The opposing teams

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CCCP
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CCCP

• Cardioembolic
• Carotid Stenosis
• Clot
• Pressure

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the starting lineup

• Hypertension
• Diabetes
• Smoking
• Atrial Fibrillation
• Carotid Disease
• Hyperlipidemia

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the second string

• Obesity
• Sedentary lifestyle
• Diet
• Sodium
• Alcohol

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Sudden Death Overtime

• Some players on the ice increase the likelihood
  that the game is already in Sudden Death
  Overtime.
• They need to be dealt with IMMEDIATELY

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Sudden Death Overtime

• Carotid
  imaging showing stenosis
• Get the surgical team
• to take out the opposing
• player before he can act

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Endarterectomy and timing of surgery.
Rothwell P, Eliasziw M, Gutnikov S, et al. The
Lancet 2004363915-924.
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For this
You need this
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The Coaches

• The Coaches help define the game plan
• what players to put on the ice
• what overall strategy to use

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The Coaching Staff
Carotid Doppler
TT or TE Echocardiogram
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Specialty team coaches
MRI
Coagulation studies
HOLTER MONITOR
MRA
CTA
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Sudden Death Overtime

• If the coaches detect A. fib on the ice

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Atrial Fibrillation
A different goalie is needed
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Generally to beat the opposition a strong defense
and a good goalie are needed

• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia

These guys work well as a team. The same group
of players is usually put up against them
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Generally to beat the opposition a strong defense
and a good goalie are needed

• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia

• Anti platelet
• Anti hypertensives
• Smoking cessation
• Statins
• Diet
• Low Sodium diet
• Low BMI
• Exercise
• Reduce excessive alcohol

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Second string

• Obesity
• Sedentary lifestyle
• Poor Diet
• Sodium
• Alcohol

• Low BMI
• Exercise
• Diet
• Low Sodium diet
• Reduce excessive alcohol

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EXPRESS

• EXisting PREvention Strategies for Stroke
• Compared Usual vs Enhanced Care after TIA or
  minor stroke
• Usual
• Enhanced
• Same day seen
• Start meds at first visit
• Oxfordshire (OXVASC) pop 91000

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EXPRESS

• Make clinical judgment if a true TIA or stroke
• ASA (or clopidogrel if ASA contraindicated)- both
  were given for 30 days if presentation within 48h
• Simvistatin
• Perindopril /- indapamide if systolic BPgt130
• anticoagulation if in atrial fibrillation

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EXPRESS

• ECG
• BP
• Carotid dopplers if indicated- obtained within
  about 7 days
• CT same day or shortly thereafter- antiplatelet
  drugs initiated before CT if all symptoms
  resolved

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EXPRESS

• Mean time to assessment fell from 3 days to less
  than 1.
• Median time to first prescription fell from 20
  days to 1 day
• 90 day stroke rate fell from 10.3 to 2.1

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Recurrent Strokes within 90 days of first event
Oxforshire 10 Strokes prevented per year Leeds
and Grenville 10 strokes prevented per
year Ontario gt1000 strokes prevented
per year
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CCCP