WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

Each chapter listed in the Table of Contents (see next page) is a hyperlink to that chapter. The reader clicks the chapter name to access that chapter.

Each chapter listed here is a hyperlink. Click on the chapter name to be taken to that chapter. 

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents …

Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00163-X.pdf

Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

/pdf/guidelines-for-the-prevention-of-stroke-in-patients-with-4s66xf1dte.pdf

Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

MRI in CFD for chronic type B aortic dissection: Ready for prime time?

To assess the safety and utility of tranexamic acid (TXA) as an adjunct salvage therapy in iatrogenic vessel perforation complicating endovascular clot retrieval. Iatrogenic vessel perforation and extravasation are known and potentially fatal complications of endovascular clot retrieval (ECR). Various methods of establishing haemostasis post perforation have been reported. TXA is widely utilised intraoperatively to reduce bleeding in various surgical specialities. The use of TXA in endovascular procedures has not been previously described in the literature.Retrospective case control study of all cases that underwent ECR. Cases where arterial rupture occurred were identified. Details of management and functional status at 3 months were recorded. Modified Rankin score (mRS) 0-2 was considered a good functional outcome. Comparison of proportions analysis was performed.Of 1378 cases of ECR, rupture complicated 36 (2.6%). TXA was administered in addition to standard care in 11 cases (31%). At 3 months, 4 of 11 cases (36%) where TXA was administered had a good functional outcome compared to 3 of 22 (12%) in the standard care group (P=0.09). Mortality at 3 months occurred in 4 of 11 cases (41.7%) where TXA was administered compared to 16 of 25 (64%) where it was not (P=0.13).Tranexamic acid administration in iatrogenic vessel rupture was associated with a lower mortality rate and a larger proportion of patients achieving a good functional outcome at 3 months. This effect trended towards but was not statistically significant. TXA administration was not associated with adverse effects. 

Tranexamic acid as a novel adjunct in the management of vessel perforation complicating Endovascular Clot Retrieval.

BACKGROUND: Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. METHODS: A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. RESULTS: From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). CONCLUSION: A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme.

Multidisciplinary approach to carotid stenting

Deep learning (DL) algorithms are playing an increasing role in automatic medical image analysis.To evaluate the performance of a DL model for the automatic detection of intracranial haemorrhage and its subtypes on non-contrast CT (NCCT) head studies and to compare the effects of various preprocessing and model design implementations.The DL algorithm was trained and externally validated on open-source, multi-centre retrospective data containing radiologist-annotated NCCT head studies. The training dataset was sourced from four research institutions across Canada, the USA and Brazil. The test dataset was sourced from a research centre in India. A convolutional neural network (CNN) was used, with its performance compared against similar models with additional implementations: (1) a recurrent neural network (RNN) attached to the CNN, (2) preprocessed CT image-windowed inputs and (3) preprocessed CT image-concatenated inputs. The area under the receiver operating characteristic curve (AUC-ROC) and microaveraged precision (mAP) score were used to evaluate and compare model performances.The training and test datasets contained 21,744 and 491 NCCT head studies, respectively, with 8,882 (40.8%) and 205 (41.8%) positive for intracranial haemorrhage. Implementation of preprocessing techniques and the CNN-RNN framework increased mAP from 0.77 to 0.93 and increased AUC-ROC [95% confidence intervals] from 0.854 [0.816-0.889] to 0.966 [0.951-0.980] (p-value = 3.91 × 10-12).The deep learning model accurately detected intracranial haemorrhage and improved in performance following specific implementation techniques, demonstrating clinical potential as a decision support tool and an automated system to improve radiologist workflow efficiency.• The deep learning model detected intracranial haemorrhages on computed tomography with high accuracy. • Image preprocessing, such as windowing, plays a large role in improving deep learning model performance. • Implementations which enable an analysis of interslice dependencies can improve deep learning model performance. • Visual saliency maps can facilitate explainable artificial intelligence systems. • Deep learning within a triage system may expedite earlier intracranial haemorrhage detection. 

/pdf/evaluation-of-techniques-to-improve-a-deep-learning-kh6pzd0b.pdf

Evaluation of techniques to improve a deep learning algorithm for the automatic detection of intracranial haemorrhage on CT head imaging

1Department of Cardiology, Royal Melbourne Hospital; 2Institute for Breathing and Sleep, Heidelberg; 3Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia Correspondence: Dr Liam Hannan, Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. Telephone 778-8361863, e-mail liam.hannan@austin.org.au In April 2011, a 57-year-old woman with a long smoking history presented with transient symptoms of left-hand incoordination and dysarthria. At the time of arrival to hospital, there had been complete resolution of neurological signs and symptoms. Computed tomography and subsequent magnetic resonance imaging of the brain demonstrated no evidence of cerebral infarction and no other intracranial pathology. A routine chest radiograph revealed right middle lobe collapse. Computed tomography of the chest demonstrated a large proximal obstructing mass within the right middle lobe in addition to multiple bilateral pulmonary nodules suggestive of an advanced primary bronchogenic carcinoma with pulmonary metastases. There appeared to be tumour extension into the lateral wall of the left atrium (Figures 1A and 1B). Standard bronchoscopy demonstrated an endobronchial tumour at the origin of the right middle lobe bronchus, and endobronchial biopsy and brush cytology confirmed an adenocarcinoma that was TTF-1 and cytokeratin positive, consistent with a primary lung malignancy. A transesophageal echocardiogram demonstrated tumour infiltration of the right lower pulmonary vein with extension into the left atrium (Figure 2). There was no evidence of vegetations on the aortic or mitral valves, effectively excluding the possibility of marantic endocarditis. No other alternative sources of emboli were identified to explain the transient ischemic attack. With the exception of atrial myxoma, embolic phenomena due to intracardiac tumours are uncommon. Previous case reports of intracardiac extension of primary lung tumours have generally described extension via the pulmonary vein, as was apparent in the present case (1). The patient was referred for palliative radiotherapy for the primary lesion in addition to systemic chemotherapy. imAges in RespiRAtoRy medicine

/pdf/an-unusual-cause-of-transient-ischemic-attack-3e4nmcmi1e.pdf

M. Brooks

Papers

MRI in CFD for chronic type B aortic dissection: Ready for prime time?

Tranexamic acid as a novel adjunct in the management of vessel perforation complicating Endovascular Clot Retrieval.

Multidisciplinary approach to carotid stenting

Evaluation of techniques to improve a deep learning algorithm for the automatic detection of intracranial haemorrhage on CT head imaging

An unusual cause of transient ischemic attack.