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Sanner J, Ström JO, von Euler M, Thommessen B, Fure B. Etiological Subclassification of Stroke in Older People ≥80 Years Compared to Younger People: A Systematic Review and Meta-Analysis. J Geriatr Psychiatry Neurol 2024:8919887241254466. [PMID: 38761091 DOI: 10.1177/08919887241254466] [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] [Indexed: 05/20/2024]
Abstract
BACKGROUND Due to the rapid growth of the world´s oldest population, the number of older persons with stroke is expected to rise. Knowledge of stroke etiology is essential to offer personalized and equal health care across age groups. The present systematic review aimed to investigate the prevalence of etiological subtypes of ischemic and hemorrhagic stroke in older compared to younger people. METHODS MEDLINE, Embase, Cochrane, Epistemonikos, and Cinahl were systematically searched for studies regarding etiological classification in people ≥80 years compared to those <80 years with ischemic or hemorrhagic stroke. RESULTS Out of 28 441 identified articles, eight met the inclusion criteria. In total, 8223 individuals were included in meta-analyses, of whom 2997 were 80 years or older. We demonstrated a higher prevalence of cardioembolic stroke in people ≥80 years OR 1.68 (95% CI, 1.12-2.53). Small vessel disease was significantly less common in older people OR .64 (95% CI, .50-.81). Regarding large vessel disease, no statistically significant difference between the two groups was shown OR 1.05 (95% CI, .77-1.43). CONCLUSION In people ≥80 years, cardioembolic stroke is more common, and small vessel disease less common compared to people <80 years. Overall, the results have to be interpreted with caution due to few studies. Large studies using validated classification systems are needed.
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Affiliation(s)
- Johan Sanner
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Neurology and Rehabilitation, Central Hospital Karlstad, Karlstad, Sweden
| | - Jakob O Ström
- Department of Neurology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mia von Euler
- Department of Neurology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Bente Thommessen
- Division of Medicine, Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Brynjar Fure
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden
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Vítor J, Bonifácio GV, Fonseca AC. Diagnosis of atrial fibrillation in young patients with ischemic stroke: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107299. [PMID: 37657400 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107299] [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: 02/19/2023] [Revised: 07/21/2023] [Accepted: 08/05/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients' age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients. AIMS To determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology. METHODS Systematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals. RESULTS 8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I2 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology. CONCLUSION The proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.
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Affiliation(s)
- Joana Vítor
- Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Ana Catarina Fonseca
- Stroke Unit, Neurology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa 1640-035, Portugal; Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Medicina Molecular, Lisboa, Portugal.
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Ohya Y, Matsuo R, Sato N, Irie F, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Modification of the effects of age on clinical outcomes through management of lifestyle-related factors in patients with acute ischemic stroke. J Neurol Sci 2023; 446:120589. [PMID: 36807976 DOI: 10.1016/j.jns.2023.120589] [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: 09/16/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE This study examined the association between age and clinical outcomes after ischemic stroke, and whether the effect of age on post-stroke outcomes can be modified by various factors. METHODS We included 12,171 patients with acute ischemic stroke, who were functionally independent before stroke onset, in a multicenter hospital-based study conducted in Fukuoka, Japan. Patients were categorized into six groups according to age: ≤ 45, 46-55, 56-65, 66-75, 76-85, and > 85 years. Logistic regression analysis was performed to estimate an odds ratio for poor functional outcome (modified Rankin scale score of 3-6 at 3 months) for each age group. Interaction effects of age and various factors were analyzed using a multivariable model. RESULTS The mean age of the patients was 70.3 ± 12.2 years, and 63.9% were men. Neurological deficits at onset were more severe in the older age groups. The odds ratio of poor functional outcome linearly increased (P for trend <0.001), even after adjusting for potential confounders. Sex, body mass index, hypertension, and diabetes mellitus significantly modified the effect of age on the outcome (P < 0.05). The unfavorable effect of older age was greater in female patients and those with low body weight, whereas the protective effect of younger age was smaller in patients with hypertension or diabetes mellitus. CONCLUSIONS Functional outcome worsened with age in patients with acute ischemic stroke, especially in females and those with low body weight, hypertension, or hyperglycemia.
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Affiliation(s)
- Yuichiro Ohya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Noriko Sato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ucci A, de Troia A, D'Ospina RM, Pedrazzi G, Nabulsi B, Azzarone M, Perini P, Massoni CB, Rossi G, Freyrie A. Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years. Vascular 2023; 31:98-106. [PMID: 34923864 DOI: 10.1177/17085381211056434] [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: 11/15/2022]
Abstract
BACKGROUND The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). METHODS Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients' sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients' survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. RESULTS We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients' 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients' 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. CONCLUSIONS The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.
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Affiliation(s)
- Alessandro Ucci
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Alessandro de Troia
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | | | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Bilal Nabulsi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Matteo Azzarone
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Paolo Perini
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Claudio Bianchini Massoni
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Giulia Rossi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Antonio Freyrie
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
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Time trends in atrial fibrillation-related stroke during 2001–2020 in Sweden: a nationwide, observational study. Lancet Reg Health Eur 2023; 28:100596. [PMID: 37180742 PMCID: PMC10173271 DOI: 10.1016/j.lanepe.2023.100596] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Background Great efforts have been made to improve stroke prevention in atrial fibrillation (AF) patients. Meanwhile, incidence of AF is increasing, which may affect the share of AF-related stroke on all strokes. We aimed to examine the temporal trends in the incidence of AF-related ischemic stroke between 2001 and 2020, if it varied by use of novel oral anticoagulant drugs (NOAC), and if the relative risk of ischemic stroke associated with AF changed over time. Methods Data from the total Swedish population aged ≥70 years during the period 2001-2020 were used. Annual incidence rate (IR) was calculated for overall and AF-related ischemic stroke which was defined as first-ever ischemic stroke with AF diagnosed up to 5 years before, on the same day, or within 2 months after the stroke event. Cox regression models were performed to examine if the hazard ratio (HR) between AF and stroke changed over time. Findings While IR of ischemic strokes declined during 2001-2020, IR of AF-related ischemic stroke remained stable between 2001 and 2010 but showed a consistent decline between 2010 and 2020. The HR of ischemic stroke within 3 years from an AF diagnosis came down from 2.39 (95% confidence interval: 2.31-2.48) to 1.54 (1.48-1.61) over the study period, which was largely explained by a substantial increase in the use of NOAC among AF patients after 2012. Yet, by the end of 2020, 24% of all ischemic strokes had a preceding or concurrent AF diagnosis, which is slightly higher than in 2001. Interpretation Even though both the absolute and relative risk of AF-related ischemic stroke declined over the past 20 years, every fourth ischemic stroke in 2020 still had a preceding or concurrent AF diagnosis. This represents a great potential for future gains in stroke prevention among AF patients. Funding Swedish Research Council and Loo and Hans Osterman Foundation for Medical Research.
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Motamed-Gorji N, Hariri S, Masoudi S, Sharafkhah M, Nalini M, Oveisgharan S, Khoshnia M, Motamed-Gorji N, Gharavi A, Etemadi A, Poustchi H, Zand R, Malekzadeh R. Incidence, early case fatality and determinants of stroke in Iran: Golestan Cohort Study. J Stroke Cerebrovasc Dis 2022; 31:106658. [PMID: 35973398 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106658] [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: 02/26/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. METHODS Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. RESULTS 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. CONCLUSION Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area.
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Affiliation(s)
- Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Masoudi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Masoud Khoshnia
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdolsamad Gharavi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Zand
- Neuroscience Institute, Penn State University, Hershey, PA, USA; Neuroscience Institute, Geisinger, Danville, PA, USA.
