Introduction: Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. This study aimed to evaluate the outcomes of these patients and identify the predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke.
Methods: Patients with mild ischemic stroke (NIHSS ≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 h of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed.
Results: 254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95% CI: 1.06-5.81), cardioembolism (OR 3.34, 95% CI: 1.26-8.87), and brainstem stroke (OR 2.78, 95% CI: 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95% CI: 3.31-100), moderate to severe white matter lesions (OR 2.90, 95% CI: 1.44-5.84), clinical progression (OR 12.5, 95% CI: 5.08-31.25), and recurrent stroke (OR 8.47, 95% CI: 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95% CI: 2.35-19.02), diabetes mellitus (OR 2.59, 95% CI: 1.07-6.27), and smoking (OR 4.26, 95% CI: 1.52-11.95) were related to recurrent stroke.
Conclusion: Implementation of the up-to-date standard care in clinical practice would bring good clinical outcomes to the patients with mild stroke and high-risk TIA.
{"title":"Outcomes of Mild Stroke and High-Risk Transient Ischemic Attack in Current Clinical Practice.","authors":"Apiluk Wesanonthawech, Pornpatr A Dharmasaroja","doi":"10.1159/000526969","DOIUrl":"https://doi.org/10.1159/000526969","url":null,"abstract":"<p><strong>Introduction: </strong>Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. This study aimed to evaluate the outcomes of these patients and identify the predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke.</p><p><strong>Methods: </strong>Patients with mild ischemic stroke (NIHSS ≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 h of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed.</p><p><strong>Results: </strong>254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95% CI: 1.06-5.81), cardioembolism (OR 3.34, 95% CI: 1.26-8.87), and brainstem stroke (OR 2.78, 95% CI: 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95% CI: 3.31-100), moderate to severe white matter lesions (OR 2.90, 95% CI: 1.44-5.84), clinical progression (OR 12.5, 95% CI: 5.08-31.25), and recurrent stroke (OR 8.47, 95% CI: 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95% CI: 2.35-19.02), diabetes mellitus (OR 2.59, 95% CI: 1.07-6.27), and smoking (OR 4.26, 95% CI: 1.52-11.95) were related to recurrent stroke.</p><p><strong>Conclusion: </strong>Implementation of the up-to-date standard care in clinical practice would bring good clinical outcomes to the patients with mild stroke and high-risk TIA.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 3","pages":"109-116"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/c0/cee-0012-0108.PMC9710422.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10783251","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}
Begoña López, Maria Castañón-Apilánez, Javier Molina-Gil, Santiago Fernández-Gordón, Gemma González, Antía Reguera Acuña, Jose Maria Jimenez, Davinia Larrosa Campo, Montserrat González Delgado, Lorena Benavente-Fernández, Maria Rico-Santos, Carmen García-Cabo, Sergio Calleja Puerta, Elena López-Cancio
Introduction: Prealbumin is a marker of malnutrition and inflammation. It has been associated with poor prognosis in cardiovascular disease, but less is known in stroke patients. Our objective was to evaluate the association of prealbumin levels at admission with prognosis in patients with stroke treated with mechanical thrombectomy.
Methods: Retrospective study of a prospective database of consecutive patients treated with mechanical thrombectomy. Clinical, radiological, and blood parameters including serum prealbumin, and prognostic variables such as respiratory infection, in-hospital mortality, and the modified Rankin scale at 3 months were collected.
Results: We included 319 patients between 2018 and 2019. Prealbumin levels were significantly lower in patients older than 80 years, women, patients with a prestroke Rankin score >2, a glomerular filtrate rate <60 mL/min, and in those with atrial fibrillation. Regarding prognostic variables, prealbumin levels were not associated with respiratory infection. Low prealbumin levels were associated with poor functional prognosis (Rankin score >2), in-hospital mortality, and 3-month mortality. In multivariate analysis, prealbumin was an independent risk factor associated with mortality at 3 months, OR 0.92 [0.86-0.98], p = 0.019.
Conclusion: Lower prealbumin levels at admission behaved as an independent predictor of long-term mortality in patients treated with mechanical thrombectomy. These results should be replicated in other cohorts.
