Hypertensive heart disease: risk factors, complications and mechanisms
New Model Predicts Stroke Severity And Improves Functional Independence
A new predictive model developed by Ochsner Health helps clinicians make real-time decisions for patients who had a stroke undergoing urgent carotid intervention, improving chances of regaining functional independence.
A new predictive model developed by Ochsner Health helps clinicians make real-time decisions for patients who had a stroke undergoing urgent carotid intervention, improving chances of regaining functional independence.Image Credit: Chinnapong - stock.Adobe.Com
Functional independence following acute stroke can be predicted with high accuracy using a novel, data-driven model that incorporates factors like stroke severity and frailty, according to a study published in the Journal of the American College of Surgeons.1
Developed by Ochsner Health, the model uses a data-driven approach, offering real-time decision support. The tool combines 4 critical clinical metrics: stroke severity, frailty risk score, time to intervention, and thrombolysis use.
Stroke ranks second in worldwide mortality rates and fifth in US mortality. Stroke risk increases with age but can occur at any age.2 Stroke is the leading cause of serious long-term disability and can reduce mobility in over half of patients over 65.
Carotid artery disease causes up to 20% of ischemic strokes.1 Blood clots or other particles block brain blood vessels, and plaque buildup can also cause blockages.3
Early action is crucial to reduce stroke risk and prevent neurological decline.1 The ability to recognize signs and symptoms of stroke allows patients to react quickly, increasing their overall chances of survival.2 Signs of stroke onset include sudden numbness (especially on 1 side), confusion, speech problems, and vision impairment.4
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are popular interventions for acute carotid-related stroke.1 CEA surgically removes plaque from narrowed carotid arteries.5 CAS uses a catheter and stent to open clogged arteries and restore brain blood flow.
A retrospective cohort study analyzed data from 302 patients with prior strokes who underwent CEA and CAS at a Comprehensive Stroke Center (2015-2023).1 The primary outcome was functional independence (Modified Rankin Scale [mRS] score ≤ 2), and the secondary outcome was a composite of 30-day stroke, death, and myocardial infarction (MI).
The average time to intervention was 3 days overall (CEA, 3.8 days; CAS, 1.3). More than half of the patients (72.8%) were deemed functionally independent upon discharge. The cohort's mean age was 65.8 years, 37.4% were female, and 73.2% were White.
Cardiovascular comorbidities included hypertension (89.1%), hyperlipidemia (76.5%), tobacco use (67.5%), diabetes (34.1%), and coronary artery disease (26.5%). There were 26.2% of patients had a history of prior stroke before presenting with an index carotid-related cerebral ischemic event. Patients who were discharged as functionally dependent were often older and had experienced a higher number of stroke incidences (P = .071 and P = .190, respectively).
Procedural Characteristics and Clinical OutcomesDuring the study period, 70.9% of patients underwent CEA and 29.1% underwent CAS. Also, 76.6% of the CEA group and 63.6% of the CAS group were deemed functionally independent at discharge. Patients who underwent CAS with thrombolysis (CAS + thrombolysis or CAS + thrombolysis + thrombectomy) had the lowest rates of functional independence at discharge (CAS + thrombolysis, 38.5%; CAS + thrombolysis + thrombectomy, 57.1%). Rates of being deemed functionally independent at discharge increased among patients who underwent CAS alone (70%) or CAS with thrombectomy (71.4%).
The 30-day adverse event rate (stroke, MI, or death) was 8.3% overall: 6.5% after CEA and 12.5% after CAS. This difference may have been due to a higher proportion of severe stroke cases in the CAS group.
Frailty Risk and Stroke SeverityPatients who were deemed functionally independent had lower frailty risk (median score, 24.7; IQR, 14.3-35.3) than patients considered functionally dependent (median 37.2; IQR, 24.4-48.7). Frailty risk was categorized as low (7.9%), intermediate (50.3%), and high (41.7%).
Time to Intervention and Length of StayThe average time to intervention was 3 days (IQR, 1-4 days) in both cohorts, with 49.7% of the group receiving treatment within 48 hours (P = .173). Patients deemed functionally dependent had longer hospital stays (median, 10 days) than patients considered independent (median, 6 days).
