Abstract Details

Title Controversies in Secondary Stroke Prevention: Results of a Survey Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) (-)

Poster/Presentation
Number 006

Objective

Background Due to the heterogeneous nature of etiologies for ischemic stroke, the recommended secondary stroke prevention also differs based on the identified cause. Controversy exists regarding the best secondary stroke prevention for some of the underlying causes.

Design/Methods An on-line survey questionnaire was prepared consisting of six demographic questions and six stroke-related scenarios. The demographic questions pertained to geographical location, fellowship training, experience, and practice setting. The clinical scenario questions asked for the preferred secondary stroke treatment for following situations: simple 5 mm aortic arch atherosclerotic plaque; complex 5 mm aortic arch atherosclerotic plaque with mobile component; LVEF of 30%; LVEF of 5-10%; presence of Factor V Leiden mutation but no PFO; and presence of Factor V Leiden mutation and a PFO. The survey was emailed to 4439 AAN members and neurologists with recent stroke-related publications. Incomplete responses or responses from non-neurologists were excluded.

Results A total of 244 completed responses from neurologists were analyzed. The most preferred and second most preferred medications are as follows: simple aortic plaque: single antiplatelet therpay preferred by 88%, dual antiplatelet by 9%; complex aortic plaque: anti-coagulation by 43%, single antiplatelet by 37%; LVEF 30%: single antiplatelet by 79%, anti-coagulation by 18%; LVEF 5-10%: anti-coagulation by 63%, single antiplatelet by 32%; factor V Leiden but no PFO: single antiplatelet by 60%, anti-coagulation by 35%; factor V Leiden and PFO: anti-coagulation by 63%, single antiplatelet by 33%.

Conclusions There are significant differences in opinion among neurologists regarding the preferred secondary stroke prevention for the above-mentioned clinical situations. These were not explained based on the geographical location, fellowship training, experience, or practice setting of the responders. Future clinical trials are clearly needed.

Authors/Disclosures
Ankur Garg, MD (Orlando Neurosurgery) PRESENTER	Dr. Garg has nothing to disclose.
Shiv Saidha, MD (Johns Hopkins)	Dr. Saidha has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ReWind Therapeutics. Dr. Saidha has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Saidha has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Saidha has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Pharmaceuticals. Dr. Saidha has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Saidha has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Saidha has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Saidha has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Multiple Sclerosis Journal ETC. Dr. Saidha has stock in June Brain. Dr. Saidha has stock in Lapix Therapeutics. The institution of Dr. Saidha has received research support from Biogen. The institution of Dr. Saidha has received research support from Genentech. The institution of Dr. Saidha has received research support from Novartis. The institution of Dr. Saidha has received research support from Lapix Therapeutics. The institution of Dr. Saidha has received research support from Novartis.
Jiri Brabec, MD (Heywood Neurology)	No disclosure on file
John H. Barghols, MD (University of Oklahoma Health Science Center)	No disclosure on file
Scott Saucedo, MD (NH Stroke & Neuroscience Specialists)	No disclosure on file
Akram Shhadeh, MD, MBA (Advanced Neuroscience Innovation Institute)	No disclosure on file

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