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Li L, Shi C, Dong F, Xu G, Lei M, Zhang F. Targeting pyroptosis to treat ischemic stroke: From molecular pathways to treatment strategy. Int Immunopharmacol 2024; 133:112168. [PMID: 38688133 DOI: 10.1016/j.intimp.2024.112168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
Ischemic stroke is the primary reason for human disability and death, but the available treatment options are limited. Hence, it is imperative to explore novel and efficient therapies. In recent years, pyroptosis (a pro-inflammatory cell death characterized by inflammation) has emerged as an important pathological mechanism in ischemic stroke that can cause cell death through plasma membrane rupture and release of inflammatory cytokines. Pyroptosis is closely associated with inflammation, which exacerbates the inflammatory response in ischemic stroke. The level of inflammasomes, GSDMD, Caspases, and inflammatory factors is increased after ischemic stroke, exacerbating brain injury by mediating pyroptosis. Hence, inhibition of pyroptosis can be a therapeutic strategy for ischemic stroke. In this review, we have summarized the relationship between pyroptosis and ischemic stroke, as well as a series of treatments to attenuate pyroptosis, intending to provide insights for new therapeutic targets on ischemic stroke.
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Affiliation(s)
- Lina Li
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Chonglin Shi
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Guangyu Xu
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Mingcheng Lei
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China.
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Privitera D, Geraneo A, Li Veli G, Parravicini G, Mazzone A, Rossini M, Sanfilippo M, Gubertini A, Airoldi C, Capsoni N, Busca E, Bassi E, Langer T, Dal Molin A. Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03651-2. [PMID: 38805082 DOI: 10.1007/s11739-024-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata Rome, Rome, Italy.
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Greta Li Veli
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Parravicini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Sanfilippo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Gubertini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Busca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
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Lu WZ, Lin HA, Hou SK, Lin SF. ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke. Diagnostics (Basel) 2024; 14:1118. [PMID: 38893644 PMCID: PMC11172352 DOI: 10.3390/diagnostics14111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND the ABCD2 score is valuable for predicting early stroke recurrence after a transient ischemic attack (TIA), and Doppler ultrasound can aid in expediting stroke triage. The study aimed to investigate whether combining the ABCD2 score with carotid duplex results can enhance the identification of early acute ischemic stroke after TIA. METHODS we employed a retrospective cohort design for this study, enrolling patients diagnosed with TIA who were discharged from the emergency department (ED). The modified ABCD2-I (c50) score, which incorporates a Doppler ultrasound assessment of internal carotid artery stenosis > 50%, was used to evaluate the risk of acute ischemic stroke within 72 h. Patients were categorized into three risk groups: low risk (with ABCD2 and ABCD2-I scores = 0-4), moderate risk (ABCD2 score = 4-5 and ABCD2-I score = 5-7), and high risk (ABCD2 score = 6-7 and ABCD2-I score = 8-9). RESULTS between 1 January 2014, and 31 December 2019, 1124 patients with new neurological deficits were screened, with 151 TIA patients discharged from the ED and included in the analysis. Cox proportional hazards analysis showed that patients in the high-risk group, as per the ABCD2-I (c50) score, were significantly associated with revisiting the ED within 72 h due to acute ischemic stroke (HR: 3.12, 95% CI: 1.31-7.41, p = 0.0102), while the ABCD2 alone did not show significant association (HR: 1.12, 95% CI: 0.57-2.22, p = 0.7427). CONCLUSION ABCD2-I (c50) scores effectively predict early acute ischemic stroke presentations to the ED within 72 h after TIA.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei 23561, Taiwan;
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
- Center of Evidenced-Based Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
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Yildiz A, Demir R, Mustafaoglu R, Erkut U, Kesiktas FN. Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial. Top Stroke Rehabil 2024:1-13. [PMID: 38780025 DOI: 10.1080/10749357.2024.2356413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. OBJECTIVE To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke. METHODS A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. RESULTS Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025). CONCLUSIONS The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.
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Affiliation(s)
- Abdurrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Umit Erkut
- Department of Physiotherapy and Rehabilitation, Rumeli University, Istanbul, Türkiye
| | - Fatma Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
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Ojagbemi A, Bello T, Elugbadebo O, Alabi M, Owolabi M, Baiyewu O. Resilience in the first year of surviving a stroke in Nigeria. Aging Ment Health 2024:1-8. [PMID: 38779920 DOI: 10.1080/13607863.2024.2356873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life (QoL) across the first poststroke year in Nigeria. METHOD Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI). RESULTS Resilience improved across time points of measurement (p < 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= -4.2, 95% CI= -5.6, -2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime. CONCLUSION Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Toyin Bello
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olufisayo Elugbadebo
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Morufat Alabi
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Division of Neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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56
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Jiang F, Li J, Yu S, Miao J, Wang W, Xi X. Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects. Future Sci OA 2024; 10:FSO931. [PMID: 38817358 PMCID: PMC11137785 DOI: 10.2144/fsoa-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Acute ischemic stroke (AIS) is one of the most common strokes posing a grave threat to human life and health. Predicting the prognosis of AIS allows for an understanding of disease progress, and a better quality of life by making individualized treatment scheme. In this paper, we conducted a systematic search on PubMed, focusing on the relevant literature in the last 5 years. Summarizing the candidate prognostic biomarkers of AIS in body fluids such as blood, urine, saliva and cerebrospinal fluid is often of great significance for the management of acute ischemic stroke, which has the potential to facilitate early diagnosis, treatment, prevention and long-term outcome improvement.
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Affiliation(s)
- Fengmang Jiang
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Junhua Li
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Simin Yu
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Jinli Miao
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Wenmin Wang
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Xiaohong Xi
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
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57
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Colantoni A, Bucci T, Cocomello N, Angelico F, Ettorre E, Pastori D, Lip GYH, Del Ben M, Baratta F. Lipid-based insulin-resistance markers predict cardiovascular events in metabolic dysfunction associated steatotic liver disease. Cardiovasc Diabetol 2024; 23:175. [PMID: 38769519 PMCID: PMC11106932 DOI: 10.1186/s12933-024-02263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) is the cornerstone of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), pathophysiologically being the key link between MASLD, metabolic disorders, and cardiovascular (CV) diseases. There are no prospective studies comparing the predictive values of different markers of insulin resistance (IR) in identifying the presence of MASLD and the associated risk of cardiovascular events (CVEs). METHODS Post hoc analysis of the prospective Plinio Study, involving dysmetabolic patients evaluated for the presence of MASLD. The IR markers considered were Homeostatic Model Assessment for IR (HOMA-IR), Triglycerides-Glycemia (TyG) index, Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C), Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI). Receiver operative characteristic (ROC) analyses were performed to find the optimal cut-offs of each IR marker for detecting MASLD and predicting CVEs in MASLD patients. Logistic and Cox multivariable regression analyses were performed, after dichotomizing the IR markers based on the optimal cut-offs, to assess the factors independently associated with MASLD and the risk of CVEs. RESULTS The study included 772 patients (age 55.6 ± 12.1 years, 39.4% women), of whom 82.8% had MASLD. VAI (Area Under the Curve [AUC] 0.731), TyG Index (AUC 0.723), and TG/HDL-C ratio (AUC: 0.721) predicted MASLD but was greater with HOMA-IR (AUC: 0.792) and LAP (AUC: 0.787). After a median follow-up of 48.7 (25.4-75.8) months, 53 MASLD patients experienced CVEs (1.8%/year). TyG index (AUC: 0.630), LAP (AUC: 0.626), TG/HDL-C (AUC: 0.614), and VAI (AUC: 0.590) demonstrated comparable, modest predictive values in assessing the CVEs risk in MASLD patients. CONCLUSION In dysmetabolic patients HOMA-IR and LAP showed the best accuracy in detecting MASLD. The possible use of lipid-based IR markers in stratifying the CV risk in patients with MASLD needs further validation in larger cohorts.
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Affiliation(s)
- Alessandra Colantoni
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Nicholas Cocomello
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Angelico
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Evaristo Ettorre
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Maria Del Ben
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Baratta
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
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Lim XY, Gao NL, Lee WY, Neo JH, Tan AH, Sia CH, Sharma VK, Yeo LL, Lim Y, Lin CY, Ho JSY, Tan BY. Patent foramen ovale closure in ischemic stroke patients with and without thrombophilia: a systematic review and meta-analyses. J Thromb Thrombolysis 2024:10.1007/s11239-024-02990-3. [PMID: 38762709 DOI: 10.1007/s11239-024-02990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
Ischemic stroke patients with thrombophilia and patient foramen ovale (PFO) may have an increased risk of recurrent stroke and transient ischemic attack (TIA), and may benefit from PFO closure. However, screening for thrombophilia is not routinely performed and the impact of thrombophilia on prognosis after PFO closure is uncertain. We aim to compare the risk of recurrent stroke and TIA after PFO closure in patients with thrombophilia versus those without. We performed a systematic review and meta-analyses of the literature, with a comprehensive literature search performed on 12 January 2023. Studies comparing the outcomes of patients with and without thrombophilia after PFO closure were included. The primary outcome evaluated was a recurrence of acute cerebrovascular event (ACE), a composite of recurrent ischemic stroke and recurrent TIA. The secondary outcomes included recurrent ischemic stroke only or TIA only. A total of 8 cohort studies were included, with a total of 3514 patients. There was an increased risk of stroke/TIA in patients with thrombophilia compared to those without thrombophilia after PFO (OR: 1.42, 95% CI: 1.01-1.99, I2 = 50%). The association between risk of TIA only (OR: 1.36, 95% CI: 0.77-2.41, I2 = 0%) and stroke only (OR: 1.09, 95% CI: 0.54-2.21, I2 = 0%) with thrombophilia did not reach statistical significance. There is an increased risk of recurrent cerebral ischemia event in patients with thrombophilia compared to those without thrombophilia after PFO closure. Future large prospective studies are necessary to characterise the risk and benefits of PFO closure, as well as the appropriate medical treatment to reduce the risk of recurrent stroke and TIA in this high-risk population.
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Affiliation(s)
- Xue Yang Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Lx Gao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wynne Yu Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jia Hui Neo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alethea He Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yinghao Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chee Yen Lin
- Division of Hematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Jamie Sin Ying Ho
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Diel NJ, Gerner ST, Doeppner TR, Juenemann M, Maxhuni T, Frühwald T, Worm A, Alhaj Omar O, Lytvynchuk L, Struffert T, Bauer P, Huttner HB. Comparison of vascular risk profile and clinical outcomes among patients with central (branch) retinal artery occlusion versus amaurosis fugax. Neurol Res Pract 2024; 6:27. [PMID: 38750601 PMCID: PMC11097454 DOI: 10.1186/s42466-024-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF. METHODS Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT. RESULTS Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients. CONCLUSION The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes.
