The Impact of Physical Activity Before and After Stroke on Stroke Risk and Recovery: a Narrative Review
AbstractPurpose of the ReviewSummarising the evidence for pre- and post-stroke physical activity (PA) and exercise to reduce stroke risk, and improve recovery and brain health.Recent FindingsPre-stroke PA reduces the risk of stroke, and post-stroke PA and exercise reduce cardiovascular risk factors, which can moderate the risk of recurrent strokes. Pre-clinical evidence indicates that exercise enhances neuroplasticity. The results from clinical studies showed that exercise changes brain activity patterns in stroke survivors, which can be a signal neuroplasticity. The intensity of pre- and post-stroke PA and exercise is a key factor with higher intensities leading to greater benefits, including improvement in fitness. Having low fitness levels is an independent predictor for increased risk of stroke.SummaryHigher intensity leads to greater benefits; however, the optimum intensity of PA and exercise is yet unknown and needs to be further investigated. Strategies to decrease sedentary behaviour and improve fitness need to be considered.
The UR Medicine Mobile Stroke Unit (MSU) is now being dispatched to provide stroke care to patients throughout Monroe County. The MSU had been operating on a pilot basis in the City of Rochester since its launch in October 2018.
The optimal closure technique of the arteriotomy after carotid endarterectomy (CEA) has been the subject of extensive debate. A recent systematic review and meta-analysis compared outcomes after CEA with patch vs primary closure (N = 29 studies; 9 randomized controlled trials [RCTs] and 20 non-RCTs; n = 13,219 CEAs).1 Primary closure was associated with a higher 30-day stroke rate compared with patch closure when both RCTs and non-RCTs were pooled together (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-2.9) as wel l as when non-RCTs alone were considered (OR, 1.9; 95% CI, 1.1-3.3).
We read with interest the paper entitled “Knowledge gap of peripheral artery disease starts in medical school” from AlHamzah and colleagues.1 In their study of 72 graduating medical students, the authors found that students have a suboptimal knowledge of coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD). In view of the small number of students, readers may doubt the generality of these results. However, we would like to underscore that we found similar results in two studies in France using a national survey with three clinical cases: one about CAD, one about ischemic stroke, and one about PAD.
In this study, we report long-term stroke and death risk after CEA in a large integrated health care system.
The appropriate timing of carotid endarterectomy (CEA) in symptomatic carotid artery disease is still controversial. Despite guideline recommendations to perform CEA within 14 days, recent studies have favored delayed CEA to decrease the risk of postoperative stroke. The goal of this study was to evaluate the timing of CEA for symptomatic disease in the Medicare population and its effects on postoperative stroke rates.
Upper extremity and neck access is increasingly being used for complex endovascular aortic repairs. We sought to compare perioperative stroke and other complications of (1) arm/neck with femoral/iliac access (AN) vs femoral/iliac access alone (FI), (2) right- vs left-sided AN, and (3) arm vs neck access sites.
Review of the Nationwide Inpatient Sample between 2005 and 2015.
Whether recent stroke mandates shunting during carotid endarterectomy (CEA) is controversial. Our goal was to determine associations of various shunting practices with perioperative outcomes of CEAs performed after acute stroke.
Carotid endarterectomy (CEA) has historically demonstrated a higher risk of perioperative adverse events for women. However, recent evidence suggests similar outcomes for CEA between the sexes. In contrast, few studies have specifically examined sex in carotid artery stenting (CAS). Using contemporary data from the National Surgical Quality Improvement Program, we hypothesize that female patients who undergo CEA or CAS will exhibit higher postoperative complications.
The aim of this study was to determine the subsequent risk of stroke after a diagnosis of retinal artery occlusion (RAO). We hypothesized that the risk would be low and comparable to that of the general population. RAO is relatively rare and often incorrectly diagnosed. We believe our institution is in a unique position to investigate this relationship with both a high-volume eye center and vascular laboratory.