Pub Date : 2023-03-16DOI: 10.3389/fstro.2023.1149406
K. H. Ignacio, J. Medrano, Sitti Khadija U. Salabi, Alvin J. Logronio, Sedric John V. Factor, S. Ignacio, J. L. R. Pascual, Maria Carissa C. Pineda-Franks, J. Diestro
Background Health-related quality of life (HRQoL) is important to assess in young adults who suffer from various physical and mental consequences after stroke. We aimed to evaluate the HRQoL of young adults after ischemic or hemorrhagic stroke and to determine the association of anxiety and depression with poor HRQoL in this special population. Methods We administered the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) to assess the HRQoL in our study population. This tool describes health outcomes in five dimensions. Socio-demographic and clinical data including modified Rankin scale (mRS), Barthel Index and Hospital Anxiety and Depression Scale scores were available from our previous cross-sectional study on young adults with stroke. We performed bivariate analyses to assess the association of psychiatric comorbidities with categorical characteristics and determined risk factors for poor HRQoL using multivariable logistic regression analysis. Results We evaluated HRQoL, psychiatric and functional outcomes in 114 young adult stroke patients. CVD infarct was more common than hemorrhage (58.8 vs. 41.2%). Patients with both anxiety and depression were found to have the lowest ratings on the HRQoL scales, with an EQ VAS of 60 vs. 90 (p = 0.01) and an EQ Index of 0.64 vs. 0.89 (p < 0.01) when compared to those without both conditions. Anxiety and depression were significantly correlated with poor quality of life on all dimensions of the EQ-5D-5L. Similarly, Barthel Index was a significant predictor for problems in HRQoL (OR 0.17, 95% CI 0.03–1.02 on the mobility dimension and OR 0.08, 95% CI 0.01–0.55 on the self-care dimension). Cerebral hemorrhage was an independent predictor for poorer self-care dimension scores (OR 4.99, 95% CI 1.42–17.56). Conclusions Our study showed that anxiety, depression and poor functional status are associated with poorer HRQoL in young adult Filipinos after stroke. Screening for psychiatric conditions and evaluating mobility are crucial in the management of this special population after stroke.
{"title":"Impact of post stroke depression and anxiety on health-related quality of life in young Filipino adults","authors":"K. H. Ignacio, J. Medrano, Sitti Khadija U. Salabi, Alvin J. Logronio, Sedric John V. Factor, S. Ignacio, J. L. R. Pascual, Maria Carissa C. Pineda-Franks, J. Diestro","doi":"10.3389/fstro.2023.1149406","DOIUrl":"https://doi.org/10.3389/fstro.2023.1149406","url":null,"abstract":"Background Health-related quality of life (HRQoL) is important to assess in young adults who suffer from various physical and mental consequences after stroke. We aimed to evaluate the HRQoL of young adults after ischemic or hemorrhagic stroke and to determine the association of anxiety and depression with poor HRQoL in this special population. Methods We administered the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) to assess the HRQoL in our study population. This tool describes health outcomes in five dimensions. Socio-demographic and clinical data including modified Rankin scale (mRS), Barthel Index and Hospital Anxiety and Depression Scale scores were available from our previous cross-sectional study on young adults with stroke. We performed bivariate analyses to assess the association of psychiatric comorbidities with categorical characteristics and determined risk factors for poor HRQoL using multivariable logistic regression analysis. Results We evaluated HRQoL, psychiatric and functional outcomes in 114 young adult stroke patients. CVD infarct was more common than hemorrhage (58.8 vs. 41.2%). Patients with both anxiety and depression were found to have the lowest ratings on the HRQoL scales, with an EQ VAS of 60 vs. 90 (p = 0.01) and an EQ Index of 0.64 vs. 0.89 (p < 0.01) when compared to those without both conditions. Anxiety and depression were significantly correlated with poor quality of life on all dimensions of the EQ-5D-5L. Similarly, Barthel Index was a significant predictor for problems in HRQoL (OR 0.17, 95% CI 0.03–1.02 on the mobility dimension and OR 0.08, 95% CI 0.01–0.55 on the self-care dimension). Cerebral hemorrhage was an independent predictor for poorer self-care dimension scores (OR 4.99, 95% CI 1.42–17.56). Conclusions Our study showed that anxiety, depression and poor functional status are associated with poorer HRQoL in young adult Filipinos after stroke. Screening for psychiatric conditions and evaluating mobility are crucial in the management of this special population after stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83012935","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}
Pub Date : 2023-02-21DOI: 10.3389/fstro.2023.1119120
R. Hood, Daniel J. Beard, D. McLeod, L. Murtha, N. Spratt
Intracranial pressure (ICP) elevation post-stroke has long been thought of as a cause of secondary deterioration after large, malignant infarction, and dramatic ICP elevation is frequently a pre-terminal event. However, there is an increasing body of evidence to suggest that ICP also rises after small stroke, typically within 24 h of the infarct. The timing of this rise suggests that it may play an important role in the collateral failure associated with early infarct expansion. Despite its increasingly recognized importance to patient outcome, very little is currently known about the underlying mechanisms of ICP elevation post-stroke. The traditional understanding suggests ICP elevation occurs solely due to cerebral edema, however this does not seem to be the case in mild-moderate infarction. Instead, recent studies suggest a role for changes in cerebrospinal fluid (CSF) volume. In this article, we will discuss recent mechanistic observations, as well as the consequences of ICP elevation post-stroke.