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Affiliation(s)
- Norma J Diel
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Stefan T Gerner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Toska Maxhuni
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Tobias Frühwald
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Andre Worm
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Omar Alhaj Omar
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | | | - Tobias Struffert
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Pascal Bauer
- Department of Internal Medicine I, Division of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
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Asowata OJ, Okekunle AP, Olaiya MT, Akinyemi J, Owolabi M, Akpa OM. Stroke risk prediction models: A systematic review and meta-analysis. J Neurol Sci 2024; 460:122997. [PMID: 38669758 DOI: 10.1016/j.jns.2024.122997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Prediction algorithms/models are viable methods for identifying individuals at high risk of stroke across diverse populations for timely intervention. However, evidence summarizing the performance of these models is limited. This study examined the performance and weaknesses of existing stroke risk-score-prediction models (SRSMs) and whether performance varied by population and region. METHODS PubMed, EMBASE, and Web of Science were searched for articles on SRSMs from the earliest records until February 2022. The Prediction Model Risk of Bias Assessment Tool was used to assess the quality of eligible articles. The performance of the SRSMs was assessed by meta-analyzing C-statistics (0 and 1) estimates from identified studies to determine the overall pooled C-statistics by fitting a linear restricted maximum likelihood in a random effect model. RESULTS Overall, 17 articles (cohort study = 15, nested case-control study = 2) comprising 739,134 stroke cases from 6,396,594 participants from diverse populations/regions (Asia; n = 8, United States; n = 3, and Europe and the United Kingdom; n = 6) were eligible for inclusion. The overall pooled c-statistics of SRSMs was 0.78 (95%CI: 0.75, 0.80; I2 = 99.9%), with most SRSMs developed using cohort studies; 0.78 (95%CI: 0.75, 0.80; I2 = 99.9%). The subgroup analyses by geographical region: Asia [0.81 (95%CI: 0.79, 0.83; I2 = 99.8%)], Europe and the United Kingdom [0.76 (95%CI: 0.69, 0.83; I2 = 99.9%)] and the United States only [0.75 (95%CI: 0.72, 0.78; I2 = 73.5%)] revealed relatively indifferent performances of SRSMs. CONCLUSION SRSM performance varied widely, and the pooled c-statistics of SRSMs suggested a fair predictive performance, with very few SRSMs validated in independent population group(s) from diverse world regions.
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Affiliation(s)
- Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, 200284, Nigeria; Research Institute of Human Ecology, Seoul National University, 08826, Republic of Korea.
| | - Muideen Tunbosun Olaiya
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Nigeria; Lebanese American University, 1102 2801 Beirut, Lebanon; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, 200284, Nigeria
| | - Onoja M Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284, Nigeria; Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, USA.
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Berger C, Hammer H, Costa M, Lowiec P, Yagensky A, Scutelnic A, Antonenko K, Biletska O, Karaszewski B, Sarikaya H, Zdrojewski T, Klymiuk A, Bassetti CLA, Yashchuk N, Chwojnicki K, Arnold M, Saner H, Heldner MR. Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe. Eur Stroke J 2024:23969873241245518. [PMID: 38745422 DOI: 10.1177/23969873241245518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke. PATIENTS AND METHODS In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/n = 293 (high-income), Gdansk/PL/n = 140 (high-income), and Lutsk/UA/n = 188 (lower-middle-income). RESULTS We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each p < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each p < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) (p < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted-p = 0.01/adjusted-p CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted-p < 0.001/adjusted-p CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted-p = 0.71/adjusted-p CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-p/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted-p < 0.001/adjusted-p CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted-p = 0.245/adjusted-p CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up. DISCUSSION AND CONCLUSION Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.
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Affiliation(s)
- Charlotte Berger
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marino Costa
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pawel Lowiec
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Andriy Yagensky
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Olga Biletska
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | | | - Hakan Sarikaya
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Tomasz Zdrojewski
- Department of Cardiovascular Prevention, Medical University of Gdansk, Gdansk, Poland
| | - Anastasiia Klymiuk
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Claudio LA Bassetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Natalia Yashchuk
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Kitchen NM, Dexheimer B, Yuk J, Maenza C, Ruelos PR, Kim T, Sainburg RL. The complementary dominance hypothesis: a model for remediating the 'good' hand in stroke survivors. J Physiol 2024. [PMID: 38733166 DOI: 10.1113/jp285561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The complementary dominance hypothesis is a novel model of motor lateralization substantiated by decades of research examining interlimb differences in the control of upper extremity movements in neurotypical adults and hemisphere-specific motor deficits in stroke survivors. In contrast to earlier ideas that attribute handedness to the specialization of one hemisphere, our model proposes complementary motor control specializations in each hemisphere. The dominant hemisphere mediates optimal control of limb dynamics as required for smooth and efficient movements, whereas the non-dominant hemisphere mediates impedance control, important for countering unexpected mechanical conditions and achieving steady-state limb positions. Importantly, this model proposes that each hemisphere contributes its specialization to both arms (though with greater influence from either arm's contralateral hemisphere) and thus predicts that lesions to one hemisphere should produce hemisphere-specific motor deficits in not only the contralesional arm, but also the ipsilesional arm of stroke survivors - a powerful prediction now supported by a growing body of evidence. Such ipsilesional arm motor deficits vary with contralesional arm impairment, and thus individuals with little to no functional use of the contralesional arm experience both the greatest impairments in the ipsilesional arm, as well as the greatest reliance on it to serve as the main or sole manipulator for activities of daily living. Accordingly, we have proposed and tested a novel intervention that reduces hemisphere-specific ipsilesional arm deficits and thereby improves functional independence in stroke survivors with severe contralesional impairment.
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Affiliation(s)
- Nick M Kitchen
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Brooke Dexheimer
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jisung Yuk
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Candice Maenza
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Paul R Ruelos
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Taewon Kim
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert L Sainburg
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
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Schneckenburger R, Boulanger M, Nehme A, Watrin M, Le Du G, Guettier S, Guittet L, Touzé E. Epidemiology of transient ischemic attack in the normandy stroke population-based study. Eur Stroke J 2024:23969873241251722. [PMID: 38711259 DOI: 10.1177/23969873241251722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Transient ischemic attack (TIA) is a frequent neurological emergency which management and definition have changed radically over the last 15 years. However, recent epidemiological studies of TIA are scarce. We report here on the impact of the shift from a time-based to a tissue-based definition of TIA on its incidence and risk of recurrence in a new population-based cohort with a high rate of patients investigated by MRI. MATERIALS AND METHODS We prospectively included all TIAs that occurred between May 2017 and May 2021 from the Normandy Stroke Study, a population-based registry using multiple overlapping sources for exhaustive case identification in Caen la Mer area. TIAs were classified as either time-based (symptoms <24 h) or tissue-based (<24 h and no lesion on brain imaging). Attack and incidence rates were calculated, as was the 90-day ischemic stroke rate. RESULTS Five hundred and sixty-seven TIAs (549 single patients) were included, with 80.6% having a brain MRI. Four hundred and ten (72.3%) met the definition of tissue-based TIA. The age standardized attack (to the 2013 European population) rate was 39.5 (95% CI 35.7-43.5) and the age-standardized incidence rate (first ever cerebrovascular event) was 29.7 (95% CI 27.3-34.2). The overall recurrent stroke rate at 90 days was 2.7%, with no difference between patients with or without ischemic lesions on MRI. CONCLUSION We found that the use of the tissue-based definition of TIA resulted in a 27.5% reduction in incidence as compared to the time-based definition, but had no impact on the 90-day stroke rate. The burden of TIA remains high, and is likely to increase as the population ages.
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Affiliation(s)
- Romain Schneckenburger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marion Boulanger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Ahmad Nehme
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marguerite Watrin
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Gwendoline Le Du
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Sophie Guettier
- Department of Neurology, CHU de Caen Normandie, Caen, France
| | - Lydia Guittet
- Université Caen Normandie, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Emmanuel Touzé
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
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Dong J, Ma Y, Chen Y, Guo J, Zhang T, Yang T, Zhang H, Yan F, Han L. Prevalence and influencing factors of patient delay in stroke patients: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:202. [PMID: 38700541 DOI: 10.1007/s10143-024-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Determine the prevalence and influencing factors of patient delay in stroke patients and explore variation in prevalence by country and delayed time. METHODS PubMed, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Weipu database, and Wanfang database were comprehensively searched for observational studies from inception to April, 2023. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata 16.0 software. RESULTS In total, 2721 articles were screened and data from 70 studies involving 85,468 subjects were used in meta-analysis. The pooled prevalence of patient delay in stroke patients was 59% (95% CI, 0.54-0.64). The estimates of pooled prevalence calculated for African, Asian, and European patient delay in stroke patients were 55% (0.29-0.81), 61% (0.56-0.66), and 49% (0.34-0.64).According to the patient delay time, the prevalence of 6 h, 5 h, 4.5 h, 3.5 h, 3 h and 2 h were 54% (0.47-0.61), 73% (0.61-0.86), 60% (0.49-0.71), 81% (0.68-0.93), 52% (0.42-0.62), 63% (0.19-1.07). Distance from the place of onset to the hospital > 10 km [OR=2.49, 95%CI (1.92, 3.24)], having medical insurance [OR = 0.45, 95%CI (0.26,0.80)], lack of stroke-related knowledge [OR = 1.56, 95%CI (1.08,2.26)], education level below junior high school [OR = 1.69, 95%CI (1.22,2.36)], non-emergency medical services (Non-EMS) [OR = 2.10, 95%CI (1.49,2.97)], living in rural areas [OR = 1.54, 95%CI (1.15,2.07)], disturbance of consciousness [OR = 0.60, 95%CI (0.39,0.93)], history of atrial fibrillation [OR = 0.53, 95%CI (0.47,0.59)], age ≥ 65 years [OR = 1.18, 95%CI (1.02,1.37)], National institutes of health stroke scale (NIHSS) ≤ 4 points [OR= 2.26, 95%CI (1.06,4.79)]were factors for patient delay in stroke patients. CONCLUSIONS The prevalence of patient delay in stroke patients is high, we should pay attention to the influencing factors of patient delay in stroke patients and provide a theoretical basis for shortening the treatment time of stroke patients.
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Affiliation(s)
- Jianhui Dong
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, 730000, China.
| | - Yanru Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Jiali Guo
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tong Zhang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tingting Yang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China
| | - Fanghong Yan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China.
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Gibello L, Antonello M, Civilini E, Pellenc Q, Bellosta R, Carbonari L, Bonardelli S, Freyrie A, Riambau V, Varetto G, Verzini F. Multicentre experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases. Eur J Cardiothorac Surg 2024; 65:ezae185. [PMID: 38733578 DOI: 10.1093/ejcts/ezae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The goal of this multicentre retrospective cohort study was to evaluate technical success and early and late outcomes of thoracic endovascular repair (TEVAR) with grafts deployed upside down through antegrade access, to treat thoracic aortic diseases. METHODS Antegrade TEVAR operations performed between January 2010 and December 2021 were collected and analysed. Both elective and urgent procedures were included. Exclusion criteria were endografts deployed in previous or concomitant surgical or endovascular repairs. RESULTS Fourteen patients were enrolled; 13 were males (94%) with a mean age of 71 years (interquartile range 62; 78). Five patients underwent urgent procedures (2 ruptured aortas and 3 symptomatic patients). Indications for treatment were 8 (57%) aneurysms/pseudoaneurysms, 3 (21%) dissections and 3 (21%) penetrating aortic ulcers. Technical success was achieved in all procedures. Early mortality occurred in 4 (28%) cases, all urgent procedures. Median follow-up was 13 months (interquartile range 1; 44). Late deaths occurred in 2 (20%) patients, both operated on in elective settings. The first died at 19 months of aortic-related reintervention; the second died at 34 months of a non-aortic-related cause. Two patients (14%) underwent aortic-related reinterventions for late type I endoleak. The survival rate of those having the elective procedures was 100%, 84% and 67% at 12, 24 and 36 months, respectively. Freedom from reintervention was 92%, 56% and 56% at 12, 24 and 36 months, respectively. CONCLUSIONS Antegrade TEVAR can seldom be considered an alternative when traditional retrograde approach is not feasible. Despite good technical success and few access-site complications, this study demonstrates high rates of late type I endoleak and aortic-related reinterventions.
