Trimethyllysine, vascular risk factors and outcome in acute ischemic stroke (MARK–STROKE)

Objectives: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke (IS) and the small number of patients eligible for that treatment justifies the development of Stroke Center networks with interhospital transfer of eligible patients. But it is possible that this approach generate “futile“ transfers (i.e. shift of patients who finally do not receive ET) generating unnecessary costs. Our aim is to analyze the frequency of “futile” transfers, the reasons for rejection for ERT and to identify the possible associated factors. Methods: We analyzed a prospective registry of ERT from a Stroke Network integrated by three hospitals with facilities for ERT for acute stroke patients. These hospitals share a common stroke protocol and have established a weekly rotatory shift with inter-hospital transference to the on-call center for ERT in those patients in whom this therapy is indicated, both primarily, after completing IV thrombolysis or in patients attended in outside hospitals (drip and shift). We analyzed: demographic data, vascular risk factors, stroke severity, frequency of prior intravenous thrombolysis, time from stroke onset and reasons for rejection. Study period: 1/02/2012 to 07/05/2013. Results: ERT protocol was activated in 199 patients, receiving ERT 129 (64.8%). 120 (60.3%) patients required inter-hospital transfer, among them 50 (41%) were not finally treated (futile transfer). These were more often male (74.1% vs. 25.9%, P = 0.04), with no differences in age, vascular risk factors, time-lapse from stroke onset or delay of inter-hospital transfer, baseline NIHSS, baseline ASPECTS or rate of prior intravenous thrombolysis between transferred patients treated with ERT and those non-treated. Reasons for rejection were: clinical improvement (16%), arterial recanalization (24%), clinical deterioration (8%); ASPECTS <7 in the 2nd TC (20%), absence of mismatch (20%); delay in shipment (2%), revocation of consent (1%). Conclusions: 40% of shipments for ERT are “futile”. None of the baseline patient characteristics predict this fact, being arterial recanalization and findings in a second imaging test done in the receiving hospital the main reasons for ERT rejection.

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Abstract: P1384 VASCULAR RISK FACTORS AND PREVALENCE OF CEREBRAL ARTERY CALCIFICATION IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Atherosclerosis Supplements ◽

10.1016/s1567-5688(09)71392-3 ◽

2009 ◽

Vol 10 (2) ◽

pp. e1434

Author(s):

K-Y Park

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Vascular Risk Factors ◽

Vascular Risk

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Vascular risk factors, etiology and outcome comparison between cancer and non-cancer patients with acute ischemic stroke: Nested case–control/INS; study

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.942 ◽

2013 ◽

Vol 333 ◽

pp. e242-e243

Author(s):

A.M. Carrilho ◽

M. Brum ◽

C. Rosado ◽

A. Valadas ◽

C. Semedo ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cancer Patients ◽

Case Control ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Outcome Comparison ◽

Nested Case Control

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Clustering of vascular risk factors and in-hospital death after acute ischemic stroke

Journal of Neurology ◽

10.1007/s00415-007-0559-y ◽

2007 ◽

Vol 254 (12) ◽

pp. 1636-1641 ◽

Cited By ~ 11

Author(s):

J. Roquer ◽

A. Ois ◽

A. Rodríguez Campello ◽

M. Gomis ◽

E. Munteis ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Vascular Risk Factors ◽

Hospital Death ◽

Vascular Risk

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Abstract TMP17: Safety of Thrombolysis for Acute Ischemic Stroke in Patients with Recent Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Setareh Salehi Omran ◽

Alexander E Merkler ◽

Gino Gialdini ◽

Michael Lerario ◽

Shadi Yaghi ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Vascular Risk Factors ◽