{"title":"Intracranial pressure elevation post-stroke: Mechanisms and consequences","authors":"R. Hood, Daniel J. Beard, D. McLeod, L. Murtha, N. Spratt","doi":"10.3389/fstro.2023.1119120","DOIUrl":"https://doi.org/10.3389/fstro.2023.1119120","url":null,"abstract":"Intracranial pressure (ICP) elevation post-stroke has long been thought of as a cause of secondary deterioration after large, malignant infarction, and dramatic ICP elevation is frequently a pre-terminal event. However, there is an increasing body of evidence to suggest that ICP also rises after small stroke, typically within 24 h of the infarct. The timing of this rise suggests that it may play an important role in the collateral failure associated with early infarct expansion. Despite its increasingly recognized importance to patient outcome, very little is currently known about the underlying mechanisms of ICP elevation post-stroke. The traditional understanding suggests ICP elevation occurs solely due to cerebral edema, however this does not seem to be the case in mild-moderate infarction. Instead, recent studies suggest a role for changes in cerebrospinal fluid (CSF) volume. In this article, we will discuss recent mechanistic observations, as well as the consequences of ICP elevation post-stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79976813","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}
Pub Date : 2023-02-09DOI: 10.3389/fstro.2023.1066491
T. Yoshimoto, Satoshi Hosoki, Kanta Tanaka, J. Koge, T. Satow, H. Yamagami, K. Toyoda, M. Ihara
Although mechanical thrombectomy for acute large vessel occlusion is generally effective, some occlusions are refractory. We report a patient in whom the parallel stent retriever technique using two Trevo stent retrievers (Stryker Neurovascular, Fremont, California, USA) was required to treat an intracranial and epidural internal carotid artery occlusion after other techniques had failed. A 68-year-old woman presented with an acute left internal carotid artery occlusion 4 days after mechanical thrombectomy of a left middle cerebral artery occlusion. She was not a candidate for intravenous thrombolysis because of a recent cerebral infarction. Attempts at mechanical thrombectomy using a stent retriever, contact aspiration, or combined contact aspiration and stent retriever were unsuccessful. The parallel stent retriever technique using two 6 × 25-mm Trevo stent retrievers enabled coverage of the entire thrombus, and successful reperfusion was achieved (extended Thrombolysis in Cerebral Infarction grade 2b). After the procedure, the patient was able to walk without assistance. Her modified Rankin Scale score was 2 at 90 days follow-up. Microscopic examination of the retrieved thrombi demonstrated red blood cells, fibrin, and partial endothelialization. The parallel Trevo stent retriever technique has the potential as rescue therapy for refractory large-vessel occlusion. However, complications arising from this technique remain uncertain. Further studies are needed to determine the effect of this technique in terms of recanalization and clinical safety.
