Nav: Home

RESPECT trial shows closing a small hole in heart may protect against recurrent stroke

September 13, 2017

A device used to close a small hole in the heart may benefit certain stroke patients by providing an extra layer of protection for those facing years of ongoing stroke risk, according to the results of a large clinical trial led by UCLA researchers.

"It is a major new treatment option for some people," said Dr. Jeffrey Saver, director of the UCLA Comprehensive Stroke Center and lead author of the study. However, he added, "Using the device is going to have to be a considered clinical decision between the doctor and the patient about who's the right person to get it."

The findings appear in the Sept. 14 New England Journal of Medicine.

Over eight years, the RESPECT study (Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment) enrolled 980 people, ages 18 to 60, at 69 locations in the United States and Canada. All of the participants had experienced a stroke, possibly caused by a condition known as patent foramen ovale, known as a PFO, which is a hole in the heart that did not close the way it should after birth. Nearly half of the people in the study had suffered a major stroke.

About 25 to 30 percent of people in the United States have a PFO, which typically causes no health problems and does not require treatment. However, this type of hole in the heart is the possible cause in about 10 percent of the 795,000 strokes that occur in the United States each year. Most strokes are caused by high blood pressure, narrowed arteries or a blood clot caused by an abnormal heart rhythm. When medical tests can't identify the cause, it's called a cryptogenic stroke. Patients with a cryptogenic stroke and a PFO may be at an increased risk of having a second stroke. The standard treatment for them would be to take an anti-clotting medication as a precaution.

For the RESPECT study, half the patients, by random assignment, received a closure device: two disks that clamp together to close the opening, inserted via a wire routed through a blood vessel in the person's leg. The other study participants received standard therapy with anti-clotting drugs.

After an average of 5.9 years of follow-up, researchers found that among adults with stroke of unknown origin, closing the PFO -- compared with standard therapy alone -- was associated with a 45 percent reduction in stroke recurrence. The actual number of recurrent strokes of undetermined cause was modest: 10 people in the closure group versus 23 in the medical-therapy group.

"People on medical therapy have fairly low risk, but people on the device have even lower risk," said Saver, who is also a professor of neurology in the David Geffen School of Medicine at UCLA. "It's a good option to have available."

In 2013, researchers published preliminary results from RESPECT when patients had been followed for an average of just more than two years. Those findings suggested a benefit, but were not definite, and the longer-term effects weren't known. This latest study, which includes data from nearly six years of follow-up, shows a more pronounced benefit, Saver noted.

One remaining concern is that the closure group had a slightly increased likelihood of a condition known as deep vein thrombosis, a type of blood clot that forms in a vein deep in the body, most often in the leg.

"An additional lesson from this study is that certain patients, those who have had a definite deep venous thrombosis in the past, may need lifelong strong anti-clotting medications, whether or not they receive the device," Saver said.

Saver said usage of the closure device may be appropriate for patients under age 60 who have a prior stroke, who have a hole in their heart, and who have no other apparent causes found for their prior stroke. Stronger anti-clotting medications would be an alternative for people with a known history of clots or deep vein thrombosis.

Other people, who may be facing multiple medical procedures that preclude them from regular use of anti-clotting medicines, might get more protection from a future stroke by using the closure device.

"There are patients for whom it is clearly the best thing to do," Saver said. "There are patients for whom it should probably be avoided, and patients for whom it's still a gray zone."
-end-
In addition to Saver, the study's other are Dr. John Carroll of the University of Colorado, Dr. David Thaler of Tufts University, Dr. Richard Smalling of the University of Texas Memorial Hermann Heart and Vascular Institute, Dr. Lee MacDonald of South Denver Cardiology, Dr. David Marks of the Medical College of Milwaukee and Dr. David Tirschwell of the University of Washington, on behalf of the investigators from all 69 centers.

Funding for the study was provided by St. Jude Medical, maker of the closure device.

