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Jiang Y, Zhao Q, Guan J, Wang Y, Chen J, Li Y. Analyzing prehospital delays in recurrent acute ischemic stroke: Insights from interpretable machine learning. Patient Educ Couns 2024; 123:108228. [PMID: 38458092 DOI: 10.1016/j.pec.2024.108228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study investigates prehospital delays in recurrent Acute Ischemic Stroke (AIS) patients, aiming to identify key factors contributing to these delays to inform effective interventions. METHODS A retrospective cohort analysis of 1419 AIS patients in Shenzhen from December 2021 to August 2023 was performed. The study applied the Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP) for identifying determinants of delay. RESULTS Living with others and lack of stroke knowledge emerged as significant risk factors for delayed hospital presentation in recurrent AIS patients. Key features impacting delay times included residential status, awareness of stroke symptoms, presence of conscious disturbance, diabetes mellitus awareness, physical weakness, mode of hospital presentation, type of stroke, and presence of coronary artery disease. CONCLUSION Prehospital delays are similarly prevalent among both recurrent and first-time AIS patients, highlighting a pronounced knowledge gap in the former group. This discovery underscores the urgent need for enhanced stroke education and management. PRACTICE IMPLICATION The similarity in prehospital delay patterns between recurrent and first-time AIS patients emphasizes the necessity for public health initiatives and tailored educational programs. These strategies aim to improve stroke response times and outcomes for all patients.
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Affiliation(s)
- Youli Jiang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Qingshi Zhao
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jincheng Guan
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Yuying Wang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jingfang Chen
- The Third People's Hospital of Shenzhen, Shenzhen 518112, China; National Clinical Research Center for Infectious Diseases, 29 Bulan Road, Longgang District, Shenzhen 518112, China.
| | - Yanfeng Li
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China.
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Heath T, Shrishail N, Wong KH, Johnston KC, Sharma R, Ney JP, Sheth KN, de Havenon AH. Trends in American Indian/Alaskan native self-reported stroke prevalence and associated modifiable risk factors in the United States from 2011-2021. J Stroke Cerebrovasc Dis 2024; 33:107650. [PMID: 38460776 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Stroke prevalence varies by race/ethnicity, as do the risk factors that elevate the risk of stroke. Prior analyses have suggested that American Indian/Alaskan Natives (AI/AN) have higher rates of stroke and vascular risk factors. METHODS We included biyearly data from the 2011-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults (age ≥18) in the United States. We describe survey-weighted prevalence of stroke per self-report by race and ethnicity. In patients with self-reported stroke (SRS), we also describe the prevalence of modifiable vascular risk factors. RESULTS The weighted number of U.S. participants represented in BRFSS surveys increased from 237,486,646 in 2011 to 245,350,089 in 2021. SRS prevalence increased from 2.9% in 2011 to 3.3% in 2021 (p<0.001). Amongst all race/ethnicity groups, the prevalence of stroke was highest in AI/AN at 5.4% and 5.6% in 2011 and 2021, compared to 3.0% and 3.4% for White adults (p<0.001). AI/AN with SRS were also the most likely to have four or more vascular risk factors in both 2011 and 2021 at 23.9% and 26.4% compared to 18.2% and 19.6% in White adults (p<0.001). CONCLUSION From 2011-2021 in the United States, AI/AN consistently had the highest prevalence of self-reported stroke and highest overall burden of modifiable vascular risk factors. This persistent health disparity leaves AI/AN more susceptible to both incident and recurrent stroke.
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Affiliation(s)
- Tyria Heath
- The Native American Summer Research Internship and Department of Neurology, University of Utah, USA
| | - Neha Shrishail
- The Department of Neurology, Center for Brain & Mind Health, Yale University, USA.
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, USA
| | - Karen C Johnston
- The Department of Neurology, University of Virginia, Department of Neurology, Brown University, USA
| | - Richa Sharma
- The Department of Neurology, Center for Brain & Mind Health, Yale University, USA
| | - John P Ney
- Department of Neurology, Boston University, USA
| | - Kevin N Sheth
- The Department of Neurology, Center for Brain & Mind Health, Yale University, USA
| | - Adam H de Havenon
- The Department of Neurology, Center for Brain & Mind Health, Yale University, USA
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3
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Sun B, Ma Q, Shen J, Meng Z, Xu J. Up-to-date advance in the relationship between OSA and stroke: a narrative review. Sleep Breath 2024; 28:53-60. [PMID: 37632670 DOI: 10.1007/s11325-023-02904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and stroke affect each other. In this review, we summarized the effect of OSA on the onset and recurrence of stroke, the prognosis, and the treatment of poststroke patients with OSA. METHODS Pubmed/MEDLINE were searched through May 2023 to explore the relationship between OSA and stroke. The relevant papers included OSA and stroke, OSA and recurrent stroke, and the prognosis and treatment of poststroke patients with OSA. RESULTS The results showed that OSA can promote the onset and recurrence of stroke and that OSA may adversely affect the prognosis of poststroke patients. The application of continuous positive airway pressure (CPAP) and other treatments may benefit poststroke patients with OSA, though the long term effects of treatment are not well documented. CONCLUSION Both the onset and recurrence of stroke closely correlated with OSA, but the specific mechanisms remain unclear. Further studies should be carried out to explore effective treatments in patients with stroke and OSA.
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Affiliation(s)
- Bo Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Qiyun Ma
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Jiani Shen
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Zili Meng
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Jing Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China.
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Xu Q, Li C, Jing P, Li H, Tian X, Xia X, Zhang Y, Zhang X, Wang Y, Wang A, Meng X. Low-Density Lipoprotein Cholesterol to Triglyceride Ratio and Clinical Outcomes after Acute Ischaemic Stroke or Transient Ischaemic Attack. J Atheroscler Thromb 2024:64704. [PMID: 38382995 DOI: 10.5551/jat.64704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
AIMS Studies showed that low-density lipoprotein cholesterol (LDL-C) to triglyceride (TG) ratio could be used as a predictive parameter of low-density lipoprotein oxidation in vivo and the level of small dense LDL-C. However, whether LDL-C/TG ratio is associated with stroke prognosis remains unclear. We investigated the associations of LDL-C/TG ratio with outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attacks (TIA) and explored whether it produced more predictive value than LDL-C and TG. METHODS Data were derived from the Third China National Stroke Registry (CNSR-III). Multivariable Cox regression for stroke recurrence, composite vascular events and all-cause death and logistic regression for the poor functional outcome (modified Rankin Scale score 3-6) were used. RESULTS A total of 14123 patients were included. After adjusting for confounding factors, quartile 4 of LDL-C/TG ratio was associated with an increased risk of recurrent stroke (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.03-1.56), composite vascular events (HR,1.23; 95% CI, 1.00-1.52), death (HR,1.70; 95% CI, 1.13-2.54) and poor functional outcome (odds ratio, 1.34; 95% CI, 1.12-1.61) at 3 months follow-up compared with quartile 1. We also found that quartile 4 of LDL-C and TG was positively and negatively associated with poor functional outcome at 3 months, respectively. LDL-C/TG ratio performed better than LDL-C or TG in predicting clinical outcomes. CONCLUSIONS LDL-C/TG ratio was associated with the risk of stroke recurrence, composite vascular events, death and poor functional outcome in patients with AIS or TIA.
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Affiliation(s)
- Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Changjun Li
- Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology
| | - Ping Jing
- Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
| | - Xue Tian
- Beijing Municipal Key Laboratory of Clinical Epidemiology
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
| | - Xue Xia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
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Wang A, Tian X, Xie X, Li H, Jing J, Lin J, Wang Y, Zhao X, Li Z, Liu L, Wang Y, Meng X. Effects of remnant cholesterol on the efficacy of genotype-guided dual antiplatelet in CYP2C19 loss-of -function carriers with minor stroke or transient ischaemic attack: a post-hoc analysis of the CHANCE-2 trial. EClinicalMedicine 2024; 67:102357. [PMID: 38125963 PMCID: PMC10730355 DOI: 10.1016/j.eclinm.2023.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background The atherogenicity of remnant cholesterol (RC), a contributor to residual risk of cardiovascular events, has been underlined by recent guidelines. We aimed to evaluate the relationship between RC levels and the efficacy and safety of genotype-guided dual antiplatelet therapy in the CHANCE-2 trial. Methods This post-hoc study used data from the CHANCE-2 trial, which was a randomised, double-blind, placebo-controlled trial of 6412 patients (aged >40 years) enrolled from 202 hospitals in China, between Sept 23, 2019, and March 22, 2021, who carried CYP2C19 loss-of-function alleles and had either an acute minor stroke or high-risk transient ischaemic attack (TIA), and could start treatment within 24 h of symptom onset. Participants received either (1:1) ticagrelor plus aspirin (control) or clopidogrel plus aspirin (intervention) and the effect of reducing the 3-month risk of any new stroke was assessed (ischemic or haemorrhagic, primary outcome). From the CHANCE-2 study population, we enrolled 5890 patients with complete data on RC. The cutoff point of RC for distinguishing patients with greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin was determined with subpopulation treatment effect pattern plot. The primary efficacy and safety outcome was recurrent stroke and severe or moderate bleeding within 90 days, respectively. CHANCE-2 is registered with ClinicalTrials.gov, NCT04078737. Findings The cutoff to define elevated RC was 0.91 mmol/L. Ticagrelor-aspirin versus clopidogrel-aspirin was associated with a reduced risk of recurrent stroke in patients with non-elevated RC levels (122 [5.3%] versus 179 [7.8%]; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.54-0.85), but this benefit was absent in those with elevated RC levels (58 [8.4%] versus 48 [7.3%]; HR, 1.10; 95% CI, 0.73-1.65; P-interaction = 0.03). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin on recurrent stroke decreased as RC levels increased. The rates of severe or moderate bleeding between treatment groups were similar across RC categories (0.3% versus 0.3%, P-interaction = 0.95). Interpretation Our post-hoc findings suggest that RC could be a potential biomarker to discriminate patients who received more benefits from ticagrelor-aspirin versus clopidogrel-aspirin therapy in CYP2C19 loss-of-function carriers with minor stroke or TIA. These findings need to be validated in an independent study. Funding The National Key Research and Development Program of China, Beijing Natural Science Foundation Haidian original innovation joint fund, Fund for Young Talents of Beijing Medical Management Center, the high-level public health talents, Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University; and Salubris.
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Gurgoglione FL, Vignali L, Cattabiani MA, Solinas E, Benatti G, Tadonio I, Barocelli F, Dizdari C, Tuttolomondo D, Ardissino D, Nicolini F, Niccoli G. Predictors of recurrent cerebral ischemia after patent foramen ovale closure: A single center observational study. J Stroke Cerebrovasc Dis 2024; 33:107448. [PMID: 37988831 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Transcatheter patent foramen ovale closure lowers recurrent stroke in patients with cryptogenic stroke or transient ischemic attack with an indication for closure. However, the incidence of recurrent stroke is not negligible and underlying pathophysiology remains largely unknown. We sought to evaluate the prevalence of recurrent ischemic neurological events and to assess its predictors after transcatheter patent foramen ovale closure. METHODS We enrolled consecutive patients who underwent patent foramen ovale closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2006 and 2021. Clinical and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up. RESULTS We enrolled a total of 169 patients with mean Risk of Paradoxical Embolism score at hospital admission of 6.4 ± 1.5. The primary indication was previous cryptogenic stroke (94 [55.6 %] subjects), followed by transient ischemic attack (75 [44.4 %]). Among patients with complete outcome data (n= 154), after a median follow-up of 112 months, recurrent cerebral ischemia occurred in 13 [8.4 %], with an annualized rate of 0.92/100 patients. The presence of obesity [OR 5.268, p = 0.018], Risk of Paradoxical Embolism score < 7 [OR 5.991, p = 0.035] and migraine [OR = 5.932 p = 0.012] were independent positive predictors of recurrent stroke/ transient ischemic attack after patent foramen ovale closure. CONCLUSIONS The presence of obesity, Risk of Paradoxical Embolism score < 7 and migraine were independent positive predictors of recurrent ischemic neurological events after patent foramen ovale closure.