{"title":"Parallel stent retriever mechanical thrombectomy of an acute internal carotid artery occlusion refractory to standard techniques: A case report","authors":"T. Yoshimoto, Satoshi Hosoki, Kanta Tanaka, J. Koge, T. Satow, H. Yamagami, K. Toyoda, M. Ihara","doi":"10.3389/fstro.2023.1066491","DOIUrl":"https://doi.org/10.3389/fstro.2023.1066491","url":null,"abstract":"Although mechanical thrombectomy for acute large vessel occlusion is generally effective, some occlusions are refractory. We report a patient in whom the parallel stent retriever technique using two Trevo stent retrievers (Stryker Neurovascular, Fremont, California, USA) was required to treat an intracranial and epidural internal carotid artery occlusion after other techniques had failed. A 68-year-old woman presented with an acute left internal carotid artery occlusion 4 days after mechanical thrombectomy of a left middle cerebral artery occlusion. She was not a candidate for intravenous thrombolysis because of a recent cerebral infarction. Attempts at mechanical thrombectomy using a stent retriever, contact aspiration, or combined contact aspiration and stent retriever were unsuccessful. The parallel stent retriever technique using two 6 × 25-mm Trevo stent retrievers enabled coverage of the entire thrombus, and successful reperfusion was achieved (extended Thrombolysis in Cerebral Infarction grade 2b). After the procedure, the patient was able to walk without assistance. Her modified Rankin Scale score was 2 at 90 days follow-up. Microscopic examination of the retrieved thrombi demonstrated red blood cells, fibrin, and partial endothelialization. The parallel Trevo stent retriever technique has the potential as rescue therapy for refractory large-vessel occlusion. However, complications arising from this technique remain uncertain. Further studies are needed to determine the effect of this technique in terms of recanalization and clinical safety.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"166 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73813493","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}
Pub Date : 2023-02-06DOI: 10.3389/fstro.2023.1110506
D. Nwafor, Allison L. Brichacek, Michael S. Rallo, Nina Bidwai, R. Marsh
Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke characterized by high morbidity and mortality. Saccular intracranial aneurysms account for most cases of SAH. While the role of hemodynamic stress and inflammation have been extensively studied in SAH, little is known about the role of the microbiome in SAH despite recent studies uncovering new insights on the effects of microbiome alteration in ischemic stroke. This review presents the current knowledge around the role of the microbiome in intracranial aneurysm formation and rupture. We also highlight the influence of diet on intracranial aneurysm formation and provide evidence that corroborates the targeting of inflammatory pathways as a potential strategy to curb SAH-associated neurological dysfunction.
{"title":"Subarachnoid hemorrhage: New insights on pathogenesis","authors":"D. Nwafor, Allison L. Brichacek, Michael S. Rallo, Nina Bidwai, R. Marsh","doi":"10.3389/fstro.2023.1110506","DOIUrl":"https://doi.org/10.3389/fstro.2023.1110506","url":null,"abstract":"Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke characterized by high morbidity and mortality. Saccular intracranial aneurysms account for most cases of SAH. While the role of hemodynamic stress and inflammation have been extensively studied in SAH, little is known about the role of the microbiome in SAH despite recent studies uncovering new insights on the effects of microbiome alteration in ischemic stroke. This review presents the current knowledge around the role of the microbiome in intracranial aneurysm formation and rupture. We also highlight the influence of diet on intracranial aneurysm formation and provide evidence that corroborates the targeting of inflammatory pathways as a potential strategy to curb SAH-associated neurological dysfunction.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73247639","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}
Pub Date : 2023-01-26DOI: 10.3389/fstro.2023.1126130
E. D. W. Loh, Gabriel Yi Ren Kwok, Keith Zhi-Xian Toh, Ming-Yi Koh, Y. Teo, Y. N. Teo, B. Chan, V. Sharma, Megan Bi-Jia Ng, Hui Shi Lim, B. Soon, A. Gopinathan, Cunli Yang, C. Sia, P. Bhogal, P. Brouwer, L. Meyer, J. Fiehler, T. Andersson, B. Tan, L. Yeo
Background The optimal mechanical thrombectomy technique for acute ischaemic stroke (AIS) caused by distal, medium vessel occlusion (DMVO) is uncertain. We performed a systematic review and meta-analysis evaluating the efficacy and safety of first-line thrombectomy with combined techniques, which entail simultaneous use of a stent retriever and aspiration catheter, vs. single-device techniques, whether stent retriever or direct aspiration alone, for DMVO-AIS patients. Methods We systematically searched the PubMed, Embase and Cochrane CENTRAL databases from inception until 2 September 2022 for studies comparing combined and single-device techniques in DMVO-AIS patients. We adopted the Distal Thrombectomy Summit Group's definition of DMVO. Our outcomes were the modified first-pass effect [mFPE; modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 at first-pass], first-pass effect (FPE; mTICI 2c-3 at first-pass), successful and complete final reperfusion (mTICI 2b-3 and 2c-3 at end of all procedures, respectively), 90-day functional independence (modified Rankin scale 0-2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH). Results Nine studies were included, with 477 patients receiving combined techniques, and 670 patients receiving single-device thrombectomy. Combined techniques achieved significantly higher odds of mFPE [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.12–4.02; p = 0.021] and FPE (OR, 3.55; 95% CI, 1.97–6.38; p < 0.001), with lower odds of sICH (OR, 0.23; 95% CI 0.06–0.93; p = 0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87–1.63; p = 0.658), or mortality (OR, 0.94; 95% CI, 0.50–1.76; p = 0.850). Conclusions In DMVO-AIS patients, mechanical thrombectomy combining stent retrievers and aspiration catheters achieved higher odds of FPE and lower odds of sICH over single-device techniques. There were no differences in functional independence and mortality. Further trials are warranted to establish these findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_recor d.php?ID=CRD42022370160, identifier: CRD42022370160.