Sensitivity Analyses ◽

Secondary Outcome ◽

Vascular Risk ◽

Risk Of Death ◽

Increased Risk ◽

Iv Tpa

Background: The safety of intravenous tissue plasminogen activator (IV-tPA) is uncertain in acute ischemic stroke patients (AIS) with recent stroke because these patients were generally excluded from randomized stroke trials evaluating IV-tPA. We aimed to determine whether history of stroke within the previous 3 months is associated with an increased risk of intracerebral hemorrhage (ICH) or death after thrombolysis for AIS. Methods: Using previously validated ICD-9-CM codes, we retrospectively analyzed all adult patients with AIS who received IV-tPA in nonfederal EDs or acute care hospitals in CA, FL, and NY from 2005-2013. The primary outcome was the development of ICH (ICD-9-CM code 431) during index hospitalization for AIS. The secondary outcome was inpatient death. Logistic regression was used to compare the rate of ICH and death in patients with previous ischemic stroke within 3 months of IV-tPA therapy for AIS to all other patients treated with IV-tPA for AIS. Results: We identified 34,461 AIS patients treated with IV-tPA, including 454 with prior ischemic stroke in the past 3 months. Patients with recent stroke were on average younger and had more vascular risk factors and Elixhauser comorbidities than patients without recent stroke. The ICH rate after IV-tPA was similar in patients with AIS within the previous 3 months (6.6%, 95% CI 6.3-6.8) compared to patients without recent AIS (6.8%, 95% CI 4.5–9.1), but the rate of death was higher in those with AIS within the previous 3 months (16.5%, 95% CI 13.1-19.9 vs. 11.1%, 95% CI 10.7-11.4, p<0.001). After adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index, the risk of ICH following IV-rPA in patients with AIS in the previous 3 months was not different from those without recent AIS (OR=1.0, 95% CI 0.7-1.5, p=0.90), although the risk of death remained higher in patients with AIS in the previous 3 months (OR=1.6, 95% CI 1.2-2.1, p<0.001). Our results were unchanged in sensitivity analyses excluding patients with other approved indications for thrombolysis (e.g., MI, PE, and hemodialysis). Conclusions: In a large, multistate cohort, prior stroke within 3 months of receiving IV-tPA for AIS was not associated with an increased risk of ICH but was associated with a higher risk of death.

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Abstract 1122‐000237: Prior Vascular Risk Factors Affecting Presentation Time and Utilization of Acute Ischemic Stroke Therapies

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000237 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Jude H Charles ◽

Mario P Zamora ◽

Dileep R Yavagal

Keyword(s):

Risk Factors ◽

High School ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Grade School ◽

Stroke Therapy ◽

History Of ◽

Prior Stroke

Introduction : Multiple factors have been reported to influence the time between onset of symptoms in acute ischemic stroke and hospital presentation. Although education level is one independent factor in presentation, as we previously reported, health literacy has not been fully assessed regarding specific patient knowledge on stroke or its known risk factors. This study aims to determine whether having a history of vascular risk factors such as prior stroke, coronary artery disease (CAD), or atrial fibrillation (AF) influence presentation time and acute ischemic stroke therapy utilization. Methods : This study included 250 acute ischemic stroke patients presenting to a large academic community hospital from February to December 2018. Educational level was defined within four categories: Grade School, High School, College or Higher, and Unknown. Last seen normal, symptom onset, and arrival times were acquired. Vascular risk factors chosen for this study included prior stroke, CAD, and AF. History of vascular risk factors was verified by medical documentation showing prior diagnosis by physician. Initial NIH Stroke Scale score, stroke location, vessel involved, LDL, hemoglobin A1c, gender, and race were also obtained. Patients were categorized based on their level of education, the presence or absence of vascular risk factors, and utilization of tPA or thrombectomy (MT). The primary outcomes were onset‐to‐arrival time (OTA), in minutes, and utilization rates of acute ischemic stroke therapies (either tPA, MT, or both). Subgroup analysis was conducted to associate education level with each vascular risk factor, comparing OTA and acute ischemic stroke therapy utilization rate. Results : As previously reported, educational level was inversely associated with OTA and positively associated with utilization of at least one acute ischemic stroke therapy. Prior stroke, CAD, and AF showed a substantial OTA decrease for all education groups except for College. Prior stroke decreased OTA in Grade School by 24% (764 vs. 579); High School by 30% (222 vs. 154) and College by 20% (52 vs. 41). CAD decreased OTA in Grade School by 65% (734 vs. 253), High School by 14% (209 vs. 180), and College by 3% (50 vs 49). AF decreased OTA in Grade School by 88% (764 vs. 91) and High School by 56% (216 vs. 95), but increased in College by 35% (47 vs. 64). History of prior stroke decreased utilization of both tPA and MT by 14%; CAD increased tPA use by 8% and MT by 5%; while AF increased tPA use by 9% and MT by 12%. Conclusions : Having at least one prior vascular risk factor (prior stroke, CAD, AF), diagnosed by a physician, was associated with lower OTA in Grade School and High School educated patients. A history of prior stroke was associated with lower acute stroke therapy utilization (tpa and MT), while both CAD and AF were associated with increased acute stroke therapy utilization.