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Artmann A, Rahn AC, Köpke S, Thomalla G, Heesen C, Alegiani AC. Risk communication in acute stroke patients - from qualitative data to a pilot randomised controlled trial. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:19-27. [PMID: 35227636 DOI: 10.1016/j.zefq.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/11/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The probability of recurring strokes in patients with atrial fibrillation is high. Within 1.8 years, 6.6 % of the patients suffered a new stroke. While effective secondary prevention options exist, low adherence challenges effective medical treatment. The aim of our study was to examine the risk understanding of acute stroke patients and to find the best way to communicate risk reduction. MATERIALS AND METHODS Risk communication had three formats: a text, a pictogram, and a cube diagram. All three were developed on the basis of the criteria of evidence-based patient information. Patients who were admitted to the stroke unit and diagnosed with acute stroke, assessed the information material. Data on secondary prevention using acetylsalicylic acid were taken as an example, with no reference to actual patient treatment. In a first step, we interviewed a focus group to check the feasibility of the questionnaire (qualitative study). In the second step, the information material was tested in a pilot randomized controlled trial. RESULTS Acute stroke patients (qualitative study, n=13) understood the information and were interested in numerical risk communication. The visualized representations were superior in terms of understandability of the numbers communicated (pilot randomized controlled trial, n=60, 50 % correct answers for question 1, p value of 0.502, and 55 % correct answers for question 2, p value of 0.338). Stroke-related neurologic deficits, measured with the National Institute of Health Stroke Scale (NIHSS) on admission, revealed a significant influence on the number of correct answers to stroke risk questions, whereas the type of stroke and education did not. CONCLUSIONS Acute stroke patients were able to understand risk communication. Visualization helped them capture information on stroke risk.
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Affiliation(s)
- Anna Artmann
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Christin Rahn
- Institute of Social Medicine & Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Social Medicine & Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Institut for Neuroimmunology und Multiple Sklerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Christina Alegiani
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Asklepsios Klinik Altona, Hamburg, Germany
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Giugliani R, Marques S, Andrade LGMD, Pessoa A, Vaisbich MH, Blum A, Tenório F, Rosa Neto NS. Clinical and diagnostic aspects of Fabry disease management: a narrative review with a particular focus on Brazilian experts’ perspectives. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2022. [DOI: 10.1590/2326-4594-jiems-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Roberto Giugliani
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Brazil; Universidade Estadual do Ceará, Brazil
| | - Maria H. Vaisbich
- Universidade Federal de São Paulo, Brazil; Universidade de São Paulo (HCFMUSP), Brazil
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Brouwer J, Smaal JA, Emmer BJ, de Ridder IR, van den Wijngaard IR, de Leeuw FE, Hofmeijer J, van Zwam WH, Martens JM, Roos YBWEM, Majoie CB, van Oostenbrugge RJ, Coutinho JM. Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study. Stroke 2021; 53:34-42. [PMID: 34872339 DOI: 10.1161/strokeaha.120.034033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients. METHODS We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18-49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding. RESULTS We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16, P<0.001) and less cardiovascular comorbidities than older patients. Stroke etiologies in young patients included carotid dissection (16%), cardio-embolism (15%), large artery atherosclerosis (10%), and embolic stroke of undetermined source (31%). Clinical outcome was better in young than older patients (acOR for modified Rankin Scale shift: 1.8 [95% CI, 1.5-2.2]; functional independence [modified Rankin Scale score 0-2] 61 versus 39% [adjusted odds ratio, 2.1 [95% CI, 1.6-2.8]); mortality 7% versus 32%, adjusted odds ratio, 0.2 [95% CI, 0.1-0.3]). Symptomatic intracranial hemorrhage occurred less frequently in young patients (3% versus 6%, adjusted odds ratio, 0.5 [95% CI, 0.2-1.00]). Successful reperfusion (expanded Thrombolysis in Cerebral Infarction Score 2b-3) did not differ between groups. Onset to reperfusion time was shorter in young patients (253 versus 255 minutes, adjusted B in minutes 12.4 [95% CI, 2.4-22.5]). CONCLUSIONS Ten percent of patients with acute ischemic stroke undergoing endovascular thrombectomy were younger than 50. Cardioembolism and carotid dissection were common underlying causes in young patients. In one-third of cases, no cause was identified, indicating the need for more research on stroke cause in young patients. Young patients had better prognosis and lower risk of symptomatic intracranial hemorrhage than older patients.
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Affiliation(s)
- Josje Brouwer
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (J.B., Y.B.W.E.M.R., J.M.C.)
| | - Johanna A Smaal
- Department of Neurology, Maastricht University Medical Center, the Netherlands (J.A.S., I.R.d.R., R.J.v.O.)
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands (C.B.M., B.E.)
| | - Inger R de Ridder
- Department of Neurology, Maastricht University Medical Center, the Netherlands (J.A.S., I.R.d.R., R.J.v.O.)
| | - Ido R van den Wijngaard
- Department of Neurology and Radiology, Haaglanden Medical Center, the Hague, the Netherlands (I.R.v.d.W.)
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (F.-E.d.L.)
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate, Arnhem, the Netherlands (J.H.).,University of Twente, Faculty of Science and Technology, Enschede, the Netherlands (J.H.)
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands (W.H.v.Z.)
| | - Jasper M Martens
- Department of Radiology, Rijnstate, Arnhem, the Netherlands (J.M.M.)
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (J.B., Y.B.W.E.M.R., J.M.C.)
| | - Charles B Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands (C.B.M., B.E.)
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, the Netherlands (J.A.S., I.R.d.R., R.J.v.O.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (J.B., Y.B.W.E.M.R., J.M.C.)
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Vibo R, Schneider S, Kõrv L, Mallene S, Torop LA, Kõrv J. Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke. Eur Stroke J 2021; 6:262-267. [PMID: 34746422 PMCID: PMC8564150 DOI: 10.1177/23969873211040990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18-54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8-8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1-3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8-21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2-6), stroke was more severe in men (p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.
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Affiliation(s)
- Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Siim Schneider
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | - Sandra Mallene
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
| | | | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Estonia
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Kehaya S. Stroke Burden in Agrı: Stroke Situation in Underdeveloped Region of Turkey. Eurasian J Med 2021; 53:174-179. [PMID: 35110092 PMCID: PMC9879219 DOI: 10.5152/eurasianjmed.2021.20034] [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] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Stroke is the second cause of mortality and the third cause of disability worldwide in adults. There is no published data about stroke in Agrı.We aim to define stroke subtypes and associated risk factors. Thus, we can be aware of stroke burden in rural areas and can develop strategies to reduce the stroke risk. MATERIALS AND METHODS Records of Agrı State Hospital were investigated for a period of 3 years retrospectively. Patients were divided to ischemic and hemorrhagic stroke groups. Hemorrhagic strokes were classified as subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). Ischemic strokes were classified according to localization and etiology. Vascular risk factors for ischemic stroke were assessed and compared between groups. The differences between variables were evaluated using Pearson κi square test and one-way ANOVA. RESULTS There were 1246 patients evaluated for stroke in Emergency Department and 525 (42% of prediagnosis) patients were diagnosed as stroke. There were 25.3% hemorrhagic (5.1% SAH and 20.1% ICH) versus 74.6% ischemic stroke. Intensive care required for 61.6% of hemorrhagic and 22.4% of ischemic patients. The most prevalent localization was partial anterior circulation infarction, and the most known etiology was cardioembolism after unknown cause in ischemic strokes. The most encountered risk factor was hypertension (HT). Coronary artery disease history, HT, and atrial fibrillation (AF) were risk factors for recurrent stroke (P = .001). CONCLUSION Stroke types in Agrı resembles more to Asian population than Europe. Awareness for stroke, HT, and AF treatment could be the primary targets for stroke reduction in underdeveloped regions.