{"title":"Serum Prealbumin Levels on Admission as a Prognostic Marker in Stroke Patients Treated with Mechanical Thrombectomy.","authors":"Begoña López, Maria Castañón-Apilánez, Javier Molina-Gil, Santiago Fernández-Gordón, Gemma González, Antía Reguera Acuña, Jose Maria Jimenez, Davinia Larrosa Campo, Montserrat González Delgado, Lorena Benavente-Fernández, Maria Rico-Santos, Carmen García-Cabo, Sergio Calleja Puerta, Elena López-Cancio","doi":"10.1159/000526354","DOIUrl":"https://doi.org/10.1159/000526354","url":null,"abstract":"<p><strong>Introduction: </strong>Prealbumin is a marker of malnutrition and inflammation. It has been associated with poor prognosis in cardiovascular disease, but less is known in stroke patients. Our objective was to evaluate the association of prealbumin levels at admission with prognosis in patients with stroke treated with mechanical thrombectomy.</p><p><strong>Methods: </strong>Retrospective study of a prospective database of consecutive patients treated with mechanical thrombectomy. Clinical, radiological, and blood parameters including serum prealbumin, and prognostic variables such as respiratory infection, in-hospital mortality, and the modified Rankin scale at 3 months were collected.</p><p><strong>Results: </strong>We included 319 patients between 2018 and 2019. Prealbumin levels were significantly lower in patients older than 80 years, women, patients with a prestroke Rankin score >2, a glomerular filtrate rate <60 mL/min, and in those with atrial fibrillation. Regarding prognostic variables, prealbumin levels were not associated with respiratory infection. Low prealbumin levels were associated with poor functional prognosis (Rankin score >2), in-hospital mortality, and 3-month mortality. In multivariate analysis, prealbumin was an independent risk factor associated with mortality at 3 months, OR 0.92 [0.86-0.98], p = 0.019.</p><p><strong>Conclusion: </strong>Lower prealbumin levels at admission behaved as an independent predictor of long-term mortality in patients treated with mechanical thrombectomy. These results should be replicated in other cohorts.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 3","pages":"103-108"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/8a/cee-0012-0102.PMC9941761.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10742879","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}
Background: The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy.
Methods: This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared.
Results: We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5-1.9] vs. 1.2 [1.2-1.5] mm, p = 0.007) and shorter length (7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90).
Conclusion: In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.
背景:急性大血管闭塞时闭塞血管的长度对机械取栓成功再灌注的影响尚不清楚。本研究评估急性大脑中动脉(MCA)闭塞血管的直径和长度是否与机械取栓后成功再灌注有关。方法:本回顾性研究纳入了急性MCA闭塞患者,他们接受主动脉内注射造影剂,通过配备血管造影系统的平板计算机断层扫描(FD-CT)获得最大强度投影(MIP)图像。所有患者均接受机械取栓,并分为再灌注成功组(Thrombolysis in Cerebral Infarction [TICI] 2b/3)和再灌注失败组。我们比较了两组间闭塞血管的直径和长度。在使用支架回收器患者的亚分析中,比较闭塞血管长度与活动区长度的比例。结果:我们纳入了29例患者(中位年龄:73岁,M1闭塞:51%,支架回收器使用率:72%)。18例患者达到TICI 2b/3,闭塞血管远端直径明显增大(1.7[四分位数间距:1.5-1.9]比1.2 [1.2-1.5]mm, p = 0.007),长度明显缩短(7.1[4.9-9.7]比12.3 [7.2-15.8]mm, p = 0.043)。21例患者的亚分析显示,闭塞血管与支架回收器活动区(曲线下受者工作特征面积:0.90)之比为TICI 2b/3再灌注的临界值为0.32。结论:在急性MCA闭塞中,FD-CT MIP图像显示远端直径越大,闭塞血管长度越短,机械取栓后达到TICI 2b/3的可能性越大。
{"title":"Short-Vessel Occlusion Might Indicate Higher Possibility of Success in Reperfusion following Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion.","authors":"Tomoyuki Yoshihara, Ryuzaburo Kanazawa, Takanori Uchida, Tetsuhiro Higashida, Hidenori Ohbuchi, Naoyuki Arai, Yuichi Takahashi","doi":"10.1159/000519556","DOIUrl":"https://doi.org/10.1159/000519556","url":null,"abstract":"<p><strong>Background: </strong>The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy.</p><p><strong>Methods: </strong>This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared.</p><p><strong>Results: </strong>We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5-1.9] vs. 1.2 [1.2-1.5] mm, p = 0.007) and shorter length (7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90).</p><p><strong>Conclusion: </strong>In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"131-136"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/b2/cee-0011-0131.PMC8647116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39710195","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}
Pub Date : 2021-01-01Epub Date: 2021-05-10DOI: 10.1159/000515123
Narayanaswamy Venketasubramanian, Yee Mon Khine, Ohnmar Ohnmar, Myat Po Po Kyaw Khin, Min Thit Win
Myanmar is home to over 51 million people. The age- and sex-standardized mortality rate due to stroke is 165.4/100,000, while the rate of age- and sex-standardized disability-adjusted life years lost due to stroke is 2971.3/100,000. The prevalence of stroke among adults aged 40-99 years is 1.5%. Stroke is the leading cause of morbidity and mortality and comprises 20% of the neurological workload. There are only 10 stroke units in the whole country. Doctors are aware of the importance of hypertension in stroke prevention and the need for physiotherapy after stroke, but, until recently and in rural areas, they also tend to use steroids and neuroprotectants, and lower blood pressure aggressively acutely after stroke; antiplatelets are not widely used. Thrombolysis service is available at some tertiary centers but mechanical thrombectomy is not yet available.