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Abstract P593: Association Between Troponin and Ischemic Stroke Recurrence in the Greater Cincinnati/Northern Kentucky Stroke Study

Stroke ◽

10.1161/str.52.suppl_1.p593 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alexander E Merkler ◽

Heidi Sucharew ◽

Kathleen S Alwell ◽

Mary Haverbusch ◽

Florence Rothenberg ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Proportional Hazards Model ◽

Vascular Risk Factors ◽

Cox Proportional Hazards Model ◽

Stroke Recurrence ◽

Stroke Severity ◽

Vascular Risk ◽

Acute Mi

Introduction: Elevations in troponin (cTn) are common in patients with acute ischemic stroke, yet their significance remains uncertain. Hypothesis: Elevated cTn at the time of acute ischemic stroke is associated with ischemic stroke recurrence. Methods: We included all adult patients with acute ischemic stroke who were residents of the Greater Cincinnati/Northern Kentucky region and who presented to an emergency department (ED) in 2015 and who had a cTn measured within 24 hours of ED arrival. Our exposure variable was an elevated cTn, defined as a value exceeding the laboratory’s 99 th percentile. Our primary outcome was ischemic stroke recurrence, defined as a new ischemic stroke with radiographic confirmation in the 3 years following the index ischemic stroke event. Cox proportional hazards model was used to evaluate the association between elevated cTn and ischemic stroke recurrence while adjusting for demographics, vascular risk factors, and stroke severity. In a secondary analysis, we excluded patients with a concomitant adjudicated myocardial infarction (MI) at the time of the index ischemic stroke. Results: Among 2,334 patients with acute ischemic stroke, 1,992 (85%) had a cTn assay within 24 hours of ED arrival and were included in the analysis. 402 (20%) patients had an elevated cTn and 259 (13%) patients had a recurrent ischemic stroke. 66 (3%) patients had an elevated cTn and a concomitant acute MI and 336 (17%) patients had an elevated cTn without a concomitant acute MI. After adjustment for demographics, vascular risk factors, and stroke severity, we found an association between elevated cTn and recurrent ischemic stroke (hazards ratio [HR], 1.5; 95% CI, 1.1-2.0). Our results were unchanged after excluding patients with a concomitant adjudicated MI (HR 1.4; 95% CI, 1.03-2.0). Conclusions: Among patients with acute ischemic stroke, elevated cTn even in the absence of concomitant adjudicated MI, was associated with ischemic stroke recurrence. Further mechanistic studies are necessary to explore the underlying etiology of hypertroponinemia among patients with acute ischemic stroke in order to guide targeted therapies to reduce stroke recurrence.

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Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study

Acta Médica Portuguesa ◽

10.20344/amp.6156 ◽

2015 ◽

Vol 28 (5) ◽

pp. 613 ◽

Cited By ~ 5

Author(s):

Ana Carrilho Romeiro ◽

Anabela Valadas ◽

José Marques

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cancer Patients ◽

Case Control Study ◽

Case Control ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Control Study ◽

Active Cancer

Introduction: It is still unclear whether the etiology of ischemic stroke differs between cancer and non-cancer patients. Stroke and cancer share common modifiable risk factors but evidence suggests that cancer patients have specific conditions that increase the risk of stroke. Our goal was to compare the etiology of ischemic stroke in cancer and non-cancer patients. Material and Methods: Case-control study conducted in patients admitted to a stroke unit between January 2007 and December 2012. Cases had a concomitant diagnosis of cancer and acute ischemic stroke, controls of only stroke. Age, gender, vascular risk factors and etiology were compared between groups. Results: Fifty-six cases were identified; 64.3% were men with a mean age of 71 years; 21 patients had evidence of active cancer. Gastrointestinal cancer (25.9%) was the most common; 151 controls were included matched for gender and age. Common modifiable vascular risk factors, between groups (cases versus controls) were not significantly different, except for diabetes mellitus, more frequent in the control group (16.1% vs 33.8%, p = 0.02). Previous thrombotic events were more frequent in the cancer cohort (8.9% vs 0.7%, p = 0.007). Other determined etiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (13.0% vs 0.8%, p < 0.01), and a hypercoagulable state was significantly more prevalent in active cancer patients. Discussion: In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism. Conclusion: In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.

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