1
|
Nordanstig A, Gu T, Henze A, Wester P, Fox AJ, Johansson E. Risk of Stroke Recurrence After Intravenous Thrombolysis in Patients with Symptomatic Carotid Stenosis. Can J Neurol Sci 2023:1-8. [PMID: 37681233 DOI: 10.1017/cjn.2023.284] [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: 09/09/2023]
Abstract
OBJECTIVE To assess if intravenous thrombolysis (IVT) affects the risk of recurrent preoperative cerebrovascular events before carotid surgery or stenting in patients with symptomatic ≥ 50% carotid stenosis. METHODS Three cohorts of symptomatic ≥ 50% carotid stenosis patients were merged. To make the control group relevant, we excluded patients not presenting with stroke on the day of symptom onset. The risk of preoperative cerebrovascular events up to 30 days was compared between the IVT-treated and non-IVT-treated. RESULTS In total, 316 patients were included, 64 (20%) treated with IVT. Those treated with IVT had similar risk of recurrent ipsilateral ischemic stroke or retinal artery occlusion (12% at day 7, 12% at day 30) as those not treated (9% at day 7, 15% at day 30; adjusted HR 0.9, 95% CI 0.4-2.2). There was a tendency (p = 0.09) towards time-dependency in the data where the recurrence risk was higher in IVT-treated at day 0 (6% in IVT-treated, 1% in non-IVT-treated, OR 5.5, 95% CI 1.2-25.4, p = 0.03). This was not significant when adjusting for co-factors (adjusted OR 4.4, 95% CI 0.9-21.8, p = 0.07) and was offset by a later risk decrease, with no remaining risk difference between IVT-treated and non-IVT-treated at day 7. CONCLUSIONS Intravenous thrombolysis treatment does not seem to affect the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic ≥50% carotid stenosis: The risk is high in both IVT-treated and non-IVT-treated. However, there might be a risk increase on the day of IVT treatment that is offset by a risk decrease during the first week.
Collapse
Affiliation(s)
- Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Gu
- Department of Neurosciences, Institution of Clinical Science, Umea University, Umea, Sweden
| | - Alexander Henze
- Department of Diagnostic Radiology, Institution of Radiation Sciences, Umea University, Umea, Sweden
| | - Per Wester
- Institution of Public Health and Clinical Medicine, Umea University, Umea, Sweden
- Department of Clinical Sciences, Danderyds hospital Karolinska Institute, Stockholm, Sweden
| | - Allan J Fox
- Department of Medical Imaging, Sunnybrook health Science Center, University of Toronto, Toronto, ON, Canada
| | - Elias Johansson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosciences, Institution of Clinical Science, Umea University, Umea, Sweden
- Wallenberg Center of Molecular Medicine, Umea University, Umea, Sweden
| |
Collapse
|
2
|
Li Q, Chai X, Zhang C, Wang X, Ma W. Prediction Model of Ischemic Stroke Recurrence Using PSO-LSTM in Mobile Medical Monitoring System. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8936103. [PMID: 35371252 PMCID: PMC8970909 DOI: 10.1155/2022/8936103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
Abstract
Aiming at the problems of low prediction accuracy and low sensitivity of traditional ischemic stroke recurrence prediction methods, which limits its application range, by introducing an adaptive particle swarm optimization (PSO) algorithm into the Long and Short-Term Memory (LSTM) model, a prediction model of ischemic stroke recurrence using deep learning in mobile medical monitoring system is proposed. First, based on the clustering idea, the particles are divided into local optimal particles and ordinary particles according to the characteristic information and distribution of different particles. By updating the particles with different strategies, the diversity of the population is improved and the problem of local optimal solution is eliminated. Then, by introducing the adaptive PSO algorithm into the LSTM, the PSO-LSTM prediction model is constructed. The optimal super parameters of the model are determined quickly and accurately, and the model is trained combined with the patient's clinical data. Finally, by using SMOTE method to process the original data, the imbalance of positive and negative sample data is eliminated. Under the same conditions, the proposed PSO-LSTM prediction model is compared with two traditional LSTM models. The results show that the prediction accuracy of PSO-LSTM model is 92.0%, which is better than two comparison models. The effective prediction of ischemic stroke recurrence is realized.
Collapse
Affiliation(s)
- Qingjiang Li
- School of Medical Technology, Qiqihar Medical University, Qiqihar, Heilongjiang 161000, China
| | - Xuejiao Chai
- School of Public Health, Qiqihar Medical University, Qiqihar, Heilongjiang 161000, China
| | - Chunqing Zhang
- Clinical Teaching Center, Qiqihar Medical University, Qiqihar, Heilongjiang 161000, China
| | - Xinjia Wang
- School of General Practice and Continuing, Qiqihar Medical University, Qiqihar, Heilongjiang 161000, China
| | - Wenhui Ma
- Clinical Teaching Center, Qiqihar Medical University, Qiqihar, Heilongjiang 161000, China
| |
Collapse
|
3
|
Johansson E, Nordanstig A. The Issue of Optimal Timing of Carotid Revascularisation Is Both Relevant and Unresolved. Eur J Vasc Endovasc Surg 2021; 63:181-183. [PMID: 34973878 DOI: 10.1016/j.ejvs.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/29/2021] [Accepted: 11/19/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Elias Johansson
- Clinical Science, Neurosciences, Umeå University, 901 87, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, 901 87 Umeå, Sweden.