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Affiliation(s)
- Sezgin Kehaya
- Department of Neurology, Trakya University School of Medicine, Edirne, Turkey,Correspondence to: Sezgin Kehaya
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12
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Abstract
OBJECTIVES Although comorbidity increases the health care and community support needs for patients, and the burden for the health care system, there are few population-based studies on comorbidity in patients with stroke. This study aims to evaluate the occurrence of important comorbidities among stroke patients in the Canadian population. METHODS Data from the population-based 2011-2012 Canadian Community Health Survey containing responses from 124,929 participants covering about 98% of the Canadian population when weighted were examined and analyzed by means of logistic regression models. RESULTS There was a statistically significant association between stroke history and multiple comorbid risk factors. Stroke prevalence increased in individuals with heart disease (odds ratio (OR): 3.80, 95% confidence interval (CI): 3.77-3.84), hypertension (OR: 1.97, 95% CI: 1.95-1.99), diabetes (OR: 1.74, 95% CI: 1.72-1.75), mood disorder (OR: 2.14, 95% CI: 2.12-2.17), and chronic obstructive pulmonary disease (COPD) (OR: 1.46, 95% CI: 1.44-1.48) compared to others without the condition. Of 2067 participants with stroke, 1680 (81.3%) had one or more comorbid conditions (heart disease, hypertension, diabetes, mood disorder, or COPD) that coexist with stroke and 48% had two or more. Comorbidity increased with age, and two-thirds of stroke patients with comorbid medical conditions were 60 years of age or older. CONCLUSION This population-based study provides evidence of comorbidity between stroke and other conditions that include heart disease, hypertension, diabetes, mood disorder, and COPD. Canadian individuals with stroke have a high burden of comorbidity. Health care systems need to recognize and respond to the strong association of comorbidity and stroke occurrence. This key factor should be considered when allocating resources.
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Béjot Y, Duloquin G, Graber M, Garnier L, Mohr S, Giroud M. Current characteristics and early functional outcome of older stroke patients: a population-based study (Dijon Stroke Registry). Age Ageing 2021; 50:898-905. [PMID: 33009911 DOI: 10.1093/ageing/afaa192] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND the ongoing growing and ageing population is associated with an increase in older patients suffering a stroke. We aimed to assess the current profile of these patients in a population-based setting. METHODS all patients with acute stroke were prospectively identified among residents of Dijon, France, between 2013 and 2017, using a population-based registry. Characteristics and early outcome of patients were compared according to age groups. RESULTS 1,288 stroke cases were recorded (median age: 81.1 years, interquartile range: 66.1-86.7, 54% women). Patients aged 75-85 years and those >85 years accounted for 27.6 and 33.9% of overall cases. Increasing age was associated with a greater prevalence of vascular risk factors, pre-existing cognitive impairment and handicap, higher initial severity, more frequent cardioembolic ischemic stroke, post-stroke pulmonary infection and delirium. Only 41% of patients aged 75-85 years and 18% of those aged >85 years had a good early recovery. Compared with patients aged <75 years, patients aged 75-85 years [adjusted odds ratio (OR) = 2.61; 95% confidence interval (CI): 1.74-3.93, P < 0.001] and those aged >85 years (adjusted OR = 7.18; 95% CI: 4.58-11.3, P < 0.001) had an increased risk of poor post-stroke functional outcome. Among survivors, the proportion of patients discharged to home was 60% in age group <75 years, compared with 49% in patients aged 75-85 years and 29% in those aged >85 years. Thirty per cent of patients >85 years old required a long-term care institution. CONCLUSION the increasing burden of stroke in older people has major implications for future treatment strategies and need for dedicated care facilities.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
| | - Mathilde Graber
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
| | - Lucie Garnier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
| | - Sophie Mohr
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, UBFC, Dijon, France
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Wen HJ, Wang XY. Left ventricular diastolic dysfunction is associated with cerebral infarction in young hypertensive patients: A retrospective case-control study. Exp Ther Med 2020; 20:61. [PMID: 32952651 PMCID: PMC7485303 DOI: 10.3892/etm.2020.9189] [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: 08/24/2019] [Accepted: 01/23/2020] [Indexed: 11/06/2022] Open
Abstract
Studies have indicated that hypertension is associated with the occurrence of acute cerebral infarction (CI) in young patients (18-45 years). However, the association between CI and left ventricular diastolic (LVD) dysfunction in young patients with hypertension has rarely been reported. The purpose of the present study was to investigate the association between LVD dysfunction and acute CI in young patients with hypertension. A total of 92 patients with acute CI who had hypertension were selected as the study group (CI group) and 98 young patients with only hypertension were selected as the control group (non-CI group). Blood pressure measurements, LVD functional assessment and cerebral MRI were performed. The χ² test was used to compare the left ventricular diastolic function between the CI and non-CI groups. The results indicated that LVD function of young patients was associated with hypertension and there was a correlation between the decrease in LVD function and the occurrence of acute CI in young patients with hypertension. The incidence of acute CI was higher in patients with decreased LVD function than in those with normal LVD function. In conclusion, hypertension in the young is associated with decreased LVD function and is a risk factor for diastolic dysfunction of the left ventricle. LVD function may be an independent predictor of acute CI in young patients with hypertension and should be considered by clinicians. By predicting the risk of acute CI in young patients with hypertension, LVD testing may aid in the primary prevention of CI or guide early treatment.
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Affiliation(s)
- Hui-Jun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Xiao-Yong Wang
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
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15
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Age-Related Risk Factors at the First Stroke Event. J Clin Med 2020; 9:jcm9072233. [PMID: 32674391 PMCID: PMC7408897 DOI: 10.3390/jcm9072233] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Stroke is a multifactorial disease, which can affect individuals at any age. Risk factors (RFs) associated with the first stroke event have been well identified; however, the influence of these RFs on the patient’s age needs to be studied. (2) Objective: This study aimed to examine the effect of modifiable RFs on the age at which a stroke occurs. (3) Methods: A cross-sectional study was conducted on patients admitted consecutively with a first-ever acute stroke at the Burgos University Hospital (Spain). Data on sociodemographic and clinical parameters were collected (high blood pressure (HBP), smoking habit, diabetes mellitus (DM), dyslipemia, abdominal obesity, sedentary lifestyle, alcohol consumption, and cardiovascular diseases). The possible associations between RFs and age were studied using univariate and multivariate regression analyses and a decision tree. (4) Results: A total of 436 patients with a mean age of 75.39 years (standard deviation (SD) ± 12.67) were included. HBP and overweight/obesity were the most prevalent stroke RFs. Being an active smoker (OR 21.48; 95% confidence interval (CI) 8.80–52.41), having a sedentary lifestyle (OR 3.24; 95% CI 1.97–5.31), being an excessive alcohol drinker (OR 2.36; 95% CI 1.45–3.84), or being overweight or obese (OR 1.95; 95% CI 1.14–3.34) increased the risk of having an acute cerebrovascular event in individuals aged 75 years or below. However, a personal history of HBP (OR 0.40; 95% CI 0.24–0.67) was significantly associated with a greater likelihood of having an acute stroke in individuals aged more than 75 years. (5) Conclusions: This study showed that the modifiable RFs strongly influence the first stroke event in patients aged below 75 years, which will be useful in guiding different prevention strategies.
