loop could not be fit in and kept pushing the microcatheter tip into the arterial lumen.

So I left the procedure at that point and put my hands up.

The patient is fine, and we all are happy, but do not know what this anueurysm was ot how best to treat it.

My surgeon too told he would have clipped in the midpart  so the result would have been same, or rather bad as this looked to me like an infundibulum which had ruptured and the distal portion to me was nothing but a pseudoaneurysm.

I am keeping my fingers crossed. let’s see….

Heparin dosing is associated with diffusion weighted imaging lesion load following aneurysm coiling: Background and purpose
Diffusion weighted imaging (DWI) may be used to evaluate post-coiling ischemia. Heparinization protocols for cerebral aneurysm coiling procedures differ among operators and centers, with little literature surrounding its effect on DWI lesions. The goal of this study was to determine which factors, including heparinization protocols, may affect DWI lesion load post-coiling.
Materials and methods
A review of 135 coiling procedures over 5 years at our centre was performed. Procedural data including length of procedure, number of coils used, stent or balloon assistance and operators were collected. Procedures were either assigned as using a bolus dose (>2000 U at any one time) or small aliquots of heparin (≤2000 U). Postprocedure DWI was reviewed and lesions were classified as small (< 5mm), medium (5–10 mm) or large (>10 mm). The cases were then classified into group 1 (≤5 small lesions) or group 2 (>5 small lesions or ≥1 medium or large lesion). Multivariate regression of the procedural variables for the two groups was calculated. A p value of <0.05 was considered significant.
Results
There were 78 procedures in group 1 and 57 procedures in group 2. Patients who received small aliquots (n=37) versus boluses of heparin (n=98) intraprocedurally had significantly greater frequency and size of DWI lesions (p=0.03). None of the other procedural variables was found to impact on lesion load.
Conclusions
More substantial DWI lesions were associated with small aliquots of heparin dosage compared with bolus doses. Heparin boluses should be preferentially administered during aneurysm coiling.