Model PerformanceThe model correctly classified 93% of patients who are functionally independent, demonstrating strong predictive performance. The 30-day adverse event rate was higher in patients classified as functionally dependent (8.3% overall).
LimitationsThe study design limits generalizability, and future research should validate the model across multiple centers. Further investigation of key clinical variables is also warranted.
Integrating frailty assessments into the electronic medical record system highlights the model's practicality and potential for widespread adoption. The model personalizes treatment to improve acute stroke care outcomes by informing clinical decisions.
"Predicting a patient's recovery potential with such reliability gives us an unprecedented level of confidence in our treatment decisions," said Leo Seoane, MD, executive vice president and chief academic officer at Ochsner Health and founding dean for the Xavier Ochsner College of Medicine.6
References
Ask A Doctor: Carotid Artery Disease Can Increase Stroke Risk
Q: I'm worried about carotid artery disease — what symptoms should I watch for?
A: Carotid artery disease often develops silently but can present symptoms such as sudden weakness or numbness on one side of the body, temporary vision loss, dizziness or difficulty speaking. These signs may indicate a transient ischemic attack or an impending stroke, making early detection critical. While carotid artery disease significantly increases stroke risk, it doesn't guarantee a stroke, especially with proper management.
Prevention involves addressing modifiable risk factors: maintaining a healthy diet, staying active, avoiding tobacco, managing chronic conditions like diabetes and getting regular check-ups, particularly if you have a family history of vascular disease. Treatment often begins with lifestyle changes and medications to control cholesterol, blood pressure and blood clotting. Surgery or stenting is reserved for severe blockages or symptomatic cases.
When surgical intervention is needed, carotid endarterectomy involves removing plaque from the artery, while carotid stenting uses a small tube to keep the artery open. The choice depends on the severity of the blockage, overall health and risk of complications.
Dr. Chris LeSar is a board-certified vascular surgeon with Vascular Institute of Chattanooga and a member of the Chattanooga-Hamilton County Medical Society.
AVS Raises Financing To Support Pulse IVL System Launch In The United States
January 28, 2025—Amplitude Vascular Systems (AVS), developer of the Pulse intravascular lithotripsy (PIVL) platform for the treatment of severely calcified arterial disease, announced that it has completed a Series B round of financing of $36 million.
According to the company, the funding will support the United States peripheral commercial launch as well as the United States coronary and carotid investigational device exemption (IDE) trials for the PIVL system, which is an investigational device and not yet cleared for commercial distribution within or outside the United States.
AVS advised it began enrolling patients in October 2024 in the POWER PAD II United States IDE trial. POWER PAD II is a prospective, single-arm, multicenter study evaluating the technical and clinical success of the PIVL system for treating patients with calcific femoropopliteal arteries. The study will enroll up to 120 patients at 20 sites in the United States and enrollment is expected to be completed in the middle of 2025.
Chris Metzger, MD, who is an interventional cardiologist at OhioHealth Riverside Methodist Hospital in Columbus, Ohio, serves as National Principal Investigator of the POWER PAD II study.
"AVS is the second company to conduct a peripheral intravascular lithotripsy pivotal IDE trial in the United States," commented Dr. Metzger in the company's press release. "By introducing a new, innovative treatment for calcified arterial disease, we can make a dramatic impact on patient lives and improve outcomes."
The company stated that the funding will also support the company's coronary United States IDE study.
Steven Yakubov, MD, stated in the press release, "Because the Pulse IVL device uses a unique mechanism of action that eliminates the need for electrical emitters, the deliverability, crossability, and efficiency are optimized for very challenging and tortuous coronary cases." Dr. Yakubov is Medical Director of the OhioHealth Research Foundation in Columbus, Ohio, and a member of AVS' Physician Steering Committee.
Finally, the company stated that the funding will support the United States carotid IDE trial, as part of its partnership with the Jacobs Institute in Buffalo, New York, led by Adnan Siddiqui, MD. The partnership was announced in August 2024.
"We are looking forward to studying the Pulse IVL system in carotids to improve stroke care," stated Dr. Siddiqui in the press release. "We believe the differentiated efficiency of this device versus other IVL catheters will be an important solution for our carotid disease patients, where a shorter treatment time is of utmost importance."
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