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Si Y, Xiang S, Zhang Y, Lu T, Guo J, Xiao X, Dong L. Clinical profile of aetiological and risk factors of young adults with ischemic stroke in West China. Clin Neurol Neurosurg 2020; 193:105753. [PMID: 32126283 DOI: 10.1016/j.clineuro.2020.105753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our study aimed to present the clinical characteristics of aetiological and risk factors of ischemic stroke (IS) in young adults in order to provide reference to the early prevention and management. PATIENTS AND METHODS Data of young IS patients aged 18-50 years who were admitted to our tertiary stroke center were retrospectively reviewed. Demographic and clinical characteristics, and risk factors/aetiologies were assessed. Differences of clinical characteristics between the young (18-34 years) and old (35-50 years) age groups were investigated. RESULTS 343 consecutive inpatients were recruited (mean age 43.8 years). 40 patients (11.7 %) were in the young age group. The prevalence of smoking, diabetes and hypertension accounted for 49.0 %, 24.8 % and 36.2 % respectively, with higher rates in old age group (all p < 0.05). Hyperlipidemia and drinking took up 34.4 % and 45.2 %, with no statistical difference between age groups. 56 patients (16.3 %) were in the "large-artery atherosclerosis" category, and higher percentage of patients was in the old age group (17.8 % vs 5.0 %, p < 0.05). 9.9 % of the patients were classified as the "cardioembolism'' category, and higher percentage of patients was in the young age group (20.0 % vs 8.6 %, p < 0.05). 46 patients (13.4 %) were diagnosed as small vessel occlusion, with similar prevalence in the young and old age group. 15 patients (4.6 %) had other determined causes and 192 patients (56.0 %) were due to undetermined cause. CONCLUSION the traditional vascular risk factors are frequent and increases with age in young stroke. Further investigation on the 'rare' risk factor and etiology would beneficial.
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Affiliation(s)
- Yang Si
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
| | - Shunju Xiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Yi Zhang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
| | - Ting Lu
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
| | - Jiang Guo
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
| | - Xiaoqiang Xiao
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China; Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
| | - Lingling Dong
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
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17
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Forti P, Maioli F, Arnone G, Nativio V, Zoli M, Coveri M, Di Pasquale G, Procaccianti G. Age-specific rate of undiagnosed diabetes and prediabetes in acute stroke. Diabetes Res Clin Pract 2020; 159:107968. [PMID: 31830515 DOI: 10.1016/j.diabres.2019.107968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/23/2019] [Accepted: 11/29/2019] [Indexed: 11/20/2022]
Abstract
AIMS We investigated age-specific rates of undiagnosed diabetes and prediabetes among patients with acute stroke. METHODS We used data from 2223 patients with acute stroke consecutively admitted to an Italian Stroke Unit (SU) between 2010 and 2015. Information from medical records and glycated hemoglobin (HbA1c) measured on admission was retrospectively used to screen for diabetes and prediabetes defined according to standard criteria. RESULTS Overall rate of diabetes undiagnosed at admission and diabetes still undiagnosed at SU discharge were 9.7% and 6.7% but age-specific prevalence peaked up to 12.0% and 9.0% after age 80. At admission, the proportion of all undiagnosed diabetes on total diabetes cases was one out of every two cases before age 60 and three out of every four cases after age 80. In these same age intervals, one out of every three diabetes cases was still undiagnosed at SU discharge. Regardless of age, about three out of ten patients with acute stroke had prediabetes. Less than 2% of these patients had a prediabetes diagnosis before or after SU admission. CONCLUSIONS In patients with acute stroke, diabetes is substantially underdiagnosed before age 60 and after age 80. Prediabetes is highly prevalent but mostly undiagnosed at all ages.
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Affiliation(s)
- Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | | | | | | | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Maura Coveri
- Medical Department, Maggiore Hospital, Bologna, Italy
| | | | - Gaetano Procaccianti
- Institute of Neurological Sciences [Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS], Bologna, Italy
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18
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Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians. J Vasc Surg 2019; 71:518-524. [PMID: 31471235 DOI: 10.1016/j.jvs.2019.05.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Carotid endarterectomy (CEA) is the gold standard to prevent a recurrent stroke in symptomatic patients with carotid stenosis. However, in the modern era, the benefit of CEA in asymptomatic octogenarian patients has come into question. This study investigates real-world outcomes of CEA in asymptomatic octogenarians. METHODS Patients who underwent CEA for asymptomatic carotid stenosis were identified in the American College of Surgeons National Surgical Quality Improvement Program CEA-targeted database from 2012 to 2017. They were stratified into two groups: octogenarians (≥80 years old) and younger patients (<80 years old). The 30-day outcomes evaluated included mortality and major morbidities such as stroke, cardiac events, pulmonary, and renal dysfunction. Multivariable logistic regression was used for data analysis. RESULTS We identified 13,846 patients with asymptomatic carotid stenosis who underwent an elective CEA including 2509 octogenarians and 11,337 younger patients. Octogenarians were more likely to be female and less likely to be diabetic or smokers compared with younger patients. There was no difference in preoperative use of statins or antiplatelet therapy. Examination of 30-day outcomes revealed that octogenarians had slightly higher mortality (1.2% vs 0.5%; odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P < .01), and a higher risk of return to the operating room (3.3% vs 2.3%; odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P = .01). However, there was no difference between octogenarians and younger patients in adverse cardiac events or pulmonary, renal, or wound complications. Twenty-five octogenarian and 138 younger patients suffered from periprocedural stroke at a similar rate (1.0% vs 1.2%; P = .54). Stroke/death occurred for 51 of 2509 patients (2.0%) in the older group and 184 of 11,337 patients (1.6%) in the younger group, a difference that was not significant (P = .15). CONCLUSIONS The 30-day outcomes of CEA in octogenarians are comparable with those in younger patients. Although the octogenarians had slightly higher mortality than younger patients, the absolute risk of mortality was still low at 1.2%. Therefore, CEA is safe in asymptomatic carotid stenosis in octogenarians. Overall life expectancy and preoperative functional status, rather than age, should be the major determinants in the decision to operate.
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Zhu Z, Jiang S, Li C, Liu J, Tao M. Relationship between serum homocysteine and different menopausal stage. Climacteric 2019; 23:59-64. [PMID: 31294633 DOI: 10.1080/13697137.2019.1634045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to investigate the serum level of homocysteine in menopausal women and to explore the association between menopausal status, blood lipids, and homocysteine concentrations.Methods: The study recruited females aged 40-60 years who were not receiving menopausal hormone therapy. The demographic characteristics and menopausal status of the women were collected in the form of questionnaires. The study analyzed the association between hyperhomocysteinemia and variables using binary logistic stepwise regression.Results: Among 366 enrolled subjects, menopausal status was divided into four stages: premenopause stage (n = 135), menopausal transition stage (n = 91), early postmenopause stage (n = 87), and late postmenopause stage (n = 53). The proportion of hyperhomocysteinemia in the premenopausal stage, menopausal transition stage, and postmenopausal stage was 43%, 26.4%, and 45%, respectively (χ2 = 8.999, p = 0.011). The mean concentration of homocysteine was 9.75 µmol/l. The level of homocysteine was higher in the postmenopause stage than in the other stages (p = 0.043), and the difference between postmenopause and menopausal transition was statistically significant (p < 0.01). In the binary logic analysis, menopausal transition compared with postmenopause (odds ratio = 2.027, 95% confidence interval = 1.117-3.679, p = 0.005).Conclusions: Serum homocysteine levels are associated with menopausal status. Homocysteine concentrations were progressively higher across menopausal stages. The transformation in the female body across the menopause transition stages may cause elevations in the homocysteine level in postmenopausal women.
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Affiliation(s)
- Z Zhu
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - S Jiang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C Li
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - J Liu
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - M Tao
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Siriratnam P, Godfrey A, O'Connor E, Pearce D, Hu CC, Low A, Hair C, Oqueli E, Sharma A, Kraemer T, Sahathevan R. Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective. Intern Med J 2019; 50:698-704. [PMID: 31211881 DOI: 10.1111/imj.14407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/26/2019] [Accepted: 06/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no universally accepted age cut-off for defining young strokes. AIMS We aimed to determine, based on the profile of young stroke patients in our regional centre, an appropriate age cut-off for young strokes. METHODS A retrospective analysis of all ischaemic stroke patients admitted to our centre from 2015 to 2017. We identified 391 ischaemic stroke patients; 30 patients between the ages of ≤50, 40 between 51-60 inclusive and 321 ≥ 61 years of age. We collected data on demographic profiles, risk factors and stroke classification using the Trial of Org 10 172 in Acute Stroke Treatment criteria. RESULTS We found significant differences between the ≤50 and ≥61 age groups for most of the risk factors and similarities between the 51-60 inclusive and ≥ 61 age groups. At least one of the six risk factors assessed in the study was present in 86.7% of the youngest group, 97.5% of the intermediate age group and 97.2% in the oldest group. In terms of the mechanisms of stroke, the youngest and oldest age groups in our study differed in the prevalence of cryptogenic, cardioembolic and other causes of stroke. The middle and older age groups had similar mechanisms of stroke. CONCLUSIONS The prevalence of vascular risk factors and mechanisms of stroke likewise differed significantly across age groups. This study suggests that 50 years is an appropriate age cut-off for defining young strokes and reinforces the importance of primary prevention in all age groups.
