Decision letter for "Cerebral autoregulation is heterogeneous in different stroke mechanism of ischemic stroke caused by intracranial atherosclerotic stenosis"

2020 ◽  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Autoregulation ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Stroke Mechanism

Abstract TP113: Intracranial Atherosclerotic Stenosis Prevalence in a North American Stroke Population

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yongkun Li ◽  
Konark Malhotra ◽  
Graham W Woolf ◽  
Jason D Hinman ◽  
Radoslav Raychev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
North America ◽  
Univariate Analysis ◽  
Common Cause ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Significant Difference ◽  
Stroke Center ◽  
The Impact

Background and Purpose: Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke especially in Asia, but little is known about its prevalence in ischemic stroke patients in North America. We studied the prevalence of ICAS in a single comprehensive stroke center leveraging the routine acquisition of MRI and MR angiography (MRA). Methods: We retrospectively reviewed patients with ischemic stroke and transient ischemic attack who were admitted within seven days of onset from Jan 2014 to July 2016. Patients we excluded: 1) Age <18 years; 2) without intracranial angiography; 3) overt cardiogenic occlusion or risk factors. Data were retrieved including demographics, vascular risk factors, brain imaging including MRA, CTA, and /or DSA, and prior medical prevention of stroke. ICAS was defined as the proximal atherosclerotic stenosis or occlusion ≥50% in diameter. We estimated the prevalence of ICAS at this single stroke center. Results: 685 included patients were aged 20 to 101 years, 384(56.1%) were men, 520 (75.9%) were white, and 74(10.8%) were black. ICAS was prevalent in 41.6% of all included patients. Univariate analysis indicated that the prevalence of ICAS was significantly increased along with age, it was 39.3% for 41-60 years, and 43.8% for 61-80 years (P=0.034). But no significant difference was found between different races, it was 40.8% in Whites, and 40.5% in Blacks, and other races were 47.3%. Patients with ICAS had more severe stroke (NIHSS>3 vs NIHSS≤3: OR 2.729; 95%CI: 1.748-4.260; P<0.001). Higher levels of high-density lipoprotein cholesterol were associated with decreased odds of ICAS (OR 0.981; 95% CI: 0.968-0.995; P<0.006). Our data did not show hypertension, dyslipidemia and body mass index and smoking were associated with ICAS. Conclusions: The prevalence of ICAS in North America may be much higher than previous estimates. The impact of this common cause of recurrent stroke warrants further study, even in populations were cardiogenic embolic risk is common.

Abstract WP169: Symptomatic Intracranial Atherosclerotic Stenosis: The Associations Between Cerebral Hemodynamics and the Stroke Mechanisms

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Jill Abrigo ◽  
Linda Lan ◽  
Yuming Xu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Perfusion ◽  
Recurrent Stroke ◽  
Pressure Ratio ◽  
Teaching Hospitals ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Arterial Embolism ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: Intracranial atherosclerotic stenosis (ICAS) may cause ischemic stroke by various mechanisms; artery-to-artery (AA) embolism and hypoperfusion often co-exist and bear a high risk of recurrent stroke despite optimal medical treatment. Little is known regarding how ICAS lesions cause ischemic strokes via different mechanisms, while the hemodynamic features of ICAS lesions may play an important role. Methods: Patients with acute ischemic stroke attributed to 50-99% ICAS in the anterior circulation confirmed in CT angiography (CTA) were recruited from two teaching hospitals. We classified probable stroke mechanisms as parent artery atherosclerosis occluding penetrating artery (PAO), AA embolism, hypoperfusion, and mixed mechanisms, based on infarct topography and ICAS lesion features. Computational fluid dynamics (CFD) models were built based on CTA to simulate blood flow across culprit ICAS lesions. We calculated translesional pressure ratio (PR), the ratio of pressures distal and proximal to the lesion; and translesional wall shear stress ratio (WSSR), the ratio of WSS at the stenosis throat and at proximal normal vessel segment. We defined PR ≤ median as low PR, indicating larger pressure gradient across the lesion, hence restricted downstream perfusion; and WSSR ≥ 4 th quartile as high WSSR, indicating higher WSS upon the lesion. We associated PR and WSSR with probable stroke mechanisms. Results: Among 99 patients, 44 had AA embolism as a probable stroke mechanism, 13 with AA embolism alone and 31 with coexisting hypoperfusion; 18 and 37 respectively had isolated PAO and isolated hypoperfusion as the probable stroke mechanisms. High WSSR was independently associated with AA embolism (adjusted OR 4.86; p = 0.008). The significant, positive relationship between high WSSR and higher risk of AA embolism remained in those with a low PR (adjusted OR 4.01; p = 0.044), but not in those with a normal PR (p = 0.621). Conclusions: High WSS upon ICAS lesions may increase plaque vulnerability, but it may only cause distal arterial embolism when there is impaired cerebral perfusion. Therefore, in secondary prevention of ischemic stroke in ICAS via AA embolism, impaired cerebral perfusion may be an important therapeutic target.

scholarly journals Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yuanlin Ying ◽  
Fang Yu ◽  
Yunfang Luo ◽  
Xianjing Feng ◽  
Di Liao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Severity ◽  
Short Term ◽  
Severe Stroke ◽  
Lymphocyte Ratio ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS &gt;8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts.Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P &lt; 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P &lt; 0.001) compared with the lowest NLR tertile (&lt;2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P &lt; 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P &lt; 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS.Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

scholarly journals Neutrophil Count, Intracranial Atherosclerotic Stenosis, and Prognosis of Ischemic Stroke After Endovascular Treatment: A Mediation Analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Tingting Li ◽  
Zhonglun Chen ◽  
Xuyin Zhu ◽  
Xianbiao Tang ◽  
Song Pan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Scale Score ◽  
Neutrophil Count ◽  
Mediation Analysis ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Poor Outcomes

Background and Purpose: Data on the relationship among neutrophil count, intracranial atherosclerotic stenosis (ICAS), and functional outcomes after endovascular thrombectomy (EVT) for ischemic stroke patients remains unclear. We aimed to evaluate the association between neutrophil count and prognosis of EVT patients and to determine whether the association was mediated by ICAS.Methods: We retrospectively analyzed consecutive patients who underwent EVT at two comprehensive stroke centers between June 2016 and December 2019. A remaining stenosis &gt;70%, or a lesser degree of stenosis with a tendency toward re-occlusion or flow impairment during the procedure, was classified as ICAS. A poor outcome was defined as a 90-day modified Rankin Scale score of 3–6.Results: Of the 221 patients (mean age, 65.9 years; males, 61.1%) included in this study, 81 (36.3%) had ICAS, and 120 (54.3%) experienced a poor outcome at 90 days, respectively. In the multivariate adjustment for potential confounders, neutrophil count (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.04–1.36; P = 0.012) and presence of ICAS (OR, 2.65; 95CI%, 1.28–5.45; P = 0.008) were risk factors of poor outcomes. Furthermore, mediation analysis indicated that total ICAS mediated the association between increased neutrophil count and worse functional outcome after EVT (the regression coefficient was changed by 11.7% for poor outcome, and 17.1% for modified Rankin Scale score, respectively).Conclusions: Our study demonstrated that a higher neutrophil count might increase the risk of a poor outcome among ischemic stroke patients who underwent EVT, which was partially mediated by ICAS.

Sign in / Sign up

Export Citation Format

Share Document