{"title":"Thrombectomy for distal medium vessel occlusion stroke: Combined vs. single-device techniques - A systematic review and meta-analysis","authors":"E. D. W. Loh, Gabriel Yi Ren Kwok, Keith Zhi-Xian Toh, Ming-Yi Koh, Y. Teo, Y. N. Teo, B. Chan, V. Sharma, Megan Bi-Jia Ng, Hui Shi Lim, B. Soon, A. Gopinathan, Cunli Yang, C. Sia, P. Bhogal, P. Brouwer, L. Meyer, J. Fiehler, T. Andersson, B. Tan, L. Yeo","doi":"10.3389/fstro.2023.1126130","DOIUrl":"https://doi.org/10.3389/fstro.2023.1126130","url":null,"abstract":"Background The optimal mechanical thrombectomy technique for acute ischaemic stroke (AIS) caused by distal, medium vessel occlusion (DMVO) is uncertain. We performed a systematic review and meta-analysis evaluating the efficacy and safety of first-line thrombectomy with combined techniques, which entail simultaneous use of a stent retriever and aspiration catheter, vs. single-device techniques, whether stent retriever or direct aspiration alone, for DMVO-AIS patients. Methods We systematically searched the PubMed, Embase and Cochrane CENTRAL databases from inception until 2 September 2022 for studies comparing combined and single-device techniques in DMVO-AIS patients. We adopted the Distal Thrombectomy Summit Group's definition of DMVO. Our outcomes were the modified first-pass effect [mFPE; modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 at first-pass], first-pass effect (FPE; mTICI 2c-3 at first-pass), successful and complete final reperfusion (mTICI 2b-3 and 2c-3 at end of all procedures, respectively), 90-day functional independence (modified Rankin scale 0-2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH). Results Nine studies were included, with 477 patients receiving combined techniques, and 670 patients receiving single-device thrombectomy. Combined techniques achieved significantly higher odds of mFPE [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.12–4.02; p = 0.021] and FPE (OR, 3.55; 95% CI, 1.97–6.38; p < 0.001), with lower odds of sICH (OR, 0.23; 95% CI 0.06–0.93; p = 0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87–1.63; p = 0.658), or mortality (OR, 0.94; 95% CI, 0.50–1.76; p = 0.850). Conclusions In DMVO-AIS patients, mechanical thrombectomy combining stent retrievers and aspiration catheters achieved higher odds of FPE and lower odds of sICH over single-device techniques. There were no differences in functional independence and mortality. Further trials are warranted to establish these findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_recor d.php?ID=CRD42022370160, identifier: CRD42022370160.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80350226","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}
Pub Date : 2023-01-18DOI: 10.3389/fstro.2022.1093386
Paulette D. Orhii, M. Haque, M. Fujita, S. Selvaraj
Ischemic strokes make up 87% of all cerebrovascular events. Intravenous tissue plasminogen activator (tPA), a thrombolytic agent, has been recognized as the only viable option for patients with ischemic stroke if administered within 3.5 h of onset and increases the risk of hemorrhagic transformation if administered beyond the treatment window. Acute treatment strategies are centered around rescuing salvageable penumbra. Molecular imaging using positron emission tomography (PET) has shown higher sensitivity and specificity than CT and MRI in delineating penumbral tissues. In addition, PET imaging has identified the role of key inflammatory mediators in atherosclerosis, cellular damage, and recovery. Recently, a novel PET imaging study has shown the feasibility of investigating synaptic density in subacute stroke. Lastly, novel PET radiotracers have been developed to further explore biochemical mechanisms implicated in stroke pathophysiology. Further investigation with PET is needed to understand stroke mechanisms and advance pharmacologic treatment.
