URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500.

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Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months postrandomization are approximately 80% higher with endovascular treatment among patients with acute ischemic stroke.

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Background: An increased risk of stroke has been found in women with early or late menarche in a cohort in the United Kingdom. It is uncertain if there is a similar increase in risk of stroke in women who experience early or late menarche in the United States. Methods: Using data from the observational component of the Women’s Health Initiative (WHI) [WHI Observational Study (OS)], we analyzed the 93,676 women aged 50-79 years, who participated in the OS over a period of 12±1 years. We compared the outcome of ischemic stroke in participants of 5 strata of age of menarche (10 years or younger, 11-12 years, 13-14 years, 15-16 years, and 17 years or older), as recorded at the baseline visit. An ordinal regression analysis was run to determine if there was a change in the risk of stroke over these strata. Results: Of the 93, 676 participants, 6067 reached menarche at 10 years of age or younger, and 965 reached menarche at 17 years of age or older. A smaller proportion of participants who developed an outcome of stroke were 10 years old or younger at menarche as compared to those who never developed stroke (6.4% vs. 6.5% p=0.85). A greater proportion of participants who developed an outcome of stroke were 11-12 years of age at menarche as compared to those who did not develop an outcome of stroke (42.8% vs. 41.3% p <.122). In the ordinal regression, there was a stronger correlation between developing a stroke and being a participant in the categories of 11- 12 years and 13-14 years of age at menarche than in the younger or older age group, respectively (0.14 and 0.103 vs 0.94 and 0.02 p=0.45). Conclusion: There is no significant increase in stroke risk in senior women in the United States who have menarche at an early (≤10 years) or late (≥17 years) age.

Background: There has been debate in the role of exogenous testosterone as a risk factor for stroke. Hormone replacement therapy (HRT) is considered a risk factor for stroke. The risk of ischemic stroke may increase when using testosterone-containing HRT. Methods: Using data from the observational component of the Women’s Health Initiative (WHI) [WHI Observational Study (OS)], we analyzed the 93,676 women aged 50-79 years, who participated in the OS over a period of 12±1 years. We compared the outcome of stroke in participants with reported use of a combination of testosterone and estrogen, estrogen alone, progesterone alone, and a combination of estrogen and progesterone, as recorded at the baseline visit. A logistic regression analysis was run to determine the odds of developing stroke. Results: Of the 93, 676 participants, 1772 used a combination of testosterone and estrogen (Estratest) HRT, 11,282 used progesterone alone, 10,808 used a combination of estrogen and progesterone, and 31,673 used estrogen alone. A smaller proportion of participants who developed an outcome of stroke had used Estratest as compared to estrogen alone or a combination of estrogen and progesterone (1.9% vs. 96.3% p=0.62). In the logistic regression, participants who had used Estratest were 1.2 times as likely to develop stroke as users of other hormone replacement therapy (OR 1.2 95%CI (0.96-1.6)), while women who had used progesterone only were 0.87 times less likely to develop stroke than users of other hormone replacement therapy (OR 0.874 95%CI (0.77-0.99)). After adjusting for confounders, the risk of developing stroke increased in users of Estratest (OR 1.25 95%CI (0.96-1.6) p=0.04), and decreased in users of progesterone only (OR 0.873 95%CI (0.77-0.99) p=0.038). Conclusion: Use of testosterone-containing HRT slightly increased the risk of stroke in women when compared to progesterone alone HRT, although this was not found to be significant. Stroke risk with Estratest may be considered to be similar to estrogen only and combination of estrogen plus progesterone HRT. Future studies are required to investigate these correlations.

Background: Faster treatment with tPA may be achieved by optimizing prehospital triage with mobile stroke units (MSUs). The Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit (BEST-MSU) study is a prospective comparative effectiveness trial of outcomes in patients randomized to MSU or standard management (SM). Purpose: To evaluate the inter-rater agreement for tPA eligibility between a telemedicine vascular neurologist (TM-VN) and the onboard vascular neurologist (OB-VN) in acute stroke patients seen on the MSU. Methods: Cluster randomization of MSU and SM weeks started on August 18, 2014. On scene, both the TM-VN and OB-VN evaluated the patient and independently documented their tPA treatment decision, NIHSS and CT interpretation. Agreement was determined using Cohen’s kappa (K) statistic. TM related technical failures that impeded remote assessment were recorded. Results: The remote TM-VN evaluated 173 patients. In 4 (2%) cases the TM-VN was not able to make a decision about tPA because of technical difficulties ( 1 case due to TM camera failure and 3 cases due to poor connectivity). The TM-VN agreed with the OB-VN on 88% of evaluations, with a K of 0.73 representing substantial agreement. Baseline NIHSS correlation between the TM-VN and OB-VN was 0.88. Agreement about ICH on CTH was a near-perfect K of 0.97. Conclusions: We conclude from these results that remote VN assessment of stroke patients in the MSU via TM is clinically and technologically feasible, reliable and accurate. TM assessment of CTH and NIHSS was also comparable to the OB evaluation. These findings will allow either OB-VN or TM-VN assessment for the remainder of the study.