University of California - Los Angeles

Related Stroke Articles:

Retraining the brain to see after stroke
A new study out today in Neurology, provides the first evidence that rigorous visual training restores rudimentary sight in patients who went partially blind after suffering a stroke, while patients who did not train continued to get progressively worse.
Catheter ablations reduce risks of stroke in heart patients with stroke history, study finds
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent, according to new research from the Intermountain Medical Center Heart Institute.
Imaging stroke risk in 4-D
A new MRI technique developed at Northwestern University detects blood flow velocity to identify who is most at risk for stroke, so they can be treated accordingly.
Biomarkers may help better predict who will have a stroke
People with high levels of four biomarkers in the blood may be more likely to develop a stroke than people with low levels of the biomarkers, according to a study published in the Aug.
Pre-stroke risk factors influence long-term future stroke, dementia risk
If you had heart disease risk factors, such as high blood pressure, before your first stoke, your risk of suffering subsequent strokes and dementia long after your initial stroke may be higher.
Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality
Blacks are four times more likely than their white counterparts to die from stroke at age 45.
Study shows area undamaged by stroke remains so, regardless of time stroke is left untreated
A study led by Achala Vagal, M.D., associate professor at the University of Cincinnati College of Medicine and a UC Health radiologist, looked at a group of untreated acute stroke patients and found that there was no evidence of time dependence on damage outcomes for the penumbra, or tissue that is at risk of progressing to dead tissue but is still salvageable if blood flow is returned in a stroke, but rather an association with collateral flow -- or rerouting of blood through clear vessels.
Immediate aspirin after mini-stroke substantially reduces risk of major stroke
Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events.
SAGE launches the European Stroke Journal with the European Stroke Organisation
SAGE, a world leading independent and academic publisher, is delighted to announce the launch of the European Stroke Journal, the flagship journal of the European Stroke Organisation.
The S-stroke or I-stroke?
The year 2016 is an Olympic year. Developments in high-performance swimwear for swimming continue to advance, along with other areas of scientific research.

Related Stroke Reading:

My Stroke of Insight: A Brain Scientist's Personal Journey
by Jill Bolte Taylor (Author)

The astonishing New York Times bestseller that chronicles how a brain scientist's own stroke led to enlightenment

On December 10, 1996, Jill Bolte Taylor, a thirty-seven- year-old Harvard-trained brain scientist experienced a massive stroke in the left hemisphere of her brain. As she observed her mind deteriorate to the point that she could not walk, talk, read, write, or recall any of her life-all within four hours-Taylor alternated between the euphoria of the intuitive and kinesthetic right brain, in which she felt a sense of complete well-being and peace, and the... View Details


Stronger After Stroke, Third Edition: Your Roadmap to Recovery
by Peter G Levine (Author)

Now in its third edition, Stronger After Stroke puts the power of recovery in the reader's hands by providing simple-to-follow instructions for reaching the highest possible level of recovery. The book’s neuroplastic recovery model stresses repetition of task-specific practice, proper scheduling of practice, setting goals, and measuring progress to achieve optimal results. Researcher Peter G. Levine breaks down the science and gives survivors evidence-based tools to retrain the brain and take charge of recovery.

In easy-to-read sections, Stronger After... View Details


Stronger After Stroke: Your Roadmap to Recovery, 2nd Edition
by Peter G. Levine (Author)

Stronger After Stroke puts the power of recovery in the reader's hands by providing simple-to-follow instructions for reaching the highest possible level of recovery. Basic concepts covered include repetition of task-specific practice, proper scheduling of practice, setting goals and measuring recovery.

Sections new to the second edition cover the latest research from neuroscience, treatments for recovering sensation as well as recovery strategies for the young stroke survivor. Also included is a breakdown of the phases of recovery and how these phases can provide structure... View Details


Healing the Broken Brain: Leading Experts Answer 100 Questions about Stroke Recovery
by Dr. Mike Dow (Author), David Dow (Author), Megan Sutton CCC-SLP (Contributor)

If you’re holding this book, it likely means you or someone you love has had a stroke. Dealing with the onslaught of information about stroke can be confusing and overwhelming. And if you happen to be a stroke survivor with newly impaired language skills, it can be especially hard to comprehend everything your doctors, nurses, and specialists are telling you.