{"title":"Advances in PET imaging of ischemic stroke","authors":"Paulette D. Orhii, M. Haque, M. Fujita, S. Selvaraj","doi":"10.3389/fstro.2022.1093386","DOIUrl":"https://doi.org/10.3389/fstro.2022.1093386","url":null,"abstract":"Ischemic strokes make up 87% of all cerebrovascular events. Intravenous tissue plasminogen activator (tPA), a thrombolytic agent, has been recognized as the only viable option for patients with ischemic stroke if administered within 3.5 h of onset and increases the risk of hemorrhagic transformation if administered beyond the treatment window. Acute treatment strategies are centered around rescuing salvageable penumbra. Molecular imaging using positron emission tomography (PET) has shown higher sensitivity and specificity than CT and MRI in delineating penumbral tissues. In addition, PET imaging has identified the role of key inflammatory mediators in atherosclerosis, cellular damage, and recovery. Recently, a novel PET imaging study has shown the feasibility of investigating synaptic density in subacute stroke. Lastly, novel PET radiotracers have been developed to further explore biochemical mechanisms implicated in stroke pathophysiology. Further investigation with PET is needed to understand stroke mechanisms and advance pharmacologic treatment.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82335027","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}
Pub Date : 2023-01-01Epub Date: 2023-06-07DOI: 10.3389/fstro.2023.1172854
Youngran Kim, Maria A Parekh, Xiaojin Li, Yan Huang, Guo-Qiang Zhang, Bharti Manwani
Background: COVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.
Methods: A retrospective cohort study was conducted using individual-level data from Optum® de-identified COVID-19 EHR. A total of 387,330 individuals aged ≥18 with laboratory-confirmed COVID-19 between March 1, 2020 and December 31, 2020 were included. The primary outcome was cumulative incidence of stroke after COVID-19 confirmation within 180 days of follow-up or until death. Kaplan-Meier cumulative incidence curves for acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and a composite outcome of all strokes were stratified by sex and age, and the differences in curves were assessed using a log-rank test. The relative risk of stroke by demographics and risk factors was estimated using multivariable Cox-proportional hazards regressions and adjusted hazard ratios (aHRs).
Results: Of 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68-0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62-0.67), and ICH in 0.11% (95% CI 0.10-0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially higher stroke risk, with aHR 6.92 (5.72-8.38) for ages 65-74, 9.42 (7.74-11.47) for ages 75-84, and 11.35 (9.20-14.00) for ages 85 and older compared to ages 18-44 years. Men had a 32% higher risk of stroke compared to women. African-American [aHR 1.78 (1.61-1.97)] and Hispanic patients [aHR 1.48 (1.30-1.69)] with COVID-19 had an increased risk of stroke compared to white patients.
Conclusion: This study has several important findings. AIS and ICH risk in patients with COVID-19 is highest in the first 3 days of COVID-19 positivity; this risk decreases with time. The incidence of stroke in patients with COVID-19 (both inpatient and outpatient) is 0.65% for AIS and 0.11% for ICH during the 180-day follow-up. Traditional stroke risk factors increase the risk of stroke in patients with COVID-19. Male sex is an independent risk factor for stroke in COVID-19 patients across all age groups. African-American and Hispanic patients have a higher risk of stroke from COVID-19.