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Affiliation(s)
| | - Luigi Vignali
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Emilia Solinas
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Iacopo Tadonio
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Federico Barocelli
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Chiara Dizdari
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Diego Ardissino
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Giampaolo Niccoli
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Clark A, Freedman B, Thomas L. Embolic Stroke of Undetermined Source: Urgency for Improved Aetiological Understanding and Patient Treatment. Heart Lung Circ 2024; 33:9-11. [PMID: 38135592 DOI: 10.1016/j.hlc.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Amy Clark
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia. https://twitter.com/AmyClarkPhD
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Zhao Y, Song P, Feng P, Yuan S, Wu H, Cui J, Liu L, Zhang S, Miao R, Guo L, Xu W, Liu X. Plaque enhancement predicts recurrence in acute ischemic stroke patients with large artery intracranial atherosclerosis. J Stroke Cerebrovasc Dis 2023; 32:107406. [PMID: 37837801 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND The association between the degree of plaque enhancement and ischemic brain stroke recurrence remains unclear. We aimed to establish models to predict plaque enhancement and stroke recurrence. METHODS Seventy-eight participants with acute ischemic brain stroke due to intracranial arterial stenosis were recruited and divided into high enhancement (HE) and non-HE groups. The relationship between imaging characteristics (degree of stenosis, minimal lumen area, intraplaque hemorrhage, and plaque burden) and the degree of plaque contrast enhancement was analyzed. Inflammatory cytokine expression was examined by flow cytometry. Independent predictors of stroke recurrence were investigated via multivariate Cox proportional hazards regression analysis. Nomogram was used to construct a prediction model. Harrell's concordance indices (c-indices) and calibration curves were used to assess the discrimination of the nomogram. A risk prediction nomogram for prognosis was constructed. RESULTS Thirty-three participants were assigned to the HE group and 45 to the non-HE group. The degree of stenosis and plaque burden in the HE group was higher than that in the non-HE group (P<0.05). Multiple linear regression analysis showed the degree of stenosis was associated with HE (β=0.513; P=0.000). After adjusting for confounding factors, age (HR=1.115; 95%CI=1.034-1.203, P=0.005) and HE plaques (HR=10.457; 95%CI=1.176-93.018; P=0.035) were independent risk factors of stroke recurrence, whereas cytokine levels were not statistically significant between two group. CONCLUSIONS HE of intracranial atherosclerosis plaques is an independent factor for ischemic brain stroke recurrence.
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Affiliation(s)
- Yanying Zhao
- Department of Psychosomatic Medicine, Department of Neurology, The Second Hospital of Medical University, No. 215 Heping West Road, Shijiazhuang, Hebei 050000, China
| | - Peng Song
- Department of Radiology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Pingyong Feng
- Department of Radiology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Si Yuan
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Haoran Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Junzhao Cui
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Lijuan Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Shaoru Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei 050000, China
| | - Ruihan Miao
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Weihai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - Xiaoyun Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China.
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Sezgin M, Aliyeva G, Ekizoğlu E, Yeşilot N, Çoban O. Medial medullary infarction: clinical, radiological findings and long-term prognosis. Acta Neurol Belg 2023:10.1007/s13760-023-02427-3. [PMID: 38010575 DOI: 10.1007/s13760-023-02427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Medial medullary infarction (MMI) is a rare type of posterior circulation stroke. We aim to examine the clinical and radiological features, etiology, and prognosis of patients with MMI. METHOD MMI patients registered consecutively in the stroke databank of the Istanbul Medical Faculty between January 1999 and April 2022 were included in the study. Medullary lesions were rostrocaudally classified as rostral, middle, and caudal, and ventrodorsally as ventral, middle, and dorsal. The etiological classification was performed, and functional outcome was assessed based on the modified Rankin Scale (mRS). Overall survival was estimated using the Kaplan-Meier technique. RESULTS We examined 48 cases of MMI including 9 with bilateral MMI. There were 34 men (70%), and mean age was 62.9 (± 12.8) years. The median NIHSS score was 7 (IQR; 4.5-10.5). The most common symptom was motor dysfunction. The medullary lesions were located caudally in 4 patients, rostrally in 30, rostromedially in 10, and rostro-medio-caudally in 2 patients. On ventro-dorsal classification; unilateral lesions were found ventrally in 19, ventromedially in 11, and ventro-medio-dorsally in 4 patients. The median follow-up duration was 20 months (interquartile range (IQR); 1-60). According to the third-month mRS, 39% of the patients were considered to have a good prognosis. CONCLUSION The most common etiology was distal vertebral artery atherosclerosis. More than 50% of the patients could walk unassisted in the long-term follow-up, and stroke recurrence was infrequent. Patients with bilateral MMI had poor outcomes.
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Affiliation(s)
- Mine Sezgin
- Department of Neurology, İstanbul University İstanbul Faculty of Medicine, 34390, Çapa, İstanbul, Turkey.
| | - Gulshan Aliyeva
- Department of Neurology, İstanbul University İstanbul Faculty of Medicine, 34390, Çapa, İstanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, İstanbul University İstanbul Faculty of Medicine, 34390, Çapa, İstanbul, Turkey
| | - Nilüfer Yeşilot
- Department of Neurology, İstanbul University İstanbul Faculty of Medicine, 34390, Çapa, İstanbul, Turkey
| | - Oğuzhan Çoban
- Department of Neurology, İstanbul University İstanbul Faculty of Medicine, 34390, Çapa, İstanbul, Turkey
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10
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Zhang JQ, Pan ZB. Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke. World J Clin Cases 2023; 11:7814-7821. [DOI: 10.12998/wjcc.v11.i32.7814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events. However, the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.
AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.
METHODS We conducted a randomized, open-label, controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset. Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset. The primary outcome was the occurrence of recurrent stroke, myocardial infarction, or vascular death within 90 d. The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale (mRS), incidence of bleeding complications, and mortality rate.
RESULTS The mean age of the patients was 67.8 years and 55% of them were male. The median time from stroke onset to randomization was 12 h. The baseline characteristics were well balanced between the two groups. The primary outcome occurred in 6.7% of patients in the aspirin group and 16.7% of patients in the no aspirin group (relative risk = 0.40, 95% confidence interval: 0.12-1.31, P = 0.13). The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group (median, 2 vs 3, respectively; P = 0.04). The incidence of bleeding complications was similar between the groups (6.7% vs 6.7%, P = 1.00). The mortality rates were also comparable between the two groups (10% vs 13.3%, P = 0.69).
CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events. Its acceptable safety profile is comparable to that of no aspirin. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
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Affiliation(s)
- Jian-Quan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
| | - Zhi-Bin Pan
- Department of Neurology, Jiujiang First People's Hospital, Jiujiang 332100, Jiangxi Province, China
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11
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Lee KH, Hung WT, Huang WY, Ovbiagele B, Lee M. Direct oral anticoagulants compared with other strategies in patients with atrial fibrillation and stroke or transient ischemic attack: Systematic review. J Formos Med Assoc 2023:S0929-6646(23)00407-2. [PMID: 37838540 DOI: 10.1016/j.jfma.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND For patients with atrial fibrillation and a prior stroke or transient ischemic attack (TIA), the risk-benefit of direct oral anticoagulants (DOACs) compared to alternative treatment approaches has not been firmly established. We conducted a systematic review of randomized controlled trials (RCTs) to investigate efficacy and safety of DOACs vs warfarin and DOACs vs aspirin or placebo in patients with AF and a prior stroke or TIA. METHODS We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 1, 2000, to January 31, 2023, to find RCTs. Risk ratio (RR) with 95 % CI measured the association of DOACs vs warfarin, and DOACs vs aspirin or placebo, with clinical outcomes. Primary efficacy outcome was stroke or systemic embolism and primary safety outcome was ICH. RESULTS We identified 7 RCTs with 19,111 patients with AF and a prior stroke or TIA, of which 5 trials compared DOACs with warfarin and 2 trials compared DOACs vs aspirin or placebo. Compared with warfarin, DOACs were associated with a lower risk of stroke or systemic embolism (RR, 0.85; 95 % CI, 0.75-0.97) and ICH (RR, 0.53; 95 % CI, 0.41-0.68). Compared with aspirin or placebo, DOACs were associated with a reduced risk of stroke or systemic embolism (RR, 0.33; 95 % CI, 0.19-0.58) and risk of ICH did not differ between apixaban and aspirin. CONCLUSIONS This contemporary evaluation of the literature indicates that DOACs, rather than other antithrombotic agents or no treatment, should be used in patients with AF and a prior stroke or TIA.
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Affiliation(s)
- Kuan-Hsin Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Wei-Tse Hung
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
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12
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Lkharrat FZ, Bouchal S, Bennani H, Akammar A, El Bouardi N, Haloua M, Alami B, Boubbou M, Faouzi Belahcen M, Maaroufi M, Alaoui Lamrani MY. Management of a recurrent stroke due to a carotid web. J Med Vasc 2023; 48:136-141. [PMID: 37914458 DOI: 10.1016/j.jdmv.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023]
Abstract
Carotid web is a rare intraluminal parietal protrusion in the carotid artery. This vascular anomaly mostly occurs at the bifurcation causing turbulent flow, and is responsible of thrombi formation associated with embolic ischemic events. We report the case of a 35-year-old woman, with no medical history, who presented a recurrent middle cerebral artery (MCA) occlusion within twelve hours caused by a carotid bulb web. Although considered as a rare entity, carotid web is associated with the risk of recurrent strokes in the MCA territory and especially in the absence of the typically recognized risk factors. The key imaging is the CT angiography that shows the web, the cerebral artery occlusion, and the outcome appreciation. Therapeutic strategy associates antithrombotic treatment and operative management with stenting of the carotid web or endarterectomy.
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Affiliation(s)
- F-Z Lkharrat
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco.
| | - S Bouchal
- Neurology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - H Bennani
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - A Akammar
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - N El Bouardi
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - M Haloua
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - B Alami
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - M Boubbou
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - M Faouzi Belahcen
- Neurology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - M Maaroufi
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - M Y Alaoui Lamrani
- Radiology Department, CHU Hassan II, University Sidi Mohammed Ben Abdellah, Fez, Morocco
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Kijpaisalratana N, Ament Z, Patki A, Bhave VM, Jones AC, Garcia Guarniz AL, Couch CA, Cushman M, Long DL, Irvin MR, Kimberly WT. Acetylglutamine Differentially Associated with First-Time Versus Recurrent Stroke. Transl Stroke Res 2023:10.1007/s12975-023-01181-1. [PMID: 37531033 PMCID: PMC10834852 DOI: 10.1007/s12975-023-01181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
Approximately one-quarter of strokes occur in individuals with prior stroke. Despite the advancement in secondary stroke prevention, the long-term risk of recurrent stroke has remained unchanged. The objective of this study was to identify metabolite risk markers that are associated with recurrent stroke. We performed targeted metabolomic profiling of 162 metabolites by liquid chromatography-tandem mass spectrometry in baseline plasma in a stroke case-cohort study nested within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an observational cohort study of 30,239 individuals aged 45 and older enrolled in 2003-2007. Weighted Cox proportional hazard models were used to identify metabolites that had a differential effect on first-time versus recurrent stroke using an interaction term between metabolite and prior stroke at baseline (yes or no). The study included 1391 incident stroke cases identified during 7.1 ± 4.5 years of follow-up and 1050 participants in the random cohort sample. Among 162 metabolites, 13 candidates had a metabolite-by-prior stroke interaction at a p-value <0.05, with one metabolite, acetylglutamine, surpassing the Bonferroni adjusted p-value threshold (p for interaction = 5.78 × 10-5). In an adjusted model that included traditional stroke risk factors, acetylglutamine was associated with recurrent stroke (HR = 2.27 per SD increment, 95% CI = 1.60-3.20, p = 3.52 × 10-6) but not with first-time stroke (HR = 0.96 per SD increment, 95% CI = 0.87-1.06, p = 0.44). Acetylglutamine was associated with recurrent stroke but not first-time stroke, independent of traditional stroke risk factors. Future studies are warranted to elucidate the pathogenesis of acetylglutamine and recurrent stroke risk.
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Affiliation(s)
- Naruchorn Kijpaisalratana
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Zsuzsanna Ament
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Amit Patki
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Alana C Jones
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Catharine A Couch
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Ryan Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Taylor Kimberly
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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Kongwatcharapong J, Sornkhamphan A, Kaveeta C, Nathisuwan S. Validation and comparison of the stroke prognosis instrument (SPI-II) and the essen stroke risk score (ESRS) in predicting stroke recurrence in Asian population. BMC Neurol 2023; 23:287. [PMID: 37528418 PMCID: PMC10391888 DOI: 10.1186/s12883-023-03329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Currently, there are limited data on the accuracy of available risk scores to predict stroke recurrence in the Asian population. METHOD A single-center, retrospective cohort study was conducted among patients with acute ischemic stroke during January 2014 - December 2018. Longitudinal data with three years of follow-up among these patients were collected and validated through both electronic and manual chart review. The area under the receiver-operating curve (AUROC) method or C-statistic and calibration plot were used to evaluate and compare the Stroke Prognosis Instrument II (SPI-II) and the Essen Stroke Risk Score (ESRS) in predicting the long-term risk of recurrent ischemic stroke. The predictive performances of the two scores were compared using DeLong's method. RESULTS The study cohort consisted of 543 patients, including 181 and 362 patients with and without recurrent events. There were no significant differences in mean age and gender between the two groups. Recurrence cases tended to have significant more risk factors compared to those without events. Among cases with recurrent events, 134 (74.03%) and 65.74% (119) cases were classified as high-risk based on SPI-II and ESRS, respectively. The AUROC curve of the SPI-II and ESRS score was 0.646 (95% CI, 0.594-0.697) and 0.614 (95%CI, 0.563-0.665), respectively (p = 0.394). Based on the calibration plot, the SPI-II and ESRS scores showed similar moderate predictive performance on recurrence stroke with a C statistic (95% CI) of 0.655 (95% CI: 0.603-0.707) and 0.631 (95% CI 0.579-0.684), respectively. CONCLUSION Both ESRS and SPI-II scores had moderate predictive performance in Thai population.
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Affiliation(s)
- Junporn Kongwatcharapong
- Pharmaceutical Care in Inpatient unit, Department of Pharmacy, Siriraj Hospital, Bangkok, Thailand
| | - Akaporn Sornkhamphan
- Pharmaceutical Care in Inpatient unit, Department of Pharmacy, Siriraj Hospital, Bangkok, Thailand
| | - Chitapa Kaveeta
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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Liu Z, Lin X, Zeng L, Zhang H, Guo W, Lu Q, Huang C, Wang J, Liu P, Chang Q, Zhang M, Huo Y, Wang Y, Wang F, Wu S. Elevated non-HDL-C/HDL-C ratio increases the 1-year risk of recurrent stroke in older patients with non-disabling ischemic cerebrovascular events: results from the Xi'an Stroke Registry Study of China. BMC Geriatr 2023; 23:410. [PMID: 37407911 DOI: 10.1186/s12877-023-04102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Few studies have explored the prognostic role of nontraditional lipid-related indicators in non-disabling ischemic cerebrovascular events (NICE). In this study, we aimed to investigate the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) and the1-year risk of recurrent stroke in patients with NICE. METHODS Total cholesterol (TC), HDL-C, and patient information were collected at admission. Recurrent stroke events were followed up 3, 6, and 12 months after onset. Non-HDL-C levels were calculated by subtracting HDL-C from TC. The non-HDL-C/HDL-C ratio was treated as a continuous variable and in quartiles (Q1-Q4). Stratified multivariate Cox regression was used to investigate the relationship between the non-HDL-C/HDL-C ratio and the 1-year risk of recurrent stroke in patients with NICE. RESULTS Overall, 1,659 patients with NICE were enrolled. For each unit increase in the non-HDL-C/HDL-C ratio, the 1-year risk of recurrent stroke in patients aged ≥ 65 years (older patients) with NICE increased by 64% in the adjusted model (hazard ratio [HR]: 1.64, 95%confidence interval [CI]:1.18-2.27, P = 0.003), and the HRs were 3.21 and 4.24 times higher in the Q3 and Q4 groups than that in the Q1 group, which was considered to be the reference (adjusted model Q3: HR: 3.21, 95%CI: 1.05-9.83, P = 0.041; adjusted model Q4: HR: 4.24, 95%CI: 1.30-13.85, P = 0.017). However, there was no significant difference in patients younger than 65 years. Both curve fitting and Kaplan-Meier cumulative risk analysis showed that an elevated non-HDL-C/HDL-C ratio significantly increased the 1-year risk of recurrent stroke in older patients with NICE. The optimal range for the non-HDL-C/HDL-C ratio should be no higher than the Q2 group (2.256-2.939). Stratified Cox regression analysis showed that these results tended to be stable for different comorbidities (all P for interaction > 0.05). CONCLUSIONS Elevated non-HDL-C/HDL-C ratios significantly increased the 1-year risk of recurrent stroke in older patients with NICE. Therefore, clinicians need to pay more attention to this indicator when managing older patients with NICE.
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Affiliation(s)
- Zhongzhong Liu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Department of Epidemiology and Biostatistics, School of Public Health of Xi'an Jiaotong University Health Science Center, Xi'an, 71006, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Xuemei Lin
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health of Xi'an Jiaotong University Health Science Center, Xi'an, 71006, China
| | - Huan Zhang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Weiyan Guo
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Qingli Lu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Congli Huang
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
- Department of Traditional Chinese Medicine, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
| | - Jing Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Pei Liu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Qiaoqiao Chang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Mi Zhang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Yan Huo
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Yan Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Fang Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Songdi Wu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China.
- College of Life Science, Northwest University, Xi'an, 710069, China.
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China.
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Chiangkhong A, Suwanwong C, Wongrostrai Y. Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis. Heliyon 2023; 9:e13949. [PMID: 36915512 PMCID: PMC10006477 DOI: 10.1016/j.heliyon.2023.e13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Background Stroke recurrence is increasing in the working-age population. This study aimed to summarize and evaluate the risk factors for recurrent stroke among the working-age population. Methods Relevant studies were extracted from several databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fixed- or random-effects estimates of the pooled odds ratio (OR) and 95% confidence interval (CI) of risk factors for recurrent stroke were generated based on heterogeneity. Subgroup and publication bias analyses were also performed. Results Seventeen studies were included in the meta-analysis. Pooled effects results revealed that the risk of recurrent stroke in the working-age group was as follows: Diabetes (OR = 1.85, 95% CI: 1.47, 2.32), hypertension (OR = 1.27, 95% CI: 1.12, 1.44), smoking (OR = 1.52, 95% CI: 1.27, 1.81), history of cardiac disease (OR = 2.86, 95% CI: 2.22, 3.67), history of stroke (OR = 2.45, 95% CI: 1.81, 3.31), and National Institutes of Health stroke severity score (OR = 1.09, 95% CI: 1.03, 1.15). Conclusion These findings suggest that several factors, such as diabetes, hypertension, smoking, history of cardiac disease and stroke, and severity of a stroke, are potential risk factors for recurrent stroke in the working-age group. Therefore, strategies to reduce those risk factors should be adopted and attention paid to prevent recurrent stroke among working-age populations.
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Affiliation(s)
- Araya Chiangkhong
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
| | - Charin Suwanwong
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Yupha Wongrostrai
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
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Drescher C, Buchwald F, Ullberg T, Pihlsgård M, Norrving B, Petersson J. Epidemiology of First and Recurrent Ischemic Stroke in Sweden 2010-2019: A Riksstroke Study. Neuroepidemiology 2023; 56:433-442. [PMID: 36223758 PMCID: PMC9945185 DOI: 10.1159/000527373] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ischemic stroke incidence appears to have decreased during the last decades, but most studies focus on the first-ever events and epidemiological data on recurrent stroke are scarce. The aim of our study was to investigate trends in incidence, risk factors, and medication in patients with first-ever and recurrent ischemic stroke between 2010 and 2019 in Sweden. METHODS We included patients (≥18 years old) with ischemic stroke registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. The coverage of Riksstroke was consistently high (about 90%) during this period. Data were stratified by first-ever and recurrent ischemic stroke in three different time periods (2010-2012, 2013-2016, and 2017-2019) and shown as crude and age-specific incidence rates per 100,000 person-years. Statistics Sweden provided census data on the Swedish population in different age groups. RESULTS During the study period, 201,316 cases of ischemic stroke were registered in Riksstroke, including 153,865 (76.4%) cases of first-ever ischemic stroke and 46,248 (23.0%) cases of recurrent ischemic stroke (0.6% of cases unclassified). The crude incidence of first-ever ischemic stroke decreased by 17% from 216 (95% CI 214-218) to 179 (95% CI 177-181) between 2010-2012 and 2017-2019, whereas recurrent ischemic stroke decreased by 33% from 72 (95% CI 71-73) to 48 (95% CI 47-49). Between these time periods, diminishing ischemic stroke incidence was seen in all age groups with highest decline noted in those aged 75-84 years (928 [95% CI 914-943] to 698 [95% CI 686-709]; -25% in first-ever ischemic stroke and 361 [95% CI 351-370] to 219 [95% CI 213-226]; -39% in recurrent ischemic stroke) and ≥85 years (1,674 [95% CI 1,645-1,703] to 1,295 [95% CI 1,270-1,320]; -23% in first-ever ischemic stroke and 683 [95% CI 664-702] to 423 [95% CI 409-437]; -38% in recurrent ischemic stroke). Treatment with anticoagulants in patients with atrial fibrillation and lipid-lowering drugs increased considerably in patients with first-ever and recurrent ischemic stroke both at admission and discharge during the study period. CONCLUSION Whereas both first-ever and recurrent ischemic stroke rates declined in Sweden between 2010 and 2019, the proportional decline was almost double for recurrent ischemic stroke than for first-ever ischemic stroke and most pronounced in the elderly. Increased use of secondary preventive drugs, in particular anticoagulants in atrial fibrillation, appears to have contributed, but further studies on precise causes for the decline in recurrent ischemic stroke are needed.
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Affiliation(s)
- Conrad Drescher
- Neurology, Department of Clinical Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö, Lund/Malmö, Sweden
| | - Fredrik Buchwald
- Neurology, Department of Clinical Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö, Lund/Malmö, Sweden
| | - Teresa Ullberg
- Neurology, Department of Clinical Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö, Lund/Malmö, Sweden
| | - Mats Pihlsgård
- Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Bo Norrving
- Neurology, Department of Clinical Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö, Lund/Malmö, Sweden
| | - Jesper Petersson
- Neurology, Department of Clinical Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö, Lund/Malmö, Sweden
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Morishima Y, Ueno Y, Satake A, Fukao T, Tsuchiya M, Hata T, Ogawa T, Oishi N, Nakajima S, Hirata S, Shindo K, Takiyama Y. Recurrent embolic stroke associated with adenomyosis: A single case report and literature review. Neurol Sci 2023:10.1007/s10072-023-06701-3. [PMID: 36820990 DOI: 10.1007/s10072-023-06701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Uterine adenomyosis is a benign disorder in which endometrial glands and stroma are present within the myometrium. There have been several case reports of cerebral infarction associated with adenomyosis, but their clinical characteristics, optimal treatment, and prognosis have not been systematically reviewed. METHODS A case of cerebral infarction with adenomyosis is reported, and a comprehensive systematic literature search using the PubMed database was conducted. RESULTS A 42-year-old woman, previously diagnosed with adenomyosis, developed multiple cerebral infarctions during menstruation. Her CA125 level was 293 U/mL, and treatment with edoxaban 30 mg was started. Seven days after hospital discharge, she had her subsequent menstrual period and then developed a recurrent stroke. Her CA125 level was 743 U/mL on readmission. A hysterectomy was performed, and the patient has had no further stroke recurrence. A systematic review identified 19 cases with cerebral infarction associated with adenomyosis, including the present case. The patients' clinical characteristics included young age (44.7 ± 6.2 years), stroke development during menstruation (85%), multiple infarctions affecting ≥ 3 vessel territories (39%), and high levels of CA125 and D-dimer (810.6 ± 888.4 U/mL, and 10.3 ± 18.6 μg/mL, respectively). Antithrombotic therapy was given to 14 patients, but recurrent stroke occurred in 5 (36%) patients. Hysterectomy was conducted in 5 and 4 patients with initial and recurrent stokes, respectively, and there were no further recurrences thereafter. CONCLUSION Cerebral infarction associated with adenomyosis has specific clinical characteristics. Antithrombotic therapy was insufficient, and hysterectomy should particularly be considered in cases of recurrent stroke.
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Affiliation(s)
- Yuto Morishima
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Yuji Ueno
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.
| | - Akane Satake
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.,Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan
| | - Toko Fukao
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.,Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan
| | - Mai Tsuchiya
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Takanori Hata
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Tatsuyuki Ogawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Sho Nakajima
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Kazumasa Shindo
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.,Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan
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19
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Tian Y, Pan Y, Wang M, Meng X, Zhao X, Liu L, Wang Y, Wang Y. The combination of heart rate variability and ABCD 2 score portends adverse outcomes after minor stroke or transient ischemic attack. J Neurol Sci 2023; 445:120522. [PMID: 36634579 DOI: 10.1016/j.jns.2022.120522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The residual recurrent risk of stroke, which cannot be entirely explained by the traditional ABCD2 score, still existed. Heart rate variability (HRV), a method for reflecting the function of automatic nervous system (ANS), was a novel predictor of secondary stroke events. We aimed to investigate the relationships of combined HRV and ABCD2 score with adverse outcomes after acute minor stroke (MS) or transient ischemic attack (TIA), and further investigate the independent associations between HRV and adverse outcomes after MS/TIA stratified by ABCD2 score. METHODS Data were obtained from the Third China National Stroke Registry (CNSR-III) study. We assessed the activity of ANS using standard deviation of NN intervals (SDNN), a time domain index of HRV. Trained investigators collected clinical characteristics and estimated ABCD2 score for each participant. All enrolled patients were categorized into different risk groups based on SDNN level and ABCD2 score. The clinial outcomes included recurrent stroke, recurrent ischemic stroke, and disability within 1-year follow-up. We evaluated whether combined SDNN and ABCD2 score were associated with recurrent events using multivariable Cox regression models, and those with disability using multivariable logistic regression models. The independent associations between SDNN and diverse outcomes stratified by ABCD2 score were explored using multivariable Cox and logistic regression analyses. RESULTS A total of 5,743 participants [3,316 (70.02) males, 62.0 (54.0-69.0) years] were included. Patients with low SDNN and ABCD2 ≥ 4 were associated with higher risk of recurrent stroke within 1 year (10.8% versus 4.9%; [HR] 1.31, 95% [CI] 0.92-1.88, P = 0.14) compared to patients with high SDNN with ABCD2 < 4. Lower SDNN was associated with higher recurrent stroke in patients with ABCD2 0-3 score ([HR] 0.73, 95% [CI] 0.57-0.947, P = 0.01) and ABCD2 4-5 score ([HR] 0.85, 95% [CI] 0.74-0.97, P = 0.02), but not in patients with ABCD2 6-7 score. CONCLUSION The combination of HRV and ABCD2 score might efficiently stratify the risk of 1-year recurrent stroke after MS/TIA. Moreover, lower SDNN was independently related to recurrent stroke in patients with MS/TIA, especially for those with low-to-moderate traditional vascular risk factors.
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Affiliation(s)
- Yu Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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20
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Oguro H, Takahashi T. [A case of recurrent non embolic stroke with non-fluent aphasia due to polycythemia vera]. Nihon Ronen Igakkai Zasshi 2023; 60:177-183. [PMID: 37225510 DOI: 10.3143/geriatrics.60.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 79-year-old woman was admitted to our hospital with a diagnosis of acute noncardioembolic stroke on division of the left middle cerebral artery with non-fluent aphasia. Although she was treated with dual antiplatelet therapy of aspirin and clopidogrel at first, she suffered a second stroke with enlargement of the same stroke lesion and worsening aphasia symptoms. There were only 46 days between the initial onset and recurrent stroke event.She had been diagnosed with polycythemia vera (PV) based on an increase in the blood cell count and a JAK2 mutation. The administration of hydroxyurea was effective for normalizing the blood cell count and preventing stroke recurrence. Cerebral infarction with or without any risk factors accompanied by an elevated blood cell count with a hematocrit value >45% can be PV, so it is necessary to start cytoreductive therapy as soon as possible in such cases.
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21
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Suo Y, Pan Y, Chen W, Jing J, Yan H, Li H, Liu L, Zhao X, Wang Y, Meng X, Wang Y. Aminotransferase Level and the Effects of Dual Antiplatelet in Minor Stroke or Transient Ischemic Attack: A post hoc Analysis of a Randomized Control Trial. Cerebrovasc Dis 2022; 52:442-450. [PMID: 36502795 DOI: 10.1159/000527611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/05/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION This study was intended to evaluate whether the safety and efficacy of dual antiplatelet treatment in patients with minor ischemic stroke (MIS) or transient ischemic attack (TIA) could be modified by the aminotransferase level. Also, we sought to assess the interaction between aminotransferase level and CYP2C19 loss-of-function status on the efficacy of dual antiplatelet therapy. METHODS This study is a post hoc analysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) study, a double-blinded randomized control trial. We included 5,133 patients with a complete workup of baseline alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. The primary outcome is stroke or TIA recurrence within 90 days. Cox proportional hazard models were used in the evaluation of the efficacy of antiplatelet treatment in patients with different aminotransferase levels and subgroups categorized by the aminotransferase level × CYP2C19 loss-of-function status. RESULTS The median age of all the included patients was 62 years; 66.3% of the patients were male. More recurrent stroke or TIA occurred in patients with elevated ALT and AST levels within 90 days compared to patients with normal ALT and AST levels (14.5 vs. 11.2%, p = 0.029). Dual antiplatelet treatment with aspirin and clopidogrel reduced recurrence compared with aspirin alone in patients with both normal (adjusted hazard ratio [HR], 95% confidence interval [CI]: 0.72 [0.60-0.86], p < 0.001) and elevated (adjusted HR [95% CI]: 0. 57 [0. 35-0. 92], p = 0. 020) ALT and AST levels (p = 0.64 for interaction). No significant difference in treatment efficacy on 90-day all-cause death or bleeding events was found. CONCLUSIONS Dual antiplatelet treatment was safe for minor stroke or high-risk TIA patients with mildly elevated aminotransferase. Mild elevation of ALT or AST did not undermine the protective efficacy of the dual antiplatelet regimen in reducing recurrent stroke or TIA within 90 days after MIS or TIA. The interaction between the CYP2C19 loss-of-function allele carrier status and aminotransferase level on the efficacy of dual antiplatelet treatment was not observed.
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Affiliation(s)
- Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,
- China National Clinical Research Center for Neurological Diseases, Beijing, China,
- Tiantan Neuroimaging Center of Excellence, Beijing, China,
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
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22
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Nakanishi Y, Furuta Y, Hata J, Yubi T, Oishi E, Sakata S, Hirakawa Y, Wakisaka Y, Ago T, Kitazono T, Ninomiya T. Long-Term Trends in The 5-Year Risk of Recurrent Stroke over A Half Century in A Japanese Community: The Hisayama Study. J Atheroscler Thromb 2022; 29:1759-1773. [PMID: 35185108 PMCID: PMC9881531 DOI: 10.5551/jat.63344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM Secular trends in the risk of recurrent stroke have been reported in several epidemiological studies worldwide, but this issue has not been investigated in general Japanese populations. We examined the trends in the 5-year risk of recurrent stroke over a half century using community-based prospective data in Japan. METHODS We established 4 cohort studies in 1961, 1974, 1988, and 2002. To examine the risk of recurrent stroke, participants who developed stroke during a 10-year follow-up period in each cohort were followed-up for 5 years from the date of first onset. A total of 154 (first sub-cohort: 1961-1971), 144 (second sub-cohort: 1974-1984), 172 (third sub-cohort: 1988-1998), and 146 (fourth sub-cohort: 2002-2012) participants from each cohort were enrolled in the present study. The 5-year cumulative risk of recurrent stroke was compared among the sub-cohorts using the Kaplan-Meier method and the age- and sex-adjusted Cox proportional hazards model. RESULTS The risks of recurrent stroke after any stroke and ischemic stroke decreased significantly from the first to the third sub-cohort, but they did not clearly change from the third to the fourth sub-cohort. The risk of recurrent stroke after hemorrhagic stroke decreased mainly from the first to the second sub-cohort and there was no apparent decrease from the second to the fourth sub-cohort. These trends were substantially unchanged after adjusting for age and sex. CONCLUSIONS In the Japanese community, the risk of recurrent stroke decreased mainly from the 1960s to 1990s, but there was no apparent decrease in recent years.
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Affiliation(s)
- Yasuyuki Nakanishi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Division of Medical Engineering and Healthy Longevity, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,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
| | - Tomohiro Yubi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan
| | - Emi Oishi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Sakata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,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
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,Department of Medicine and Clinical Science, 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
| | - 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
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, 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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23
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Luo D, Yang Z, Zhang G, Shen Q, Zhang H, Lai J, Hu H, He J, Wu S, Zhang C. Machine learning in a real-world PFO study: analysis of data from multi-centers in China. BMC Med Inform Decis Mak 2022; 22:305. [PMID: 36434650 PMCID: PMC9694545 DOI: 10.1186/s12911-022-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The association of patent foreman ovale (PFO) and cryptogenic stroke has been studied for years. Although device closure overall decreases the risk for recurrent stroke, treatment effects varied across different studies. In this study, we aimed to detect sub-clusters in post-closure PFO patients and identify potential predictors for adverse outcomes. METHODS We analyzed patients with embolic stroke of undetermined sources and PFO from 7 centers in China. Machine learning and Cox regression analysis were used. RESULTS Using unsupervised hierarchical clustering on principal components, two main clusters were identified and a total of 196 patients were included. The average age was 42.7 (12.37) years and 64.80% (127/196) were female. During a median follow-up of 739 days, 12 (6.9%) adverse events happened, including 6 (3.45%) recurrent stroke, 5 (2.87%) transient ischemic attack (TIA) and one death (0.6%). Compared to cluster 1 (n = 77, 39.20%), patients in cluster 2 (n = 119, 60.71%) were more likely to be male, had higher systolic and diastolic blood pressure, higher body mass index, lower high-density lipoprotein cholesterol and increased proportion of presence of atrial septal aneurysm. Using random forest survival (RFS) analysis, eight top ranking features were selected and used for prediction model construction. As a result, the RFS model outperformed the traditional Cox regression model (C-index: 0.87 vs. 0.54). CONCLUSIONS There were 2 main clusters in post-closure PFO patients. Traditional cardiovascular profiles remain top ranking predictors for future recurrence of stroke or TIA. However, whether maximizing the management of these factors would provide extra benefits warrants further investigations.
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Affiliation(s)
- Dongling Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Ziyang Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Gangcheng Zhang
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | - Hongwei Zhang
- Hubei Huiyi Cardiovascular Center, Enshi, Hubei China
| | - Junxing Lai
- Jiang Men Central Hospital, Jiangmen, Guangdong China
| | - Hui Hu
- grid.452881.20000 0004 0604 5998The First People’s Hospital of Foshan, Foshan, Guangdong China
| | - Jianxin He
- General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Caojin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
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Hazany S, Nguyen KL, Lee M, Zhang A, Mokhtar P, Crossley A, Luthra S, Butani P, Dergalust S, Ellingson B, Hinman JD. Regional Cerebral Small Vessel Disease (rCSVD) Score: A clinical MRI grading system validated in a stroke cohort. J Clin Neurosci 2022; 105:131-136. [PMID: 36183571 PMCID: PMC10163829 DOI: 10.1016/j.jocn.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current methods for quantitative assessment of cerebral small vessel disease (CSVD) ignore critical aspects of the disease, namely lesion type and regionality. We developed and tested a new scoring system for CSVD, "regional Cerebral Small Vessel Disease" (rCSVD) based on regional assessment of magnetic resonance imaging (MRI) features. METHODS 141 patients were retrospectively included with a derivation cohort of 46 consecutive brain MRI exams and a validation cohort of 95 patients with known cerebrovascular disease. We compared the predictive value of rCSVD against existing scoring methods. We determined the predictive value of rCSVD score for all-cause mortality and recurrent strokes. RESULTS 46 (44 male) veteran patients (age: 66-93 years), were included for derivation of the rCSVD score. A non-overlapping validation cohort consisted of 95 patients (89 male; age: 34-91 years) with known cerebrovascular disease were enrolled. Based on ROC analysis with comparison of AUC (Area Under the Curve), "rCSVD" score performed better compared to "total SVD score" and Fazekas score for predicting all-cause mortality (0.75 vs 0.68 vs 0.69; p = 0.046). "rCSVD" and total SVD scores were predictive of recurrent strokes in our validation cohort (p-values 0.004 and 0.001). At a median of 5.1 years (range 2-17 years) follow-up, Kaplan-Meier survival analysis demonstrated an rCSVD score of 2 to be a significant predictor of all-cause-mortality. CONCLUSION "rCSVD" score can be derived from routine brain MRI, has value in risk stratification of patients at risk of CSVD, and has potential in clinical trials once fully validated in a larger patient cohort.
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Affiliation(s)
- Saman Hazany
- Department of Radiology, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, USA.
| | - Kim-Lien Nguyen
- Division of Cardiology and Radiology, VA Greater Los Angeles Healthcare System and David, Geffen School of Medicine at UCLA, USA
| | - Martin Lee
- Department of Biostatistics, Fielding School of Public Health at UCLA, USA
| | - Andrew Zhang
- Department of Radiology, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, USA
| | - Parsa Mokhtar
- Department of Psychobiology, University of California Los Angeles, USA
| | - Alexander Crossley
- Department of Neurology, VA Greater Los Angeles Healthcare System and David Geffen, School of Medicine at UCLA, USA
| | - Sakshi Luthra
- College of Letters and Sciences, University of California Los Angeles, USA
| | - Pooja Butani
- Department of Neurology, VA Greater Los Angeles Healthcare System and David Geffen, School of Medicine at UCLA, USA
| | - Sunita Dergalust
- Department of Pharmacy, VA Greater Los Angeles Healthcare System, USA
| | - Benjamin Ellingson
- Department of Radiology and Psychiatry, David Geffen School of Medicine at UCLA, USA
| | - Jason D Hinman
- Department of Neurology, VA Greater Los Angeles Healthcare System and David Geffen, School of Medicine at UCLA, USA
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Du J, Miao M, Lu Z, Chen H, Bao A, Che B, Zhang J, Ju Z, Xu T, He J, Zhang Y, Zhong C. Plasma l-carnitine and risks of cardiovascular events and recurrent stroke after ischemic stroke: A nested case-control study. Nutr Metab Cardiovasc Dis 2022; 32:2579-2587. [PMID: 36155150 DOI: 10.1016/j.numecd.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS l-Carnitine was suggested to prevent the progression of atherosclerosis, myocardial and neurologic injury, and exhibited cardioprotective effects. However, epidemiological data on circulating l-carnitine and risks of cardiovascular events in the setting of stroke is rare. We aimed to explore the relationships between plasma l-carnitine and cardiovascular events and stroke recurrence after ischemic stroke in a nested case-control study. METHODS AND RESULTS A total of 323 cardiovascular events (including 264 recurrent strokes) and 323 matched controls (free of recurrent cardiovascular events) were included. Study outcomes included cardiovascular events and recurrent stroke after ischemic stroke. Plasma l-carnitine concentrations were measured by ultra-high-performance LC-MS/MS. Conditional logistic regression models were used to estimate odds ratios (ORs) of stroke outcomes. Plasma l-carnitine was inversely associated with cardiovascular events (OR = 0.69, 95% CI: 0.57-0.84 per SD) and recurrent stroke (OR = 0.72, 95% CI: 0.58-0.88 per SD) after adjusting for established risk confounders. Compared with the lowest tertile of l-carnitine, adjusted ORs of cardiovascular events and recurrent stroke for participants in the highest tertiles were 0.35 (95% CI: 0.21-0.57) and 0.36 (95% CI: 0.21-0.62), respectively. In addition, l-carnitine provided incremental predictive ability beyond established risk factors, shown by increase in C statistics, net reclassification improvement and integrated discrimination improvement. CONCLUSIONS Higher l-carnitine levels were associated with lower risks of cardiovascular events and recurrent stroke after ischemic stroke. Our findings provided evidence supporting plasma l-carnitine as a potential prognostic marker in risk discrimination and stratification in patients with ischemic stroke. TRIAL REGISTRATION Clinicaltrials.gov as NCT01840072. URL: https://www. CLINICALTRIALS gov.
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Affiliation(s)
- Jigang Du
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Mengyuan Miao
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Zian Lu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Haichang Chen
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Anran Bao
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Bizhong Che
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jintao Zhang
- Department of Neurology, The 88th Hospital of PLA, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
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Tanaka E, Nagakane Y, Yamada T, Kishitani T. Early recurrence in patients with symptomatic, non-cardioembolic, internal carotid artery occlusion. J Stroke Cerebrovasc Dis 2022; 31:106571. [PMID: 35732086 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/28/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There are limited data on the clinical course of patients with non-cardioembolic, mostly atherosclerotic, internal carotid artery occlusion (ICAO). The purpose of this study was to elucidate the frequency and underlying pathogenesis of early recurrent ischemic stroke in symptomatic non-cardioembolic ICAO. MATERIALS AND METHODS Consecutive patients with symptomatic non-cardioembolic ICAO were retrospectively reviewed. Those who had a tandem occlusion of the proximal middle cerebral artery (MCA) or underwent endovascular thrombectomy were excluded. Early recurrent stroke was defined as deterioration of the NIHSS score by ≥1 point with new lesions on magnetic resonance (MR) diffusion-weighted imaging (DWI) in the ipsilateral territory of the ICAO within 30 days of the index stroke onset. Patients were classified into two groups on carotid ultrasonography: cervical occlusion and intracranial occlusion. The presumed pathogenesis of recurrent stroke was categorized as embolic or hemodynamic according to the topographical features of subsequent lesions on DWI. RESULTS Of 36 consecutive medically treated patients with symptomatic non-cardioembolic ICAO without tandem MCA occlusion, 23 patients had cervical occlusion, and 13 had intracranial occlusion. Early recurrent stroke occurred in 16 patients (44.4%), which happened much more with intracranial occlusion than with cervical occlusion (69.2% vs 30.4%, p<0.02). Focusing on the presumed pathogenesis, hemodynamic was more common than embolic (68.8% vs 31.2%), especially with intracranial occlusion (77.8%). CONCLUSIONS Early recurrent stroke occurs at a high frequency in symptomatic non-cardioembolic ICAO, and intracranial occlusion may be a risk factor for early recurrent stroke. The pathogenesis of recurrence is more often hemodynamic than embolic.
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Affiliation(s)
- Eijirou Tanaka
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
| | | | - Takehiro Yamada
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Toru Kishitani
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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Abdulaziz KE, Perry JJ, Yadav K, Dowlatshahi D, Stiell IG, Wells GA, Taljaard M. Quality and transparency of reporting derivation and validation prognostic studies of recurrent stroke in patients with TIA and minor stroke: a systematic review. Diagn Progn Res 2022; 6:9. [PMID: 35585563 PMCID: PMC9118704 DOI: 10.1186/s41512-022-00123-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical prediction models/scores help clinicians make optimal evidence-based decisions when caring for their patients. To critically appraise such prediction models for use in a clinical setting, essential information on the derivation and validation of the models needs to be transparently reported. In this systematic review, we assessed the quality of reporting of derivation and validation studies of prediction models for the prognosis of recurrent stroke in patients with transient ischemic attack or minor stroke. METHODS MEDLINE and EMBASE databases were searched up to February 04, 2020. Studies reporting development or validation of multivariable prognostic models predicting recurrent stroke within 90 days in patients with TIA or minor stroke were included. Included studies were appraised for reporting quality and conduct using a select list of items from the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) Statement. RESULTS After screening 7026 articles, 60 eligible articles were retained, consisting of 100 derivation and validation studies of 27 unique prediction models. Four models were newly derived while 23 were developed by validating and updating existing models. Of the 60 articles, 15 (25%) reported an informative title. Among the 100 derivation and validation studies, few reported whether assessment of the outcome (24%) and predictors (12%) was blinded. Similarly, sample size justifications (49%), description of methods for handling missing data (16.1%), and model calibration (5%) were seldom reported. Among the 96 validation studies, 17 (17.7%) clearly reported on similarity (in terms of setting, eligibility criteria, predictors, and outcomes) between the validation and the derivation datasets. Items with the highest prevalence of adherence were the source of data (99%), eligibility criteria (93%), measures of discrimination (81%) and study setting (65%). CONCLUSIONS The majority of derivation and validation studies for the prognosis of recurrent stroke in TIA and minor stroke patients suffer from poor reporting quality. We recommend that all prediction model derivation and validation studies follow the TRIPOD statement to improve transparency and promote uptake of more reliable prediction models in practice. TRIAL REGISTRATION The protocol for this review was registered with PROSPERO (Registration number CRD42020201130 ).
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Affiliation(s)
- Kasim E. Abdulaziz
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jeffrey J. Perry
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Krishan Yadav
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Dar Dowlatshahi
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada
- grid.412687.e0000 0000 9606 5108Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Ian G. Stiell
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - George A. Wells
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Monica Taljaard
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
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Huang WY, Ovbiagele B, Lee M. Oral anticoagulants vs antiplatelets in cryptogenic stroke with potential cardiac emboli: Meta-analysis. Eur J Intern Med 2022; 95:44-49. [PMID: 34419310 DOI: 10.1016/j.ejim.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 08/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best antithrombotic strategy for cryptogenic stroke with potential cardiac emboli is not known. The objective of this study was to conduct a meta-analysis to evaluate the efficacy and safety of oral anticoagulants (OACs) vs. antiplatelet therapies in these patients METHODS: Pubmed, EMBASE, CENTRAL and clinicaltrials.gov were searched from January 1980 to April 2021 to identify trials comparing OACs versus antiplatelet therapies in patients with cryptogenic stroke and potential cardiac emboli (patent foramen ovale, moderate-severe left atrial enlargement, heart failure with reduced ejection fraction). Relative risk (RR) with 95% confidence (CI) was used as a measure of the effect of OACs versus antiplatelet therapies on recurrent ischemic stroke and major bleeding. We computed a random-effect estimate based on the Mantel-Haenszel method for a given outcome. RESULTS We identified 6 studies derived from 5 trials with 2282 patients. Pooled results from 6 studies showed that compared with antiplatelet therapies, OACs were associated with a lower risk of recurrent ischemic stroke (RR 0.61, 95% CI 0.41 to 0.91, P=0.02). Only 3 studies of cryptogenic stroke with patent foramen ovale reported a major bleeding endpoint and pooled results from random-effects model showed that OACs compared with antiplatelet therapies were associated with a non-significantly increased risk of major bleeding (RR 1.61, 95% CI 0.76 to 3.40, P=0.21). CONCLUSIONS OACs compared with antiplatelet therapies were associated with a reduced recurrent ischemic stroke risk and OACs might be a viable non-procedural alternative in patients with cryptogenic stroke and potential cardiac emboli.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Keelung branch, Taiwan
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, Taiwan.
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Wang A, Cao S, Tian X, Zuo Y, Meng X, Chen P, Li H, Zhao L, Wang Y. Lower Serum Potassium Levels at Admission are Associated with the Risk of Recurrent Stroke in Patients with Acute Ischemic Stroke or Transient Ischemic Attack. Cerebrovasc Dis 2021; 51:304-312. [PMID: 34856549 DOI: 10.1159/000520052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Serum potassium abnormality is a risk factor of incident stroke, but whether it is associated with recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. This study aimed to investigate the association of serum potassium with the risk of recurrent stroke in patients with AIS or TIA. METHODS We included 12,425 patients from the China National Stroke Registry III. Patients were classified into 3 groups according to tertiles of potassium. The outcomes were recurrence of stroke and combined vascular events at 1 year. Cox proportional hazards regression was adopted to explore the associations by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs). RESULTS Among 12,425 enrolled patients, the median (interquartile range) of potassium was 3.92 (3.68-4.19) mmol/L. Compared with the highest tertile, after adjusted for confounding factors, the lowest tertile potassium was associated with increased risk of recurrent stroke at 1 year. The adjusted HR with 95% CI was 1.21 (1.04-1.41). There was an independent, linear association between serum potassium and stroke recurrence. Per 1 mmol/L decrease of potassium was associated with 19% higher risk of recurrent stroke (HR, 1.19; 95% CI, 1.04-1.37). Similar trends were found in ischemic stroke and combined vascular events. CONCLUSIONS Lower serum potassium level was independently associated with elevated risk of recurrent stroke in patients with AIS or TIA. The finding suggested that monitoring serum potassium may help physicians to identify patients at high risk of recurrent stroke and to stratify risk for optimal management.
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Affiliation(s)
- Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuang Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China, .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China,
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pan Chen
- China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hashmi AT, Batool A, Khalid MO, Raheja H, Sadiq A, Hollander G. Multiple strokes due to pulmonary arteriovenous malformation. Radiol Case Rep 2021; 16:2362-2365. [PMID: 34306282 PMCID: PMC8258794 DOI: 10.1016/j.radcr.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case of recurrent strokes in a patient with absent left internal carotid artery (ICA) and pulmonary arteriovenous malformation. Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary artery and pulmonary vein, cause extracardiac right to left shunting of blood and are known to significantly increase the risk of stroke primarily due to paradoxical embolization. They are often hereditary and are commonly associated with hereditary hemorrhagic telangiectasias (HHT). Delayed bubbles seen in the left ventricle (after 3 cardiac cycles) on transthoracic echocardiogram with bubble study is often the first clue to the presence of PAVMs. CT scan of the chest can confirm the diagnosis. Percutaneous embolotherapy is the treatment of choice with reduction in stroke risk post embolization.
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Affiliation(s)
- Arsalan Talib Hashmi
- Department of Cardiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, USA
- Corresponding author.
| | - Asiya Batool
- Department of Medicine, Jinnah Hospital, Lahore, Pakistan
| | - Mazin O. Khalid
- Department of Cardiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, USA
| | - Hitesh Raheja
- Department of Cardiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, USA
| | - Adnan Sadiq
- Department of Cardiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, USA
| | - Gerald Hollander
- Department of Cardiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, USA
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Zhao JJ, Lu Y, Cui JY, Ma LQ, Zhang RP, Xu Z. Characteristics of symptomatic plaque on high-resolution magnetic resonance imaging and its relationship with the occurrence and recurrence of ischemic stroke. Neurol Sci 2021; 42:3605-3613. [PMID: 34236554 DOI: 10.1007/s10072-021-05457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events. METHODS The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020. RESULTS We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke. CONCLUSION High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.
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Affiliation(s)
- Jie-Ji Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Yue Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Jun-Yi Cui
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China
| | - Lin-Qing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Run-Ping Zhang
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China.
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Wang X, Liu X, Wang Z, Tong S, Jin Z, Guo X. Different reorganizations of functional brain networks after first-ever and recurrent ischemic stroke. Brain Res 2021; 1765:147494. [PMID: 33887252 DOI: 10.1016/j.brainres.2021.147494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Even though recurrent stroke patients constitute a large percentage of the stroke population, few studies specifically investigated their neural reorganization. In this study, we recruited seventeen first-ever stroke patients as well as fourteen recurrent stroke patients, and recorded their resting EEG signals and NIHSS score before and after two weeks of recovery, to compare their neural reorganization from network scale. The clinical improvements were comparable in two groups during the two weeks. However, their brain networks were differently reorganized, especially in the delta band. The recurrent stroke patients showed an increased clustering coefficient and a decreased characteristic path length of the delta network, along with increased ipsilesional intrahemispheric connectivity; while no such changes were observed in the first-ever stroke patients. Our results suggest that stroke history influences neural reorganization during recovery.
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Affiliation(s)
- Xu Wang
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiaonan Liu
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Zhuo Wang
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Shanbao Tong
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zheng Jin
- Department of Neurology, Minhang Branch of Yueyang Hospital, Chinese Medicine University of Shanghai, Shanghai 200241, China.
| | - Xiaoli Guo
- The School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
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Chaudhary D, Khan A, Shahjouei S, Gupta M, Lambert C, Avula V, Schirmer CM, Holland N, Griessenauer CJ, Azarpazhooh MR, Li J, Abedi V, Zand R. Trends in ischemic stroke outcomes in a rural population in the United States. J Neurol Sci 2021; 422:117339. [PMID: 33592506 DOI: 10.1016/j.jns.2021.117339] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. METHODS This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. RESULTS The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. CONCLUSION Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.
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Pham BN, Phan HT, Nguyen TQ, Nguyen TH. A Case of Successful Intravenous Thrombolysis Bridged with Repeated Endovascular Treatment in Acute Basilar Artery Occlusion. Case Rep Neurol 2021; 12:34-40. [PMID: 33505270 DOI: 10.1159/000507752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/03/2020] [Indexed: 11/19/2022] Open
Abstract
Acute basilar artery occlusion (BAO) is a neurological emergency that has a high rate of mortality and poor functional outcome. Endovascular therapy (ET) is the gold standard therapy for large vessel occlusion stroke of the anterior circulation. Whether ET can also be effectively and safely performed in early recurrent large vessel occlusion, especially in BAO, is unclear. We describe a case of successful recanalization and independent functional outcome of a BAO patient treated with intravenous thrombolysis combined with repeated ET. The patients was a 32-year-old man with a history of heavy smoking and drinking who presented to the Emergency Department with dizziness and hypertension, and progressed over the next 13 h to left hemiparesis and mild dysarthria with an NIHSS score of 7. CT angiography demonstrated occlusion of the proximal basilar artery (BA). Intravenous alteplase was given followed by ET. The first intervention failed and over the next 8 h, the patient's NIHSS score increased to 12. A second attempt with balloon angioplasty managed to reconstitute arterial blood flow with a severe residual stenosis of the proximal BA. Subsequently, the patient progressed into deep coma with reocclusion of the BA demonstrated on transcranial Doppler. A third intervention with emergent stenting resulted in complete recanalization of the BA and excellent neurological recovery. This patient received three endovascular treatments within 24 h due to reocclusion of the BA and achieved good outcomes. In conclusion, repeated ET for early recurrent BAO is feasible in carefully selected patients.
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Affiliation(s)
| | - Hoang Thi Phan
- 115 People's Hospital, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Thang Huy Nguyen
- 115 People's Hospital, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Lee HJ, Kwak HS, Chung GH, Park JS. Repeated Endovascular Thrombectomy in Patients with Acute Ischemic Stroke in a Single Center. J Stroke Cerebrovasc Dis 2020; 30:105457. [PMID: 33188951 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients with acute ischemic stroke treated with endovascular thrombectomy may be treated with repeat endovascular thrombectomy (rEVT) in case of recurrent large vessel occlusion (LVO). The purpose of this study is to report the frequency, timing, and outcomes of rEVT in a single center. MATERIALS AND METHODS We retrospectively reviewed our databases for anterior or posterior circulation rEVT cases. Patient characteristics, procedural data, and functional outcomes (modified Rankin scale at 90 days) were analyzed. Early and late recurrence of stroke was divided at 30 days. RESULTS Of 1025 patients treated between January 2011 and January 2020, 23 (2.2%) underwent rEVT. The median time between the first and second procedure was 185 days; 7 (30.4%) patients were re-treated within 30 days. Eleven patients (47.8%) had different occlusion sites between the two procedures. Good clinical outcome of patients with late ipsilateral recurrence was significantly higher than that of patients with late contralateral recurrence (83.3% vs. 16.7, p = 0.027). Overall good functional outcome after the second procedure was 43.5% (10/23). Overall good functional outcome of early and late recurrence groups were similar (57.1% vs. 37.5%, p = 0.650). One patient died due to an underlying cardiac problem. CONCLUSION rEVT can be performed in patients with recurrent stroke of LVO. Ipsilateral recurrence of stroke was associated with good clinical outcome after rEVT.
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Affiliation(s)
- Hyun Jin Lee
- Jeonbuk National University Medical School, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea.
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do 561-756, Republic of Korea.
| | - Jung-Soo Park
- Departments of Neurosurgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea.
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Widjaja KK, Chulavatnatol S, Suansanae T, Wibowo YI, Sani AF, Islamiyah WR, Nathisuwan S. Knowledge of stroke and medication adherence among patients with recurrent stroke or transient ischemic attack in Indonesia: a multi-center, cross-sectional study. Int J Clin Pharm 2020; 43:666-672. [PMID: 33124676 DOI: 10.1007/s11096-020-01178-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BackgroundThere is a limited data in Indonesia regarding the stroke knowledge and medication adherence among stroke survivors.ObjectiveTo assess the level of stroke knowledge and medication adherence along with their relationship among stroke survivors.SettingTwo tertiary-care hospitals in Surabaya, East Java, Indonesia.MethodsA prospective, cross-sectional study was conducted among 215 stroke survivors. Stroke Knowledge Test and the Morisky Green Levine Adherence Scale questionnaires were used to evaluate stroke knowledge and medication adherence, respectively. Binary logistic regression was performed to assess the rela tionship between stroke knowledge and medication adherence. Main outcome measuresRelationship between stroke knowledge and medication adherence.ResultsA total of 215 patients with mean age of 56.34 ± 8.69 years were recruited into this study. Mean Stroke Knowledge Test score was 7.89 ± 3.38 with 76.7% had low level of stroke knowledge. Mean Morisky Green Levine Adherence Scale was 3.05 ± 1.11 with 52.1% had low to medium medication adherence. Education and duration of stroke correlated with stroke knowledge level (Spearman's correlation coefficient: 0.307, p = 0.001 and 0.128, p = 0.041, respectively). Age and disability correlated with medication adherence (Spearman's correlation coefficient: 0.169; p = 0.013 and 0.171; p = 0.012), respectively. After adjustment for covariates, stroke knowledge level was independently associated with medication adherence (adjusted OR: 4.37, 95% CI 2.00-9.53; p < 0.001).ConclusionStroke knowledge was low among Indonesian stroke survivors and independently related to medication adherence. Attempts should be made to increase stroke knowledge which may improve medication adherence among stroke survivors.
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Affiliation(s)
- Karina Kumaladewi Widjaja
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suvatna Chulavatnatol
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Thanarat Suansanae
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yosi Irawati Wibowo
- Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Achmad Firdaus Sani
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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Ozaki D, Endo T, Suzuki H, Sugiyama SI, Endo K, Itabashi R, Fujimura M, Tominaga T. Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence. Acta Neurochir (Wien) 2020; 162:2583-2588. [PMID: 32152755 DOI: 10.1007/s00701-020-04272-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/19/2020] [Indexed: 11/25/2022]
Abstract
Carotid web has been recognized as a rare cause of ischemic stroke with high recurrence rate. We describe a 48-year-old woman with carotid web who developed embolic stroke. We obtained a fresh thrombus from the internal carotid artery when carotid endarterectomy was performed. A preoperative computational fluid dynamics (CFD) study showed stagnation of blood around the web structure as well as the low wall shear stress. The rheological analysis newly disclosed mechanisms of thrombus formation related to the carotid web. CFD study in the carotid web may determine indication and timing of surgical interventions with further accumulation of clinical evidence.
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Affiliation(s)
- Dan Ozaki
- Department of neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami Taihaku, Sendai, 982-8523, Japan
| | - Toshiki Endo
- Department of neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami Taihaku, Sendai, 982-8523, Japan.
| | - Hiroyoshi Suzuki
- Departments of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | | | - Kaoru Endo
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Miki Fujimura
- Department of neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami Taihaku, Sendai, 982-8523, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Multon S, Denier C, Charbonneau P, Sarov M, Boulate D, Mitilian D, Mougin J, Chassin O, Legris N, Fadel E, Haulon S, Fabre D. Carotid webs management in symptomatic patients. J Vasc Surg 2020; 73:1290-1297. [PMID: 32889072 DOI: 10.1016/j.jvs.2020.08.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atypical fibromuscular dysplasia (AFMD), also known as carotid web, is a rare underdiagnosed shelf-like fibrous tissue arising from the posterior carotid artery bulb that is a cause of cryptogenic stroke of the anterior cerebral vascularization. Despite the recurrence and severity of strokes caused by embolization associated with AFMD, there are no recommendations on the best strategy to manage single and bilateral lesions, which have unsatisfactory outcomes when treated with medical treatment exclusively. METHODS From January 2016 to April 2019, 365 patients were operated on for a carotid stenosis in our institution. This cohort included 11 patients (3%), with a median age of 41 years (range, 39-51 years), referred by a stroke unit, treated for a symptomatic (10 strokes and 1 recurrent transient ischemic attack) AFMD lesion. Preoperative workup revealed a contralateral similar lesion in 45% of patients (5/11), which all also underwent surgery during a subsequent hospitalization. The diagnosis was confirmed by histologic examination when open surgery was performed. The 30-day and 1-year outcomes were retrospectively reviewed. RESULTS Of the 16 AFMD lesions operated, 13 were treated by open surgery (2 by classic endarterectomy and 11 by internal carotid resection-anastomosis) and 3 by carotid artery stenting, respectively, with a mean delay of 85.5 days and 20.5 days after the latest stroke. There was one complication after stenting (external iliac rupture) that was treated by a covered stent, and no perioperative complications after open surgery. The follow-ups at 30 days and 1 year were uneventful for all patients, without any deaths or stroke recurrences. CONCLUSIONS Symptomatic AFMD is a rare cause of cryptogenic stroke. Bilateral lesions are frequent. Early intervention is associated with favorable perioperative and 1-year outcomes. Open surgery is the first-line therapeutic option in this young patient population.
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Affiliation(s)
- Sébastien Multon
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Christian Denier
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Phillippe Charbonneau
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Mariana Sarov
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - David Boulate
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Delphine Mitilian
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Justine Mougin
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Olivier Chassin
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Nicolas Legris
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Elie Fadel
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Stephan Haulon
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Dominique Fabre
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
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Kadwa RA, Nair AK. Isolated left ventricular non-compaction with moyamoya syndrome and renal agenesis-a rare association and a rare cause of recurrent stroke in a young boy. Childs Nerv Syst 2020; 36:1581-2. [PMID: 32483656 DOI: 10.1007/s00381-020-04681-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
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40
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Lin SY, Tang SC, Tsai LK, Yeh SJ, Huang CF, Jeng JS. Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy. J Formos Med Assoc 2020; 119:1799-1806. [PMID: 32107099 DOI: 10.1016/j.jfma.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/27/2019] [Accepted: 02/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND/PURPOSE Atrial fibrillation (AF) patients with a history of ischemic stroke or transient ischemic attack (TIA) carry excessive risk of recurrent stroke. Real-world data for the Asian population is scarce. This study aimed to investigate the thromboembolism and major bleeding risk of non-vitamin K antagonist oral anticoagulant (NOAC) therapy among Asian patients, and to identify the risk factors of recurrent stroke. METHODS This retrospective study recruited AF patients aged over 20 years, who had a previous stoke or TIA, and received NOAC therapy. Thromboembolic events were recurrent ischemic stroke or TIA, and the major bleeding events were classified according to the PLATO (Platelet Inhibition and Patient Outcomes) criteria. RESULTS A total of 361 patients (61.2% male) were enrolled for data analysis. The incidence rate for recurrent ischemic stroke or TIA was 3.6 (95% CI = 2.5 to 5.5) per 100 person-years, and 0.9 (95% CI = 0.4 to 1.7) per 100 person-years for major bleeding. Patients with recurrent ischemic stroke or TIA were more likely to have malignancy (hazard ratio [HR] for malignancy = 4.4, 95% CI = 1.9 to 10.3, p = 0.001) and concomitantly take enzyme inducing antiepileptic drugs (EIAED, HR = 8.1, 95% CI = 2.7 to 24.1, p < 0.001). CONCLUSION Atrial fibrillation patients with underlying malignancy or concurrently use of EIAED may have increased risk of treatment failure in secondary stroke prevention.
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Affiliation(s)
- Shin-Yi Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Joe Yeh
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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Kondo A, Ikeguchi R, Shirai Y, Kobayashi M, Toi S, Shimizu Y, Kitagawa K. Association of IgG4-Related Arteritis With Recurrent Stroke. J Stroke Cerebrovasc Dis 2020; 29:104514. [PMID: 31796239 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 01/13/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4)-related disease is a newly recognized form of immune-mediated disease, which is characterized by IgG4+ lymphoplasmacytic infiltration and fibrosis in the systemic organs. Although aortitis/periaortitis is a phenotype of IgG4-related disease, the relationship between cerebrovascular disease and IgG4-related disease remains unclear. Herein, we report the case of a 49-year-old man with recurrent stroke induced by IgG4-related arteritis. Case reports or studies examining the association between IgG4-related arteritis and stroke are limited. Although a definitive link between IgG4-related arteritis and stroke has not been established, IgG4-related arteritis should be considered as an etiology in patients with recurrent idiopathic stroke.
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Wen Z, Jiang Y, Zhang L, Xu X, Zhao N, Xu X, Wang F, Gao J, Yang GY, Liu X. The effect of anterior communicating artery flow on neurovascular injury and neurobehavioral outcomes in mice with recurrent stroke. Brain Res 2019; 1724:146440. [PMID: 31513789 DOI: 10.1016/j.brainres.2019.146440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies have estimated that the risk of recurrent stroke was nearly 20% shortly after a transient ischemic attack (TIA) or minor stroke. A missing or hypoplastic (<0.5 mm) anterior communicating artery can have deleterious effects on the brain. Our study aimed to investigate the effect of anterior communicating artery flow on neurovascular injury and neurobehavioral outcomes in mice with recurrent stroke and to identify its underlying mechanisms. METHODS A recurrent stroke model was established by an initial cortical infarction followed by a corticostriatal infarction 3 days later. The vascular structure was visualized using synchrotron radiation angiography & magnetic resonance angiography in vivo and transparent endovascular perfusion imaging in vitro. Microvessel perfusion was assessed via fluorescein isothiocyanate perfusion. The infarct volume was measured by magnetic resonance imaging. RESULTS The finding that anterior communicating artery flow facilitates pial artery patency in the ipsilateral hemisphere in mice with recurrent stroke suggests that compensatory collateral patency contributes to increased regional cerebral blood flow, enhanced microcirculatory perfusion, improved neurological function and reduced infarct volume. CONCLUSIONS The results of this study demonstrate that anterior communicating artery flow alleviates recurrent stroke-induced neurovascular injury and improves neurobehavioral outcomes by promoting the establishment of collateral circulation.
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Affiliation(s)
- Zhuoyu Wen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Neurology, Shanghai Fifth People's Hospital Affiliated with Fudan University, Shanghai, China
| | - Yongjun Jiang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Linyuan Zhang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomeng Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Nan Zhao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaohui Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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El-Gohary TM, Alshenqiti AM, Ibrahim SR, Khaled OA, Ali ARH, Ahmed MS. Risk factors and types of recurrent stroke: a Saudi hospital based study. J Phys Ther Sci 2019; 31:743-746. [PMID: 31645798 PMCID: PMC6801352 DOI: 10.1589/jpts.31.743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/15/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To identify the risk factors and the stroke types in recurrent stroke patients of Madinah Al-Munawarah city. [Participants and Methods] A prospective research hospital based study was conducted through the year of 2014. The patients were entered in the study when they had recurrent cerebrovascular accident led to hospital admission. All details of patients were obtained include history, demographic data, risk factors and stroke types. [Results] Ninety-four (83.9%) ischaemic strokes, 12 (10.7%) intercerebral hemorrhage strokes and 6 (5.4%) undefined out of 112 patients had recurrent stroke found in this study. Hypertension was the most prevalent risk factors (90.2%) followed by diabetes mellitus (62.5%) and ischaemic heart disease (51.8%). [Conclusion] Hypertension, diabetes, and ischaemic heart disease in particular were exhibited to be crucial risk factors for stroke recurrence in this study. Future studies are needed for secondary prevention planning.
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Affiliation(s)
- Tarek Mohamed El-Gohary
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia.,Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
| | - Abdullah M Alshenqiti
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia
| | - Sameh R Ibrahim
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia.,Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
| | - Osama Ahmed Khaled
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia.,Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
| | - Abdul Rahman H Ali
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia
| | - Mostafa S Ahmed
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University: P.O. Box 344, Almadina Almunawara 41411, Saudi Arabia
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Vincent-Onabajo G, Adamu A. Prevalence of Recurrent Stroke among a Rehabilitation Cohort in Nigeria. P R Health Sci J 2019; 38:181-184. [PMID: 31536632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE A recurrent stroke increases the rates of mortality and morbidity after an initial stroke. There is, however, a dearth of data on the prevalence of recurrent stroke in Nigeria. METHODS A secondary analysis of the data obtained from 100 stroke survivors undergoing physiotherapy at 2 health facilities in Nigeria was carried out to document the prevalence of recurrent stroke. The association between recurrent stroke and selected socio-demographic and clinical factors of the participants was explored using logistic regression analysis. RESULTS Thirty-two (32%) participants had had a recurrent stroke. Employment status and educational level were significantly associated with recurrent stroke. The outcome of the logistic regression analysis further showed that participants who were employed (OR = 0.08; P<0.001; 95% CI = 0.02-0.32) and who had no formal education (OR = 0.22; P = 0.03; 95% CI = 0.05-0.87) were significantly less likely to present with recurrent stroke compared to the unemployed participants and those who had tertiary educational qualification, respectively. CONCLUSION Approximately 1 in 3 stroke survivors undergoing rehabilitation had experienced stroke recurrence. The finding of this study buttresses the urgent need to emphasize and aggressively pursue secondary stroke prevention. Further studies are, however, required to explore those potentially modifiable factors that are associated with recurrent stroke, and having more representative samples.
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Affiliation(s)
- Grace Vincent-Onabajo
- Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Abdulbaqi Adamu
- Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
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Guillaumier A, McCrabb S, Spratt NJ, Pollack M, Baker AL, Magin P, Turner A, Oldmeadow C, Collins C, Callister R, Levi C, Searles A, Deeming S, Wynne O, Denham AMJ, Clancy B, Bonevski B. An online intervention for improving stroke survivors' health-related quality of life: study protocol for a randomised controlled trial. Trials 2019; 20:491. [PMID: 31399140 PMCID: PMC6688335 DOI: 10.1186/s13063-019-3604-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health-risk behaviours and mental health has the potential to significantly improve recovery, enhance health-related quality of life (HRQoL), independent living, and lower the risk of recurrent stroke. The primary aim will be to test the effectiveness of an online intervention to improve HRQoL among stroke survivors at 6 months’ follow-up. Programme effectiveness on four health behaviours, anxiety and depression, cost-effectiveness, and impact on other hospital admissions will also be assessed. Methods/design An open-label randomised controlled trial is planned. A total of 530 adults will be recruited across one national and one regional stroke registry and block randomised to the intervention or minimal care control group. The intervention group will receive access to the online programme Prevent 2nd Stroke (P2S); the minimal care control group will receive an email with Internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. A full analysis plan will compare between groups from baseline to follow-up. Discussion A low-cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke. Trial registration Australian and New Zealand Clinical Trials Registry, ID: ACTRN12617001205325p. Registered on 17 August 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3604-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Neil J Spratt
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.,Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Michael Pollack
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, PO Box 291, Geelong, VIC, Australia.,Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Clare Collins
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Robin Callister
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Chris Levi
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Andrew Searles
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Simon Deeming
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Alexandra M J Denham
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Brigid Clancy
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.
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Mehta T, McClure LA, White CL, Taylor A, Benavente OR, Lakshminarayan K. Effect of Postural Hypotension on Recurrent Stroke: Secondary Prevention of Small Subcortical Strokes (SPS3) Study. J Stroke Cerebrovasc Dis 2019; 28:2124-2131. [PMID: 31147254 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/27/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) has been independently associated with increased risk of stroke and other cardiovascular events. We sought to investigate the relationship between OH at follow-up and recurrent stroke risk in SPS3 (Secondary Prevention of Small Subcortical Strokes) trial patient cohort. This is a retrospective cohort analysis. METHODS We included all SPS3 trial participants with blood pressure measurements in both sitting and standing position per protocol at baseline, with at least 1 follow-up visit to establish the relationship between OH at follow-up and recurrent stroke risk (primary outcome). Secondary outcomes included major vascular events, myocardial infarction, all-cause mortality, and, ischemic and hemorrhagic stroke subtypes. Participants were classified as having OH at baseline and at each follow-up visit based on a systolic BP decline ≥20 mm Hg or a diastolic BP decline ≥10 mm Hg on position change from sitting to standing. We used Cox proportional hazards regression modeling to compare the risk of outcomes among those with and without OH. RESULTS A total of 2275 patients were included with a mean follow up time 3.2 years (standard deviation = 1.6 years). 39% (881/2275) had OH at some point during their follow-up. Of these, 41% (366/881) had orthostatic symptoms accompanying the BP drop. In a fully adjusted model, those with OH had a 1.8 times higher risk of recurrent stroke than those without OH (95% confidence interval: 1.1-3.0). The risk of ischemic stroke, major vascular events, and all-cause mortality was similarly elevated among the OH group. CONCLUSION OH was associated with increased recurrent stroke risk, vascular events, and all-cause death in this large cohort of lacunar stroke patients. Whether minimizing OH in the management of poststroke hypertension in patients with lacunar stroke reduces recurrent stroke risk deserves further study.
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Affiliation(s)
- Tapan Mehta
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Leslie A McClure
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Addison Taylor
- Michael E. DeBakey VA Medical Center & Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Oscar R Benavente
- Department of Medicine, Division of Neurology University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
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Bhogal P, AlMatter M, Hellstern V, Pérez MA, Ganslandt O, Bäzner H, Henkes H. Mechanical thrombectomy for recurrent large vessel occlusion. J Clin Neurosci 2019; 66:107-112. [PMID: 31113697 DOI: 10.1016/j.jocn.2019.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 04/13/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
Abstract
Although mechanical thrombectomy (MT) has been shown in numerous trials to be a successful treatment option for patients with large vessel occlusion (LVO), there is limited information on the safety and effectiveness of the technique in cases of recurrent LVO. To this end, we performed a retrospective review of our prospectively maintained database to identify all patients that had undergone more than one MT procedure January 2008 and January 2018. The data collected on these patients included baseline demographics and any history of diabetes mellitus, hypercholesterolaemia, hypertension, atrial fibrillation or smoking. We also recorded when the symptoms had started, the patient's NIHSS and ASPECT scores, the number of passes taken, the patient's final TICI score, any complications which arose and the patient's mRS at 90 days. Our dataset encompassed 25 patients (of which 17 (68%) were female) who had undergone a total number of 52 MT's. Average age at 1st presentation was 70 ± 12.8 years. The median time between one stroke and the next was 71 days (range 1-1059, IQR 183 days). The majority of the strokes were deemed cardioembolic (86.5%) in origin. There was no significant difference in the procedure times, number of passes or TICI scores. There was a significant difference in the mRS after the 1st and 2nd events (p = 0.014) but no significant difference if the 2nd event occurred contralateral to the 1st event (p = 0.66) (n = 22). It is therefore concluded that recurrent thrombectomy can be safely performed with no significant difference in the technical aspects of the procedure.
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Affiliation(s)
- P Bhogal
- The Royal London Hospital, Whitechapel Road, London, UK.
| | - M AlMatter
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - V Hellstern
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - M Aguilar Pérez
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - H Henkes
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany; Medical Faculty, University Duisburg-Essen, Germany
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Dhawan SR, Chatterjee D, Radotra BD, Vaidya PC, Vyas S, Sankhyan N, Singhi PD. A Child with Tuberculous Meningitis Complicated by Cortical Venous and Cerebral Sino-Venous Thrombosis. Indian J Pediatr 2019; 86:371-8. [PMID: 30623313 DOI: 10.1007/s12098-018-2830-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023]
Abstract
Stroke is common in tuberculous meningitis. Stroke commonly affects the tubercular zone, comprising the anterior part of the thalamus, caudate and the internal capsule (anterior limb and genu). Stroke, in tuberculous meningitis is predominantly arterial ischemic stroke, and is due to infiltrative, proliferative or necrotizing arteritis. Rarely, aneurysm formation and mycotic aneurysms have also been described. The authors describe the clinical and autopsy findings of a 27-mo-old boy with tuberculous meningitis whose course was complicated by arterial and venous strokes, and nonresponse to adequate and appropriate antitubercular therapy.
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Béjot Y, Bailly H, Graber M, Garnier L, Laville A, Dubourget L, Mielle N, Chevalier C, Durier J, Giroud M. Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry. Neuroepidemiology 2019; 52:78-85. [PMID: 30602168 DOI: 10.1159/000492820] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to evaluate the impact of the ageing population on temporal trends in burden of stroke and to provide projections for the coming years. METHODS Stroke cases (ischemic strokes, spontaneous intracerebral hemorrhages, or undetermined strokes) were prospectively identified between 1987 and 2015 in Dijon, France, using a population-based registry. Age-standardized incidence rates of first-ever and recurrent stroke were calculated, and their temporal trends were assessed using age- and sex-adjusted annual incidence rate ratios (RR). RESULTS The population of Dijon increased by 3.8% over time, with an increase by 28% in the number of residents aged ≥75 years. We recorded 5,899 strokes including 5,101 patients with a first-ever event. Incidence of first-ever stroke was stable both in people < 75 and ≥75 years old, but an increase in standardized incidence rates of total strokes was noted due to a rise in the incidence of recurrent stroke (from 4.7/100,000/year in 1987-1994 to 12.3/100,000/year in 2009-2015 in people < 75 years old, RR 1.036; p < 0.001; from 74/100,000/year in 1987-1994 to 200/100,000/year in 2009-2015 in people ≥75 years, RR 1.040; p < 0.001). The absolute number of first-ever strokes increased by 43%, and that of total stroke events rose by 58% over time, with a more pronounced increase in people ≥75 years old (+47 and +65% respectively). The annual number of patients who survived > 90 days after a first-ever stroke increased by 90%. According to demographic projections, the total number of strokes will increase by 55% (+65% patients ≥75 years, and +25% patients < 75 years) by 2,030 in Dijon. CONCLUSIONS Ageing and growth of the population led to a rise in the absolute number of strokes, especially in the elderly, that is expected to increase dramatically in the coming years. Improved stroke care was accompanied with an increase in stroke survivors that contributed to a rise in recurrent events. Urgent action is needed to meet this epidemiological challenge.
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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, Dijon, France,
| | - Henri Bailly
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Mathilde Graber
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Lucie Garnier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Annabel Laville
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Lucile Dubourget
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Nathalie Mielle
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Corinne Chevalier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Jérôme Durier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
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50
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Muengtaweepongsa S, Tantibundhit C. Microembolic signal detection by transcranial Doppler: Old method with a new indication. World J Methodol 2018; 8:40-43. [PMID: 30519538 PMCID: PMC6275557 DOI: 10.5662/wjm.v8.i3.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Transcranial Doppler (TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke (or stroke with undetermined etiology), and patent foramen ovale (PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.
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Affiliation(s)
- Sombat Muengtaweepongsa
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Charturong Tantibundhit
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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