Incidence of stroke has risen steadily among marijuana users, show studies

WHAT: 11th World Stroke Congress brings together leading international stroke experts and an unparalleled scientific program covering epidemiology, prevention, acute care, rehabilitation and recovery in 100s of sessions and oral posters. Congress is attended by stroke professionals, researchers, policy makers, survivors and caregivers from around the world. #worldstroke2018

WHERE: Montreal, Canada, Palais des Congrès

WHEN: October 17 - 20, 2018

MEDIA OPPORTUNTIES: Stroke experts and people with lived experience of stroke will be available for interviews.

TODAY'S CONGRESS HIGHLIGHTS

Late-breaking trials

• A study of Nationwide Implementation of Mechanical Thrombectomy in Germany will be presented by Dr. Christian Weimar (8:35 am, Hall H). The study found that a wide range of both IVT and MT rates in German ischemic stroke patients indicates the need for further improvement of access to acute recanalization therapies in many, mainly rural, regions.
• Dr. David Gladstone of the University of Toronto and Sunnybrook Research Institute will present the results of a study evaluating the use of the drug rivaroxaban versus acetylsalicylic acid (ASA) to prevent strokes in patients with an enlarged left atrium of the heart. The results showed some potential benefit from rivaroxaban but caution was urged. "We are seeing a very intriguing signal here, and it has biological plausibility, but it is going to require independent validation before making any changes to practice recommendations," Dr. Gladstone said. (8:53 am, Hall H)

HOT TOPIC: Review of U.S. hospital statistics shows rise in stroke incidence among marijuana users from 2010-14 while overall stroke prevalence remained stable

A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

The study, presented today during the third day of the World Stroke Congress in Montreal, looked at U.S. hospital statistics from 2010 to 2014. It examined a total of 2.3 million hospitalizations among people who used marijuana recreationally. Of these, 32,231, or 1.4 percent, had a stroke including 19,452 with acute ischemic stroke (AIS).

Over the five years studied, the rate of stroke of all types among marijuana users increased from 1.3 percent to 1.5 percent. The rate of AIS increased from 0.7 percent to 0.9 percent. During the same five-year period, the prevalence of stroke among all patients was stable.

As result, the researchers conclude that these growing trends of stroke among marijuana users "warrant further prospective studies to evaluate the marijuana-stroke association amidst legalization of recreational use."

The researchers noted in introducing their study that marijuana "has a potential link to stroke owing to cerebrovascular effects of cannabinoids."

HOT TOPIC: Young stroke survivors at high long-term risk of adverse outcomes

A significant percentage of strokes - estimated from 8-21 per cent - affect adults under age 45. A Canadian study by senior author Dr. Richard Swartz and his team sought to determine what the future might hold for these young patients who show no early complications from their initial stroke.

This analysis of more than 26,000 young stroke survivors using data from the Institute for Clinical Evaluative Sciences (ICES) showed that, although absolute rates of adverse events including recurrent stroke, heart attack, death and institutionalization were low among young clinically stable stroke patients, these patients still showed 7 times the risk of having an adverse complication one year after their initial stroke compared to only twice the risk among older patients. After accounting for other vascular risk factors, long-term risks remained at almost 3 times that of young controls, even for these patients who were clinically stable and had no early complications during what is considered the high-risk period immediately after a stroke.

"This study shows us that even young stroke and TIA patients who are clinically stable after their stroke remain at a significant risk of adverse events, like another stroke, death or requiring long- term care," said lead study author Dr. Jodi Edwards of the Brain and Heart Nexus Research Program at the University of Ottawa Heart Institute. "This is important as it highlights the need for guidelines and strategies for long-term aggressive prevention to reduce stroke risk in young stroke patients."

HOT TOPIC: Three studies highlight changes in stroke care in Quebec

With the World Stroke Congress being held in Montreal it is appropriate that there are three presentations concerning the evaluation of different aspects of stroke care in the province of Quebec. The lead author is Dr. Laurie Lambert, Coordinator of the Cardiovascular Evaluation Unit of Quebec's Institut national d'excellence en santé et en services sociaux (INESSS).

The first presentation evaluates changes in processes and quality of care in Québec's comprehensive stroke centres following a province-wide field evaluation in 2013-14 and the development and implementation of a plan to promote best practices by the Ministry of Health. It found that times to initiating treatment improved, with the proportion treated with thrombolysis in less than 60 minutes increasing from 47 to 80 per cent and that more patients in these centres were admitted to a stroke unit: 91 per cent in 2016-17 compared to 75 per cent previously.