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Mastrorilli D, Mezzetto L, D'Oria M, Fiorini R, Lepidi S, Scorsone L, Veraldi E, Veraldi GF. NIHSS score at admission can predict functional outcomes in patients with ischemic stroke undergoing carotid endarterectomy. J Vasc Surg 2021; 75:1661-1669.e2. [PMID: 34954269 DOI: 10.1016/j.jvs.2021.11.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of present study was to evaluate the prognostic impact of National Institutes of Health Stroke Scale (NIHSS) score in patients undergoing acute CEA, and to assess clinical and morphological factors that could predict worse outcomes. METHODS The data of 183 consecutive patients who have undergone CEA after ischemic stroke was analyzed from January 2015 to January 2021. Patients were divided into two groups using the NIHSS cut off point of 4. Functional dependence was assessed on hospital discharge and 90 days after. RESULTS In total, 102 patients (55.7%) had a minor stroke (Group A: NIHSS ≤ 4), whereas 81 patients (44.3%) had a moderate-major stroke (Group B: NIHSS > 4). Group A and group B showed significant differences in their intracranial anatomic features: presence of incomplete Circle of Willis (7.8% vs 17.3%; p=.05), volume of Cerebral ischemic lesion volume ≥4000 mm3 (5.9 % vs 24.7%; p=<.001), and high ASPECTS of 8 to 10 (75.5% vs 44.4%; p=<.001). The overall rate of combined perioperative stroke/myocardial infarction/death was 1.1%, with no strokes recorded during the waiting time to carotid endarterectomy (CEA). Patients in group A had a lower rate of functional dependence at discharge (4.9% vs. 35.8%; p = <.001) and at 90 days after index stroke event (2.5% vs. 19.6%; p = <.001) versus those in group B. Using multivariate binary logistic regression, admission NIHSS>4 was significantly associated with higher odds of functional dependence at discharge (OR= 7.9, 95%CI= 2.7-18.5, p = <.001) and at 90 days (OR= 10.4, 95%CI= 2.7-19.3, p = .002). CONCLUSIONS NIHSS>4 at admission will increase the risk of having higher mRS scores both at hospital discharge and at 90 days after index stroke event. acute CEA was safe and feasible in patients with ischemic stroke, even if they had previously undergone intravenous thrombolysis.
Collapse
Affiliation(s)
- Davide Mastrorilli
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy.
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, Cattinara University Hospital ASUGI, Trieste, Italy
| | - Roberta Fiorini
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, Cattinara University Hospital ASUGI, Trieste, Italy
| | - Lorenzo Scorsone
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Edoardo Veraldi
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| |
Collapse
|
5
|
Coelho A, Peixoto J, Mansilha A, Naylor AR, de Borst GJ. Timing of Carotid Intervention in Symptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 63:3-23. [PMID: 34953681 DOI: 10.1016/j.ejvs.2021.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/05/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This review aimed to analyse the timing of carotid endarterectomy (CEA) and carotid artery stenting (CAS) after the index event as well as 30 day outcomes at varying time periods within 14 days of symptom onset. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analysis statement, comprising an online search of the Medline and Cochrane databases. Methodical quality assessment of the included studies was performed. Endpoints included procedural stroke and/or death stratified by delay from the index event and surgical technique (CEA/CAS). RESULTS Seventy-one studies with 232 952 symptomatic patients were included. Overall, 34 retrospective analyses of prospective databases, nine prospective, three RCT, three case control, and 22 retrospective studies were included. Compared with CEA, CAS was associated with higher 30 day stroke (OR 0.70; 95% CI 0.58 - 0.85) and mortality rates (OR 0.41; 95% CI 0.31 - 0.53) when performed ≤ 2 days of symptom onset. Patients undergoing CEA/CAS were analysed in different time frames (≤ 2 vs. 3 - 14 and ≤ 7 vs. 8 - 14 days). Expedited CEA (vs. 3 - 14 days) presented a sampled 30 day stroke rate of 1.4%; 95% CI 0.9 - 1.8 vs. 1.8%; 95% CI 1.8 - 2.0, with no statistically significant difference. Expedited CAS (vs. 3 - 14 days) was associated with no difference in stroke rate but statistically significantly higher mortality rate (OR 2.76; 95% CI 1.39 - 5.50). CONCLUSION At present, CEA is safer than transfemoral CAS within 2/7 days of symptom onset. Also, considering absolute rates, expedited CEA complies with the accepted thresholds in international guidelines. The ideal timing for performing CAS (when indicated against CEA) is not yet defined. Additional granular data and standard reporting of timing of intervention will facilitate future monitoring.
Collapse
Affiliation(s)
- Andreia Coelho
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Portugal; Department of Surgery and Physiology, Faculdade Medicina da Universidade do Porto, Portugal
| | - João Peixoto
- Department of Surgery and Physiology, Faculdade Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Armando Mansilha
- Department of Surgery and Physiology, Faculdade Medicina da Universidade do Porto, Portugal
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, the Netherlands.
| |
Collapse
|
6
|
Kakisis JD, Antonopoulos C. Prediction of Stroke Recurrence: Knowledge is the Prophet's Best Qualification. Eur J Vasc Endovasc Surg 2020; 60:816. [PMID: 32782206 DOI: 10.1016/j.ejvs.2020.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- John D Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Constantine Antonopoulos
- Department of Vascular Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|