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Affiliation(s)
- Lorenzo Gibello
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Antonello
- Section of Vascular and Endovascular Surgery, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Efrem Civilini
- Humanitas University Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Quentin Pellenc
- Department of Thoracic and Vascular Surgery, Marfan Syndrome National Referral Center, Bichat University Hospital, APHP, Paris, France
- Vascular and Endovascular Surgery Division, La Cote HealthCare Group, Morges, VD, Switzerland
| | - Raffaello Bellosta
- Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Stefano Bonardelli
- Vascular Surgery, Department of Surgery, Spedali Civili University Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vincent Riambau
- Department of Vascular Surgery, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gianfranco Varetto
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Jeong H, Lim H, Yoon C, Won J, Lee GY, de la Rosa E, Kirschke JS, Kim B, Kim N, Kim C. Robust Ensemble of Two Different Multimodal Approaches to Segment 3D Ischemic Stroke Segmentation Using Brain Tumor Representation Among Multiple Center Datasets. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01099-6. [PMID: 38693333 DOI: 10.1007/s10278-024-01099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
Ischemic stroke segmentation at an acute stage is vital in assessing the severity of patients' impairment and guiding therapeutic decision-making for reperfusion. Although many deep learning studies have shown attractive performance in medical segmentation, it is difficult to use these models trained on public data with private hospitals' datasets. Here, we demonstrate an ensemble model that employs two different multimodal approaches for generalization, a more effective way to perform on external datasets. First, after we jointly train a segmentation model on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) MR modalities, the model is inferred on the DWI images. Second, a channel-wise segmentation model is trained by concatenating the DWI and ADC images as input, and then is inferred using both MR modalities. Before training with ischemic stroke data, we utilized BraTS 2021, a public brain tumor dataset, for transfer learning. An extensive ablation study evaluates which strategy learns better representations for ischemic stroke segmentation. In our study, nnU-Net well-known for robustness is selected as our baseline model. Our proposed method is evaluated on three different datasets: the Asan Medical Center (AMC) I and II, and the 2022 Ischemic Stroke Lesion Segmentation (ISLES). Our experiments are widely validated over a large, multi-center, and multi-scanner dataset with a huge amount of 846 scans. Not only stroke lesion models can benefit from transfer learning using brain tumor data, but combining the MR modalities using different training schemes also highly improves segmentation performance. The method achieved a top-1 ranking in the ongoing ISLES'22 challenge and performed particularly well on lesion-wise metrics of interest to neuroradiologists, achieving a Dice coefficient of 78.69% and a lesion-wise F1 score of 82.46%. Also, the method was relatively robust on the AMC I (Dice, 60.35%; lesion-wise F1, 68.30%) and II (Dice; 74.12%; lesion-wise F1, 67.53%) datasets in different settings. The high segmentation accuracy of our proposed method could improve radiologists' ability to detect ischemic stroke lesions in MRI images. Our model weights and inference code are available on https://github.com/MDOpx/ISLES22-model-inference .
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Affiliation(s)
- Hyunsu Jeong
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Hyunseok Lim
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Chiho Yoon
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Jongjun Won
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Grace Yoojin Lee
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ezequiel de la Rosa
- icometrix, Leuven, Belgium
- Department of Informatics, Technical University of Munich, Neuroradiology Munich, Germany
| | - Jan S Kirschke
- Department of Informatics, Technical University of Munich, Neuroradiology Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechtsder Isar, Technical University of Munich, Munich, Germany
| | - Bumjoon Kim
- Department of Biomedical Engineering, Convergence Medicine, Radiology, Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Namkug Kim
- Department of Biomedical Engineering, Convergence Medicine, Radiology, Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Chulhong Kim
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea.
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Ironside N, Melmed K, Chen CJ, Dabhi N, Omran S, Park S, Agarwal S, Connolly ES, Claassen J, Hod EA, Roh D. ABO blood type and thromboembolic complications after intracerebral hemorrhage: An exploratory analysis. J Stroke Cerebrovasc Dis 2024; 33:107678. [PMID: 38479493 PMCID: PMC11097653 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND AND PURPOSE Non-O blood types are known to be associated with thromboembolic complications (TECs) in population-based studies. TECs are known drivers of morbidity and mortality in intracerebral hemorrhage (ICH) patients, yet the relationships of blood type on TECs in this patient population are unknown. We sought to explore the relationships between ABO blood type and TECs in ICH patients. METHODS Consecutive adult ICH patients enrolled into a prospective observational cohort study with available ABO blood type data were analyzed. Patients with cancer history, prior thromboembolism, and baseline laboratory evidence of coagulopathy were excluded. The primary exposure variable was blood type (non-O versus O). The primary outcome was composite TEC, defined as pulmonary embolism, deep venous thrombosis, ischemic stroke or myocardial infarction, during the hospital stay. Relationships between blood type, TECs and clinical outcomes were separately assessed using logistic regression models after adjusting for sex, ethnicity and ICH score. RESULTS Of 301 ICH patients included for analysis, 44% were non-O blood type. Non-O blood type was associated with higher admission GCS and lower ICH score on baseline comparisons. We identified TECs in 11.6% of our overall patient cohort. . Although TECs were identified in 9.9% of non-O blood type patients compared to 13.0% in O blood type patients, we did not identify a significant relationship of non-O blood type with TECs (adjusted OR=0.776, 95%CI: 0.348-1.733, p=0.537). The prevalence of specific TECs were also comparable in unadjusted and adjusted analyses between the two cohorts. In additional analyses, we identified that TECs were associated with poor 90-day mRS (adjusted OR=3.452, 95% CI: 1.001-11.903, p=0.050). We did not identify relationships between ABO blood type and poor 90-day mRS (adjusted OR=0.994, 95% CI:0.465-2.128, p=0.988). CONCLUSIONS We identified that TECs were associated with worse ICH outcomes. However, we did not identify relationships in ABO blood type and TECs. Further work is required to assess best diagnostic and prophylactic and treatment strategies for TECs to improve ICH outcomes.
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Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Kara Melmed
- Department of Neurology and Neurosurgery, New York University Grossman School of Medicine, New York, NY, United States
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Nisha Dabhi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Setareh Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Soojin Park
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - Sachin Agarwal
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - E Sander Connolly
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Jan Claassen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - David Roh
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States.
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Eltayib EM, Jirjees F, Suliman D, AlObaidi H, Ahmed M, Kharaba ZJ, Alfoteih Y, Barakat M, Khidhair Z, ALSalamat H, Mustafa N, Cherri S, El Khatib S, Hallit S, Malaeb D, Hosseini H. Stroke awareness and knowledge in Sudan: a cross-sectional analysis of public perceptions and understanding. Front Public Health 2024; 12:1362979. [PMID: 38774053 PMCID: PMC11107802 DOI: 10.3389/fpubh.2024.1362979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Stroke, a leading cause of morbidity and mortality globally, demands heightened awareness and knowledge for effective preventive strategies and tailored response. Sudan is classified as a low income country with a low rate of literacy, lack of knowledge, and awareness about diseases. Thus, this study aimed to assess stroke awareness and knowledge among Sudanese population, and identify the associated factors influencing awareness. Methods A cross-sectional study conducted between October and November 2022 through a self-administered online survey distributed via various social media platforms. The study involved adults aged 18 years and above through snow-ball sampling technique. The survey covered general awareness and knowledge concerning stroke risk factors, consequences, and the appropriate responses taken during acute stroke attacks. Results A total of 410 participants were enrolled in the study, majority (93.4%) were from urban area and had university degree (92.4%). Furthermore, 92.2% were aware about stroke and 74.9% were able to recognize the symptoms of stroke. Only 40.2% identified all correct answers, 96.3, 92.3, and 95.1% recognized at least one risk factor, early symptom, and consequences, respectively. Females were significantly more than males able to identify at least one risk factor. Almost all participants (99.5%) perceived stroke as a serious disease (99.5%). Notably, 86.3% would promptly transport a suspected stroke patient to the hospital. The multivariable analysis showed that females versus males and patients with depression versus without depression had significantly higher odds to identify at least one risk factor (OR of 14.716 [95% CI 1.901; 113.908] and 0.241 [95% CI 0.059; 0.984], respectively). Conclusion The study concluded that stroke knowledge and awareness among Sudanese population is suboptimal. Furthermore, early stroke recognition and intake of the appropriate management strategies are lacking which highlights the need for targeted education and awareness campaigns.
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Affiliation(s)
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Duaa Suliman
- Health Policy, Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
| | - Hala AlObaidi
- School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Munazza Ahmed
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Zelal J. Kharaba
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Yassen Alfoteih
- College of Dentistry and College of Humanities, City University College of Ajman, Ajman, United Arab Emirates
| | - Muna Barakat
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | | | - Husam ALSalamat
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Nazik Mustafa
- Department of Pharmacology, Faculty of Pharmacy, Al Neelain University, Khartoum, Sudan
| | - Sarah Cherri
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology, West Mishref, Kuwait
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Hassan Hosseini
- UPEC-University Paris-Est, Creteil, France
- RAMSAY SANTÉ, HPPE, Champigny-sur-Marne, France
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Chen HS, Cui Y, Wang XH, Ma YT, Han J, Duan YJ, Lu J, Shen LY, Liang Y, Wang WZ, Wang H, Zhao Y, Zhang JT, Song YL, He XM, Li RH, Tao DB, Li J, Huang SM, Wang N, Hong M, Meng C, Zhang W, Wang DL, Nguyen TN. Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial. JAMA Neurol 2024; 81:450-460. [PMID: 38466274 PMCID: PMC10928538 DOI: 10.1001/jamaneurol.2024.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Abstract
Importance Dual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking. Objective To evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Design, Setting, and Participants This was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome. Interventions Within 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio. Main Outcomes and Measures The primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified intention-to-treat population, which included all randomized participants with at least 1 efficacy evaluation regardless of treatment allocation. Bleeding events were safety end points. Results Of the 3000 randomized patients, 1942 (64.6%) were men, the mean (SD) age was 65.9 (10.6) years, median (IQR) NIHSS score at admission was 5 (4-6), and 1830 (61.0%) had a stroke of undetermined cause. A total of 2915 patients were included in the modified intention-to-treat analysis. Early neurologic deterioration occurred in 72 of 1502 (4.8%) in the dual antiplatelet therapy group vs 95 of 1413 (6.7%) in the aspirin alone group (risk difference -1.9%; 95% CI, -3.6 to -0.2; P = .03). Similar bleeding events were found between 2 groups. Conclusions and Relevance Among Chinese patients with acute mild to moderate ischemic stroke, clopidogrel plus aspirin was superior to aspirin alone with regard to reducing early neurologic deterioration at 7 days with similar safety profile. These findings indicate that dual antiplatelet therapy may be a superior choice to aspirin alone in treating patients with acute mild to moderate stroke. Trial Registration ClinicalTrials.gov Identifier: NCT02869009.
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Affiliation(s)
- Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu-Tong Ma
- Department of Neurology, Beipiao Central Hospital, Beipiao, China
| | - Jing Han
- Department of Neurology, Panjin Central Hospital, Panjin, China
| | - Ying-Jie Duan
- Department of Neurology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Jiang Lu
- Department of Neurology, Linghai Dalinghe Hospital, Jinzhou, China
| | - Li-Ying Shen
- Department of Neurology, Tieling County Central Hospital, Tieling, China
| | - Yong Liang
- Department of Neurology, Tieling Central Hospital, Tieling, China
| | - Wei-Zhong Wang
- Department of Neurology, Dandong Central Hospital, Dandong, China
| | - Hui Wang
- Department of Neurology, Chinese People’s Liberation Army 966 Hospital, Dandong, China
| | - Yong Zhao
- Department of Neurology, Haicheng Traditional Chinese Medicine Hospital, Haicheng, China
| | - Jin-Tao Zhang
- Department of Neurology, Chinese People’s Liberation Army 960 Hospital, Taian, China
| | - Yu-Lin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Xiao-Mei He
- Department of Neurology, Chaoyang Central Hospital, Chaoyang, China
| | - Run-Hui Li
- Department of Neurology, The Affiliated Central Hospital of Shenyang Medical College, Shenyang, China
| | - Ding-Bo Tao
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Neurology, Donggang Central Hospital, Donggang, China
| | - Shu-Man Huang
- Department of Neurology, Dawa District People’s Hospital, Panjin, China
| | - Ni Wang
- Department of Neurology, Wafangdian Central Hospital, Wafangdian, China
| | - Mei Hong
- Department of Neurology, China Railway 19th Bureau Group Central Hospital, Liaoyang, China
| | - Chong Meng
- Department of Neurology, Liaoyang County Central Hospital, Liaoyang, China
| | - Wei Zhang
- Department of Neurology, Liaoning Electrical Power Central Hospital, Shenyang, China
| | - Duo-Lao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts
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Wang L, Guo T, Wang L, Yang W, Wang J, Nie J, Cui J, Jiang P, Li J, Zhang H. Improving radiomic modeling for the identification of symptomatic carotid atherosclerotic plaques using deep learning-based 3D super-resolution CT angiography. Heliyon 2024; 10:e29331. [PMID: 38644848 PMCID: PMC11033096 DOI: 10.1016/j.heliyon.2024.e29331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Rationale and objectives Radiomic models based on normal-resolution (NR) computed tomography angiography (CTA) images can fail to distinguish between symptomatic and asymptomatic carotid atherosclerotic plaques. This study aimed to explore the effectiveness of a deep learning-based three-dimensional super-resolution (SR) CTA radiomic model for improved identification of symptomatic carotid atherosclerotic plaques. Materials and methods A total of 193 patients with carotid atherosclerotic plaques were retrospectively enrolled and allocated into either a symptomatic (n = 123) or an asymptomatic (n = 70) groups. SR CTA images were derived from NR CTA images using deep learning-based three-dimensional SR technology. Handcrafted radiomic features were extracted from both the SR and NR CTA images and three risk models were developed based on manually measured quantitative CTA characteristics and NR and SR radiomic features. Model performances were assessed via receiver operating characteristic, calibration, and decision curve analyses. Results The SR model exhibited the optimal performance (area under the curve [AUC] 0.820, accuracy 0.802, sensitivity 0.854, F1 score 0.847) in the testing cohort, outperforming the other two models. The calibration curve analyses and Hosmer-Lemeshow test demonstrated that the SR model exhibited the best goodness of fit, and decision curve analysis revealed that SR model had the highest clinical value and potential patient benefits. Conclusions Deep learning-based three-dimensional SR technology could improve the CTA-based radiomic models in identifying symptomatic carotid plaques, potentially providing more accurate and valuable information to guide clinical decision-making to reduce the risk of ischemic stroke.
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Affiliation(s)
- Lingjie Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Tiedan Guo
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Li Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Wentao Yang
- Basic Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Jingying Wang
- Department of Endemic Disease Prevention and Control, Shanxi Province Disease Prevention and Control Center, Shanxi Province, 030001, China
| | - Jianlong Nie
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Jingjing Cui
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Pengbo Jiang
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Junlin Li
- Department of Imaging Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, China
| | - Hua Zhang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
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Didier R, Garnier L, Duloquin G, Meloux A, Sagnard A, Graber M, Dogon G, Benali K, Pommier T, Laurent G, Vergely C, Bejot Y, Guenancia C. Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study. Stroke Vasc Neurol 2024; 9:165-173. [PMID: 37429637 PMCID: PMC11103154 DOI: 10.1136/svn-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS). METHODS Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission. RESULTS A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029). CONCLUSION AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations. TRIAL REGISTRATION NUMBER NCT03570060.
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Affiliation(s)
| | - Lucie Garnier
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | | | - Mathilde Graber
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | - Karim Benali
- Cardiology, CHU Saint Etienne, Saint Etienne, France
| | - Thibaut Pommier
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | | | - Yannick Bejot
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Charles Guenancia
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
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French S, Arias J, Bolakale-Rufai I, Zahra S, Rubab Khakwani KZ, Bedrick EJ, Serrano GE, Beach TG, Reiman E, Weinkauf C. Serum detection of blood brain barrier injury in subjects with a history of stroke and transient ischemic attack. JVS Vasc Sci 2024; 5:100206. [PMID: 38873494 PMCID: PMC11170223 DOI: 10.1016/j.jvssci.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/13/2024] [Indexed: 06/15/2024] Open
Abstract
Objective Stroke and transient ischemic attack may have long-term negative effects on the blood-brain barrier (BBB) and promote endothelial inflammation, both of which could increase neurodegeneration and dementia risk beyond the cell death associated with the index event. Methods Serum from 88 postmortem subjects in the Arizona Study of Aging and Neurodegenerative Disorders were analyzed by sandwich ELISA for specific biomarkers to investigate the effects of cerebrovascular accidents (CVAs) on BBB integrity and endothelial activation. Statistical analyses were performed using the Mann-Whitney U Test, Spearman rank correlation, and linear/logistic regressions adjusted for potential confounders; a P-value < .05 was considered significant for all analyses. Results Serum PDGFRẞ, a putative biomarker of BBB injury, was significantly increased in subjects with vs without a history of CVA who had similar cardiovascular risk factors (P < .01). This difference was stable after adjusting for age, hypertension, and other potential confounders in regression analysis (odds ratio, 27.02; 95% confidence interval, 2.61-411.7; P < .01). In addition, PDGFRẞ was positively associated with VCAM-1, a biomarker of endothelial inflammation (ρ = 0.42; P < .01). Conclusions Our data suggest that patients with stroke or transient ischemic attack have lasting changes in the BBB. Still more, this demonstrates the utility of PDGFRẞ as a serum-based biomarker of BBB physiology, a potentially powerful tool in studying the role of the BBB in various neurodegenerative diseases and COVID infection sequelae. Clinical Relevance Our data demonstrate the utility of serum PDGFRẞ, a putative biomarker of BBB integrity in the setting of stroke and TIA (CVA). A serum biomarker of BBB integrity could be a useful tool to detect early BBB damage and allow prospective work to study how such damage affects long-term neurodegenerative risk. Since BBB disruption occurs early in ADRD development, it could be monitored to help better understand disease progression and involvement of vascular pathways in ADRD.
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Affiliation(s)
- Scott French
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | - Juan Arias
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Summan Zahra
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Edward J. Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, AZ
| | | | | | - Eric Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ
| | - Craig Weinkauf
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
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Lengyel B, Magyar-Stang R, Pál H, Debreczeni R, Sándor ÁD, Székely A, Gyürki D, Csippa B, István L, Kovács I, Sótonyi P, Mihály Z. Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis. J Clin Med 2024; 13:2487. [PMID: 38731014 PMCID: PMC11084304 DOI: 10.3390/jcm13092487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.
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Affiliation(s)
- Balázs Lengyel
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Hanga Pál
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Róbert Debreczeni
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Ágnes Dóra Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary; (Á.D.S.); (A.S.)
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary; (Á.D.S.); (A.S.)
| | - Dániel Gyürki
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary; (D.G.); (B.C.)
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary; (D.G.); (B.C.)
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary; (L.I.); (I.K.)
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary; (L.I.); (I.K.)
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Wróbel D, Wrona P, Homa T, Jakobschy K, Wrona G, Sawczyńska K, Giełczyński M, Popiela T, Słowik A, Turaj W. Sex Alters the Effect of Perfusion Deficits on Functional Outcome in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. Cerebrovasc Dis 2024:1-10. [PMID: 38631293 DOI: 10.1159/000538633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The discourse surrounding differences in cerebral hemodynamics and clinical outcomes among male and female patients treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains unresolved. We aimed to elucidate these differences by employing computed tomography perfusion (CTP) imaging before MT and examining the influence of perfusion deficits on the 90-day functional outcome. METHODS This single-center retrospective analysis involved patients with anterior circulation AIS treated with MT at the Comprehensive Stroke Center, University Hospital, Krakow, from January 2019 to July 2023. We compared male and female patients in terms of baseline characteristics, CTP deficits, hypoperfusion intensity ratio (HIR, defined as T10max/T6max), and complications. The endpoints included the 90-day excellent functional outcome, defined as modified Rankin Score <2, and the 90-day mortality rate. RESULTS We included 794 patients, of whom 408 were female (51.4%). Female patients had a smaller early infarct volume (median [interquartile range]: 7 mL [0-24.8] vs. 10 mL [0-33], p = 0.004), smaller penumbra volume (77.5 mL [46-117] vs. 99.5 mL [59.8-140], p < 0.001), lower HIR (0.34 [0.16-0.5] vs. 0.37 [0.2-9.53], p = 0.043) and were less likely to achieve an excellent functional outcome (55.6% vs. 66.1%, p = 0.003). For every 10 mL increase in early infarct volume, the odds for achieving an excellent outcome were lower in females (odds ratio [OR]: 0.82 [95% confidence interval: 0.73-0.92]) compared to males (OR: 0.96 [0.88-1.04]), whereas the risk of death was higher for females (OR: 1.25 [1.13-1.39] than for males (OR: 1.05 [0.98-1.14]). DISCUSSION Despite more favorable cerebral hemodynamic profile, female AIS patients have worse outcomes than their male counterparts. This effect seems to be independently mediated by the more pronounced impact of early infarct volume on the prognosis in female patients. These findings underscore the possible explanatory power arising from sex-specific interpretation of early infarct volume in clinical practice.
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Affiliation(s)
- Dominik Wróbel
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Klaudia Jakobschy
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | | | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Mateusz Giełczyński
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, University Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
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Rehman S, Nadeem A, Akram U, Sarwar A, Quraishi A, Siddiqui H, Malik MAJ, Nabi M, Ul Haq I, Cho A, Mazumdar I, Kim M, Chen K, Sepehri S, Wang R, Balar AB, Lakhani DA, Yedavalli VS. Molecular Mechanisms of Ischemic Stroke: A Review Integrating Clinical Imaging and Therapeutic Perspectives. Biomedicines 2024; 12:812. [PMID: 38672167 PMCID: PMC11048412 DOI: 10.3390/biomedicines12040812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Ischemic stroke poses a significant global health challenge, necessitating ongoing exploration of its pathophysiology and treatment strategies. This comprehensive review integrates various aspects of ischemic stroke research, emphasizing crucial mechanisms, therapeutic approaches, and the role of clinical imaging in disease management. It discusses the multifaceted role of Netrin-1, highlighting its potential in promoting neurovascular repair and mitigating post-stroke neurological decline. It also examines the impact of blood-brain barrier permeability on stroke outcomes and explores alternative therapeutic targets such as statins and sphingosine-1-phosphate signaling. Neurocardiology investigations underscore the contribution of cardiac factors to post-stroke mortality, emphasizing the importance of understanding the brain-heart axis for targeted interventions. Additionally, the review advocates for early reperfusion and neuroprotective agents to counter-time-dependent excitotoxicity and inflammation, aiming to preserve tissue viability. Advanced imaging techniques, including DWI, PI, and MR angiography, are discussed for their role in evaluating ischemic penumbra evolution and guiding therapeutic decisions. By integrating molecular insights with imaging modalities, this interdisciplinary approach enhances our understanding of ischemic stroke and offers promising avenues for future research and clinical interventions to improve patient outcomes.
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Affiliation(s)
- Sana Rehman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore 54700, Pakistan;
| | - Umar Akram
- Department of Medicine, Allama Iqbal Medical College, Lahore 54700, Pakistan;
| | - Abeer Sarwar
- Department of Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54000, Pakistan; (A.S.); (H.S.)
| | - Ammara Quraishi
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Hina Siddiqui
- Department of Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54000, Pakistan; (A.S.); (H.S.)
| | | | - Mehreen Nabi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Ihtisham Ul Haq
- Department of Medicine, Amna Inayat Medical College, Sheikhupura 54300, Pakistan;
| | - Andrew Cho
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Ishan Mazumdar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Minsoo Kim
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Kevin Chen
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Sadra Sepehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Richard Wang
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Aneri B. Balar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Dhairya A. Lakhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
| | - Vivek S. Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.N.); (A.C.); (I.M.); (M.K.); (K.C.); (S.S.); (R.W.); (A.B.B.); (D.A.L.); (V.S.Y.)
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77
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Mbalinda SN, Kaddumukasa M, Najjuma JN, Kaddumukasa M, Nakibuuka J, Burant CJ, Moore S, Blixen C, Katabira ET, Sajatovic M. Stroke Recurrence Rate and Risk Factors Among Stroke Survivors in Sub-Saharan Africa: A Systematic Review. Neuropsychiatr Dis Treat 2024; 20:783-791. [PMID: 38586306 PMCID: PMC10999215 DOI: 10.2147/ndt.s442507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Evidence supporting secondary stroke in sub-Saharan Africa is scarce. This study describes the incidence of stroke recurrence and associated risk factors in sub-Saharan Africa. Methods and Materials Scientific databases were systematically searched from January 2000 to December 2022 for population-based observational studies, case-control or cohort studies of recurrent stroke involving adults aged 18 years and above in sub-Saharan Africa (SSA). We assessed the quality of the eligible studies using the Critical Appraisal Skills Program (CASP) checklist for observational studies. Results Six studies met the inclusion criteria and were included in this study. Stroke recurrence rates in SSA ranged from 9.4% to 25%. Majority of the studies were conducted from Western Africa and showed that stroke recurrence rates are high within sub-Saharan Africa ranging from 2% to 25%. The known stroke risk factors such as hypertension, chronic alcohol consumption, etc., remained the leading causes of stroke recurrence. The studies reported a higher mortality rate ranging from 20.5 -23% among those with recurrent strokes compared to primary strokes. Conclusion This systematic review is an update and summary of the available literature on stroke recurrence within sub-Saharan Africa. Further studies are warranted to assess the outcomes and burden of stroke recurrence in SSA.
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Affiliation(s)
- Scovia Nalugo Mbalinda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Martin Kaddumukasa
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Mulago Hospital, Kampala, Uganda
| | - Jane Nakibuuka
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Mulago Hospital, Kampala, Uganda
| | - Christopher J Burant
- Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, 44106, USA
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Elly T Katabira
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
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78
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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79
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Prasad S, Jones EM, Gebreyohanns M, Kwon Y, Olson DM, Anderson JA, Savitz SI, Cruz-Flores S, Warach SJ, Rhodes CE, Goldberg MP, Ifejika NL. Multicenter exploration of tenecteplase transition factors: A quantitative analysis. J Stroke Cerebrovasc Dis 2024; 33:107592. [PMID: 38266690 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Tenecteplase (TNK) is gaining recognition as a novel therapy for acute ischemic stroke (AIS). Despite TNK offering a longer half-life, time and cost saving benefits and comparable treatment and safety profiles to Alteplase (ALT), the adoption of TNK as a treatment for AIS presents challenges for hospital systems. OBJECTIVE Identify barriers and facilitators of TNK implementation at acute care hospitals in Texas. METHODS This prospective survey used open-ended questions and Likert statements generated from content experts and informed by qualitative research. Stroke clinicians and nurses working at 40 different hospitals in Texas were surveyed using a virtual platform. RESULTS The 40 hospitals had a median of 34 (IQR 24.5-49) emergency department beds and 42.5 (IQR 23.5-64.5) inpatient stroke beds with 506.5 (IQR 350-797.5) annual stroke admissions. Fifty percent of the hospitals were Comprehensive Stroke Centers, and 18 (45 %) were solely using ALT for treatment of eligible AIS patients. Primary facilitators to TNK transition were team buy-in and a willingness of stroke physicians, nurses, and pharmacists to adopt TNK. Leading barriers were lack of clinical evidence supporting TNK safety profile inadequate evidence supporting TNK use and a lack of American Heart Association guidelines support for TNK administration in all AIS cases. CONCLUSION Understanding common barriers and facilitators to TNK adoption can assist acute care hospitals deciding to implement TNK as a treatment for AIS. These findings will be used to design a TNK adoption Toolkit, utilizing implementation science techniques, to address identified obstacles and to leverage facilitators.
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Affiliation(s)
- Sidarrth Prasad
- University of Texas Southwestern Medical Center, United States
| | - Erica M Jones
- University of Texas Southwestern Medical Center, United States
| | | | - Yoon Kwon
- University of Texas Southwestern Medical Center, United States
| | - DaiWai M Olson
- University of Texas Southwestern Medical Center, United States
| | | | - Sean I Savitz
- University of Texas Health Science Center at Houston, United States
| | | | - Steven J Warach
- Dell Medical School, The University of Texas at Austin, United States
| | - Charlotte E Rhodes
- The University of Texas Health Science Center at San Antonio, United States
| | - Mark P Goldberg
- The University of Texas Health Science Center at San Antonio, United States
| | - Nneka L Ifejika
- University of Texas Southwestern Medical Center, United States.
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80
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Yang F, Li X, Long J, Gao Q, Pan M, Wang J, Zhang Y. Therapeutic efficacy and pharmacological mechanism of Yindan Xinnaotong soft capsule on acute ischemic stroke: a meta-analysis and network pharmacology analysis. Metab Brain Dis 2024; 39:523-543. [PMID: 38157100 DOI: 10.1007/s11011-023-01337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
Yindan Xinnaotong soft capsule (YDXNT), a traditional Chinese medicine preparation, has shown a promising effect in the treatment of acute ischemic stroke (AIS). The goal of this study was to investigate the therapeutic effects and pharmacological mechanisms of YDXNT on AIS. Randomized controlled trials were searched and screened. Review Manager 5.4 was used for a meta-analysis. Active ingredients and targets of YDXNT were extracted from the Traditional Chinese Medicine Systems Pharmacology Database, Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine, and Encyclopaedia of Traditional Chinese Medicine. AIS-related targets were retrieved from GeneCards, OMIM, and DrugBank databases. We constructed PPI and ingredient-target networks, performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, and conducted molecular docking. The YDXNT group had a higher total effective rate and a higher Barthel Index score. YDXNT reduced the low-density lipoprotein cholesterol and the whole blood viscosity at high and shear rates. Our study identified 313 ingredients and 1196 common targets. The key ingredients were mainly quercetin, neocryptotanshinone II, miltionone I, neotanshinone C, and tanshiquinone B, and the key targets were mainly SRC, MAPK3, AKT1, MAPK1, and JUN. GO analysis showed that the core targets mainly involved in atherosclerosis and neural apoptosis. The core pathways were lipid and atherosclerosis, PI3K-Akt, MAPK, and other pathways. Key ingredients exhibited robust binding interactions with core targets. YDXNT could effectively improve the total effective rate, ability of daily life, blood lipids, and blood viscosity. Antiatherosclerotic and neuroprotective effects are the main pharmacological mechanisms.Registration number: CRD42023400127.
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Affiliation(s)
- Fangjie Yang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Xinmin Li
- School of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Junzi Long
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Qian Gao
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Mengyang Pan
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Jing Wang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Yasu Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China.
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81
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Bramucci A, Nerla R, Bianchini Massoni C, Giovannini D, Chester J, Freyrie A, Castriota F. Thirty-day outcomes of carotid endarterectomy versus carotid artery stenting in asymptomatic and symptomatic patients: a propensity score-matched analysis. EUROINTERVENTION 2024; 20:e445-e452. [PMID: 38562068 PMCID: PMC10979384 DOI: 10.4244/eij-d-23-00624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Technological and surgical approaches to carotid artery stenting (CAS) have evolved. Modern randomised controlled trials comparing CAS and carotid endarterectomy (CEA) are limited, and information about updated post-intervention outcomes are mostly from retrospective, small studies. AIMS This study aims to compare the 30-day outcomes of stroke, transient ischaemic attack (TIA), acute myocardial infarction (AMI) and death with propensity-matched groups of CEA and CAS in asymptomatic and symptomatic patients over a recent study period of new CAS technologies and approaches. METHODS A retrospective, observational, multicentre analysis was conducted including consecutive symptomatic and asymptomatic patients treated with either primary CEA or CAS for internal carotid artery stenosis, between 2015 and 2022. Patients were propensity score-matched based on comorbidities and assessed according to symptom status. Primary endpoints include composite ipsilateral stroke, TIA, AMI and death within 30 days. Secondary endpoints include technical success and length of hospital stay. RESULTS From a cohort of 1,110 patients, propensity matching produced 269 distinct treatment pairs (n=538). Most patients were asymptomatic (n=456, 85%). All 6 strokes were minor (CEA=2; CAS=4) and registered among asymptomatic patients. One AMI (CEA) and 1 patient death (CAS) were reported among symptomatic patients. Composite stroke/AMI/death were not significantly different between both types of symptom status and both revascularisation techniques (p=0.44 and p=1, respectively). Technical success was 100%. The length of hospital stay was significantly shorter in asymptomatic patients treated with CAS compared to those treated with CEA (p=0.05), but no difference was registered among symptomatic patients (p=0.32). CONCLUSIONS Propensity-matched analysis suggests that CAS has similar postprocedural outcomes for stroke, AMI and death at 30 days compared to CEA.
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Affiliation(s)
- Alberto Bramucci
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Roberto Nerla
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Davide Giovannini
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Johanna Chester
- Medical and Dental Department of Morphological Sciences related to Transplant, Research Unit, Surgical, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Montero-Almagro G, Bernal-Utrera C, Geribaldi-Doldán N, Nunez-Abades P, Castro C, Rodriguez-Blanco C. Influence of High-Intensity Interval Training on Neuroplasticity Markers in Post-Stroke Patients: Systematic Review. J Clin Med 2024; 13:1985. [PMID: 38610750 PMCID: PMC11012260 DOI: 10.3390/jcm13071985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Exercise has shown beneficial effects on neuronal neuroplasticity; therefore, we want to analyze the influence of high-intensity interval training (HIIT) on neuroplasticity markers in post-stroke patients. Methods: A systematic review of RCTs including studies with stroke participants was conducted using the following databases (PubMed, LILACS, ProQuest, PEDro, Web of Science). Searches lasted till (20/11/2023). Studies that used a HIIT protocol as the main treatment or as a coadjutant treatment whose outcomes were neural plasticity markers were used and compared with other exercise protocols, controls or other kinds of treatment. Studies that included other neurological illnesses, comorbidities that interfere with stroke or patients unable to complete a HIIT protocol were excluded. HIIT protocol, methods to assess intensity, neuroplasticity markers (plasmatic and neurophysiological) and other types of assessments such as cognitive scales were extracted to make a narrative synthesis. Jadad and PEDro scales were used to assess bias. Results: Eight articles were included, one included lacunar stroke (less than 3 weeks) and the rest had chronic stroke. The results found here indicate that HIIT facilitates neuronal recovery in response to an ischemic injury. This type of training increases the plasma concentrations of lactate, BDNF and VEGF, which are neurotrophic and growth factors involved in neuroplasticity. HIIT also positively regulates other neurophysiological measurements that are directly associated with a better outcome in motor learning tasks. Conclusions: We conclude that HIIT improves post-stroke recovery by increasing neuroplasticity markers. However, a limited number of studies have been found indicating that future studies are needed that assess this effect and include the analysis of the number of intervals and their duration in order to maximize this effect.
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Affiliation(s)
- Gines Montero-Almagro
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41013 Seville, Spain; (G.M.-A.); (C.R.-B.)
| | - Carlos Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41013 Seville, Spain; (G.M.-A.); (C.R.-B.)
- Institute for Biomedical Research and Innovation of Cadiz (INiBICA), 11009 Cadiz, Spain; (P.N.-A.); (C.C.)
| | - Noelia Geribaldi-Doldán
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cadiz, 11002 Cadiz, Spain;
| | - Pedro Nunez-Abades
- Institute for Biomedical Research and Innovation of Cadiz (INiBICA), 11009 Cadiz, Spain; (P.N.-A.); (C.C.)
- Department of Physiology, Faculty of Pharmacy, University of Seville, 41013 Seville, Spain
| | - Carmen Castro
- Institute for Biomedical Research and Innovation of Cadiz (INiBICA), 11009 Cadiz, Spain; (P.N.-A.); (C.C.)
- Department of Biomedicine, Biotechnology and Public Health, Area of Physiology, Faculty of Medicine, University of Cadiz, 11002 Cadiz, Spain
| | - Cleofas Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41013 Seville, Spain; (G.M.-A.); (C.R.-B.)
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Aarnio K, Martinez-Majander N, Haapaniemi E, Kokkola E, Broman J, Tulkki L, Kaste M, Tatlisumak T, Putaala J. Etiologic subtypes of first and recurrent ischemic stroke in young patients using A-S-C-O and TOAST classification criteria: A retrospective follow-up study. Eur Stroke J 2024:23969873241238508. [PMID: 38528455 DOI: 10.1177/23969873241238508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Scarce data exist on the etiology of recurrent ischemic strokes (ISs) among young adults. We analyzed the etiology of first-ever and recurrent events and the differences between them. PATIENTS AND METHODS Patients aged 15-49 years with a first-ever IS in 1994-2007 were included in the Helsinki Young Stroke Registry. In this retrospective cohort study, data on recurrent ISs were identified from Care Register for Health Care until the end of 2017 and Causes of Death Register and from patient records until the end of 2020. All first-ever and recurrent ISs were classified using Atherosclerosis-Small vessel disease-Cardioembolism-Other Cause (A-S-C-O) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. RESULTS A total of 970 patients were included (median age at index IS 46 years, interquartile range 43-48, 33% women), of which 155 (16.0%) patients had recurrent IS, with 8 (5.2%) fatal cases and 5 (3.2%) unverifiable cases. The median follow-up was 17.4 (IQR 13.9-21.7) years. Median time from the index event to the first recurrent event was 4.5 (interquartile range [IQR] 1.6-10.2) years. Recurrence was more often due to definite cardioembolism (10.7% vs 18.0%, p = 0.013), while the proportion of other definite A-S-C-O subgroups remained the same. With TOAST classification, the proportion of true cryptogenic ISs decreased (16.7% vs 6.7%, p = 0.003), while those with incomplete evaluation increased (9.3% vs 19.3%, p = 0.015). Other TOAST phenotypes remained the same. CONCLUSION The proportion of definite cardioembolism increased at recurrence using the A-S-C-O classification and the number of cryptogenic ISs decreased using the TOAST classification, while cases with incomplete evaluation increased. Most etiologies remained the same.
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Affiliation(s)
- Karoliina Aarnio
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Elena Haapaniemi
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva Kokkola
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jenna Broman
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Tulkki
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Kaste
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Sahlgrenska Academy, University of Gothenburg & Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Peng Q, Zhou Y, Wang C, Xie X, Dong L, Zhang Y, Zhang H, Wang J, Li L, Zhang P, Zhao Y, Wang Y, Xiao F, Luo B, Li W, Mu S. Effects of calcium channel blockers on perioperative ischemic events in hypertensive patients with intracranial aneurysms undergoing neurointervention. J Neurointerv Surg 2024:jnis-2024-021543. [PMID: 38527796 DOI: 10.1136/jnis-2024-021543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/16/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Although calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear. METHODS We retrospectively examined 458 hypertensive patients with intracranial aneurysms who underwent stent treatment, drawn from a larger multicenter cohort comprising 1326 patients across eight centers. Patients were dichotomized into two groups according to use of a CCB. Propensity score matching (PSM) was performed to balance group differences in patient and aneurysm characteristics. We conducted a comparison of patient and aneurysm characteristics, ischemic complications, and clinical outcomes between the two groups. RESULTS The CCB and non-CCB groups comprised 279 and 179 patients, respectively. PSM resulted in 165 matched pairs. After PSM, the incidence of ischemic events within 1 month of the procedure (4.2% vs 10.9%; P=0.022) and proportion of patients with modified Rankin Scale score >2 at last follow-up (1.5% vs 7.8%; P=0.013) were significantly lower in the CCB group. Among patients treated with combination therapy, inclusion of a CCB was associated with a lower incidence of ischemic events (1.5% vs 13.3%; P=0.345), but the difference was not statistically significant after correction. CONCLUSIONS CCB use in hypertensive patients undergoing endovascular stenting for treatment of intracranial aneurysms is associated with a lower incidence of ischemic events and a lower incidence of unfavorable neurological outcomes, especially when used in combination therapy.
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Affiliation(s)
- Qichen Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yangyang Zhou
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuanping Xie
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, Beijing, China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, Beijing, China
| | - Pinyuan Zhang
- Department of Neurosurgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuanli Zhao
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Beijing, Beijing, China
| | - Fushun Xiao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bin Luo
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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85
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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86
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Rilianto B, Kurniawan RG, Rajab NM, Prasetyo BT. Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning. Neuropsychiatr Dis Treat 2024; 20:621-630. [PMID: 38528854 PMCID: PMC10962920 DOI: 10.2147/ndt.s453629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
High rates of morbidity and mortality indicate that stroke is a major health concern. Unfortunately, the management of ischemic stroke is hindered by several obstacles, particularly in developing countries such as Indonesia, where the burden of morbidity and mortality remains high. In this literature review, we intend to conduct a thorough investigation and analysis of the obstacles to stroke thrombectomy in developing countries, with a focus on Indonesia. Even though numerous studies and recent advances in thrombectomy techniques have been developed, many centers around the world continue to struggle to implement them. The majority of these institutions are located in developing nations like Indonesia. It faces numerous obstacles, including a lack of public awareness, infrastructure, human resources, and financial difficulties. The absence of early education and large-scale campaigns contributes to the dearth of public awareness. Inadequate imaging facilities, prehospital and referral systems, as well as disparities in healthcare expenditure and accessibility, contribute to the absence of infrastructure. Inadequate numbers of neurointerventionists, neurologists, and neurosurgeons, as well as a disparate distribution of these professionals, contribute to human resource issues. Inadequate national insurance coverage, high import tariffs on medical devices, and the high cost of healthcare have a negative impact on the financial situation. We provide related strategies regarding the current situation in Indonesia based on the recent evidence and comparison with developed countries. Academic institutions, medical associations, and government agencies must collaborate to overcome these challenges.
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Affiliation(s)
- Beny Rilianto
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Ricky Gusanto Kurniawan
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Nurfadilah M Rajab
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Bambang Tri Prasetyo
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
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87
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Hou X, Zhang X. Enhancing the evaluation of acute ischemic stroke risk in individuals with non-valvular atrial fibrillation by including laboratory indicators. Sci Rep 2024; 14:6844. [PMID: 38514850 PMCID: PMC10958006 DOI: 10.1038/s41598-024-57497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/19/2024] [Indexed: 03/23/2024] Open
Abstract
To investigate the clinical significance of the CHA2DS2-VASc-60 score, lipoprotein (a) [Lp(a)], red blood cell distribution width (RDW), and their combined effect in patients with non-valvular atrial fibrillation (NVAF) who experience acute ischemic stroke (AIS). This retrospective analysis was conducted on the clinical data of hospitalized patients with NVAF at the Third Affiliated Hospital of Anhui Medical University between April 1, 2020, and April 1, 2023. Based on the diagnosis of acute ischemic stroke (AIS), the patients were divided into two groups: the AIS group (150 cases of NVAF patients with comorbid AIS) and the non-AIS group (163 cases of NVAF patients without AIS). We performed CHA2DS2-VASc-60 scoring for all patients and collected their laboratory indicators and echocardiographic indicators during hospitalization. The study comprised 313 individuals with NVAF in total. There is a statistically significant difference (P < 0.05) in the comparison of CHA2DS2-VASc-60 score (5.68 ± 1.12 vs. 3.67 ± 1.47), Lp(a) [23.98 (13.28, 42.22) vs. 14.32 (7.96, 21.91)] and RDW (13.67 ± 1.25 vs. 12.94 ± 0.76) between NVAF patients with and without concomitant AIS. The results of the Spearman correlation analysis demonstrate a positive association between Lp(a) and RDW levels and both the CHA2DS2-VASc score and the CHA2DS2-VASc-60 score in patients with NVAF. Multivariate logistic regression analysis revealed that CHA2DS2-VASc-60 score [OR = 6.549, 95% CI: 4.110-10.433, P < 0.05], Lp(a) [OR = 1.023, 95% CI: 1.005-1.041, P < 0.05], and RDW [OR = 1.644, 95% CI: 1.071-2.525, P < 0.05] were independent risk factors for AIS in patients with non-valvular atrial fibrillation (NVAF). The receiver operator characteristic (ROC) curves showed that the area under the curve of CHA2DS2-VASc-60 score, Lp(a), RDW, and CHA2DS2-VASc-60 score combined with Lp(a) and RDW predicted that NVAF patients with AIS were 0.881 [95% CI: 0.804-0.906], 0.685 [95% CI: 0.626-0.744], 0.695 [95% CI: 0.637-0.754], and 0.906 [95% CI: 0.845-0.921], respectively. The CHA2DS2-VASc-60 score, Lp(a), and RDW were significantly increased in NVAF patients with AIS, which were independent risk factors for NVAF patients with AIS. The combination of the three has a high predictive capacity for NVAF patients with AIS.
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Affiliation(s)
- Xin Hou
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, 230001, Anhui, China
| | - Xiaohong Zhang
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, 230001, Anhui, China.
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Wu Z, Tang X. Bioinformatics analysis and experimental validation revealed that Paeoniflorigenone effectively mitigates cerebral ischemic stroke by suppressing oxidative stress and inflammation. Sci Rep 2024; 14:5580. [PMID: 38448479 PMCID: PMC10918059 DOI: 10.1038/s41598-024-55041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Inflammation and oxidative stress are becoming more recognized as risk factors for ischemic stroke. Paeoniflorigenone (PA) has diverse pharmacological effects that include anti-inflammatory and antioxidant properties. However, the specific mechanisms by which PA affects cerebral ischemic stroke have not been studied. Our objective was to investigate the potential targets and mechanisms of PA in preventing cerebral ischemic stroke. We obtained the potential targets of PA from the SwissTargetPrediction, Super-PRED, and SEA Search Server databases. The GSE97537 dataset was utilized to identify gene targets related to ischemic stroke. The overlapping targets were imported into the STRING database to construct a protein-protein interaction network, and enrichment analyses were conducted using R software. Rats were pretreated with PA for three weeks before undergoing MCAO and reperfusion. H&E staining, ELISA, and qRT-PCR analyses were then performed to explore the potential mechanisms of PA. In the study, we identified 439 potential targets for PA and 1206 potential targets for ischemic stroke. Out of these, there were 71 common targets, which were found to be primarily associated with pathways related to oxidative stress and inflammation. The results from animal experiments showed that PA was able to improve nerve function and reduce inflammatory cytokines and oxidative stress in the MCAO-induced ischemic stroke model. Additionally, the expression of core genes in the MCAO + HPA group was significantly lower compared to the MCAO group. Our study revealed that the potential mechanisms by which PA prevents ischemic stroke involve oxidative stress and inflammation. These findings provide important theoretical guidance for the clinical use of PA in preventing and managing ischemic stroke.
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Affiliation(s)
- Zhiyan Wu
- Department of Preventive Treatment, Dongguan Humen Hosipital of Traditional Chinese Medicine, Building No.375, Jienan lu, Dongguan, 523900, Guangdong, China
| | - Xingrong Tang
- Department of Science and Education, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Building No.30, Huayuandong lu, Jiangmen, 529000, Guangdong, China.
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Bae NY, Rhee TM, Park CS, Choi YJ, Lee HJ, Choi HM, Park JB, Yoon YE, Kim YJ, Cho GY, Hwang IC, Kim HK. Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy. J Korean Med Sci 2024; 39:e80. [PMID: 38442721 PMCID: PMC10911940 DOI: 10.3346/jkms.2024.39.e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM. METHODS Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates. RESULTS Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased. CONCLUSION This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.
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Affiliation(s)
- Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - You-Jung Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Mi Choi
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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Yu AHK, Leung LY, Leung TWH, Abrigo JM, Cheung KH, Cheng CH, Graham CA. The TriAGe + score for vertigo or dizziness: A validation study in a university hospital emergency department in Hong Kong. Am J Emerg Med 2024; 77:39-45. [PMID: 38096638 DOI: 10.1016/j.ajem.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Patients with dizziness commonly present to Emergency Departments (ED) and 6% of these patients will be diagnosed with acute stroke. The TriAGe+ score comprises of eight clinical parameters and stratifies patients into four risk groups. The Japanese authors reported that the tool performed well, so our aim was to validate this diagnostic tool in our ED in Hong Kong. MATERIALS AND METHODS A single-center retrospective observational study was conducted in the ED of our university hospital in Hong Kong. The primary outcome was the diagnosis of an acute cerebrovascular event. Receiver operator characteristic (ROC) analysis was performed to determine the best cut-off score. Secondary outcomes included univariable and multivariable analyses of stroke predictors. RESULTS 455 patients aged 18 years or above with dizziness or vertigo at ED triage were recruited between 19 July and 30 September 2021. The overall prevalence of stroke was 11.9%. The median TriAGe+ score was 7 (IQR = 4-9). The AUC was 0.9. At a cut-off >5, sensitivity was 96.4% (95%CI: 87.3-99.5) and the negative likelihood ratio was 0.09 (95%CI: 0.02-0.3). At a cut-off >10, specificity was 99.8% (95%CI: 98.6-100.0), and the positive likelihood ratio was 237.6 (95%CI: 33.1-1704). On multivariable analyses, atrial fibrillation, blood pressure, gender, dizziness (not vertigo) and no history of dizziness, vertigo or labyrinth/vestibular disease were found to be positively associated with stroke outcomes significantly. CONCLUSION The TriAGe+ score is an efficient stroke prediction score for patients presenting to the ED with dizziness.
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Affiliation(s)
- Adrian Ho-Kun Yu
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Koon Ho Cheung
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Chi Hung Cheng
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Colin A Graham
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
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91
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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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92
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Xue X, Zhang L, Zhen J, Zeng X. Effects of evidence-based nursing in patients with stroke: A systematic review and meta-analysis. Nurse Educ Pract 2024; 76:103921. [PMID: 38395003 DOI: 10.1016/j.nepr.2024.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
AIM The aim of this study was to evaluate the efficacy of evidence-based nursing (EBN) in patients with confirmed stroke. BACKGROUND After acute hospital treatment, stroke patients often return home for rehabilitation. Stroke ward nursing, demonstrates improved disability-free survival rates. EBN as a new nursing paradigm, rooted in authentic scientific evidence, will transform traditional nursing models. The goal is to advance nursing science, enhance practices and optimize patient outcomes. DESIGN AND METHODS PubMed, Embase, Cochrane Library and Web of Science were comprehensively searched from the inception to July 2nd, 2023. 13015 patients with confirmed stroke were included, of which 3351 patients were in EBN group, 9664 patients were in the control group. Odd ratio (OR) and standardized mean difference (SMD) and the 95% confidence intervals (CIs) were calculated. RESULTS Twelve studies were included in this study. The risk of bias in included studies was assessed as low. The OR for cumulative death was 1.61 (95% CI: 0.68, 3.85; z = 1.08, P = 0.2811). The pooled SMD for SF-36 physical component scores was -0.06 (95% CI: -1.15, 0.04; z = -1.11, P = 0.2688). The SMD for SF-36 mental health scores was -0.01 (95% CI: -0.10, 0.09; z = -0.10, P = 0.9207). The SMD for WHOQOL-BREF mentality scores was -0.06 (95% CI: -0.21, 0.10; z = -0.71, P = 0.4754). The SMD for WHOQOL-BREF physiology scores was 1.13 (95% CI: -1.13, 3.39; z = 0.98, P = 0.3283). CONCLUSIONS EBN is effective in improving psychological status, physical functions and quality of life in patients with stroke in individual studies, efficacy of EBN was not observed in pooled analyses, more evidence-based information is needed to comprehensively assess the efficacy of EBN in stroke patients.
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Affiliation(s)
- Xiaolu Xue
- Department of Neurology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi 030024, China.
| | - Lifang Zhang
- Department of Nursing, Shanxi Coal Central Hospital, Taiyuan, Shanxi 030006, China
| | - Jiao Zhen
- Department of Neurology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Xiaoxia Zeng
- Department of Nursing, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi 030024, China
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93
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Wei L, Liu Y, Wang Y, Bian J, Song Z, Liu X, Wang S. The effects of Baduanjin on physical function, daily living activities and quality of life in patients with stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2024; 31:178-198. [PMID: 37555455 DOI: 10.1080/10749357.2023.2238433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Baduanjin is a traditional Chinese exercise that combines respiration and movement. The study is designed to evaluate the effects of Baduanjin on physical function, daily living activities, and quality of life in stroke patients. METHODS Eleven databases were searched from inception through 16 September 2022. The methodological quality evaluation of the studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. The quality evaluation of the evidence was graded with the Guideline Development Tool . RESULTS A total of 24 studies were included. Three indicators with moderate quality evidence, six indicators with low quality evidence, and one indicator with very low quality evidence. Meta-analysis results suggest that Baduanjin group is better than the control group in increasing Berg balance scale [MD = 7.99, 95%CI (4.99, 10.99), P < 0.00001], Fugl- Meyer balance scale [MD = 5.26, 95%CI (0.12, 10.40), P = 0.04]; Total Fugl-Meyer assessment scale [MD = 7.17, 95%CI (3.13, 11.2), P = 0.0005], Fugl-Meyer assessment lower extremity scale[MD = 3.05, 95%CI(0.95, 5.15), P = 0.004], Fugl-Meyer assessment upper extremity scale[MD = 4.60, 95%CI (1.64,7.56), P = 0.002]; walking function scale[SMD = 0.69, 95%CI (0.14, 1.23), P = 0.01]; trunk function scale[MD = 2.46, 95%CI (1.75,3.17), P < 0.00001]; Barthel index[MD = 9.43, 95%CI (6.20,12.65), P < 0.00001] and quality of life score[SMD = 1.85, 95%CI (1.46, 2.23), P < 0.00001]. Meanwhile, Baduanjin reduced Neurological deficit scores SMD = -1.41, 95%CI (-1.83, -0.98), P < 0.00001]). CONCLUSIONS Baduanjin is probably an effective rehabilitation method to improve balance, motor, trunk, neurological functions, daily living activities, and quality of life in stroke patients. However, the result of Baduanjin in improving walking function is unstable, and further high-quality randomized controlled trials are needed to confirm the results.
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Affiliation(s)
- Lirong Wei
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin Key Laboratory of Cancer Prevention and Treatment, Tianjin Medical Research Center for Malignant Tumors
| | - Yun Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanan Wang
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
| | - Jiping Bian
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhengyang Song
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
| | - Xiaofeng Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shen Wang
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
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94
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Li Q, Tian Y, Niu J, Guo E, Lu Y, Dang C, Feng L, Li L, Wang L. Identification of diagnostic signatures for ischemic stroke by machine learning algorithm. J Stroke Cerebrovasc Dis 2024; 33:107564. [PMID: 38215553 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/25/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Ischemic stroke (IS) is one of the major diseases threatening human health and survival and a leading cause of acquired mortality and disability in adults. The aim of this study was to screen diagnostic features of IS and to explore the characteristics of immune cell infiltration in IS pathogenesis. METHODS The microarray data of IS (GSE16561, GSE58294, GSE37587, and GSE124026) in the GEO database were merged after removing the batch effect. Then integrated bioinformatic analysis and machine-learning strategies were adopted to analyze the functional correlation and select diagnostic signatures. The WGCNA was used to identify the co-expression modules related to IS. The CIBERSORT algorithm was performed to assess the inflammatory state of IS and to investigate the correlation between diagnostic signatures and infiltrating immune cells. RESULTS Functional analysis of dysregulated genes showed that immune response-regulating signaling pathway and pattern recognition receptor activity were enriched in the pathophysiology of IS. The turquoise module was identified as the significant module with IS. By using Lasso and SVM-RFE learning methods, we finally obtained four diagnostic genes, including LAMP2, CR1, CLEC4E, and F5. The corresponding results of AUC of ROC prediction model in training and validation cohort were 0.954 and 0.862, respectively. The immune cell infiltration analysis suggested that plasma cells, resting and activated NK cells, activated dendritic cells, memory B cells, CD8+ T cells, naïve CD4+ T cells, and resting mast cells may be involved in the development of IS. Additionally, these diagnostic signatures might be correlated with multiple immune cells in varying degrees. CONCLUSION We identified four biologically relevant genes (LAMP2, CR1, CLEC4E, and F5) with diagnostic effects for IS, our results further provide novel insights regarding molecular mechanisms associated with various immune cells that related to IS for future investigations.
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Affiliation(s)
- Qian Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150081, China.
| | - Yu Tian
- Department of Geriatrics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jingyan Niu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University
| | - Erliang Guo
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Yaoheng Lu
- Department of General Surgery, Chengdu Integrated TCM&Western Medicine Hospital, Chengdu, China
| | - Chun Dang
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Feng
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150081, China
| | - Lei Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150081, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province 150081, China.
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95
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van Niftrik CHB, Sebök M, Germans MR, Halter M, Pokorny T, Stumpo V, Bellomo J, Piccirelli M, Pangalu A, Katan M, Wegener S, Tymianski M, Kulcsár Z, Luft AR, Fisher JA, Mikulis DJ, Regli L, Fierstra J. Increased Risk of Recurrent Stroke in Symptomatic Large Vessel Disease With Impaired BOLD Cerebrovascular Reactivity. Stroke 2024; 55:613-621. [PMID: 38328926 DOI: 10.1161/strokeaha.123.044259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) has been correlated with recurrent ischemic stroke. However, for clinical purposes, most CVR techniques are rather complex, time-consuming, and lack validation for quantitative measurements. The recent adaptation of a standardized hypercapnic stimulus in combination with a blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging signal as a surrogate for cerebral blood flow offers a potential universally comparable CVR assessment. We investigated the association between impaired BOLD-CVR and risk for recurrent ischemic events. METHODS We conducted a retrospective analysis of patients with symptomatic cerebrovascular large vessel disease who had undergone a prospective hypercapnic-challenged BOLD-CVR protocol at a single tertiary stroke referral center between June 2014 and April 2020. These patients were followed up for recurrent acute ischemic events for up to 3 years. BOLD-CVR (%BOLD signal change per mm Hg CO2) was calculated on a voxel-by-voxel basis. Impaired BOLD-CVR of the affected (ipsilateral to the vascular pathology) hemisphere was defined as an average BOLD-CVR, falling 2 SD below the mean BOLD-CVR of the right hemisphere in a healthy age-matched reference cohort (n=20). Using a multivariate Cox proportional hazards model, the association between impaired BOLD-CVR and ischemic stroke recurrence was assessed and Kaplan-Meier survival curves to visualize the acute ischemic stroke event rate. RESULTS Of 130 eligible patients, 28 experienced recurrent strokes (median, 85 days, interquartile range, 5-166 days). Risk factors associated with an increased recurrent stroke rate included impaired BOLD-CVR, a history of atrial fibrillation, and heart insufficiency. After adjusting for sex, age group, and atrial fibrillation, impaired BOLD-CVR exhibited a hazard ratio of 10.73 (95% CI, 4.14-27.81; P<0.001) for recurrent ischemic stroke. CONCLUSIONS Among patients with symptomatic cerebrovascular large vessel disease, those exhibiting impaired BOLD-CVR in the affected hemisphere had a 10.7-fold higher risk of recurrent ischemic stroke events compared with individuals with nonimpaired BOLD-CVR.
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Affiliation(s)
- Christiaan H B van Niftrik
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Matthias Halter
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Thomas Pokorny
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Marco Piccirelli
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Mira Katan
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Michael Tymianski
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
| | - Zsolt Kulcsár
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (M.P., A.P., Z.K.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Andreas R Luft
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Department of Neurology (T.P., M.K., S.W., A.R.L.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Joseph A Fisher
- Institute of Medical Science (J.A.F.), University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management (J.A.F.), University Health Network, Toronto, ON, Canada
| | - David J Mikulis
- Joint Department of Medical Imaging and Functional Neuroimaging Laboratory (D.J.M.), University Health Network, Toronto, ON, Canada
| | - Luca Regli
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery (C.H.B.v.N., M.S., M.R.G., M.H., V.S., J.B., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Clinical Neuroscience Center (C.H.B.v.N., M.S., M.R.G., M.H., T.P., V.S., J.B., M.P., A.P., M.K., S.W., Z.K., A.R.L., L.R., J.F.), University Hospital of Zürich, University of Zürich, Switzerland
- Division of Neurosurgery, Toronto Western Hospital (M.T., J.F.), University of Toronto, ON, Canada
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Lee YJ, Lee SH, You SC, Lee YH, Lee SJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Kim JS. Moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome and atherosclerotic cardiovascular disease: A post-hoc analysis of the RACING trial. Diabetes Obes Metab 2024; 26:829-839. [PMID: 37994242 DOI: 10.1111/dom.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/28/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
AIM This study evaluated the safety and efficacy of a moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome (MetS) and atherosclerotic cardiovascular disease. MATERIALS AND METHODS In this post-hoc subgroup analysis of the RACING trial, patients were analysed based on the presence of MetS. MetS was defined as meeting at least three of the five following criteria: (a) elevated waist circumference; (b) elevated triglycerides; (c) reduced high-density lipoprotein cholesterol; (d) elevated blood pressure; and (e) elevated fasting glucose. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. RESULTS Of the 3780 patients enrolled in the RACING trial, 1703 (45.1%) had MetS at baseline. The primary outcome rate was 10.1% and 10.3% in patients with MetS receiving ezetimibe combination therapy versus high-intensity statin monotherapy (hazard ratio = 0.97; 95% confidence interval = 0.72-1.32; p = .868). Lower rates of intolerance-related drug discontinuation or dose reduction (3.9% vs. 8.0%; p < .001) and lower low-density lipoprotein cholesterol levels (57 vs. 65 mg/dl; p < .001) were observed with ezetimibe combination therapy versus high-intensity statin monotherapy. Furthermore, the rate of new-onset diabetes was 18.5% and 19.1% in each group (p = .822). There were no significant interactions between MetS and therapy regarding study outcomes in the total population. CONCLUSIONS In patients with MetS and atherosclerotic cardiovascular disease, a moderate-intensity statin with ezetimibe combination therapy had comparable cardiovascular benefits with those of high-intensity statin monotherapy. Meanwhile, ezetimibe combination therapy was associated with lower drug intolerance and low-density lipoprotein cholesterol levels, but there was no apparent between-group difference in new-onset diabetes.
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Affiliation(s)
- Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyup Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- CHA University College of Medicine, Seongnam, South Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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97
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Zhang L, Xu X, Zhang X, Jiang S, Hui P. Systemic immune-inflammation index is associated with ulcerative plaque in patients with acute ischemic stroke: A single center exploratory study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:295-304. [PMID: 38143429 DOI: 10.1002/jcu.23632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE This study explored the correlation between inflammatory markers and ulcerative plaques based on carotid doppler ultrasound (CDU) in individuals with acute ischemic stroke (AIS). METHODS A total of 202 cases diagnosed with AIS associated with atherosclerotic plaque (AP) in the carotid artery were enrolled in this research. Collecting clinical baseline data, laboratory data (such as the complete blood count) and imaging data (CDU and Brain magnetic resonance imaging [MRI]). Then the correlation between Systemic immune-inflammation index (SII, SII = P N/L, where P, N, and L were the peripheral blood platelet, neutrophil and lymphocyte counts, respectively), the shape and position of AP, the degree of carotid artery stenosis, and the presence of ulcerative plaques. Cutoff values were determined accordingly. RESULTS SII and high sensitivity CRP (hs-CRP) were independent risk factors for the presence of vulnerable carotid plaques. SII, type A plaque, plaque above carotid bifurcation, and severe carotid stenosis were independent risk factors for the presence of ulcerative plaque. The AUC value, the sensitivity, specificity, the best cutoff value of SII in predicting the presence of ulcerative plaque was 0.895, 93.3%, 89.2%, and 537.4 (109 /L), respectively. CONCLUSION SII at admission was found to be independently associated with the presence of AIS with vulnerable plaque, especially ulcerative plaques. Moreover, plaque ulceration was more likely to form when the area of higher plaque thickness was located in the upstream arterial wall of maximum plaque thickness (WTmax), plaque was above the carotid bifurcation and severe carotid stenosis.
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Affiliation(s)
- Lianlian Zhang
- Department of Ultrasound, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Jiangsu, China
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Xinchun Xu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Xinyuan Zhang
- Department of Ultrasound, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Jiangsu, China
| | - Shu Jiang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Jiangsu, China
- Department of Magnetic Resonance, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Jiangsu, China
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Jiangsu, China
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98
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Lopez-Espejo M, Skorin I, Mesa T, Hernandez-Chavez MI. Three-year incidence and acute setting predictors of epilepsy after neonatal and childhood arterial ischaemic stroke: a disease-based cohort study. Eur J Pediatr 2024; 183:1415-1423. [PMID: 38170290 DOI: 10.1007/s00431-023-05384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
To assess the association between clinical and MRI characteristics of arterial ischaemic stroke (AIS) and the 3-year risk of post-stroke epilepsy (PSE) in paediatric patients. Retrospective cohort study. Database from a single tertiary referral centre for paediatric stroke in Chile. Two hundred seven neonates and children (1 day to 18 years) with a first-ever supratentorial AIS diagnosed between January 2003 and December 2019 were evaluated. Diagnosis of PSE and explanatory variables were consecutively recorded from hospital inpatient and annual outpatient records in a predesigned database. Competing risk analysis (competing events: death and loss to follow-up) of multiple Cox proportional hazards regression was performed to estimate adjusted subhazard ratios (SHRs) of PSE. Confidence intervals (95% CI) were calculated using bootstrap resampling (1000 replications). Interaction terms were added to investigate moderating effects. The 3-year incidence rate of PSE was 166.5 per 1000 person-years (neonatal: 150.1; childhood: 173.9). The 3-year cumulative incidence was 33%. Patients with acute symptomatic non-status seizures (SHR = 3.13; 95% CI = 1.43-6.82), status epilepticus (SHR = 5.16; 95% CI = 1.90-13.96), abnormal discharge neurological status (SHR = 2.52; 95% CI = 1.12-5.63), cortical lesions (SHR = 2.93; 95% CI = 1.48-5.81), and multifocal infarcts with stroke size < 5% of supratentorial brain volume (SHR = 3.49; 95% CI = 1.44-8.46) had a higher risk of PSE. CONCLUSION This study identified specific and reliable acute clinical and imaging predictors of PSE in paediatric patients, helping clinicians identify high-risk patients with potential implications for treatment decisions. WHAT IS KNOWN • Numerous risk factors have been proposed for post-stroke epilepsy, but there is a lack of studies evaluating these variables while accounting for confounding factors and competing risks over time. WHAT IS NEW • After adjustment for competing events, acute symptomatic seizures, both non-status and status epilepticus, abnormal mental status or motor neurological examination at hospital discharge, cortical involvement, and multifocal ischaemic lesions in small strokes are all independent predictors of post-stroke epilepsy. • Knowing the predictors of post-stroke epilepsy is essential for clinicians to make well-informed and effective decisions about treatment.
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Affiliation(s)
- Mauricio Lopez-Espejo
- Section of Neurology, Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Ilona Skorin
- Section of Neurology, Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomas Mesa
- Section of Neurology, Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marta I Hernandez-Chavez
- Section of Neurology, Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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99
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Scutelnic A, Sutter NL, Beyeler M, Meinel TR, Riederer F, Fischer U, Arnold M, Mattle HP, Jung S, Schankin CJ. Characteristics of acute ischemic stroke and unusual aura in patients with migraine with aura. Headache 2024; 64:253-258. [PMID: 38413511 DOI: 10.1111/head.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Sometimes migraine aura changes from attack to attack, raising the question of whether the change is heralding an ischemic stroke or an unusual aura. Differentiating unusual migraine aura from the onset of an acute ischemic stroke in patients with migraine with aura (MwA) can be challenging. OBJECTIVE The aim of this cohort study was to assess clinical characteristics that help distinguish between MwA and minor stroke in patients with a previous history of MwA who presented with suspicion of stroke. METHODS We interviewed patients with MwA and ischemic stroke (MwA + IS) and patients with MwA and unusual aura, but without ischemic stroke (MwA - IS) from a tertiary hospital using a structured questionnaire. We assessed how symptoms of ischemic stroke or unusual aura differed from usual, that is, the typical aura in each patient. Stroke or exclusion of stroke was verified by multimodal magnetic resonance imaging. RESULTS Seventeen patients with MwA + IS and twelve patients with MwA - IS were included. New focal neurological symptoms (13/17 [76%] vs. 3/12 [25%]), change of the first symptom (10/17 [59%] vs. 1/12 [8%]), and absence of headache (6/15 [40%] vs. 2/10 [20%]) were more often reported during ischemic stroke. The physical examination was normal in 8/17 (47%) MwA + IS and in 6/12 (50%) MwA - IS patients. In 5/17 (29%) patients with MwA + IS, there were unequivocal physical signs suggestive of stroke such as persistent visual loss, ataxia, or paresis. CONCLUSION There are clues from the history that might help identify stroke in patients with MwA with changed aura symptoms. These might be particularly useful in patients presenting without physical findings suggestive of stroke.
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nathalie L Sutter
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Franz Riederer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christoph J Schankin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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100
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Tsalta-Mladenov ME, Andonova SP. Peripheral blood cell count ratios as a predictor of poor functional outcome in patients with acute ischemic stroke. Neurol Res 2024; 46:213-219. [PMID: 37846878 DOI: 10.1080/01616412.2023.2270336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. Thromboinflammation plays an important role in the pathophysiology of stroke. The peripheral blood cell count ratios (PBCCR): neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), are global inflammatory indicators with prognostic value for the clinical outcome after stroke. We aimed to determine the relationship between NLR, PLR, or LMR and the functional outcome three months post-stroke. METHODS A prospective, hospital-based study, including 141 participants with AIS, was conducted at a referral stroke center in North-Eastern Bulgaria. The PBCCRs were obtained during the first 24 hours after stroke onset. Stroke severity was measured using the NIHSS scale, and functional outcome was assessed with the modified Rankin Scale (mRS) at discharge and 3 months post-stroke. RESULTS We found significantly lower total lymphocyte counts, and higher NLR, PLR, and C-reactive protein in the poor-outcome group (mRS>3) three months post-stroke. A positive correlation was found between the NIHSS score and mRS score on discharge, NLR, and PLR with the worse outcome on the third month. The receiver operating characteristic (ROC) curves showed the predictability of NLR (AUC, 0.626, 95%CI: 0.524-0.724, p = 0.018), and for PLR- (AUC, 0.613, 95%CI: 0.510-0.716, p = 0.031). The optimal cutoff value for NLR was 2.68 (sensitivity 77.8% and specificity 60.4%), and for PLR - 122.6 (sensitivity 77.8% and specificity 61.5%). CONCLUSION Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are simple, widely available, and cost-effective biomarkers with high prognostic value for the clinical outcome three months post-stroke.
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Affiliation(s)
- Mihael Emilov Tsalta-Mladenov
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke unit, University Hospital "Sveta Marina", Varna, Bulgaria
| | - Silva Peteva Andonova
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke unit, University Hospital "Sveta Marina", Varna, Bulgaria
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