A Hole in the Heart, Part II

This study looked at patients between 18 and 60 years of age who had a prior stroke or a transient ischemic attack within the prior 6 months. This was a resoundingly negative study.  At two years, the 12/447 patients in the closure group suffered a recurrent stroke, while 13/462 patients in the medical therapy suffered a recurrent stroke.  The trial, however, reveals one of the important chinks in the armor of the randomized control trial (RCT).  Randomized control trials are only as good as the patients they enroll.  Enroll the wrong patients, and the results don’t tell you much.  CLOSURE-1 didn’t provide closure because they included patients with transient ischemic attacks (TIAs). Transient ischemic attacks are no joking matter – they refer to a transient occlusion of a brain blood vessel that causes stroke like symptoms that only last a few minutes and cause no permanent damage. The problem with TIA’s is that they are incredibly subjective.  For instance, I recently saw a patient who presented with tingling over the left side of her face.  She had no other neurologic findings, but the neurology team noted that this may ‘possibly’ be a TIA.  A subsequent MRI showed no objective evidence of a stroke, but in the end no one can clearly say whether she actually suffered a cerebral ischemic event or  not. This represents a clinical challenge that I thankfully – as a cardiologist – want no part of.  I can say from my observations that neurologists do...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs