Pub Date : 2020-01-01Epub Date: 2020-10-08DOI: 10.1159/000510438
Ayaka Ito, Shinichi Iwata, Soichiro Tamura, Andrew T Kim, Shinichi Nonin, Sera Ishikawa, Asahiro Ito, Yasuhiro Izumiya, Takato Abe, Toshihiko Shibata, Minoru Yoshiyama
Introduction: Silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke in the general population. Although aortic stenosis (AS) is also known to be associated with an increased risk of future symptomatic stroke, little is known regarding the prevalence and risk factors for SBI in patients with AS.
Methods: The study population comprised 83 patients with severe AS with no history of stroke or transient ischemic attack and paralysis or sensory impairment (mean age 75 ± 7 years). All patients underwent brain magnetic resonance imaging to screen for SBI and multidetector-row computed tomography to quantify the aortic valve calcification (AVC) volume. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial (LA) abnormalities, such as LA enlargement, spontaneous echo contrast, or abnormal LA appendage emptying velocity (<20 cm/s), and complex plaques in the aortic arch.
Results: SBI was detected in 38 patients (46%). Multiple logistic regression analysis indicated that CHA2DS2-VASc score and estimated glomerular filtration rate (eGFR) were independently associated with SBI (p < 0.05), whereas LA abnormalities and AVC volume were not. When patients were divided into 4 groups according to CHA2DS2-VASc score and eGFR, the group with a higher CHA2DS2-VASc score (≥4) and a lower eGFR (<60 mL/min/1.73 m2) had a greater risk of SBI than the other groups (p < 0.05).
Conclusion: These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA2DS2-VASc score and eGFR are useful for risk stratification.
{"title":"Prevalence and Risk Factors of Silent Brain Infarction in Patients with Aortic Stenosis.","authors":"Ayaka Ito, Shinichi Iwata, Soichiro Tamura, Andrew T Kim, Shinichi Nonin, Sera Ishikawa, Asahiro Ito, Yasuhiro Izumiya, Takato Abe, Toshihiko Shibata, Minoru Yoshiyama","doi":"10.1159/000510438","DOIUrl":"https://doi.org/10.1159/000510438","url":null,"abstract":"<p><strong>Introduction: </strong>Silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke in the general population. Although aortic stenosis (AS) is also known to be associated with an increased risk of future symptomatic stroke, little is known regarding the prevalence and risk factors for SBI in patients with AS.</p><p><strong>Methods: </strong>The study population comprised 83 patients with severe AS with no history of stroke or transient ischemic attack and paralysis or sensory impairment (mean age 75 ± 7 years). All patients underwent brain magnetic resonance imaging to screen for SBI and multidetector-row computed tomography to quantify the aortic valve calcification (AVC) volume. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial (LA) abnormalities, such as LA enlargement, spontaneous echo contrast, or abnormal LA appendage emptying velocity (<20 cm/s), and complex plaques in the aortic arch.</p><p><strong>Results: </strong>SBI was detected in 38 patients (46%). Multiple logistic regression analysis indicated that CHA2DS2-VASc score and estimated glomerular filtration rate (eGFR) were independently associated with SBI (p < 0.05), whereas LA abnormalities and AVC volume were not. When patients were divided into 4 groups according to CHA2DS2-VASc score and eGFR, the group with a higher CHA2DS2-VASc score (≥4) and a lower eGFR (<60 mL/min/1.73 m2) had a greater risk of SBI than the other groups (p < 0.05).</p><p><strong>Conclusion: </strong>These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA2DS2-VASc score and eGFR are useful for risk stratification.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"116-123"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000510438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38467611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Izumi Yamaguchi, Y. Kanematsu, Kenji Shimada, M. Korai, Takeshi Miyamoto, E. Shikata, Tadashi Yamaguchi, N. Yamamoto, Yuki Yamamoto, K. Kitazato, Y. Okayama, Y. Takagi
Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.
{"title":"Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke","authors":"Izumi Yamaguchi, Y. Kanematsu, Kenji Shimada, M. Korai, Takeshi Miyamoto, E. Shikata, Tadashi Yamaguchi, N. Yamamoto, Yuki Yamamoto, K. Kitazato, Y. Okayama, Y. Takagi","doi":"10.1159/000504163","DOIUrl":"https://doi.org/10.1159/000504163","url":null,"abstract":"Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"129 - 138"},"PeriodicalIF":1.9,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000504163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45026610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Schaafsma, F. Silver, S. Kasner, L. Caplan, Linda Rose-Finnell, F. Charbel, D. Pandey, S. Amin‐Hanjani
Introduction: Distal territory blood flow is independently associated with subsequent strokes in symptomatic vertebrobasilar atherosclerotic disease. We aimed to assess infarct patterns in relation to hemodynamic status in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. Methods: Distal territory blood flow was measured using quantitative magnetic resonance angiography (MRA) in 72 patients with symptomatic atherosclerotic vertebrobasilar disease, and then dichotomized into normal (n = 54) and low (n = 18) flow. Patients were followed longitudinally on standard medical management. Two observers blinded to flow status independently reviewed the imaging performed at the time of subsequent strokes, in order to adjudicate the likely mechanism based on infarct patterns. The frequency of stroke mechanisms was qualitatively compared based on flow status. Results: During a median follow-up period of 23 months, 10/72 patients had a subsequent stroke; 5 of these had low distal flow. Infarct patterns were adjudicated to be consistent with hemodynamic (n = 2), embolic (n = 4), and junctional plaque/perforator (n = 4) infarcts. Hemodynamic infarcts were seen in 40% (2/5) low-flow patients, in comparison to 0% (0/5) normal-flow patients. Conclusion: In contrast to normal-flow patients, those with low distal flow seem to be uniquely susceptible to hemodynamic infarctions, although other patterns of infarction can also be seen in these hemodynamically impaired patients.
{"title":"Infarct Patterns in Patients with Atherosclerotic Vertebrobasilar Disease in Relation to Hemodynamics","authors":"J. Schaafsma, F. Silver, S. Kasner, L. Caplan, Linda Rose-Finnell, F. Charbel, D. Pandey, S. Amin‐Hanjani","doi":"10.1159/000503091","DOIUrl":"https://doi.org/10.1159/000503091","url":null,"abstract":"Introduction: Distal territory blood flow is independently associated with subsequent strokes in symptomatic vertebrobasilar atherosclerotic disease. We aimed to assess infarct patterns in relation to hemodynamic status in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. Methods: Distal territory blood flow was measured using quantitative magnetic resonance angiography (MRA) in 72 patients with symptomatic atherosclerotic vertebrobasilar disease, and then dichotomized into normal (n = 54) and low (n = 18) flow. Patients were followed longitudinally on standard medical management. Two observers blinded to flow status independently reviewed the imaging performed at the time of subsequent strokes, in order to adjudicate the likely mechanism based on infarct patterns. The frequency of stroke mechanisms was qualitatively compared based on flow status. Results: During a median follow-up period of 23 months, 10/72 patients had a subsequent stroke; 5 of these had low distal flow. Infarct patterns were adjudicated to be consistent with hemodynamic (n = 2), embolic (n = 4), and junctional plaque/perforator (n = 4) infarcts. Hemodynamic infarcts were seen in 40% (2/5) low-flow patients, in comparison to 0% (0/5) normal-flow patients. Conclusion: In contrast to normal-flow patients, those with low distal flow seem to be uniquely susceptible to hemodynamic infarctions, although other patterns of infarction can also be seen in these hemodynamically impaired patients.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"123 - 128"},"PeriodicalIF":1.9,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48647749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Stroke can produce subtle changes in the brain that may produce symptoms that are too small to lead to a diagnosis. Noting that a lack of diagnosis may bias research estimates, the current study sought to examine the utility of pattern recognition relying on serial assessments of cognition to objectively identify stroke-like patterns of cognitive decline (pattern-detected stroke, p-stroke). Methods: Secondary data analysis was conducted using participants with no reported history of stroke in the Health and Retirement Study, a large (n = 16,113) epidemiological study of cognitive aging among respondents aged 50 years and older that measured episodic memory consistently biennially between 1996 and 2014. Analyses were limited to participants with at least 4 serial measures of episodic memory. Occurrence and date of p-stroke events were identified utilizing pattern recognition to identify stepwise declines in cognition consistent with stroke. Descriptive statistics included the percentage of the population with p-stroke, the mean change in episodic memory resulting in stroke-positive testing, and the mean time between p-stroke and first major diagnosed stroke. Statistical analyses comparing cases of p-stroke with reported major stroke relied on the area under the receiver-operating curve (AUC). Longitudinal modeling was utilized to examine rates of change in those with/without major stroke after adjusting for demographics. Results: The pattern recognition protocol identified 7,499 p-strokes that went unreported. On average, individuals with p-stroke declined in episodic memory by 1.986 (SD = 0.023) words at the inferred time of stroke. The resulting pattern recognition protocol was able to identify self-reported major stroke (AUC = 0.58, 95% CI = 0.57–0.59, p < 0.001). In those with a reported major stroke, p-stroke events were detectable on average 4.963 (4.650–5.275) years (p < 0.001) before diagnosis was first reported. The incidence of p-stroke was 40.23/1,000 (95% CI = 39.40–41.08) person-years. After adjusting for sex, age was associated with the incidence of p-stroke and major stroke at similar rates. Conclusions: This is the first study to propose utilizing pattern recognition to identify the incidence and timing of p-stroke. Further work is warranted examining the clinical utility of pattern recognition in identifying p-stroke in longitudinal cognitive profiles.
背景:中风可以在大脑中产生细微的变化，这些变化可能产生的症状太小而无法诊断。注意到缺乏诊断可能会使研究估计偏倚，目前的研究试图检验依赖于认知的系列评估的模式识别的效用，以客观地识别认知衰退的卒中样模式(模式检测卒中，p-stroke)。方法:对健康与退休研究中无卒中史的参与者进行二级数据分析。健康与退休研究是一项大型(n = 16,113)的认知衰老流行病学研究，在1996年至2014年期间，50岁及以上的受访者每两年持续测量情景记忆。分析仅限于至少有4个情节记忆系列测量的参与者。使用模式识别来识别与中风一致的认知逐步下降，确定p-卒中事件的发生和日期。描述性统计包括p型中风人群的百分比，导致中风阳性测试的情景记忆的平均变化，以及p型中风和首次主要诊断中风之间的平均时间。p型脑卒中病例与重度脑卒中病例的统计分析依赖于接受者工作曲线下面积(AUC)。在调整人口统计学因素后，采用纵向模型来检查有/没有严重中风的患者的变化率。结果:模式识别方案确定了7499例未报告的p型中风。p-卒中个体在卒中发生时间情景记忆平均下降1.986个单词(SD = 0.023)。由此产生的模式识别方案能够识别自我报告的严重卒中(AUC = 0.58, 95% CI = 0.57-0.59, p < 0.001)。在有严重卒中报告的患者中，p-卒中事件在首次报告诊断前的平均时间为4.963(4.650-5.275)年(p < 0.001)。p-卒中的发生率为40.23/ 1000 (95% CI = 39.40-41.08)人年。在对性别进行调整后，年龄与p型中风和重度中风的发病率有相似的关系。结论:这是首次提出利用模式识别来识别p型卒中的发生率和时间。进一步的工作需要检查模式识别在纵向认知谱中识别p型卒中的临床应用。
{"title":"Pattern Recognition to Identify Stroke in the Cognitive Profile: Secondary Analyses of a Prospective Cohort Study","authors":"S. Clouston, Yun Zhang, Dylan M. Smith","doi":"10.1159/000503002","DOIUrl":"https://doi.org/10.1159/000503002","url":null,"abstract":"Background: Stroke can produce subtle changes in the brain that may produce symptoms that are too small to lead to a diagnosis. Noting that a lack of diagnosis may bias research estimates, the current study sought to examine the utility of pattern recognition relying on serial assessments of cognition to objectively identify stroke-like patterns of cognitive decline (pattern-detected stroke, p-stroke). Methods: Secondary data analysis was conducted using participants with no reported history of stroke in the Health and Retirement Study, a large (n = 16,113) epidemiological study of cognitive aging among respondents aged 50 years and older that measured episodic memory consistently biennially between 1996 and 2014. Analyses were limited to participants with at least 4 serial measures of episodic memory. Occurrence and date of p-stroke events were identified utilizing pattern recognition to identify stepwise declines in cognition consistent with stroke. Descriptive statistics included the percentage of the population with p-stroke, the mean change in episodic memory resulting in stroke-positive testing, and the mean time between p-stroke and first major diagnosed stroke. Statistical analyses comparing cases of p-stroke with reported major stroke relied on the area under the receiver-operating curve (AUC). Longitudinal modeling was utilized to examine rates of change in those with/without major stroke after adjusting for demographics. Results: The pattern recognition protocol identified 7,499 p-strokes that went unreported. On average, individuals with p-stroke declined in episodic memory by 1.986 (SD = 0.023) words at the inferred time of stroke. The resulting pattern recognition protocol was able to identify self-reported major stroke (AUC = 0.58, 95% CI = 0.57–0.59, p < 0.001). In those with a reported major stroke, p-stroke events were detectable on average 4.963 (4.650–5.275) years (p < 0.001) before diagnosis was first reported. The incidence of p-stroke was 40.23/1,000 (95% CI = 39.40–41.08) person-years. After adjusting for sex, age was associated with the incidence of p-stroke and major stroke at similar rates. Conclusions: This is the first study to propose utilizing pattern recognition to identify the incidence and timing of p-stroke. Further work is warranted examining the clinical utility of pattern recognition in identifying p-stroke in longitudinal cognitive profiles.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"114 - 122"},"PeriodicalIF":1.9,"publicationDate":"2019-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44704970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Toshiaki Goda, N. Oyama, T. Kitano, Takanori Iwamoto, Shinji Yamashita, Hiroki Takai, S. Matsubara, M. Uno, Y. Yagita
Introduction: Mechanical thrombectomy (MT) for acute ischemic stroke has become a standard therapy, and the recanalization rate has significantly improved. However, some cases of unsuccessful recanalization still occur. We aimed to clarify patient factors associated with unsuccessful recanalization after MT for acute ischemic stroke. Methods: This was a single-center, retrospective study of 119 consecutive patients with anterior circulation acute ischemic stroke who underwent MT at our hospital between April 2015 and March 2019. Successful recanalization after MT was defined as modified Treatment in Cerebral Ischemia (mTICI) grade 2b or 3, and unsuccessful recanalization was defined as mTICI grades 0–2a. Several factors were analyzed to assess their effect on recanalization rates. Results: Successful recanalization was achieved in 88 patients (73.9%). The univariate analysis showed that female sex (38.6 vs. 67.7%, p = 0.007), a history of hypertension (53.4 vs. 83.9%, p = 0.003), and a longer time from groin puncture to recanalization (median 75 vs. 124 min, p < 0.001) were significantly associated with unsuccessful recanalization. The multivariate analysis confirmed that female sex (OR 3.18; 95% CI 1.12–9.02, p = 0.030), a history of hypertension (OR 4.84; 95% CI 1.32–17.8, p = 0.018), M2–3 occlusion (OR 4.26; 95% CI 1.36–13.3, p = 0.013), and the time from groin puncture to recanalization (per 10-min increase, OR 1.22; 95% CI 1.09–1.37, p < 0.001) were independently associated with unsuccessful recanalization. Conclusion: Female sex and a history of hypertension might be predictors of unsuccessful recanalization after MT for anterior circulation acute ischemic stroke. Further studies are needed to fully evaluate predictors of recanalization.
{"title":"Factors Associated with Unsuccessful Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke","authors":"Toshiaki Goda, N. Oyama, T. Kitano, Takanori Iwamoto, Shinji Yamashita, Hiroki Takai, S. Matsubara, M. Uno, Y. Yagita","doi":"10.1159/000503001","DOIUrl":"https://doi.org/10.1159/000503001","url":null,"abstract":"Introduction: Mechanical thrombectomy (MT) for acute ischemic stroke has become a standard therapy, and the recanalization rate has significantly improved. However, some cases of unsuccessful recanalization still occur. We aimed to clarify patient factors associated with unsuccessful recanalization after MT for acute ischemic stroke. Methods: This was a single-center, retrospective study of 119 consecutive patients with anterior circulation acute ischemic stroke who underwent MT at our hospital between April 2015 and March 2019. Successful recanalization after MT was defined as modified Treatment in Cerebral Ischemia (mTICI) grade 2b or 3, and unsuccessful recanalization was defined as mTICI grades 0–2a. Several factors were analyzed to assess their effect on recanalization rates. Results: Successful recanalization was achieved in 88 patients (73.9%). The univariate analysis showed that female sex (38.6 vs. 67.7%, p = 0.007), a history of hypertension (53.4 vs. 83.9%, p = 0.003), and a longer time from groin puncture to recanalization (median 75 vs. 124 min, p < 0.001) were significantly associated with unsuccessful recanalization. The multivariate analysis confirmed that female sex (OR 3.18; 95% CI 1.12–9.02, p = 0.030), a history of hypertension (OR 4.84; 95% CI 1.32–17.8, p = 0.018), M2–3 occlusion (OR 4.26; 95% CI 1.36–13.3, p = 0.013), and the time from groin puncture to recanalization (per 10-min increase, OR 1.22; 95% CI 1.09–1.37, p < 0.001) were independently associated with unsuccessful recanalization. Conclusion: Female sex and a history of hypertension might be predictors of unsuccessful recanalization after MT for anterior circulation acute ischemic stroke. Further studies are needed to fully evaluate predictors of recanalization.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"107 - 113"},"PeriodicalIF":1.9,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45978316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuichiro Ohya, M. Osaki, S. Fujimoto, Juro Jinnouchi, T. Matsuki, Satomi Mezuki, M. Kumamoto, M. Kanazawa, Naoki Tagawa, T. Ago, T. Kitazono, S. Arakawa
Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.
{"title":"Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source","authors":"Yuichiro Ohya, M. Osaki, S. Fujimoto, Juro Jinnouchi, T. Matsuki, Satomi Mezuki, M. Kumamoto, M. Kanazawa, Naoki Tagawa, T. Ago, T. Kitazono, S. Arakawa","doi":"10.1159/000502713","DOIUrl":"https://doi.org/10.1159/000502713","url":null,"abstract":"Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"98 - 106"},"PeriodicalIF":1.9,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502713","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43363375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isabella Francalanza, Antonio Ciacciarelli, A.A. Caragliano, C. Casella, Masina Cotroneo, C. Dell’Aera, M. C. Fazio, F. Grillo, A. Pitrone, S. Vinci, G. Trimarchi, R. Musolino, P. La Spina
Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.
{"title":"Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study","authors":"Isabella Francalanza, Antonio Ciacciarelli, A.A. Caragliano, C. Casella, Masina Cotroneo, C. Dell’Aera, M. C. Fazio, F. Grillo, A. Pitrone, S. Vinci, G. Trimarchi, R. Musolino, P. La Spina","doi":"10.1159/000502084","DOIUrl":"https://doi.org/10.1159/000502084","url":null,"abstract":"Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"90 - 97"},"PeriodicalIF":1.9,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42987729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Q. Luong, A. D. Nguyen, C. Nguyen, T. Mai, T. A. Nguyen, S. N. Do, P. Dao, Hanh M. Pham, D. T. Pham, H. M. Ngo, Q. H. Nguyen, D. T. Nguyen, T. H. Tran, K. Le, Nam Trong Do, N. Ngo, V. D. Nguyen, H. Ngo, Ha Hoang, Ha Viet Vu, L. Vu, B. Ngo, Bai Xuan Nguyen, D. Khuong, Dung T. Nguyen, T. Vuong, T. Be, T. Gaberel, Lieu Van Nguyen
Background: Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. Methods: This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. Results: Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0–3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0–3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). Conclusions: In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.
背景:急性梗阻性脑积水(AOH)脑室内出血(IVH)患者需要脑室外引流(EVD)治疗，其预后不良的风险很高。低剂量重组组织型纤溶酶原激活剂(rtPA)可用于脑室内纤溶(IVF)改善患者预后。在这里，我们评估了体外受精对IVH合并AOH患者死亡风险和功能结局的影响。方法:本前瞻性队列研究纳入了IVH合并高血压颅内出血合并AOH的患者，这些患者需要EVD。我们评估了1个月和3个月时的死亡风险和功能结局，特别关注了低剂量rtPA联合EVD与IVF的影响。结果:2011年11月30日至2014年12月30日，纳入80例患者。单纯EVD治疗45例(EVD组)，体外受精35例(EVD+IVF组)。EVD+IVF组的30天和90天死亡率低于EVD组(分别为42.2 vs. 11.4%， p = 0.003和62.2 vs. 20%， p < 0.001)。EVD+IVF组前3天和第7天的Graeb评分显著低于EVD组(p≤0.001)。EVD+IVF组的30天良好功能预后(改良Rankin量表[mRS]评分0-3)也高于EVD组(6.7 vs. 28.6%， p = 0.008)。然而，EVD+IVF组90天良好功能结局(mRS评分0-3)没有显著增加(EVD组为30.8%，EVD+IVF组为51.6%，p = 0.112)。结论:在我们的前瞻性观察研究中，EVD+IVF与IVH患者较低的死亡风险相关。EVD+IVF提高了1个月时功能预后良好的机会;然而，这一结果在3个月时不再观察到。
{"title":"Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus","authors":"C. Q. Luong, A. D. Nguyen, C. Nguyen, T. Mai, T. A. Nguyen, S. N. Do, P. Dao, Hanh M. Pham, D. T. Pham, H. M. Ngo, Q. H. Nguyen, D. T. Nguyen, T. H. Tran, K. Le, Nam Trong Do, N. Ngo, V. D. Nguyen, H. Ngo, Ha Hoang, Ha Viet Vu, L. Vu, B. Ngo, Bai Xuan Nguyen, D. Khuong, Dung T. Nguyen, T. Vuong, T. Be, T. Gaberel, Lieu Van Nguyen","doi":"10.1159/000501530","DOIUrl":"https://doi.org/10.1159/000501530","url":null,"abstract":"Background: Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. Methods: This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. Results: Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0–3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0–3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). Conclusions: In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"77 - 89"},"PeriodicalIF":1.9,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47885118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bryant Rosell, Kristina Shkirkova, J. Saver, D. Liebeskind, S. Starkman, M. Kim-Tenser, M. Eckstein, Latisha Sharma, R. Conwit, S. Hamilton, N. Sanossian
Background and Purpose: Subject retention into clinical trials is vital, and prehospital enrollment may be associated with higher rates of subject withdrawal than more traditional methods of enrollment. We describe rates of subject retention in a prehospital trial of acute stroke therapy. Methods: All subjects were enrolled into the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial. Paramedics screened eligible subjects and contacted the physician-investigator using a dedicated in-ambulance cellular phone. Physician-investigators obtained explicit informed consent from the subject or on-scene legally authorized representative (LAR) who reviewed and signed a consent form. Exception from informed consent (EFIC) was utilized in later stages of the study. Results: There were 1,700 subjects enrolled; 1,017 provided consent (60%), 662 were enrolled via LAR (39%), and 21 were enrolled via EFIC (1%). Of the 1,700 patients, 1,413 (83%) completed the 90-day visit, 265 (16%) died prior to the 90-day visit, and 22 (1.3%) withdrew from the study before completion. There were no differences in rates of withdrawal by method of study enrolment, i.e., self-consent (n = 14), 1.4%; LAR (n = 8), 1.2%; EFIC (n = 0) 0%. Conclusion: There was a high rate of retention when subjects were enrolled into prehospital stroke research using a phone-based method to obtain explicit consent.
{"title":"Subject Retention in Prehospital Stroke Research Using a Telephone-Based Physician-Investigator Driven Enrollment Method","authors":"Bryant Rosell, Kristina Shkirkova, J. Saver, D. Liebeskind, S. Starkman, M. Kim-Tenser, M. Eckstein, Latisha Sharma, R. Conwit, S. Hamilton, N. Sanossian","doi":"10.1159/000500851","DOIUrl":"https://doi.org/10.1159/000500851","url":null,"abstract":"Background and Purpose: Subject retention into clinical trials is vital, and prehospital enrollment may be associated with higher rates of subject withdrawal than more traditional methods of enrollment. We describe rates of subject retention in a prehospital trial of acute stroke therapy. Methods: All subjects were enrolled into the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial. Paramedics screened eligible subjects and contacted the physician-investigator using a dedicated in-ambulance cellular phone. Physician-investigators obtained explicit informed consent from the subject or on-scene legally authorized representative (LAR) who reviewed and signed a consent form. Exception from informed consent (EFIC) was utilized in later stages of the study. Results: There were 1,700 subjects enrolled; 1,017 provided consent (60%), 662 were enrolled via LAR (39%), and 21 were enrolled via EFIC (1%). Of the 1,700 patients, 1,413 (83%) completed the 90-day visit, 265 (16%) died prior to the 90-day visit, and 22 (1.3%) withdrew from the study before completion. There were no differences in rates of withdrawal by method of study enrolment, i.e., self-consent (n = 14), 1.4%; LAR (n = 8), 1.2%; EFIC (n = 0) 0%. Conclusion: There was a high rate of retention when subjects were enrolled into prehospital stroke research using a phone-based method to obtain explicit consent.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"72 - 76"},"PeriodicalIF":1.9,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000500851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43848069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In the first 5 years after their stroke, about a quarter of patients will suffer from a recurrent stroke. Digital health interventions facilitating interactions between a caregiver and a patient from a distance are a promising approach to improve patient adherence to lifestyle changes proposed by secondary prevention guidelines. Many of these interventions are not implemented in daily practice, even though efficacy has been shown. One of the reasons can be the lack of clear economic incentives for implementation. We propose to map all health economic evidence regarding digital health interventions for secondary stroke prevention.
Summary: We performed a systematic search according to PRISMA-P guidelines and searched on PubMed, Web of Science, Cochrane, and National Institute for Health Research Economic Evaluation Database. Only digital health interventions for secondary prevention in stroke patients were included and all study designs and health economic outcomes were accepted. We combined the terms "Stroke OR Cardiovascular," "Secondary prevention," "Digital health interventions," and "Cost" in one search string using the AND operator. The search performed on April 20, 2017 yielded 163 records of which 26 duplicates were removed. After abstract screening, 20 articles were retained for full-text analysis, of which none reported any health economic evidence that could be included for analysis or discussion. Key Messages: There is a lack of evidence on health economic outcomes on digital health interventions for secondary stroke prevention. Future research in this area should take health economics into consideration when designing a trial and there is a clear need for health economic evidence and models.
背景：在中风后的前5年，大约四分之一的患者会遭受复发性中风。促进护理人员和患者远距离互动的数字健康干预措施是一种很有前途的方法，可以提高患者对二级预防指南提出的生活方式改变的依从性。其中许多干预措施没有在日常实践中实施，尽管已经显示出疗效。其中一个原因可能是缺乏明确的执行经济激励措施。我们建议绘制关于二次中风预防数字健康干预的所有健康经济证据。摘要：我们根据PRISMA-P指南进行了系统搜索，并在PubMed、Web of Science、Cochrane和国家卫生研究所经济评估数据库上进行了搜索。仅纳入了用于中风患者二级预防的数字健康干预措施，并接受了所有研究设计和健康经济结果。我们使用and运算符将术语“中风或心血管疾病”、“二级预防”、“数字健康干预”和“成本”组合在一个搜索字符串中。2017年4月20日进行的搜索产生了163条记录，其中26条重复记录被删除。经过摘要筛选，保留了20篇文章进行全文分析，其中没有一篇报告了任何可供分析或讨论的健康经济证据。关键信息：缺乏关于二次中风预防数字健康干预的健康经济结果的证据。在设计试验时，该领域的未来研究应考虑健康经济学，显然需要健康经济学证据和模型。
{"title":"Health Economic Evaluations of Digital Health Interventions for Secondary Prevention in Stroke Patients: A Systematic Review.","authors":"Alexis Valenzuela Espinoza, Stephane Steurbaut, Alain Dupont, Pieter Cornu, Robbert-Jan van Hooff, Raf Brouns, Koen Putman","doi":"10.1159/000496107","DOIUrl":"10.1159/000496107","url":null,"abstract":"<p><strong>Background: </strong>In the first 5 years after their stroke, about a quarter of patients will suffer from a recurrent stroke. Digital health interventions facilitating interactions between a caregiver and a patient from a distance are a promising approach to improve patient adherence to lifestyle changes proposed by secondary prevention guidelines. Many of these interventions are not implemented in daily practice, even though efficacy has been shown. One of the reasons can be the lack of clear economic incentives for implementation. We propose to map all health economic evidence regarding digital health interventions for secondary stroke prevention.</p><p><strong>Summary: </strong>We performed a systematic search according to PRISMA-P guidelines and searched on PubMed, Web of Science, Cochrane, and National Institute for Health Research Economic Evaluation Database. Only digital health interventions for secondary prevention in stroke patients were included and all study designs and health economic outcomes were accepted. We combined the terms \"Stroke OR Cardiovascular,\" \"Secondary prevention,\" \"Digital health interventions,\" and \"Cost\" in one search string using the AND operator. The search performed on April 20, 2017 yielded 163 records of which 26 duplicates were removed. After abstract screening, 20 articles were retained for full-text analysis, of which none reported any health economic evidence that could be included for analysis or discussion. Key Messages: There is a lack of evidence on health economic outcomes on digital health interventions for secondary stroke prevention. Future research in this area should take health economics into consideration when designing a trial and there is a clear need for health economic evidence and models.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000496107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36883821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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