{"title":"Burden of Stroke in Myanmar.","authors":"Narayanaswamy Venketasubramanian, Yee Mon Khine, Ohnmar Ohnmar, Myat Po Po Kyaw Khin, Min Thit Win","doi":"10.1159/000515123","DOIUrl":"https://doi.org/10.1159/000515123","url":null,"abstract":"<p><p>Myanmar is home to over 51 million people. The age- and sex-standardized mortality rate due to stroke is 165.4/100,000, while the rate of age- and sex-standardized disability-adjusted life years lost due to stroke is 2971.3/100,000. The prevalence of stroke among adults aged 40-99 years is 1.5%. Stroke is the leading cause of morbidity and mortality and comprises 20% of the neurological workload. There are only 10 stroke units in the whole country. Doctors are aware of the importance of hypertension in stroke prevention and the need for physiotherapy after stroke, but, until recently and in rural areas, they also tend to use steroids and neuroprotectants, and lower blood pressure aggressively acutely after stroke; antiplatelets are not widely used. Thrombolysis service is available at some tertiary centers but mechanical thrombectomy is not yet available.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"49-51"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000515123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38968448","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}
Pub Date : 2021-01-01Epub Date: 2021-08-06DOI: 10.1159/000517929
Balaki Parameshwaran, Dennis Cordato, Mark Parsons, Andrew Cheung, Nathan Manning, Jason Wenderoth, Cecilia Cappelen-Smith
Background and purpose: The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life.
Methods: Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018-Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L).
Results: Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (n = 64) of patients were functionally independent (mRS 0-2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving.
Conclusion: Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.
{"title":"The Benefit of Endovascular Thrombectomy for Stroke on Functional Outcome Is Sustained at 12 Months.","authors":"Balaki Parameshwaran, Dennis Cordato, Mark Parsons, Andrew Cheung, Nathan Manning, Jason Wenderoth, Cecilia Cappelen-Smith","doi":"10.1159/000517929","DOIUrl":"https://doi.org/10.1159/000517929","url":null,"abstract":"<p><strong>Background and purpose: </strong>The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life.</p><p><strong>Methods: </strong>Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018-Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L).</p><p><strong>Results: </strong>Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (n = 64) of patients were functionally independent (mRS 0-2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving.</p><p><strong>Conclusion: </strong>Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"81-86"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/26/cee-0011-0081.PMC8460944.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39377298","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}
Pub Date : 2021-01-01Epub Date: 2021-05-11DOI: 10.1159/000516238
Jose C Navarro, Narayanaswamy Venketasubramanian
{"title":"Stroke Burden and Services in the Philippines.","authors":"Jose C Navarro, Narayanaswamy Venketasubramanian","doi":"10.1159/000516238","DOIUrl":"10.1159/000516238","url":null,"abstract":"","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"52-54"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/3e/cee-0011-0052.PMC8216023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38901346","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}
Hediyeh Baradaran, Alen Delic, Ka-Ho Wong, Nazanin Sheibani, Matthew Alexander, J Scott McNally, Jennifer J Majersik, Adam De Havenon
Introduction: Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.
Methods: In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.
Results: We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.