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Affiliation(s)
- Pakeeran Siriratnam
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Amelia Godfrey
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Ellie O'Connor
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Dora Pearce
- School of Science, Engineering and Information Technology, Federation University, Ballarat, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Publication and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chih-Chiang Hu
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Ashlea Low
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Casey Hair
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Ernesto Oqueli
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Anand Sharma
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Thomas Kraemer
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ramesh Sahathevan
- Faculty of Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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21
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Xia X, Yue W, Chao B, Li M, Cao L, Wang L, Shen Y, Li X. Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey. J Neurol 2019; 266:1449-1458. [PMID: 30989368 PMCID: PMC6517347 DOI: 10.1007/s00415-019-09281-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The overall global burden of stroke is considerable and increasing. In China, stroke is the leading cause of death and disability. METHODS For this study, we used data from the National Stroke Screening Survey in 2012 and the 2010 Chinese population from sixth National Census of Populations to calculate a standardized (by age, gender, and education) stroke prevalence. Prevalence, risk factors, and management of stroke were compared by gender, age, and site. FINDINGS The standardized prevalence rate of survival stroke patients in study population aged 60 and older was 4.94% in total. Hypertension was the most prevalent risk factor for stroke. Compared to men, women were more likely to have diabetes, obesity, elevated low-density lipoprotein cholesterol (LDL-C), and atrial fibrillation (P < 0.05). Men were far more likely to drink and smoke than women (P < 0.05). The rates of diabetes and atrial fibrillation were substantially higher in urban than those in rural stroke survivors (P < 0.05). Rural stroke survivors exhibited higher rates of smoking and alcohol consumption than urban stroke survivors (P < 0.05). INTERPRETATION The stroke prevalence in China is in line with median worldwide stroke prevalence. Traditional risk factors remain highly prevalent in stroke survivors, among which hypertension was the most common. Stroke prevalence rates and risk factors varied by age, sex, and sociogeological factors.
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Affiliation(s)
- Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Baohua Chao
- Nation Project Office of Stroke Prevention and Control, Beijing, China
| | - Mei Li
- China Stroke Data Center, Beijing, China
| | - Lei Cao
- Nation Project Office of Stroke Prevention and Control, Beijing, China
| | - Lin Wang
- Department of Geratology, The Second Hospital of Tianjin Medical University and Tianjin Geriatric Institute, Tianjin, China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100000, China.
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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22
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Girotra T, Almallouhi E, Al Kasab S, Banerjee C, Turner NL, Debenham E, Holmstedt CA. Functional Outcomes of Intravenous Thrombolysis in Octogenarians and Nonagenarians Through Telestroke: Single-Center Experience. Telemed J E Health 2019; 26:18-23. [PMID: 30807264 DOI: 10.1089/tmj.2018.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients aged ≥80 years are often underrepresented in stroke trials. Observational studies have shown that older patients have worse outcomes compared with younger patients, but outcomes in patients aged ≥80 years treated with intravenous (IV)-alteplase specifically through telestroke (TS) have not been studied. Aim: To compare clinical and safety outcomes in stroke patients aged ≥80 and 60-79 years treated with IV-alteplase via TS. Methods: The Medical University of South Carolina TS database was analyzed to identify IV-alteplase-treated patients aged 60-79 and ≥80 years between January 2015 and March 2018. Baseline demographics and TS-specific variables were compared. Clinical outcomes were assessed using the 90-day modified Rankin Scale (mRS). Safety outcomes were evaluated by comparing symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis was performed to determine odds ratio (OR) for good outcome (mRS 0-2) in the older age group at 90 days. Results: IV-alteplase was used in 151 patients in ≥80 years age group and 273 patients in 60-79 years age group. The older age group had more women and a higher National Institutes of Health Stroke Scale. The mean "ED-door-to-TS-consultant-login" time was shorter (21.6 min vs. 25.6 min; p = 0.048), but "TS-consultant-login-to-alteplase" time was longer (22.1 min vs. 19.3 min; p = 0.01) in the older age group. No difference was noted in eventual "door-to-needle" time. The older age group had fewer good outcomes (39.1% vs. 74%; p = 0.001) and more deaths (38% vs. 14%; p = 0.001) at 90 days. The sICH rates were similar in the two groups. The OR for good outcome in ≥80 years age group was 0.20 (95% CI: 0.12-0.34) after controlling for baseline variables. Conclusions: Stroke patients aged ≥80 years treated via TS have similar post-thrombolysis hemorrhage rates but worse clinical outcomes compared with patients aged 60-79 years.
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Affiliation(s)
- Tarun Girotra
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Sami Al Kasab
- Department of Neurology, University of Iowa, Iowa City, Iowa
| | - Chirantan Banerjee
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nancy L Turner
- Department of Telehealth, Medical University of South Carolina, Charleston, South Carolina
| | - Ellen Debenham
- Department of Telehealth, Medical University of South Carolina, Charleston, South Carolina
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23
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Taylor A, Alakbarzade V, Chandratheva A, Simister R, Scully M. The Importance of the Full Blood Count in Cerebral Ischemia: A Review of 609 Consecutive Young Patients with Stroke and Transient Ischemic Attacks. J Stroke Cerebrovasc Dis 2018; 27:2500-2504. [PMID: 29983229 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/27/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Almost half of ischemic strokes in young individuals are cryptogenic. Thrombophilia testing is routinely sent despite limited evidence linking to arterial cerebrovascular events. A full blood count may identify underlying hematological disorder. METHODS We retrospectively reviewed all patients younger than 60 years with stroke and transient ischemic attack (TIA) presenting to a regional hyperacute stroke unit and daily TIA clinic from January 2015 to August 2016. We examined hematocrit level and platelet count, and whether abnormalities were further investigated. We examined if primary hematological disorders associated with stroke were considered, specifically myeloproliferative diseases (MPDs) and thrombotic thrombocytopenic purpura (TTP). RESULTS Of 609 patients who presented with stroke or TIA, there were 161 abnormalities in hematocrit level or platelet count in 153 patients (25.1%). One hundred sixteen patients had high hematocrit levels (19%), 19 had thrombocytosis (3.1%), 26 had thrombocytopenia (4.3%), and 8 had abnormalities in both lineages (1.3%). A total of 119 patients had repeat testing (74%). Molecular investigations for MPD were warranted in 19 patients (3.1%), performed in 3 patients (.5%) with 2 patients subsequently diagnosed. ADAMTS13 analysis was indicated in 10 patients with thrombocytopenia, performed in 2 patients with 1 diagnosed with TTP thereafter. CONCLUSIONS One quarter of our cohort (n = 153) had abnormalities in hematocrit and/or platelets. MPD or TTP was present in 3 of the 5 patients specifically investigated. At least 22 patients (14%) merited further investigation. Although primary hematological disorders are rare in stroke aetiology, the full blood count is important to exclude known causes of arterial cerebrovascular events in young patients.
