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Ozawa T, Fujimoto S, Aoki J, Matsuzono K, Kimura K. Persistent High Pulse Pressure in Acute Non-Cardiogenic Ischemic Stroke as a Predictor of Neurological Deterioration and Recurrence of Ischemic Stroke: ADS Post-Hoc Analysis. J Atheroscler Thromb 2023; 30:1703-1714. [PMID: 37081614 PMCID: PMC10627765 DOI: 10.5551/jat.64079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
AIM Studies investigating the relationship between pulse pressure (PP) and prognosis in acute ischemic stroke remain limited. Thus, in this study, we aim to determine whether changes in PP in the early phase of ischemic stroke are associated with neurological deterioration or stroke recurrence. METHODS Patients who participated in the Acute Aspirin Plus Cilostazol Dual Therapy for Non-cardiogenic Stroke Patients Within 48 Hours of Symptom Onset (ADS) trial were included in this study. We then divided the patients into four groups (low-low, low-high, high-low, high-high) according to low or high PP both on admission and 24 h after admission. The threshold PP calculated by receiver operating characteristic curve analysis of PP on admission for neurological deterioration within 14 days and recurrent ischemic stroke/transient ischemic attack (TIA) within 3 months was 69 mmHg. RESULTS Neurological deterioration within 14 days was observed in 118 patients (10.6%), whereas recurrent ischemic stroke/TIA within 3 months was noted in 34 patients (3.2%). Among these four groups, both neurological deterioration within 14 days (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.12-3.91; p=0.0209) and recurrent ischemic stroke/TIA within 3 months (OR 4.80; 95% CI 1.62-14.86; p=0.0064) were significantly more frequent in the high-high group than in the low-low group as per the results of our multivariate analysis. In addition, neurological deterioration within 14 days was significantly higher in the high-low group than that in the low-low group (OR 2.70; 95% CI 1.44-5.05; p=0.0019). CONCLUSIONS High PP during the acute phase of ischemic stroke appears to be associated with ischemic stroke recurrence and neurological deterioration, particularly if PP is elevated both on admission and 24 h later after admission.
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Affiliation(s)
- Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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2
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Gao L, Li Z, Yuan Z, Yi X, Li J, Cui C, Chen N, He L. Major intracranial arterial stenosis influence association between baseline blood pressure and clinical outcomes after thrombolysis in ischemic stroke patients. Brain Behav 2023; 13:e3022. [PMID: 37218397 PMCID: PMC10275514 DOI: 10.1002/brb3.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between baseline blood pressure (BP) and clinical outcomes after thrombolysis for acute ischemic stroke (AIS) in different intracranial arterial stenosis subgroups. METHODS AIS patients from multicenter with intravenous thrombolysis were retrospectively enrolled from January 2013 to December 2021. We categorized participants into severe (≥ 70%) and nonsevere (< 70%) stenosis of major intracranial arteries subgroups. The primary outcome was unfavorable functional outcome defined as 3-month modified Rankin Scale (mRS) ≥2. The association coefficients between baseline BP and functional outcomes were estimated in general linear regression model. The interactive effect was tested to determine the influence of intracranial arterial stenosis on the association between BP and clinical outcomes. RESULTS A total of 329 patients were included. Severe subgroup was detected in 151 patients with average age of 70.5. Association between baseline diastolic BP (DBP) and unfavorable functional outcome in intracranial artery stenosis subgroups was significantly different (p for interaction < .05). In nonsevere subgroup, higher baseline DBP was associated with higher risk of unfavorable outcome (OR 1.11, 95% CI 1.03 to 1.20, p = .009) compared with severe subgroup (OR 1.02, 95% CI 0.97 to 1.08, p = .341). Besides, intracranial artery stenosis also modified association between baseline systolic BP (SBP) and 3-month death (p for interaction < .05). In severe subgroup, higher baseline SBP was associated with decreased 3-month death risk (OR 0.88, 95% CI 0.78 to 1, p = .044) compared with nonsevere subgroup (OR 1, 95% CI 0.93 to 1.07, p = .908). CONCLUSIONS The major intracranial artery state modulates association between baseline BP and 3-month clinical outcomes after intravenous thrombolysis.
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Affiliation(s)
- Lijie Gao
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Zuoxiao Li
- Department of NeurologyAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Zhengzhou Yuan
- Department of NeurologyAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Xingyang Yi
- Department of NeurologyPeople's Hospital of Deyang CityDeyangChina
| | - Jie Li
- Department of NeurologyPeople's Hospital of Deyang CityDeyangChina
| | - Chaohua Cui
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Ning Chen
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Li He
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
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3
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Yan S, Sha S, Li S, Wang D, Jia Y. Association between hypertension and stroke in US adults in the National Health and Nutrition Examination Surveys (NHANES) 2007 to 2018. Postgrad Med 2023; 135:187-194. [PMID: 36260517 DOI: 10.1080/00325481.2022.2138470] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hypertension is associated with stroke events. The purpose of this study was to analyze the correlation between hypertension and stroke in American adults from 2007 to 2018 in National health and Nutrition Examination Survey (NHANES) database. METHODS 28528 individuals in the NHANES from 2007 to 2018 were included in the cross-sectional analysis. The independent variable was blood pressure (BP) and the outcome variable was stroke. Multivariate linear regression model was used to study the correlation between BP and stroke. RESULTS In each multivariate linear regression model, BP level was positively correlated with stroke, and this positive correlation was stable in both men and women (man OR: 1.36, 95% CI: 0.95 to 1.69; woman OR: 1.45, 95% CI: 1.12 to 1.78). CONCLUSION Our results show that there is a significant positive correlation between BP and stroke. When the systolic blood pressure (SBP) is about 140 mmHg, the risk of stroke is the lowest; Male patients with diastolic blood pressure (DBP) of about 80 mmHg have a lower risk of stroke.