This book consists of the top 100 questions that survivors and their families ask, with answers from the top physicians and therapists in the country. The questions start out basic but then get more specific to address... View Details


Stroke: Pathophysiology, Diagnosis, and Management, 6e
by James C. Grotta MD (Author), Gregory W Albers MD (Author), Joseph P Broderick MD (Author), Scott E Kasner MD MSCE FRCP (Author), Eng H. Lo PhD (Author), A David Mendelow MB BCh FRCS PhD (Author), Ralph L Sacco MD MS FAHA FAAN (Author), Lawrence KS Wong MD FRCP (Author)

Offered in print, online, and downloadable formats, this updated edition of Stroke: Pathophysiology, Diagnosis, and Management delivers convenient access to the latest research findings and management approaches for cerebrovascular disease. Picking up from where J. P. Mohr and colleagues left off, a new team of editors ― Drs. Grotta, Albers, Broderick, Kasner, Lo, Mendelow, Sacco, and Wong ― head the sixth edition of this classic text, which is authored by the world’s foremost stroke experts.

Comprehensive, expert clinical guidance... View Details


Puzzles for Stroke Patients
by Kalman Toth (Author)

BEST PUZZLE BOOK FOR STROKE REHAB! #1 Best Seller puzzle (14 challenging puzzle types with increasing difficulty) book for stroke patients to recover brain and memory functions. Customer: "Great gift for my mom!!!" Word, logic & math puzzles are recommended for patients by doctors, neurologists, speech & cognitive therapists to rebuild mental abilities in language, math & logic. Puzzles are essential for brain rehabilitation. Neurologist: “For stroke victims, I suggest word-guess puzzles because they can’t really do the New York Times Sunday magazine crossword puzzle.” Another... View Details


Living With Stroke: A Guide for Patients and Their Families
by Richard C. Senelick MD (Author)

The fifth edition of Living with Stroke updates this highly popular guide for patients and families. There are 800,000 strokes each year and this book provides survivors and families with the wide variety of information and resources in one location. It has received widespread praise from professionals and laymen for its clarity and readability. View Details


Stroke For Dummies
by John R. Marler (Author)

Features tons of advice for recovery and rehabilitation

Get the latest on the symptoms, diagnosis, and treatment of stroke

Have questions and concerns about strokes? This reassuring guide provides invaluable information for stroke victims and their loved ones, from what a stroke is and what it feels like to proven treatments and therapies. You'll see how to implement a plan for preventing stroke, treat the lingering effects of stroke, and maximize home caregiver effectiveness while minimizing fatigue.

Discover how to:

Understand what causes different... View Details


Stroke Certification Study Guide for Nurses: Q&A Review for Exam Success
by Kathy Morrison MSN RN CNRN SCRN (Author)

Now with a free mobile & web app with print purchase!

This sought-after companion to the author’s popular Fast Facts for Stroke Care Nursing is a must-have study guide for nurses seeking Stroke Certified Registered Nurse (SCRN®) status. It contains comprehensive information about the exam, answers to commonly asked questions, and savvy tips for maximizing your score, along with 300 practice questions and answers with rationales.

Designed to prepare nurses for the multiple-choice format of the certification exam, questions are arranged in chapters... View Details


Stroke and Brain Injury Unraveled: Prevention, Causes, Symptoms, Diagnosis, Treatment, Recovery and Rehabilitation of One of the Most Debilitating Maladies You Hope You Never Have in Your Lifetime
by Arun Thaploo (Author)

Stroke and brain injury can be the most traumatic experience in a person’s life. It not only changes the entire world for the patient but also takes a colossal toll on the patient’s family members. A major stroke can confine a person to bed, or even kill him or her due to its consequences. If the stroke is acute, and the individual is still alive, the person keeps thinking he or she might die anytime soon. The individual keeps brooding about things he or she had planned for the future that perhaps will not come to fruition anymore.

A person can lose his or her memory, voice,... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Attention Please
In an age of constant information and infinite distractions, how can we pay more attention to our ... attention? This hour, TED speakers explore the battle for our awareness during the digital age. Guests include sociologist Zeynep Tufekci, podcast host Manoush Zomorodi, neuroscientist Amishi Jha, designer Tristan Harris, and computer scientist Jaron Lanier.
Now Playing: Science for the People

#475 Mother Nature is Trying to Kill You (Rebroadcast)
This week, we're learning how deadly and delightful our planet and its ecosystem can be. We're joined by biologist Dan Riskin, co-host of Discovery Canada's Daily Planet, to talk about his book "Mother Nature Is Trying to Kill You: a Lively Tour Through the Dark Side of the Natural World." And we'll talk to astronomer and author Phil Plait about Science Getaways, his company that offers educational vacation experiences for science lovers.