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Affiliation(s)
- Alice Taylor
- University College London Hospitals NHS Trust, London, United Kingdom.
| | - Vafa Alakbarzade
- University College London Hospitals NHS Trust, London, United Kingdom
| | | | - Robert Simister
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Marie Scully
- University College London Hospitals NHS Trust, London, United Kingdom
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24
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Perera KS, Sharma M, Connolly SJ, Wang J, Gold MR, Hohnloser SH, Lau CP, Van Gelder IC, Morillo C, Capucci A, Israel CW, Botto G, Healey JS. Stroke type and severity in patients with subclinical atrial fibrillation: An analysis from the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT). Am Heart J 2018; 201:160-163. [PMID: 29764671 DOI: 10.1016/j.ahj.2018.03.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) demonstrated that subclinical atrial fibrillation (SCAF) was associated with a 2.5-fold increased risk of stroke. However, the absolute stroke rate was only 1.7% per year and fewer than 20% patients with stroke had SCAF in the preceding 30 days. This raises the possibility that SCAF is merely a risk marker for stroke rather than the cause. Systematic characterization of stroke subtypes among patients with SCAF would help clarify this issue. METHODS All ischemic strokes that occurred in the ASSERT trial were blindly adjudicated by stroke neurologists, classified as cortical versus subcortical, and subtyped using modified TOAST criteria. Stroke severity was measured using the modified Rankin Score. RESULTS Of the 44 participants who had an ischemic stroke, 14 had SCAF before stroke. Among patients with SCAF who had stroke, 57% of strokes (n = 8) were judged to be cardioembolic, 36% to be lacunar (n = 5), and 7% (n = 1) to be large artery disease. However, of 5 patients who had SCAF detected within 30 days before their index stroke, 4 patients had a cardioembolic stroke. The average duration of SCAF in these 4 patients was 6.0 ± 6.1 h/d. The modified Rankin score at 30 days was similar between patients with (2.7 ± 2.3) and without SCAF (2.3 ± 2.0; P = .68). CONCLUSIONS In patients with SCAF and stroke, SCAF seems probably causal in many cases; however, in more than 40%, it seems to be acting only as a risk marker.
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25
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Selvik HA, Bjerkreim AT, Thomassen L, Waje-Andreassen U, Naess H, Kvistad CE. When to Screen Ischaemic Stroke Patients for Cancer. Cerebrovasc Dis 2018; 45:42-47. [PMID: 29402826 DOI: 10.1159/000484668] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. METHODS All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients' medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes' theorem was used to calculate post-test probabilities of active cancer. RESULTS Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1-1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5-0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2-4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1-3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65-0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. CONCLUSIONS Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.
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Affiliation(s)
- Henriette Aurora Selvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anna Therese Bjerkreim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Ulrike Waje-Andreassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Halvor Naess
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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26
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Lanthier S, Saposnik G, Lebovic G, Pope K, Selchen D, Moore DF, Selchen D, Boulanger JM, Buck B, Butcher K, del Campo M, Gosselin S, Hachinski V, Hill MD, Mackey A, Mehdiratta M, Spence JD, Stotts G, Swartz R, West ML, Yegappan C. Prevalence of Fabry Disease and Outcomes in Young Canadian Patients With Cryptogenic Ischemic Cerebrovascular Events. Stroke 2017; 48:1766-1772. [DOI: 10.1161/strokeaha.116.016083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Previous studies reported Fabry disease in 0% to 4% of young patients with cryptogenic ischemic stroke (IS). We sought to determine the prevalence of Fabry and outcomes among young Canadians with cryptogenic IS or transient ischemic attack (TIA).
Methods—
We prospectively enrolled individuals aged 18 to 55 with IS or speech or motor TIA, and no cause identified despite predetermined investigation.
α-galactosidase-A
gene was sequenced for Fabry diagnosis. National Institutes of Health Stroke Scale score was measured at presentation to quantify stroke severity. Modified Rankin Scale determined functional outcomes ≤7 days after presentation and 6 months later.
Results—
We enrolled 365 patients with IS and 32 with TIA.
α-galactosidase-A
sequencing identified a single carrier of a genetic variant of unknown significance (p.R118C) and no well-recognized pathogenic variants. Mean National Institutes of Health Stroke Scale score was 3.1. Proportion of patients with modified Rankin Scale of 0 to 2 was 70.7% at ≤7 days and 87.4% at 6 months. National Institutes of Health Stroke Scale score at presentation and diabetes mellitus predicted 6-month modified Rankin Scale. Thirteen patients experienced 5 recurrent IS and 9 TIA during follow-up. No patient died. Most patients (98.7%) returned home. Among previous workers, 43% had residual working limitations.
Conclusions—
In this Canadian cohort of patients with cryptogenic IS or TIA, the prevalence of Fabry was 0.3% if p.R118C variant is considered as pathogenic. This suggests that more cost-effective methods should be applied for diagnosis of Fabry rather than systematic genetic screening in this population. Overall, cryptogenic IS in young adults is associated with favorable outcomes.
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Affiliation(s)
- Sylvain Lanthier
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
| | - Gustavo Saposnik
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
| | - Gerald Lebovic
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
| | - Karen Pope
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
| | - Daniel Selchen
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
| | - David F. Moore
- From the Division of Neurology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Quebec, Canada (S.L.); Department of Neurosciences, Faculty of Medicine, University of Montreal, Quebec, Canada (S.L.); Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine (G.S., D.S.), Department of Health Policy, Management and Evaluation (G.S.), Applied Health Research Centre (G.L., K.P.), St. Michael’s Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and
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27
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Risk Factors and Etiology of Young Ischemic Stroke Patients in Estonia. Stroke Res Treat 2017; 2017:8075697. [PMID: 28702271 PMCID: PMC5494103 DOI: 10.1155/2017/8075697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/06/2017] [Accepted: 05/16/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives Reports on young patients with ischemic stroke from Eastern Europe have been scarce. This study aimed to assess risk factors and etiology of first-ever and recurrent stroke among young Estonian patients. Methods We performed a retrospective study of consecutive ischemic stroke patients aged 18–54 years who were treated in our two hospitals from 2003 to 2012. Results We identified 741 patients with first-ever stroke and 96 patients with recurrent stroke. Among first-time patients, men predominated in all age groups. The prevalence of well-documented risk factors in first-time stroke patients was 83% and in the recurrent group 91%. The most frequent risk factors were hypertension (53%), dyslipidemia (46%), and smoking (35%). Recurrent stroke patients had fewer less well-documented risk factors compared to first-time stroke patients (19.8 versus 30.0%, P = 0.036). Atrial fibrillation was the most common cause of cardioembolic strokes (48%) and large-artery atherosclerosis (LAA) was the cause in 8% among those aged <35 years. Compared to first-time strokes, recurrent ones were more frequently caused by LAA (14.3 versus 24.0%, P = 0.01) and less often by other definite etiology (8.5 versus 1.0%, P = 0.01). Conclusions The prevalence of vascular risk factors among Estonian young stroke patients is high. Premature atherosclerosis is a cause in a substantial part of very young stroke patients.
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28
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Heo SH, Bushnell CD. Factors Influencing Decision Making for Carotid Endarterectomy versus Stenting in the Very Elderly. Front Neurol 2017; 8:220. [PMID: 28603515 PMCID: PMC5445117 DOI: 10.3389/fneur.2017.00220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/08/2017] [Indexed: 12/29/2022] Open
Abstract
As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention. When it comes to age, the patients older than 80 years were excluded or stratified to a high risk group in previous landmark trials. However, a recent guideline recommended that endarterectomy may be associated with lower stroke risk compared with carotid artery stenting in patients older than 70 years with symptomatic carotid disease. The annual risk of stroke in individuals with asymptomatic carotid stenosis is about 1-3% but the risk is about 4-12% with symptomatic stenosis without carotid intervention. Although the outcome of CAE is better than that of carotid stenting in patients older than 70 years, the perioperative risk is higher in older patients. Therefore, it is important to classify high risk patients and consider underlying disability and life expectancy of very elderly patients before deciding whether to undergo a carotid intervention. In addition, we should also consider that the stroke rate with intensive medical treatment is unknown and is currently being investigated in randomized controlled trials. Intensive medical treatment includes high intensity statins, diabetes and blood pressure control, and aggressive antiplatelet treatment. The aim of this review is to report the factors that may be responsible for the variability in the treatment of carotid stenosis, particularly in the elderly population. This will allow the readers to integrate the current available evidence to individualize the treatment of carotid stenosis in this challenging population.