{"title":"Age and sex-specific stroke epidemiology in COVID-19.","authors":"Youngran Kim, Maria A Parekh, Xiaojin Li, Yan Huang, Guo-Qiang Zhang, Bharti Manwani","doi":"10.3389/fstro.2023.1172854","DOIUrl":"10.3389/fstro.2023.1172854","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using individual-level data from Optum<sup>®</sup> de-identified COVID-19 EHR. A total of 387,330 individuals aged ≥18 with laboratory-confirmed COVID-19 between March 1, 2020 and December 31, 2020 were included. The primary outcome was cumulative incidence of stroke after COVID-19 confirmation within 180 days of follow-up or until death. Kaplan-Meier cumulative incidence curves for acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and a composite outcome of all strokes were stratified by sex and age, and the differences in curves were assessed using a log-rank test. The relative risk of stroke by demographics and risk factors was estimated using multivariable Cox-proportional hazards regressions and adjusted hazard ratios (aHRs).</p><p><strong>Results: </strong>Of 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68-0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62-0.67), and ICH in 0.11% (95% CI 0.10-0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially higher stroke risk, with aHR 6.92 (5.72-8.38) for ages 65-74, 9.42 (7.74-11.47) for ages 75-84, and 11.35 (9.20-14.00) for ages 85 and older compared to ages 18-44 years. Men had a 32% higher risk of stroke compared to women. African-American [aHR 1.78 (1.61-1.97)] and Hispanic patients [aHR 1.48 (1.30-1.69)] with COVID-19 had an increased risk of stroke compared to white patients.</p><p><strong>Conclusion: </strong>This study has several important findings. AIS and ICH risk in patients with COVID-19 is highest in the first 3 days of COVID-19 positivity; this risk decreases with time. The incidence of stroke in patients with COVID-19 (both inpatient and outpatient) is 0.65% for AIS and 0.11% for ICH during the 180-day follow-up. Traditional stroke risk factors increase the risk of stroke in patients with COVID-19. Male sex is an independent risk factor for stroke in COVID-19 patients across all age groups. African-American and Hispanic patients have a higher risk of stroke from COVID-19.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"163 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86296613","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 : 2023-01-01Epub Date: 2023-06-15DOI: 10.3389/fstro.2023.1192465
A Parker Ruhl, Neal Jeffries, Yu Yang, Steven D Brooks, Rakhi P Naik, Lydia H Pecker, Bryan T Mott, Cheryl A Winkler, Nicole D Armstrong, Neil A Zakai, Orlando M Gutierrez, Suzanne E Judd, Virginia J Howard, George Howard, Marguerite R Irvin, Mary Cushman, Hans C Ackerman
Introduction: People with African ancestry have greater stroke risk and greater heritability of stroke risk than people of other ancestries. Given the importance of nitric oxide (NO) in stroke, and recent evidence that alpha globin restricts nitric oxide release from vascular endothelial cells, we hypothesized that alpha globin gene (HBA) deletion would be associated with reduced risk of incident ischemic stroke.
Methods: We evaluated 8,947 participants self-reporting African ancestry in the national, prospective Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Incident ischemic stroke was defined as non-hemorrhagic stroke with focal neurological deficit lasting ≥ 24 hours confirmed by the medical record or focal or non-focal neurological deficit with positive imaging confirmed with medical records. Genomic DNA was analyzed using droplet digital PCR to determine HBA copy number. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) of HBA copy number on time to first ischemic stroke.
Results: Four-hundred seventy-nine (5.3%) participants had an incident ischemic stroke over a median (IQR) of 11.0 (5.7, 14.0) years' follow-up. HBA copy number ranged from 2 to 6: 368 (4%) -α/-α, 2,480 (28%) -α/αα, 6,014 (67%) αα/αα, 83 (1%) ααα/αα and 2 (<1%) ααα/ααα. The adjusted HR of ischemic stroke with HBA copy number was 1.04; 95%CI 0.89, 1.21; p = 0.66.
Conclusions: Although a reduction in HBA copy number is expected to increase endothelial nitric oxide signaling in the human vascular endothelium, HBA copy number was not associated with incident ischemic stroke in this large cohort of Black Americans.