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Affiliation(s)
- Shaoyi Yan
- Department of Cardiovascular, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuo Sha
- Department of Cardiovascular, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Senjie Li
- Department of Cardiovascular, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Di Wang
- Department of Cardiovascular, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongping Jia
- Department of Cardiovascular, the First Hospital of Shanxi Medical University, Taiyuan, China
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4
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Li X, Wang F, Zhao Z, Sun C, Liao J, Li X, Huang C, Nyame L, Zhao Z, Zheng X, Zhou J, Li M, Zou J. A SCANO Nomogram for Individualized Prediction of the Probability of 1-Year Unfavorable Outcomes in Chinese Acute Ischemic Stroke Patients. Front Neurol 2020; 11:531. [PMID: 32695060 PMCID: PMC7338753 DOI: 10.3389/fneur.2020.00531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose: Accurate prediction of functional outcomes after stroke would provide evidence for reasonable poststroke management. This study aimed to develop and validate a nomogram for individualized prediction of 1-year unfavorable outcomes in Chinese acute ischemic stroke (AIS) patients. Methods: We gathered AIS patients at the National Advanced Stroke Center of Nanjing First Hospital (China) between August 2014 and May 2017 within 12 h of symptom onset. The outcome measure was 1-year unfavorable outcomes (modified Rankin Scale 3–6). The patients were randomly stratified into the training (66.7%) and testing (33.3%) sets. With the training data, pre-established predictors were entered into a logistic regression model to generate the nomogram. Predictive performance of the nomogram model was evaluated in the testing data by calculating the area under the receiver operating characteristic curve (AUC-ROC), Brier score, and a calibration plot. Results: A total of 807 patients were included into this study, and 262 (32.5%) of them had unfavorable outcomes. Systolic blood pressure, Creatinine, Age, National Institutes of Health Stroke Scale (NIHSS) score on admission, and fasting blood glucose were significantly associated with unfavorable outcomes and entered into the SCANO nomogram. The AUC-ROC of the SCANO nomogram in the testing set was 0.781 (Brier score: 0.166; calibration slope: 0.936; calibration intercept: 0.060). Conclusions: The SCANO nomogram is developed and validated in Chinese AIS patients to firstly predict 1-year unfavorable outcomes, which is simple and convenient for the management of stroke patients.
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Affiliation(s)
- Xiang Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fusang Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chao Sun
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Liao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuemei Li
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chaoping Huang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Linda Nyame
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zheng Zhao
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaohan Zheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ming Li
- College of Life Science and Technology, China Pharmaceutical University, Nanjing, China
- *Correspondence: Jianjun Zou
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Ming Li
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6
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AlHarfany H, Haidar L, Cherri S, Malaeb D, Salameh P, Hosseini H. Assessment of acute treatment of hypertension in ischemic stroke patients. Clin Neurol Neurosurg 2020; 195:105949. [PMID: 32505063 DOI: 10.1016/j.clineuro.2020.105949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Stroke, the most common neurologic disorder and the major cause of disability and death after heart disease causing 11.8% of the total deaths worldwide, is defined as a rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 h. This study aims to assess appropriateness of hypertension treatment in acute stroke and its adherence with the choice of medications tailored according to blood pressure readings. PATIENTS AND METHODS This was a pilot study performed in Lebanese hospitals where medical records of ischemic stroke patients were used to collect required data. The study enrolled ischemic stroke patients older than 18 years of age, admitted to intensive care unit or internal medicine department. Patients with hemorrhagic stroke were excluded. Statistical analysis was done using IBM Statistical Package for the Social Science software. The significance level is p-value ≤ 0.05. RESULTS A total of 146 patients (56.8% females; mean age 76.6 ± 11.9) were included in the analysis. At baseline, patients had a mean ± standard deviation (SD) SBP of 160.6 (±31.3) and a mean DBP of 85.5. Labetalol and amlodipine were administered to patients with significantly higher baseline blood pressure (p < 0.001). Change in SBP from baseline after 2 h of drug administration was significantly higher with labetalol (p = 0.028 for patients eligible for reperfusion), amlodipine (p = 0.014), and nitroglycerine (p = 0.044). As for the change in SBP after 24 h, it was significantly higher with labetalol just for patients not eligible for reperfusion (p < 0.001), and amlodipine (p = 0.006). As for the change in DBP, it was significantly lower after 24 h on labetalol administration for patients not eligible for reperfusion (p < 0.001) and it was also lower 2 h after administration of ramipril (p = 0.001) and 24 h (p = 0.021). CONCLUSION This study reveals the gap between American Stroke Association guideline recommendations and the clinical practice and states the impact of such a difference on patients' health.
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Affiliation(s)
- Hiba AlHarfany
- School of Pharmacy, Lebanese International University, Mouseitbeh, PO Box: 146404, Beirut, Lebanon.
| | - Lara Haidar
- School of Pharmacy, Lebanese International University, Mouseitbeh, PO Box: 146404, Beirut, Lebanon.
| | - Sarah Cherri
- School of Pharmacy, Lebanese International University, Mouseitbeh, PO Box: 146404, Beirut, Lebanon.
