The incidence of stroke is on the rise and now, increasingly happening in younger patients’. Here cardiologist Joshua S. Yamamoto, medical director at Foxhall Medicine in Washington, DC talks about the four major advancements regarding stroke that everyone should be aware of. The new stroke prevention paradigm is most meaningful because it adapts with advances in both diagnostic tech and therapeutics.
1 The implantable cardiac monitor (made by Abbott/St Jude), which is a paper-clip-sized micro-chip that continuously monitors your heart and remotely alerts your doctor about significant irregularities. “This is truly superior to the clunky wearable gear from the past,” says Dr. Yamamoto. As of 2019, it’s Medicare-approved for in-office insertion. No preparation necessary.
2 DOACs—Direct Oral Anti Coagulants; a new class of “stroke prevention medications” which are way ahead of the old meds, like Warfarin/Coumadin. The new meds are revolutionary. The key benefits of this include: superior at preventing strokes, lower bleeding complications, have a stable dose that doesn’t require lab tests or constant adjustments, starts immediately and stops or can be turned off quickly, and excellent absorption and efficacy with once-daily dosing.
3 High resolution ultrasound (like for carotid studies) are much better than old-school imaging and can show disease progression. “In other words,” says Yamamoto, “this tech will let you know not just when to start treatment, but whether the treatment you are on is working well enough (for you) – all non-invasively and without radiation.”
4 Functional testing; for example, an exercise echocardiogram is an improvement on standard stress testing. “It is never just a pass/fail prospect. It tells you how effective your current therapy is and enables you to make adjustments.
Dr. Yamamoto’s new book is You Can Prevent A Stroke (RosettaBooks, July 31, 2019).