The second presentation compares care pathways in the four regional networks and the third compares treatment delays for thrombectomy between direct admission and inter-hospital transfer patients. For transferred patients, median first door-to-puncture time was 171 minutes (142-224). For patients directly admitted to a comprehensive stroke centre, the median first door-to-puncture was 69 minutes (50-100).

HOT TOPIC: Canadian researchers identify age and sex differences in stroke care

Two studies by Toronto researchers look at age and sex differences in stroke care in Canada. One study looking at data from 2003-16 concluded that in-hospital deaths from stroke decreased for all patients, but the group most at risk is older women.

The second study by the same researchers was presented on Oct. 18 and looked at data from 2014-16. It concluded younger adults are more likely to get alteplase clot-busting medication, access stroke units and be discharged home independently than older adults, and women of all ages are less likely to be discharged home independently.

HOT TOPICS: Other presentations of interest on the third day of the Congress:

• A Canadian study mapped stroke care facilities across Canada using geospatial software to evaluate access by distance and drive times. It concludes that most Canadians live within a 300-km drive to prevention services (95.5 per cent), endovascular therapy (79.1 per cent) and rehabilitation services (97.8 per cent); however due to Canada's geography, weather and resource challenges in more rural and remote communities, many of the eligible patients are not able to reach stroke hospitals in time to make a difference in their recovery and are left with lasting deficits from stroke

• SESSION 4 10:05-10:35

• A 30-minute platform discussion in the Exhibition Hall at 10:05 am brings together world experts to discuss how to put people living with stroke and non-communicable diseases (NCDs) at the centre of healthcare. If the NCD response is to be successful, it is imperative to leave no-one behind. Patients are by definition at the very centre of healthcare, and people living with and affected by stroke and NCDs will be essential to accelerate the realization of global NCD targets. People living with NCDs, their carers, and NCD survivors must be empowered to deal with the disease in the long term. Furthermore, they need to shape the NCD response and to give an effective response against stigma and discrimination faced by people living with stroke. This applies from the level of advocacy and policy development, through to design, implementation, and evaluation of programmes. Panelists include Dr. Mayowa Owolabi, Professor of Neurology, and Dean, Faculty of Clinical Sciences, University of Ibadan (Nigeria), Jon Barrick, President, Stroke Alliance for Europe (SAFE) (UK), Stephanie Mohl, Vice President, American Stroke Association (USA) and Jennifer Monaghan, stroke survivor, Living with Stroke program (Canada). For live updates, follow @ncdallliance and #enoughNCDs

• A discussion on chronic and end-of-life care for people with stroke and NCDs takes place in the Exhibition Hall at 12:40. NCDs are typically chronic conditions which require particular care towards the end of life. The WHO estimates that 40 million people are in need of palliative care each year - but that 86% do not receive it. The greatest gaps can be observed in developing country settings. Once implemented, it is imperative that end-of-life care services are holistic, extending far beyond physical treatment. The need for proper psychological and spiritual support for the person at the centre of the care, and for those around them, cannot be underestimated. Panelists include Dr. Pooja Khatri, Professor of Neurology, Director of Acute Stroke, UC Health (USA), Dr. Dylan Blacquiere, Neurologist, Saint John Regional Hospital (Canada), Dr. Gilian Mead, Professor of Stroke and Elderly Care Medicine, University of Edinburgh (UK), and Rita Melifonwu, Founder and CEO, Stroke Action Nigeria (Nigeria)

11th World Stroke Congress

The 11th World Stroke Congress, being held Oct. 17-20, 2018, at the Palais des Congrès in Montreal, Quebec, brings together leading international stroke experts and an unparalleled scientific program covering epidemiology, prevention, acute care and recovery in hundreds of sessions and oral posters. The Congress is attended by stroke professionals, researchers, policy makers and people with lived experience from around the world. This is the first time the biennial Congress has been held in North America in 12 years; the 2016 Congress was held in Hyderabad, India. This year's Congress is jointly organized by the World Stroke Organization (WSO) and the Canadian Stroke Consortium (CSC). Co-presidents are Dr. Werner Hacke, WSO President, and Dr. Mike Sharma, CSC Chair. WorldStrokeCongress.org/2018