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Mouseitbeh, PO Box: 146404, Beirut, Lebanon; Life Sciences and Health Department, Paris-Est University, Paris, France.
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon; Faculty of Pharmacy, Lebanese University, Hadath, Lebanon; Faculty of Medicine, Lebanese University, Hadath, Lebanon.
| | - Hassan Hosseini
- Life Sciences and Health Department, Paris-Est University, Paris, France; Henri Mondor Hospital, Paris, France.
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7
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Torres-Aguila NP, Carrera C, Muiño E, Cullell N, Cárcel-Márquez J, Gallego-Fabrega C, González-Sánchez J, Bustamante A, Delgado P, Ibañez L, Heitsch L, Krupinski J, Montaner J, Martí-Fàbregas J, Cruchaga C, Lee JM, Fernandez-Cadenas I. Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review. J Stroke 2019; 21:276-289. [PMID: 31590472 PMCID: PMC6780022 DOI: 10.5853/jos.2019.01522] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022] Open
Abstract
Stroke is a complex disease and one of the main causes of morbidity and mortality among the adult population. A huge variety of factors is known to influence patient outcome, including demographic variables, comorbidities or genetics. In this review, we expound what is known about the influence of clinical variables and related genetic risk factors on ischemic stroke outcome, focusing on acute and subacute outcome (within 24 to 48 hours after stroke and until day 10, respectively), as they are the first indicators of stroke damage. We searched the PubMed data base for articles that investigated the interaction between clinical variables or genetic factors and acute or subacute stroke outcome. A total of 61 studies were finally included in this review. Regarding the data collected, the variables consistently associated with acute stroke outcome are: glucose levels, blood pressure, presence of atrial fibrillation, prior statin treatment, stroke severity, type of acute treatment performed, severe neurological complications, leukocyte levels, and genetic risk factors. Further research and international efforts are required in this field, which should include genome-wide association studies.
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Affiliation(s)
- Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Caty Carrera
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jonathan González-Sánchez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura Heitsch
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jerzy Krupinski
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Joan Montaner
- Department of Neurology, Virgin Rocío and Macarena Hospitals, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Saint Cross and Saint Pau Hospital, Barcelona, Spain
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
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8
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Wang Y, Liang H, Luo Y, Zhou Y, Jin L, Wang S, Bi Y. History of Hypertension Is Associated With MR Hypoperfusion in Chinese Inpatients With DWI-Negative TIA. Front Neurol 2019; 10:867. [PMID: 31474927 PMCID: PMC6702658 DOI: 10.3389/fneur.2019.00867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/26/2019] [Indexed: 12/28/2022] Open
Abstract
Objectives: The present study aimed to examine the prevalence of and risk factors for magnetic resonance (MR) perfusion abnormality in a Chinese population with transient ischemic attack (TIA) and normal diffusion-weighted imaging (DWI) findings. Methods: Patients with TIA admitted to our stroke center between January 2015 and October 2017 were recruited to the present study. MRI, including both DWI and perfusion-weighted imaging (PWI), was performed within 7 days of symptom onset. Time to maximum of the residue function (Tmax) maps were evaluated using the RAPID software (Ischemaview USA, Version 4.9) to determine hypoperfusion. Multivariate analysis was used to assess perfusion findings, clinical variables, medical history, cardio-metabolic, and the ABCD2 scores (age, blood pressure, clinical features, symptom duration, and diabetes). Results: Fifty-nine patients met the inclusion criteria. The prevalence of MR perfusion Tmax ≥ 4 s ≥ 0 ml and ≥ 10 mL were 72.9% (43/59) and 42.4% (25/59), respectively. Multivariate analyses revealed that history of hypertension is an independent factor associated with MR perfusion abnormality (Tmax ≥ 4 s ≥ 10 mL) for Chinese patients with TIA (P = 0.033, adjusted OR = 4.11, 95% CI = 1.12–15.11). Proximal artery stenosis (>50%) tended to lead to a larger PW lesion on MRI (p = 0.067, adjusted OR = 3.60, 95% CI = 0.91–14.20). Conclusion: Our results suggest that the prevalence of perfusion abnormality is high as assessed by RAPID using the parametric Tmax ≥ 4 s. History of hypertension is a strong predictor of focal perfusion abnormality as calculated by RAPID on Tmax map of TIA patients with negative DWI findings.