{"title":"Alpha globin gene copy number and incident ischemic stroke risk among Black Americans.","authors":"A Parker Ruhl, Neal Jeffries, Yu Yang, Steven D Brooks, Rakhi P Naik, Lydia H Pecker, Bryan T Mott, Cheryl A Winkler, Nicole D Armstrong, Neil A Zakai, Orlando M Gutierrez, Suzanne E Judd, Virginia J Howard, George Howard, Marguerite R Irvin, Mary Cushman, Hans C Ackerman","doi":"10.3389/fstro.2023.1192465","DOIUrl":"10.3389/fstro.2023.1192465","url":null,"abstract":"<p><strong>Introduction: </strong>People with African ancestry have greater stroke risk and greater heritability of stroke risk than people of other ancestries. Given the importance of nitric oxide (NO) in stroke, and recent evidence that alpha globin restricts nitric oxide release from vascular endothelial cells, we hypothesized that alpha globin gene (<i>HBA)</i> deletion would be associated with reduced risk of incident ischemic stroke.</p><p><strong>Methods: </strong>We evaluated 8,947 participants self-reporting African ancestry in the national, prospective Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Incident ischemic stroke was defined as non-hemorrhagic stroke with focal neurological deficit lasting ≥ 24 hours confirmed by the medical record or focal or non-focal neurological deficit with positive imaging confirmed with medical records. Genomic DNA was analyzed using droplet digital PCR to determine <i>HBA</i> copy number. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) of <i>HBA</i> copy number on time to first ischemic stroke.</p><p><strong>Results: </strong>Four-hundred seventy-nine (5.3%) participants had an incident ischemic stroke over a median (IQR) of 11.0 (5.7, 14.0) years' follow-up. <i>HBA</i> copy number ranged from 2 to 6: 368 (4%) -α/-α, 2,480 (28%) -α/αα, 6,014 (67%) αα/αα, 83 (1%) ααα/αα and 2 (<1%) ααα/ααα. The adjusted HR of ischemic stroke with <i>HBA</i> copy number was 1.04; 95%CI 0.89, 1.21; p = 0.66.</p><p><strong>Conclusions: </strong>Although a reduction in <i>HBA</i> copy number is expected to increase endothelial nitric oxide signaling in the human vascular endothelium, <i>HBA</i> copy number was not associated with incident ischemic stroke in this large cohort of Black Americans.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10448705/pdf/nihms-1920712.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141852","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 : 2022-11-23DOI: 10.3389/fstro.2022.1026138
Julia Emde, Romy Baumgart, Niklas Langguth, M. Juenemann, S. Gerner
Purpose of review Recent trials provided evidence for safety and efficacy of intravenous thrombolytic therapy (IVT) in ischemic stroke patients beyond the 4.5 h time-window if ischemic penumbra is present in multimodal imaging. However, advanced imaging by either Magnet Resonance Imaging (MRI) or Computed Tomography Perfusion (CTP) is not available 24/7 at most stroke-centers. Therefore, the current review addresses the use of non-contrast CT (NCCT) to identify ischemic stroke patients suitable for IVT in the unknown or extended time-window in terms of efficacy and safety. Recent findings The current data on NCCT based IVT strategies in ischemic stroke patients presenting in the unknown or late time-window are relatively scarce and mainly provided by small retrospective samples. One larger registry (TRUST-CT) underlines the safety and efficacy of IVT without advanced imaging with more IVT-patients reaching an excellent outcome compared to the non-IVT treated control group. Current meta-analysis provides evidence that the rate of symptomatic intracerebral hemorrhage (sICH) is similar in the wake-up and unknown onset time-window compared to the 4.5 h time-window if patients are selected by NCCT. Results of the upcoming TWIST-trial investigating Tenecteplase (TNK) for NCCT-based IVT revealed no signals regarding an increased rate of sICH, however there was no benefit regarding functional outcomes. Summary So far, it is not well-established whether advanced imaging is indispensable and NCCT could be sufficient to identify stroke patients in the extended window who would benefit from IVT-treatment. However, current data suggests the safety of NCCT-based IVT in the extended time-window. Therefore, unavailable advanced neuroimaging should not cause delay, or even exclusion of patients from IVT and other recanalizing therapies per se.