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Affiliation(s)
- Sung Hyuk Heo
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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29
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Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, Kloss M, Grond-Ginsbach C, Majersik JJ, Worrall BB, Leys D, Baumgartner R, Caso V, Béjot Y, Compter A, Reiner P, Thijs V, Southerland AM, Bersano A, Brandt T, Gensicke H, Touzé E, Martin JJ, Chabriat H, Tatlisumak T, Lyrer P, Arnold M, Engelter ST. Cervical artery dissection in patients ≥60 years. Neurology 2017; 88:1313-1320. [DOI: 10.1212/wnl.0000000000003788] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.Methods:We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.Results:Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33–0.66]), headache (ORadjusted 0.58 [0.42–0.79]), mechanical trigger events (ORadjusted 0.53 [0.36–0.77]), and migraine (ORadjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1–2.10]) and hypertension (ORadjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]).Conclusion:In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
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30
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Aoki J, Kimura K, Morita N, Harada M, Metoki N, Tateishi Y, Todo K, Yamagami H, Hayashi K, Terasawa Y, Fujita K, Yamamoto N, Deguchi I, Tanahashi N, Inoue T, Iwanaga T, Kaneko N, Mitsumura H, Iguchi Y, Ueno Y, Kuramoto Y, Ogata T, Fujimoto S, Yokoyama M, Nagahiro S. YAMATO Study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy). Stroke 2017; 48:712-719. [DOI: 10.1161/strokeaha.116.015042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We investigated whether administration of edaravone, a free radical scavenger, before or during tissue-type plasminogen activator (tPA) can enhance early recanalization in a major arterial occlusion.
Methods—
The YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy) is an investigator-initiated, multicenter (17 hospitals in Japan), prospective, randomized, and open-label study. Patients with stroke secondary to occlusion of the M1 or M2 portion of the middle cerebral artery and within 4.5 hours of the onset were studied. The subjects were randomly allocated to the early group (intravenous edaravone [30 mg] was started before or during tPA) and the late group (edaravone was started after tPA and the assessment of early recanalization).
Results—
One-hundred sixty-five patients (96 men; median age [interquartile range], of 78 [69–85] years) were randomized 1:1 to either the early group (82 patients) or the late group (83 patients). Primary outcome, defined as an early recanalization 1.5 hour after tPA, was observed in 53% of the early group and in 53% of the late group (
P
=1.000). About secondary outcomes, the rate of significant recanalization of ≥50% was not different between the 2 groups (28% versus 34%;
P
=0.393). The symptomatic intracerebral hemorrhage has occurred in 4 patients (5%) in the early group and in 2 patients (2%) in the late group (
P
=0.443). The favorable outcome (modified Rankin Scale score of 0–2) at 3 months was also similar between the groups (53% versus 57%;
P
=0.738).
Conclusions—
The timing of edaravone infusion does not affect the rate of early recanalization, symptomatic intracerebral hemorrhage, or favorable outcome after tPA therapy.
Clinical Trial Registration—
URL:
http://www.umin.ac.jp/ctr/index-j.htm
. Unique identifier: UMIN000006330.
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Affiliation(s)
- Junya Aoki
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kazumi Kimura
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Naomi Morita
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Masafumi Harada
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Norifumi Metoki
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yohei Tateishi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kenichi Todo
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Hiroshi Yamagami
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Kouji Hayashi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yuka Terasawa
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Koji Fujita
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Nobuaki Yamamoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Ichiro Deguchi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Norio Tanahashi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Takeshi Inoue
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Takeshi Iwanaga
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Nobuyuki Kaneko
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Hidetaka Mitsumura
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yasuyuki Iguchi
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yasushi Ueno
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Yoji Kuramoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Toshiyasu Ogata
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Shigeru Fujimoto
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Mutsumi Yokoyama
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
| | - Shinji Nagahiro
- From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and
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Novotny V, Thomassen L, Waje-Andreassen U, Naess H. Acute cerebral infarcts in multiple arterial territories associated with cardioembolism. Acta Neurol Scand 2017; 135:346-351. [PMID: 27109593 DOI: 10.1111/ane.12606] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES It is generally believed that cardioembolism is the main cause of multiple acute cerebral infarcts (MACI). However, there are surprisingly few DWI studies and results are conflicting. Based on a large prospective study we hypothesized that MACI are associated with cardioembolism. MATERIALS AND METHODS We studied 2697 patients with acute cerebral infarcts between February 2006 and October 2013 who were prospectively registered in The Bergen NORSTROKE Registry. Among them, 2220 (82.3%) patients underwent magnetic resonance imaging (MRI) and 2125 (96%) of these 2220 patients had DWI lesions. Only patients with DWI lesions were included. MACI were defined as at least two DWI lesions in at least two different arterial territories. RESULTS MACI were detected in 187/2125 (8.8%) patients with DWI lesions. MACI patients were older and more often females. MACI were associated with cardioembolism (P = 0.042), especially atrial fibrillation (P = 0.002). Other associations were symptomatic internal carotid artery (ICA) stenosis (P = 0.014), asymptomatic ICA stenosis (P = 0.036), and higher NIHSS score on admission (P < 0.001). Among patients with no cardioembolism, 34 (35%) with MACI had symptomatic ICA stenosis versus 268 (25.0%) with non-MACI (P = 0.037); 20 (20%) with MACI had asymptomatic ICA stenosis versus 134 (13%) with non-MACI (P = 0.031). In the logistic regression analysis, cardiac embolism and symptomatic ICA stenosis were independently associated with MACI. CONCLUSIONS Acute cerebral infarcts in more than one arterial territory occur among almost 10% of the patients and are associated with cardioembolism.
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Affiliation(s)
- V. Novotny
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - L. Thomassen
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | | | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Centre for age-related medicine; Stavanger University Hospital; Stavanger Norway
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Osei E, Fonville S, Zandbergen AAM, Koudstaal PJ, Dippel DWJ, den Hertog HM. Glucose in prediabetic and diabetic range and outcome after stroke. Acta Neurol Scand 2017; 135:170-175. [PMID: 26918555 DOI: 10.1111/ane.12577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Newly diagnosed disturbed glucose metabolism is highly prevalent in patients with stroke. Limited data are available on their prognostic value on outcome after stroke. We aimed to assess the association of glucose in the prediabetic and diabetic range with unfavourable short-term outcome after stroke. MATERIALS AND METHODS We included 839 consecutive patients with ischemic stroke and 168 patients with intracerebral haemorrhage. In all nondiabetic patients, fasting glucose levels were determined on day 2-4. Prediabetic range was defined as fasting glucose of 5.6-6.9 mmol/L, diabetic range as ≥7.0 mmol/L, pre-existent diabetes as the use of anti-diabetic medication prior to admission. Outcome measures were poor functional outcome or death defined as modified Rankin Scale (mRS) score >2 and discharge not to home. The association of prediabetic range, diabetic range and pre-existent diabetes (versus normal glucose) with unfavourable outcome was expressed as odds ratios, estimated with multiple logistic regression, with adjustment for prognostic factors. RESULTS Compared with normal glucose, prediabetic range (aOR 1.8; 95%CI 1.1-2.8), diabetic range (aOR 2.5; 95%CI 1.3-4.9) and pre-existent diabetes (aOR 2.6; 95%CI 1.6-4.0) were associated with poor functional outcome or death. Patients in the prediabetic range (aOR 0.6; 95%CI 0.4-0.9), diabetic range (aOR 0.4; 95%CI 0.2-0.9) and pre-existent diabetes (aOR 0.6; 95%CI 0.4-0.9) were more likely not to be discharged to home. CONCLUSIONS Patients with glucose in the prediabetic and diabetic range have an increased risk of unfavourable short-term outcome after stroke. These findings illustrate the potential impact of early detection and treatment of these patients.