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Affiliation(s)
- Yue Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Huazheng Liang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yu Luo
- Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Radiology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yuan Zhou
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Shaoshi Wang
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Yong Bi
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.,Department of Neurology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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9
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Li Y, Zhong Z, Luo S, Han X, Liang Y, Huang G, Zhou W, Ding Q, Huang Y, Wu Z. Efficacy of Antihypertensive Therapy in the Acute Stage of Cerebral Infarction - A Prospective, Randomized Control Trial. ACTA CARDIOLOGICA SINICA 2018; 34:502-510. [PMID: 30449991 DOI: 10.6515/acs.201811_34(6).20180622b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background This study investigated whether patients in the acute stage of cerebral infarction (ACI) might benefit from single-drug antihypertensive therapy (AT) without the use of preset target levels. Methods A total of 320 ACI patients were randomly divided into an AT group and a control group (group C) (160 patients in each group). The AT group received single antihypertensive drug treatment after the first 48 hours of onset with 5 mg of amlodipine besylate or 150 mg of irbesartan once a day. The primary end-point event was mortality on the 14th day and in the 6th month after onset, significant dependent-survival status (SDS, Barthel Index ≤ 60), mortality/disability ratio (modified Rankin Scale ≥ 3), and recurrence rate of cardio-cerebral vascular events (RR-CVE). Results The National Institutes of Health Stroke Scale (NIHSS) score was 8.39 ± 3.21 vs. 8.16 ± 3.27 in the AT and C groups on entry to the study. On day 14, there were no significant differences in mortality (2.5% vs. 3.1%, p = 0.9994), SDS (50.0% vs. 49.0%, p = 0.864), and mortality/disability ratio (61.3% vs. 66.3%, p = 0.352) between the two groups, however the RR-CVE in the AT group was lower than in group C (4.4% vs. 11.9%, p = 0.014). In month 6, there were no significant difference in mortality rate between the two groups (3.1% vs. 3.8%, p = 0.767), however the SDS (23.4% vs. 34.4%, p = 0.033), mortality/disability ratio (32.1% vs. 45.0%, p = 0.018), and RR-CVE in group AT were lower than in group C (10.7% vs. 19.4%, p = 0.030). Conclusions Appropriate AT for patients with ACI does not worsen the disease condition and may improve the prognosis for the patients with moderate or mild stroke severity.
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Affiliation(s)
- Youjia Li
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Zhigeng Zhong
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Songbao Luo
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Xiaoyan Han
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Yuchan Liang
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Genlin Huang
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Weikun Zhou
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Qiong Ding
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Yan Huang
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
| | - Zhenmei Wu
- Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China
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10
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Ormerod E, Ali K, Cameron J, Malik M, Lee R, Getov S, Rajkumar C. The Association between Arterial Stiffness, Initial Stroke Severity, and 3-Week Outcomes in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:2541-2546. [PMID: 28684376 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/08/2017] [Accepted: 05/30/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Vascular compliance is emerging as a useful cardiovascular risk factor. The aim of this study was to investigate the association between arterial stiffness and stroke severity at presentation and 3 weeks. METHODS Forty two patients with acute ischemic stroke (55% male, mean age 71 years) were recruited over 15-months. Stroke subtypes were classified into lacunar circulation infarct (LACI), partial anterior circulation infarct (PACI), and posterior circulation infarct (POCI). Arterial stiffness was measured by QKD (defined as the time interval between the appearance of the Q wave [Q] on the ECG and the arrival of the diastolic Korotkoff [K] sound over the brachial artery in diastole [D]; QKD It is measured in milliseconds) using 24-hour ambulatory blood pressure (BP) and electrocardiogram monitoring. The measured QKD values were then corrected for a heart rate of 60 bpm and a systolic BP of 100 mm Hg (QKD100-60). Stroke severity was assessed on admission and at 3 weeks using the National Institutes of Health Stroke Scale (NIHSS). RESULTS Regression analysis for all patients showed a weak non-significant correlation between arterial stiffness and stroke severity. However, on performing subgroup analysis using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, we found that in large-artery atherosclerosis, arterial stiffness predicted stroke severity significantly at baseline (r = .45, b = .093, P = .04), but not significant for cardio embolism or small-artery occlusion subtypes. QKD100-60 and stroke severity were not significantly associated in week 3. There was no difference in NIHSS scores at weeks 0 and 3, or in QKD100-60 between LACI, PACI, and POCI, or dipper versus non-dippers and reverse dippers. CONCLUSION Further research is needed to explore the association between QKD and stroke severity.
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Affiliation(s)
- Emma Ormerod
- Department of Medicine, Bristol University Hospitals NHS Trust, Bristol, United Kingdom; Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Khalid Ali
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom.
| | - James Cameron
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom; Department of Medicine (Southern Clinical School), Monash Cardiovascular Research Centre, Monash University and Monash Heart, Clayton, Victoria, Australia
| | - Muzaffar Malik
- Division of Medical Education, Postgraduate, Brighton and Sussex Medical School, .University of Brighton, United Kingdom
| | - Richard Lee
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom; NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Spas Getov
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom; Wellcome Trust Centre for Neuroimaging, Centre of Neurology, University College London, United Kingdom
| | - Chakravarthi Rajkumar
- Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, United Kingdom
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11
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Martins AI, Sargento-Freitas J, Silva F, Jesus-Ribeiro J, Correia I, Gomes JP, Aguiar-Gonçalves M, Cardoso L, Machado C, Rodrigues B, Santo GC, Cunha L. Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke. Stroke 2016; 47:1571-6. [PMID: 27118796 DOI: 10.1161/strokeaha.115.012544] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Historical stroke cohorts reported a U- or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. METHODS Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated. Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography. Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. RESULTS We included 674 patients; mean age was 73.28 (SD, 11.50) years. Arterial recanalization was documented in 355 (52.70%) patients. In multivariate analyses, systolic BP and diastolic BP in the first 24 hours post stroke show a J-shaped relationship with functional outcome in the total population and in the nonrecanalyzed patients. Recanalyzed patients show a linear association with functional outcome (systolic BP: odds ratio, 1.015; 95% confidence interval, 1.007-1.024; P=0.001; R(2) change=0.001; P=0.412 and diastolic BP: odds ratio, 1.019; 95% confidence interval, 1.004-1.033; P=0.012; R(2) change<0.001; P=0.635). CONCLUSIONS Systemic BP in the first 24 hours after ischemic stroke influences 3-month clinical outcome. This association is dependent on the revascularization status.