{"title":"Intravenous thrombolysis in ischemic stroke patients based on non-contrast CT in the extended time-window","authors":"Julia Emde, Romy Baumgart, Niklas Langguth, M. Juenemann, S. Gerner","doi":"10.3389/fstro.2022.1026138","DOIUrl":"https://doi.org/10.3389/fstro.2022.1026138","url":null,"abstract":"Purpose of review Recent trials provided evidence for safety and efficacy of intravenous thrombolytic therapy (IVT) in ischemic stroke patients beyond the 4.5 h time-window if ischemic penumbra is present in multimodal imaging. However, advanced imaging by either Magnet Resonance Imaging (MRI) or Computed Tomography Perfusion (CTP) is not available 24/7 at most stroke-centers. Therefore, the current review addresses the use of non-contrast CT (NCCT) to identify ischemic stroke patients suitable for IVT in the unknown or extended time-window in terms of efficacy and safety. Recent findings The current data on NCCT based IVT strategies in ischemic stroke patients presenting in the unknown or late time-window are relatively scarce and mainly provided by small retrospective samples. One larger registry (TRUST-CT) underlines the safety and efficacy of IVT without advanced imaging with more IVT-patients reaching an excellent outcome compared to the non-IVT treated control group. Current meta-analysis provides evidence that the rate of symptomatic intracerebral hemorrhage (sICH) is similar in the wake-up and unknown onset time-window compared to the 4.5 h time-window if patients are selected by NCCT. Results of the upcoming TWIST-trial investigating Tenecteplase (TNK) for NCCT-based IVT revealed no signals regarding an increased rate of sICH, however there was no benefit regarding functional outcomes. Summary So far, it is not well-established whether advanced imaging is indispensable and NCCT could be sufficient to identify stroke patients in the extended window who would benefit from IVT-treatment. However, current data suggests the safety of NCCT-based IVT in the extended time-window. Therefore, unavailable advanced neuroimaging should not cause delay, or even exclusion of patients from IVT and other recanalizing therapies per se.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78311950","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}
Pub Date : 2022-11-10DOI: 10.3389/fstro.2022.1050536
Linda Ma, Silin Wu, A. Gusdon, Hua Chen, Heng Hu, Atzhiry Paz, J. Aronowski, J. Savarraj, Ryan S. Kitagawa, HUIMAHN A. Choi, Xuefang Ren
Ischemic stroke is a serious cerebrovascular event that results in cell death, blood-brain barrier dysfunction, tissue degradation, and inflammation, often leading to permanent disability or death. As the incidence of ischemic stroke continues to rise globally, it is crucial to examine the mechanisms of the various proteins and molecules contributing to worsened patient outcome and recovery. Cathepsin L, a cysteine protease known for degrading tissues in lysosomes and elsewhere, may play a role in brain tissue loss and inflammation after stroke. Studies have suggested that cathepsin L appears in the ischemic core shortly after stroke is induced. Using immunohistochemical staining, mass spectrometry, and other assays, the increase of cathepsin L in the brain was correlated with extracellular matrix and perlecan degradation after ischemic stroke. Additionally, injection of a cathepsin L inhibitor significantly reduced brain infarct size and improved functional scores. More research is needed to elucidate cathepsin L's role in post-stroke inflammation and brain damage, in order to further explore the factors contributing to worsened patient outcome after ischemic stroke and work toward finding better therapeutic interventions.
{"title":"Cathepsin L and acute ischemic stroke: A mini-review","authors":"Linda Ma, Silin Wu, A. Gusdon, Hua Chen, Heng Hu, Atzhiry Paz, J. Aronowski, J. Savarraj, Ryan S. Kitagawa, HUIMAHN A. Choi, Xuefang Ren","doi":"10.3389/fstro.2022.1050536","DOIUrl":"https://doi.org/10.3389/fstro.2022.1050536","url":null,"abstract":"Ischemic stroke is a serious cerebrovascular event that results in cell death, blood-brain barrier dysfunction, tissue degradation, and inflammation, often leading to permanent disability or death. As the incidence of ischemic stroke continues to rise globally, it is crucial to examine the mechanisms of the various proteins and molecules contributing to worsened patient outcome and recovery. Cathepsin L, a cysteine protease known for degrading tissues in lysosomes and elsewhere, may play a role in brain tissue loss and inflammation after stroke. Studies have suggested that cathepsin L appears in the ischemic core shortly after stroke is induced. Using immunohistochemical staining, mass spectrometry, and other assays, the increase of cathepsin L in the brain was correlated with extracellular matrix and perlecan degradation after ischemic stroke. Additionally, injection of a cathepsin L inhibitor significantly reduced brain infarct size and improved functional scores. More research is needed to elucidate cathepsin L's role in post-stroke inflammation and brain damage, in order to further explore the factors contributing to worsened patient outcome after ischemic stroke and work toward finding better therapeutic interventions.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78546646","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}
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