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Affiliation(s)
- E. Osei
- Neurology; Medisch Spectrum Twente; Enschede Overijssel Netherlands
| | - S. Fonville
- Erasmus MC; Rotterdam Zuid-Holland Netherlands
| | | | | | | | - H. M. den Hertog
- Neurology; Medisch Spectrum Twente; Enschede Overijssel Netherlands
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Katsanos AH, Bhole R, Frogoudaki A, Giannopoulos S, Goyal N, Vrettou AR, Ikonomidis I, Paraskevaidis I, Pappas K, Parissis J, Kyritsis AP, Alexandrov AW, Triantafyllou N, Malkoff MD, Voumvourakis K, Alexandrov AV, Tsivgoulis G. The value of transesophageal echocardiography for embolic strokes of undetermined source. Neurology 2016; 87:988-95. [PMID: 27488602 DOI: 10.1212/wnl.0000000000003063] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/18/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate the diagnostic yield of transesophageal echocardiography (TEE) in consecutive patients with ischemic stroke (IS) fulfilling the diagnostic criteria of embolic strokes of undetermined source (ESUS). METHODS We prospectively evaluated consecutive patients with acute IS satisfying ESUS criteria who underwent in-hospital TEE examination in 3 tertiary care stroke centers during a 12-month period. We also performed a systematic review and meta-analysis estimating the cumulative effect of TEE findings on therapeutic management for secondary stroke prevention among different IS subgroups. RESULTS We identified 61 patients with ESUS who underwent investigation with TEE (mean age 44 ± 12 years, 49% men, median NIH Stroke Scale score = 5 points [interquartile range: 3-8]). TEE revealed additional findings in 52% (95% confidence interval [CI]: 40%-65%) of the study population. TEE findings changed management (initiation of anticoagulation therapy, administration of IV antibiotic therapy, and patent foramen ovale closure) in 10 (16% [95% CI: 9%-28%]) patients. The pooled rate of reported anticoagulation therapy attributed to abnormal TEE findings among 3,562 acute IS patients included in the meta-analysis (12 studies) was 8.7% (95% CI: 7.3%-10.4%). In subgroup analysis, the rates of initiation of anticoagulation therapy on the basis of TEE investigation did not differ (p = 0.315) among patients with cryptogenic stroke (6.9% [95% CI: 4.9%-9.6%]), ESUS (8.1% [95% CI: 3.4%-18.1%]), and IS (9.4% [95% CI: 7.5%-11.8%]). CONCLUSIONS Abnormal TEE findings may decisively affect the selection of appropriate therapeutic strategy in approximately 1 of 7 patients with ESUS.
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Affiliation(s)
- Aristeidis H Katsanos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Rohini Bhole
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Alexandra Frogoudaki
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Sotirios Giannopoulos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Nitin Goyal
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Agathi-Rosa Vrettou
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Ignatios Ikonomidis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Ioannis Paraskevaidis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Konstantinos Pappas
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - John Parissis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Athanassios P Kyritsis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Anne W Alexandrov
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Nikos Triantafyllou
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Marc D Malkoff
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Konstantinos Voumvourakis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Andrei V Alexandrov
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic
| | - Georgios Tsivgoulis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic.
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Tsai TY, Li CY, Livneh H, Lin IH, Lu MC, Yeh CC. Decreased risk of stroke in patients receiving traditional Chinese medicine for vertigo: A population-based cohort study. JOURNAL OF ETHNOPHARMACOLOGY 2016; 184:138-143. [PMID: 26969404 DOI: 10.1016/j.jep.2016.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Patients with vertigo are reported to exhibit a higher risk of subsequent stroke. However, it remains unclear if Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of stroke for these patients. So the aim of the study was to investigate the effects of TCM on stroke risk among patients with vertigo. MATERIALS AND METHODS This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 112,458 newly diagnosed vertigo patients aged ≥20 years who received treatment between 1998 and 2007. Among these patients, 53,203 (47.31%) received TCM after vertigo onset (TCM users), and the remaining 59,201 patients were designated as a control group (non-TCM users). All enrollees received follow-up until the end of 2012 to measure stroke incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of stroke in recipients of TCM services. RESULTS During 15-year follow-up, 5532 TCM users and 12,295 non-TCM users developed stroke, representing an incidence rate of 13.10% and 25.71% per 1000 person-years. TCM users had a significantly reduced risk of stroke compared to non-TCM users (adjusted HR=0.64; 95% confidence interval CI=0.59-0.74). The predominant effect was observed for those receiving TCM for more than 180 days (adjusted HR=0.52; 95% CI=0.49-0.56). Commonly used TCM formulae, including Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Ling-Gui-Zhu-Gan-Tang, Bai Zhi (Angelica dahurica (Hoffm.) Benth. & Hook.f. ex Franch. & Sav., root), Ge Gen (Pueraria lobata (Willd.) Ohwi, root) and Hai Piao Xiao (Endoconcha Sepiae, Cuttlefish Bone) were significantly associated with lower risk of stroke. CONCLUSIONS Results of this population-based study support the effects of TCM on reducing stroke risk, and may provide a reference for stroke prevention strategies. The study results may also help to integrate TCM into clinical intervention programs that provide a favorable prognosis for vertigo patients.
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Affiliation(s)
- Tzung-Yi Tsai
- Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Nursing, Tzu Chi College of Technology, 880 Chien-Kuo Road Section 2, Hualien 97004, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Public Health, College of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR 97207-0751, USA
| | - I-Hsin Lin
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan
| | - Chia-Chou Yeh
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan; Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan.
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Abstract
The burden of stroke is increasing due to aging population and unhealthy lifestyle habits. The considerable rise in atrial fibrillation (AF) is due to greater diffusion of risk factors and screening programs. The link between AF and ischemic stroke is strong. The subtype most commonly associated with AF is cardioembolic stroke, which is particularly severe and shows the highest rates of mortality and permanent disability. A trend toward a higher prevalence of cardioembolic stroke in high-income countries is probably due to the greater diffusion of AF and the control of atherosclerotic of risk factors.
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Affiliation(s)
- Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Cindy Tiseo
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Diana Degan
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
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Nacu A, Fromm A, Sand KM, Waje‐Andreassen U, Thomassen L, Naess H. Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study. Acta Neurol Scand 2016; 133:202-7. [PMID: 26032994 PMCID: PMC4744685 DOI: 10.1111/ane.12446] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Age dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population. MATERIALS AND METHODS Patients aged 15-100 years consecutively admitted to our neurovascular centre with acute ischaemic stroke between 2006 and 2012 were included. The study population was categorized as young (15-49 years), middle-aged (50-74 years) or elderly (≥ 75 years). Stroke aetiology was defined by TOAST criteria. Risk factors and history of cardiovascular disease were recorded. RESULTS In total, 2484 patients with acute cerebral infarction were included: 1418 were males (57.3%). Mean age was 70.8 years (SD ± 14.9), 228 patients were young, 1126 middle-aged, and 1130 were elderly. The proportion of large-artery atherosclerosis and of small-vessel occlusion was highest among middle-aged patients. The proportion of cardioembolism was high at all ages, especially among the elderly. The proportion of stroke of other determined cause was highest among young patients. Some risk factors (diabetes mellitus, active smoking, angina pectoris, prior stroke and peripheral artery disease) decreased among the elderly. The proportions of several potential causes increased with age. CONCLUSION The proportion of stroke subtypes and vascular risk factors are age dependent. Age 50-74 years constitutes the period in life where cardiovascular risk factors become manifest and stroke subtypes change.
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Affiliation(s)
- A. Nacu
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - A. Fromm
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - K. M. Sand
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - U. Waje‐Andreassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
| | - L. Thomassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - H. Naess
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
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