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Affiliation(s)
- Ana Inês Martins
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - João Sargento-Freitas
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Fernando Silva
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Joana Jesus-Ribeiro
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Inês Correia
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - João Pedro Gomes
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.).
| | - Mariana Aguiar-Gonçalves
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Leila Cardoso
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Cristina Machado
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Bruno Rodrigues
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Gustavo C Santo
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
| | - Luís Cunha
- From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.)
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12
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Wu W, Huo X, Zhao X, Liao X, Wang C, Pan Y, Wang Y, Wang Y. Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study. PLoS One 2016; 11:e0144260. [PMID: 26828609 PMCID: PMC4735460 DOI: 10.1371/journal.pone.0144260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/16/2015] [Indexed: 02/05/2023] Open
Abstract
Objective Increased blood pressure (BP) management following acute ischemic stroke (AIS) remains controversial. This study aimed to identify the association between BP and clinical outcomes in AIS patients administered lytic medication in the TIMS-China (thrombolysis implementation and monitor of acute ischemic stroke in China) database. Methods The sample comprised 1128 patients hospitalized within 4.5 hours (h) of AIS for intravenous recombinant tissue plasminogen activator (i.v. rt-PA) thrombolysis. Systolic BP (SBP) and diastolic BP (DBP) at baseline, 2 h and 24 h after treatment, and changes from baseline were analyzed. The study outcomes comprised a favorable outcome (modified Rankin Scale 0–1 at 90 days) and symptomatic intracerebral hemorrhage (SICH), analyzed using logistic regression, with low BP as the reference group. Results Lower BP (baseline, 2 h, and 24 h) was beneficial in AIS patients and significantly related to a favorable outcome (P<0.05). A substantial BP decrease at 24 h after rt-PA thrombolysis was significantly associated with a favorable outcome compared with a moderate BP decrease (P = 0.0298). A SBP >160 mmHg 2 h after rt-PA thrombolysis was significantly associated with SICH compared with a SBP <140 mmHg (P = 0.0238). An increase or no change (>25 mmHg) in SBP was significantly associated with SICH (P = 0.002) compared with a small SBP decrease (1–9 mmHg). Conclusions This study provides novel evidence that lower BP within the first 24 h is associated with a more favorable outcome and less frequent SICH in AIS patients administered lytic medication. Routine BP-lowering treatment should be considered in AIS patients following lytic medication.
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Affiliation(s)
- Wei Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of neurology, Qilu Hospital of Shandong University, Jinan China & Braian Science Research Institute, Shandong University, Jinan, China
| | - Xiaochuan Huo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail: (YW); (YW)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail: (YW); (YW)
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13
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Ji N, Meng P, Liu N, Xu B, Zhang G, Zhou X, He M. A Reasonable Blood Pressure Level for Good Clinical Outcome After the Acute Phase of Ischemic Stroke. J Clin Hypertens (Greenwich) 2015; 18:536-42. [PMID: 26395246 DOI: 10.1111/jch.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Niu Ji
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Pin Meng
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Na Liu
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Bingchao Xu
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Guanghui Zhang
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Xinyu Zhou
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
| | - Mingli He
- Department of Neurology; Lianyungang Hospital affiliated with Xuzhou Medical College; Lianyungang City China
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14
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Tuttolomondo A, Casuccio A, Buttà C, Pecoraro R, Di Raimondo D, Della Corte V, Arnao V, Clemente G, Maida C, Simonetta I, Miceli G, Lucifora B, Cirrincione A, Di Bona D, Corpora F, Maugeri R, Iacopino DG, Pinto A. Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index. Atherosclerosis 2015; 243:260-7. [PMID: 26409625 DOI: 10.1016/j.atherosclerosis.2015.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/05/2015] [Accepted: 09/09/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. AIM To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. METHODS The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). RESULTS 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). CONCLUSIONS Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge.
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Affiliation(s)
- Antonino Tuttolomondo
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy.