Conclusions: In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.
{"title":"Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis.","authors":"Hediyeh Baradaran, Alen Delic, Ka-Ho Wong, Nazanin Sheibani, Matthew Alexander, J Scott McNally, Jennifer J Majersik, Adam De Havenon","doi":"10.1159/000514373","DOIUrl":"https://doi.org/10.1159/000514373","url":null,"abstract":"<p><strong>Introduction: </strong>Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.</p><p><strong>Methods: </strong>In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.</p><p><strong>Results: </strong>We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.</p><p><strong>Conclusions: </strong>In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 1","pages":"37-43"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295451","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}
Pub Date : 2021-01-01Epub Date: 2021-11-25DOI: 10.1159/000520078
Stavros Matsoukas, Brian Giovanni, Liorah Rubinstein, Shahram Majidi, Laura K Stein, Johanna T Fifi
Objective: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.
Methods: We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) ("actual" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times ("actual" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.
Results: Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.
Conclusions: Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.
{"title":"Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort.","authors":"Stavros Matsoukas, Brian Giovanni, Liorah Rubinstein, Shahram Majidi, Laura K Stein, Johanna T Fifi","doi":"10.1159/000520078","DOIUrl":"https://doi.org/10.1159/000520078","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.</p><p><strong>Methods: </strong>We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) (\"actual\" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times (\"actual\" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.</p><p><strong>Results: </strong>Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.</p><p><strong>Conclusions: </strong>Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"137-144"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/30/cee-0011-0137.PMC8740215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39771116","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}
Pub Date : 2021-01-01Epub Date: 2021-07-09DOI: 10.1159/000517234
Narayanaswamy Venketasubramanian, Muzharul Mannan
Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, and south by the Bay of Bengal [1]. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, and life expectancy is 72.3 years; 74% live in rural areas. Stroke is a major cause of death and disability in the region, with an ageand sex-standardized mortality rate of 54.8 per 100,000 and disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh [2]. The prevalence of stroke at approximately 1–2% of those aged over 20 years [3] is similar in males and females, and urban and rural areas [4], but increases with age such that the ratio of infarction to hemorrhage is 2.91 in the community [5]. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, and the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, and 5%, respectively [6]; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, and there is a clear seasonal variation in the frequency of hemorrhagic stroke [7, 8]. The high stroke mortality among Bangladeshi populations may be due to the high frequency of the conventional atherosclerotic risk factors, especially of hypertension and diabetes mellitus [9]; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, and the combined effect of smoking and tobacco chewing [10]. Stroke mortality might be related to stroke severity, delayed diagnosis, and stroke care gaps discussed further below. Medical services are free in the community [11]. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary level care is provided at district hospitals; tertiary level care is provided at medical college hospitals and super-specialty hospitals. There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh. Acute care for stroke patients is available in 2 government and 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country and 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) [12] and out-patients (24%) [13]. The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients
{"title":"Stroke Burden and Stroke Services in Bangladesh.","authors":"Narayanaswamy Venketasubramanian, Muzharul Mannan","doi":"10.1159/000517234","DOIUrl":"https://doi.org/10.1159/000517234","url":null,"abstract":"Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, and south by the Bay of Bengal [1]. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, and life expectancy is 72.3 years; 74% live in rural areas. Stroke is a major cause of death and disability in the region, with an ageand sex-standardized mortality rate of 54.8 per 100,000 and disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh [2]. The prevalence of stroke at approximately 1–2% of those aged over 20 years [3] is similar in males and females, and urban and rural areas [4], but increases with age such that the ratio of infarction to hemorrhage is 2.91 in the community [5]. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, and the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, and 5%, respectively [6]; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, and there is a clear seasonal variation in the frequency of hemorrhagic stroke [7, 8]. The high stroke mortality among Bangladeshi populations may be due to the high frequency of the conventional atherosclerotic risk factors, especially of hypertension and diabetes mellitus [9]; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, and the combined effect of smoking and tobacco chewing [10]. Stroke mortality might be related to stroke severity, delayed diagnosis, and stroke care gaps discussed further below. Medical services are free in the community [11]. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary level care is provided at district hospitals; tertiary level care is provided at medical college hospitals and super-specialty hospitals. There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh. Acute care for stroke patients is available in 2 government and 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country and 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) [12] and out-patients (24%) [13]. The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients ","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"69-71"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000517234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173802","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}