Advances in brain imaging are helping doctors identify additional stroke patients who can receive therapy later than previously believed, according to a new study that has led to new guidelines issued by the American Heart Association/American Stroke Association .
The guidelines will make it possible for more people to be eligible for a procedure called mechanical thrombectomy, in which doctors remove blood clots using a device threaded through a blood vessel. Additionally, the new guidelines suggest that more stroke patients can be considered for a clot-dissolving medication. These recommendations apply to acute ischemic stroke, the most common type of stroke triggered by a blood clot that reduces or stops blood flow to a part of the brain.
The research findings that led to the new guidelines challenges the long-held belief that doctors have just six hours to treat some ischemic strokes. In these cases, brain tissue is threatened from lack of blood flow when a major vessel to the brain is blocked. The new findings suggest doctors may have as long as 16 hours to treat the restricted vessel. A separate study published this month indicated the outer limit could be up to 24 hours.
The new guidelines indicate that some patients may now have “mechanical clot removal up to 24 hours after symptoms begin,” according to a news release by the American Heart Association. “This is going to make a huge, huge difference in stroke care,” said Dr. William J. Powers, guidelines writing group chair and chair of neurology at the University of North Carolina School of Medicine in Chapel Hill.
The results of the most recent and most prominent study were presented this week at the International Stroke Conference 2018 in Los Angeles and published Wednesday in the New England Journal of Medicine.  It “demonstrated that physically removing brain clots up to 16 hours after symptom onset in selected patients led to improved outcomes compared to standard medical therapy.” The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, or NIH.
“These striking results will have an immediate impact and save people from life-long disability or death,” said Walter Koroshetz, M.D., director of NINDS, in a NIH news release. “I really cannot overstate the size of this effect. The study shows that one out of three stroke patients who present with at-risk brain tissue on their scans improve and some may walk out of the hospital saved from what would otherwise have been a devastating brain injury.”
Strokes are the fifth-leading cause of death in the United States, according to the AHA/ASA. Stroke is also the second-leading cause of death in the world and a leading cause of adult disability. A stroke occurs in the U.S. about once every 40 seconds, killing about 133,000 Americans every year.
The NIH-funded study looked at 182 people in 38 medical centers who were stricken with blockages in brain arteries that cause 50 to 60 percent of deaths and the most severe types of disabilities. About half received typical care, involving blood pressure medication, blood thinners and other medical interventions. The other half had images taken and the clot-removal procedure, known as a “thrombectomy,” as well as the medications.
The results: 45 percent of the patients treated with the clot-removal procedure achieved functional independence, compared to 17 percent in the control group. In addition, thrombectomy was associated with improved survival. By analyzing MRI or CT scans, researchers identified patients thought to have salvageable tissue up to 16 hours after stroke onset.
“Although stroke is a medical emergency that should be treated as soon as possible, [this study] opens the door to treatment even for some patients who wake up with a stroke or arrive at the hospital many hours after their initial symptoms,” said Gregory W. Albers, M.D., professor of neurology and neurological sciences at Stanford University School of Medicine, in California, and director of the Stanford Stroke Center, in a NIH news release.
Addictive Effects of E-Cig Use Among Young Adults Concerning, Health Experts Report
Considered the most detailed review of the impact of e-cigarettes to date, a report by a national panel of public health experts has found “substantial evidence” that e-cigarette use, or “vaping,” among teens and young adults increases their likelihood of using conventional tobacco products, which contain more — and higher concentrations of — cancer-causing chemicals.
The new report  by the National Academies of Sciences, Engineering and Medicine, also said that e-cigarettes may be beneficial to adults who smoke traditional tobacco products and are vaping as a bridge toward quitting tobacco. But the benefits may be limited. Researchers said there is “limited evidence” derived from previous studies that “e-cigarettes with nicotine” are more effective than “e-cigarettes without nicotine” for quitting smoking altogether.
Millions of Americans use e-cigarettes, and vaping rates are generally higher among young adults and decrease with age. E-cigarettes represent a range of products containing a heating element that produces an aerosol from a liquid. While most e-cigarettes contain lower levels of toxic substances than traditional cigarettes, “their long-term health effects are not yet clear,” researchers said.
“In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle, in a news release. “In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”
The bottom line is that “more and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed,” the report’s authors say.
There is already conclusive evidence that most e-cigarettes contain and emit numerous potentially toxic substances, in addition to nicotine, the report said. It also notes that exposure to substances from e-cigarettes — under typical conditions of use — is significantly lower compared with conventional cigarettes.
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Caffeine’s Boost for Athletes Higher for Infrequent Drinkers
If you’re in overall good health, a moderate intake of caffeine can help reduce fatigue and drowsiness. It may also benefit runners and other amateur athletes with exercise performance, fueling improved endurance and strength.
But new research indicates that athletes may want to reduce their regular intake of coffee and energy drinks throughout the day. That’s because a daily caffeine habit could diminish caffeine’s performance-enhancing benefits when needed.
A study by sports scientists at Dublin City University (DCU) concluded the benefits of caffeine are more evident in athletes who do not drink caffeine-rich drinks, such as tea, coffee and energy drinks, on a daily basis. Researchers found that caffeinated gum given to the athletes provided little benefit to those who have become accustomed to caffeine. The athletes who had an infrequent habit of caffeine consumption kept their performance level high in repeated sprint tests after ingesting the caffeinated gum. Meanwhile, the performance of athletes who normally drink the caffeine equivalent of three or more cups of coffee per day worsened over the course of the sprint tests.
The findings of the DCU-led study were published in the International Journal of Sport Nutrition and Exercise Metabolism . Researchers recommend that athletes who consume caffeine on a regular basis should reduce their consumption of these drinks in the run-up to a big event — if they want to get the full benefits of a caffeine supplement.