| | - Alessandra Casuccio
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile "G. D'Alessandro", Universita' degli Studi di Palermo, Italy
| | - Carmelo Buttà
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Rosaria Pecoraro
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Vittoriano Della Corte
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Valentina Arnao
- Dipartimento di BioMedicina Sperimentale e Neuroscienze Cliniche, Università degli Studi di Palermo, Italy
| | - Giuseppe Clemente
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Carlo Maida
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Irene Simonetta
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Giuseppe Miceli
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Benedetto Lucifora
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Anna Cirrincione
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Danilo Di Bona
- Unità Operativa di Immunoematologia e Medicina Trasfusionale, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
| | - Francesca Corpora
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Rosario Maugeri
- Dipartimento di BioMedicina Sperimentale e Neuroscienze Cliniche, Sezione di Neurochirurgia, Università di Palermo, Italy
| | - Domenico Gerardo Iacopino
- Dipartimento di BioMedicina Sperimentale e Neuroscienze Cliniche, Sezione di Neurochirurgia, Università di Palermo, Italy
| | - Antonio Pinto
- U.O.C di Medicina Interna e Cardioangiologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
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Ishizuka K, Hoshino T, Uchiyama S. Ankle-Brachial Index and Neurologic Deterioration in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2014; 23:2506-2510. [PMID: 25282189 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 10/24/2022] Open
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Ishitsuka K, Kamouchi M, Hata J, Fukuda K, Matsuo R, Kuroda J, Ago T, Kuwashiro T, Sugimori H, Nakane H, Kitazono T. High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes. Hypertension 2014; 63:54-60. [DOI: 10.1161/hypertensionaha.113.02189] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between the poststroke blood pressure (BP) and functional outcomes in patients with acute ischemic stroke is still controversial. The aim of the present study was to elucidate the impact of the poststroke BP on the clinical outcomes of acute ischemic stroke. Among the patients in the Fukuoka Stroke Registry, 1874 patients with first-ever acute ischemic stroke (within 24 hours of onset) who had been functionally independent before onset were prospectively enrolled in the present study. The poststroke BP levels were defined as the average values during the 48 hours after onset. The study outcomes were a good neurological recovery, neurological deterioration, and a poor functional outcome. The higher poststroke BP levels were significantly associated with a lower probability of a good neurological recovery and elevated risks of neurological deterioration and a poor functional outcome after adjusting for potential confounding factors. The multivariate-adjusted odds ratios (95% confidence interval) in the highest quintile of systolic BP (versus the lowest quintile as a reference) were 0.51 (0.37–0.71) for a good neurological recovery, 1.92 (1.15–3.27) for neurological deterioration, and 2.51 (1.69–3.74) for a poor functional outcome. Similar associations were observed when we applied the poststroke diastolic BP or pulse pressure. No evidence of the J-curve phenomenon was observed for each association. These results suggest that a high poststroke BP was significantly associated with unfavorable clinical outcomes in patients with acute ischemic stroke. There was no evidence of the J-curve phenomenon between the poststroke BP levels and the clinical outcomes.
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Affiliation(s)
- Koji Ishitsuka
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Masahiro Kamouchi
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Jun Hata
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Kenji Fukuda
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Ryu Matsuo
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Junya Kuroda
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Tetsuro Ago
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Takahiro Kuwashiro
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Hiroshi Sugimori
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Hiroshi Nakane
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Takanari Kitazono
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
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Saeed NP, Panerai RB, Horsfield MA, Robinson TG. Does stroke subtype and measurement technique influence estimation of cerebral autoregulation in acute ischaemic stroke? Cerebrovasc Dis 2013; 35:257-61. [PMID: 23548789 DOI: 10.1159/000347075] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is known that dynamic cerebral autoregulation (dCA) is acutely impaired following ischaemic stroke (IS). However, the influence of stroke subtype, the affected (AF) and unaffected (UA) hemispheres, and the effects of a methodological approach on dCA estimates in stroke are all inconclusive. Therefore, we studied cortical and subcortical acute IS (AIS) patients to test the primary hypotheses that (1) dCA is impaired in stroke subtypes when compared to controls, (2) dCA impairment is more pronounced in the AF compared with the UA hemisphere, and (3) similar results are obtained with both spontaneous blood pressure (BP) fluctuation techniques, and sudden induced BP changes by thigh cuff deflation. METHODS We assessed the dCA values in AIS patients and in healthy controls (n = 10). The AIS patient group consisted of anterior circulation cortical (n = 11) and subcortical (n = 11) strokes within 48 h of symptom onset. Cerebral blood flow velocity was measured using transcranial Doppler ultrasound, and BP measurements were recorded before, during and after the release of bilateral thigh cuffs in 10 controls (7 males) of a mean age of 59 ±15 years (range 31-75), 11 cortical strokes (7 males) of a mean of age 65 ± 19 years (range 25-88) and 11 subcortical strokes (7 males) of a mean age of 60 ± 18 years (range 39-85). Autoregulation index (ARI) estimates, calculated using spontaneous fluctuations and thigh cuff manoeuvre, were derived. Differences in ARI (Tiecks' model) were tested with repeated-measures ANOVA. RESULTS A total of 22 patients were included, comprising 11 subcortical (lacunar clinical syndrome) and 11 cortical strokes (total anterior circulation stroke/partial anterior circulation syndrome). Of the 10 control subjects, 1 later withdrew because of intolerance to the thigh cuffs. Similar ARI estimates were obtained in both groups, whether assessed from spontaneous fluctuations or thigh cuff measurements (p = 0.37). ARI differences were not significantly different between hemispheres for both control and stroke populations. ARI was significantly impaired in AIS patients compared to age-, sex- and BP-matched control subjects, with a greater impairment of dCA observed in cortical IS. CONCLUSIONS The results of this study suggest that both spontaneous fluctuations and thigh cuff deflation techniques are able to provide reliable estimates of ARI, with the estimates from both spontaneous fluctuations and thigh cuff deflation techniques being in keeping with those reported elsewhere in the literature. dCA was impaired following AIS compared to controls when stroke subtype was considered. Importantly, no differences were observed between UA and AF. This has implications for the assessment of CA after stroke and reinforces the need to define a 'gold standard' test for the investigation of CA.
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Affiliation(s)
- Nazia P Saeed
- Ageing and Stroke Medicine, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Elevated blood pressure in the acute phase of stroke and the role of Angiotensin receptor blockers. Int J Hypertens 2013; 2013:941783. [PMID: 23431423 PMCID: PMC3574652 DOI: 10.1155/2013/941783] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/18/2022] Open
Abstract
Raised blood pressure (BP) is common after stroke but its causes, effects, and management still remain uncertain. We performed a systematic review of randomized controlled trials that investigated the effects of the angiotensin receptor blockers (ARBs) administered in the acute phase (≤72 hours) of stroke on death and dependency. Trials were identified from searching three electronic databases (Medline, Cochrane Library and Web of Science Database). Three trials involving 3728 patients were included. Significant difference in BP values between treatment and placebo was found in two studies. No effect of the treatment was seen on dependency, death and vascular events at one, three or six months; the cumulative mortality and the number of vascular events at 12 months differed significantly in favour of treatment in one small trial which stopped prematurely. Evidence raises doubts over the hypothesis of a specific effect of ARBs on short- and medium-term outcomes of stroke. It is not possible to rule out that different drugs might have different effects. Further trials are desirable to clarify whether current findings are generalizable or there are subgroups of patients or different approaches to BP management for which a treatment benefit can be obtained.
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Wang DM, Li J, Liu JR, Hu HY. Diffusion tensor imaging predicts long-term motor functional outcome in patients with acute supratentorial intracranial hemorrhage. Cerebrovasc Dis 2012; 34:199-205. [PMID: 23006600 DOI: 10.1159/000341857] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM It remains unclear how wallerian degeneration of the pyramidal tract (PT) in the acute phase of supratentorial intracranial hemorrhage (ICH) correlates with the long-term functional outcome. The aim of this study was to quantify and predict the long-term neuromotor outcome using diffusion tensor imaging (DTI) during the early stages of ICH. METHODS Twenty-seven patients with a hemiparetic ICH were prospectively studied using DTI either within 3 days or at 2 weeks after onset. A region-of-interest-based analysis was performed for fractional anisotropy (FA) of the PT in the cerebral peduncle. The degree of paresis was assessed upon admission and at 6 months using paresis grading (PG), and the functional outcome was evaluated using the modified Rankin Scale (mRS). The activities of daily living were evaluated using the Functional Independence Measure (FIM). RESULTS The FA values within 3 days and after 2 weeks of ICH onset were significantly decreased at the affected side (p = 0.001, reduced by 11%; p < 0.001, reduced by 14%, respectively), but the mean diffusivity at the same time points remained unchanged (p = 0.05 and p = 0.136, respectively). The ratio of the FA (rFA) at the affected side to that of the unaffected side within 3 days was negatively correlated with the PG (p < 0.001, r = -0.642), positively correlated with the FIM scores (p = 0.004, r = 0.532), and negatively correlated with the mRS scores at the end of follow-up (median = 17 months) (p = 0.010, r = -0.490). The rFA at 2 weeks was positively correlated with the FIM (p < 0.001, r = 0.661) and negatively correlated with mRS scores and PG at the end of follow-up (p < 0.001, r = -0.653; p < 0.001, r = -0.700). For both patients with good and poor outcomes based on the PG, the area under the receiver operating characteristic (ROC) curve for rFA at 2 weeks was greater than the area under the ROC for rFA within 3 days, and the cutoff point for the rFA at 2 weeks was set at 0.875 (sensitivity 76%, specificity 89%). CONCLUSIONS This study demonstrated that the use of DTI during the early stages of ICH may predict motor outcomes at 6 months after ICH. Moreover, as compared to use of DTI within 3 days of ICH onset, the application of DTI at 2 weeks after ICH could more accurately predict the motor outcomes and daily living activities of patients.
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Affiliation(s)
- Da-Ming Wang
- Departments of Physical Medicine and Rehabilitation, Zhejiang Chinese Medical University Affiliated Jinhua TCM Hospital, Jinhua, PR China.
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21
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Tuttolomondo A, Di Sciacca R, Di Raimondo D, Pedone C, La Placa S, Pinto A, Licata G. Effects of clinical and laboratory variables and of pretreatment with cardiovascular drugs in acute ischaemic stroke: A retrospective chart review from the GIFA study. Int J Cardiol 2011; 151:318-22. [DOI: 10.1016/j.ijcard.2010.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 05/15/2010] [Accepted: 06/04/2010] [Indexed: 11/29/2022]
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Abstract
Data from the European Cooperative Acute Stroke Study (ECASS) III trial demonstrated that tissue plasminogen activator given up to 4.5 h after stroke onset improves outcome and treatment guidelines support its use during this time window. Intra-arterial therapy with tissue plasminogen activator or devices is commonly used at large tertiary centers up to 6–8 h after stroke onset, but conclusive evidence of efficacy remains lacking. During the acute phase after stroke onset, blood pressure elevations should be reduced as should substantial elevations in blood glucose. Statins are recommended in essentially all non-cardioembolic stroke patients. The most important future directions for acute stroke therapy are to extend the therapeutic time window and to increase the proportion of patients treated within the currently documented 4.5-h time window. Imaging-guided selection of appropriate patients will likely be a key factor for extending the therapeutic time window and both diffusion/perfusion MRI and perfusion computed tomography will be useful imaging modalities in this effort.
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Affiliation(s)
- Nils Henninger
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Avenue, North Worcester, MA 01655, USA.
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Abstract
Hypertension is the most prevalent of the modifiable risk factors for stroke. The benefits of blood pressure (BP) lowering on primary and secondary prevention of stroke are undeniable. Despite this, BP control in hypertensive individuals and patients with prior cerebrovascular events is suboptimal. Noncompliance, inappropriate antihypertensive usage and under-utilization of medications contribute significantly to inadequate BP control. Recently, elegantly designed studies that assessed the preventive role of BP lowering in patients with cerebrovascular disease have helped clarify management issues in terms of BP targets and effective antihypertensive regimens. Current evidence suggests that BP targets for primary and secondary prevention are suboptimal and need reassessment. The effect of BP modulation in acute stroke is still not completely understood. Although the thresholds for BP treatment in acute stroke have been recommended, BP targets are as yet ill-defined. The available evidence supports early lowering of blood pressure following stroke. This review discusses the impact of blood pressure on stroke incidence and outcomes, outlines the recommendations for blood pressure lowering in stroke and delineates questions that still need to be addressed.
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Affiliation(s)
- Monica Saini
- Division of Neurology, Department of Medicine, University of Alberta, AB, Canada.
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Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol 2010. [DOI: 10.1097/wco.0b013e328334e9d9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A comparison of clinical characteristics, medications, and outcome
between acute stroke and acute myocardial infarction. Glob Heart 2009. [DOI: 10.1016/j.cvdpc.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Transient ischemic attack is a medical emergency because early stroke risk after transient ischemic attack is high. Hypertension is the most important modifiable risk factor for stroke and transient ischemic attack. The aims of this review are to provide a summary of the current knowledge concerning the relationship between blood pressure and transient ischemic attack, as well as outline issues regarding diurnal variation and the potential of chronotherapy (timing medications to accord with diurnal patterns of blood pressure). There is a strong relationship between hypertension and the incidence of transient ischemic attack and the subsequent short-term risk for stroke. Ambulatory blood pressure monitoring is a reliable diagnostic and monitoring tool for hypertension and provides additional information about diurnal variation in blood pressure. Different diurnal blood pressure patterns may confer variable stroke risk. Patients with stroke commonly have abnormal diurnal blood pressure patterns and this may relate, in part, to autonomic nervous system dysfunction. However, blood pressure patterns have not been systematically studied in patients with transient ischemic attack. Blood pressure remains poorly controlled in a large proportion of patients after transient ischemic attack and under-treatment and poor adherence are important factors. Chronotherapy for blood pressure may result in more effective blood pressure control. More research is needed in this area. Hypertension is strongly associated with transient ischemic attack. Diurnal blood pressure patterns may influence subsequent stroke risk after transient ischemic attack and more evidence is needed to inform clinical practice to improve blood pressure management for transient ischemic attack patients.
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Affiliation(s)
- W W Zhang
- National Stroke Research Institute, part of Florey Neuroscience Institutes, Victoria, Australia
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Leira R, Millán M, Díez-Tejedor E, Blanco M, Serena J, Fuentes B, Rodríguez-Yáñez M, Castellanos M, Lago A, Dávalos A, Castillo J. Age Determines the Effects of Blood Pressure Lowering During the Acute Phase of Ischemic Stroke. Hypertension 2009; 54:769-74. [DOI: 10.1161/hypertensionaha.109.133546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rogelio Leira
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Mónica Millán
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Exuperio Díez-Tejedor
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Miguel Blanco
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Joaquín Serena
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Blanca Fuentes
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Manuel Rodríguez-Yáñez
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Mar Castellanos
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Aida Lago
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - Antonio Dávalos
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
| | - José Castillo
- From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep
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Nascimbeni R, Ngassa H, Di Fabio F, Valloncini E, Di Betta E, Salerni B. Emergency surgery for complicated colorectal cancer. A two-decade trend analysis. Dig Surg 2008; 25:133-9. [PMID: 18446035 DOI: 10.1159/000128170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 10/13/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Emergency procedures for colorectal cancer have worse outcomes than elective resections. Temporal trends in emergency surgery are analyzed by comparing two decade-related series of colorectal cancer patients. METHODS The clinical data of 985 patients undergoing colorectal cancer surgery were collected during two decades (1975-1984 and 1995-2004). Rates of emergency surgery, operative mortality, 5-year cancer-related and overall survival were compared retrospectively. RESULTS The rate of emergency surgery decreased from 81 out of 513 cases (16%) during 1975-1984 to 41 out of 471 cases (9%) during 1995-2004 (p = 0.005). Over the same time, the rate of curative resections in emergency increased from 46% (37/81 cases) to 76% (31/41 cases) (p < 0.001), while patient and tumor characteristics remained similar. Operative mortality after emergency procedures decreased from 14% (11 deaths) to 5% (2 deaths) and cancer-related survival increased from 21 to 42% (p = 0.03). However, when excluding palliative procedures, survival after emergency surgery increased from 52 to 58%, while after elective treatment it increased from 56 to 78% (p < 0.001). CONCLUSIONS Frequency and operative mortality of emergency colorectal cancer surgery decreased substantially from 1975-1984 to 1995-2004. No significant improvement in long-term survival was observed when curative emergency resections only were considered. Further efforts are needed to reverse the diverging trend of long-term outcomes between emergency and elective curative procedures.
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Affiliation(s)
- Riccardo Nascimbeni
- Cattedra di Chirurgia Generale, Università degli Studi di Brescia, Brescia, Italy.
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Armario P, Tovar J, Sierra C, Cardona P, Rubio F, Álvarez-Sabin J. Manejo de las alteraciones de la presión arterial en la fase aguda del ictus Actualización 2008 del Documento de Consenso de las Sociedades Catalanas de Hipertensión y de Neurología. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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