Elevated Serum Levels of CXC Chemokine Ligand-12 Are Associated with Unfavorable Functional Outcome and Mortality at 6-Month Follow-up in Chinese Patients with Acute Ischemic Stroke

BackgroundParenchymal hemorrhage (PH) is a troublesome complication after endovascular treatment (EVT).ObjectiveTo investigate the incidence, independent predictors, and clinical impact of PH after EVT in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).MethodsSubjects were selected from the ANGEL-ACT Registry. PH was diagnosed according to the European Collaborative Acute Stroke Study classification. Logistic regression analyses were performed to determine the independent predictors of PH, as well as the association between PH and 90-day functional outcome assessed by modified Rankin Scale (mRS) score.ResultsOf the 1227 enrolled patients, 147 (12.0%) were diagnosed with PH within 12–36 hours after EVT. On multivariable analysis, low admission Alberta Stroke Program Early CT score (ASPECTS)(adjusted OR (aOR)=1.13, 95% CI 1.02 to 1.26, p=0.020), serum glucose >7 mmol/L (aOR=1.82, 95% CI 1.16 to 2.84, p=0.009), and neutrophil-to-lymphocyte ratio (NLR; aOR=1.05, 95% CI 1.02 to 1.09, p=0.005) were associated with a high risk of PH, while underlying intracranial atherosclerotic stenosis (ICAS; aOR=0.42, 95% CI 0.22 to 0.81, p=0.009) and intracranial angioplasty/stenting (aOR=0.37, 95% CI 0.15 to 0.93, p=0.035) were associated with a low risk of PH. Furthermore, patients with PH were associated with a shift towards to worse functional outcome (mRS score 4 vs 3, adjusted common OR (acOR)=2.27, 95% CI 1.53 to 3.38, p<0.001).ConclusionsIn Chinese patients with AIS caused by anterior circulation LVO, the risk of PH was positively associated with low admission ASPECTS, serum glucose >7 mmol/L, and NLR, but negatively related to underlying ICAS and intracranial angioplasty/stenting.Trial registration numberNCT03370939.

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Abstract T P10: Hounsfield Unit Value and Clot Length in the Acutely Occlude Vessel and Time Required to Achieve Thrombectomy, Complications and Outcome

Stroke ◽

10.1161/str.45.suppl_1.tp10 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Alejandro Spiotta ◽

Jan Vargas ◽

Harris Hawk ◽

Raymond Turner ◽

Imran Chaudry ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Hounsfield Unit ◽

Hounsfield Units ◽

Unit Value ◽

Procedural Complications ◽

Noncontrast Ct ◽

Time Required

Introduction: Intra-arterial therapy for acute ischemic stroke (AIS) now has an established role. We investigated if Hounsfield Units (HU) quantification on noncontrast CT is associated with ease and efficacy of mechanical thrombectomy and outcomes. Methods: We retrospectively studied a prospectively maintained database of cases of acute ischemic stroke that underwent intra-arterial therapy between May 2008 and August 2012. Functional outcome was assessed by ninety-day follow up modified Rankin Scale (mRS). Patients were dichotomized base on time to recanalization. Hounsfield units were calculated on head CT. Thrombus location and length were determined on CT angiography. Simple linear regression was used to analyze the association between clot length, average HU, and other clinical variables. Results: 141 patients were included. There was no difference in clot length or average HU among patients with good recanalization achieved within an hour compared to those in which procedures extended beyond an hour. There was no relationship between clot length or density and recanalization. The thrombus length and density were not significantly different between patients with procedural complications and those without. The presence of post procedure intracranial hemorrhage was not associated with thrombus length or density. Ninety day mRS was not associated with thrombus length or density. Conclusions: We have not found any significant associations between either thrombus length or density and likelihood of recanalization, time to achieve recanalization, intraprocedural complications, postprocedural hemorrhage or functional outcome at ninety days. These results do not support a predictive value for thrombus quantification in the evaluation of AIS.

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Abstract 162: 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.162 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Erwin Chiquete ◽

Guillermo Ramirez-Garcia ◽

Valeria Sandoval-Rodriguez ◽

Fernando Flores-Silva ◽

Jose L Ruiz-Sandoval ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Disability ◽

Brain Infarction ◽

Cox Proportional Hazards Model ◽

Seizure Recurrence ◽

Factors Associated ◽

Acute Seizures

Background and purpose: Acute ischemic stroke (AIS) is the leading cause of adult-onset epilepsy. In the context of current guidelines, AIS patients presenting with seizures are considered at high risk for seizure recurrence and as a consequence, this patients are deemed as nowadays affected by epilepsy. We aimed to describe the factors associated with acute seizures, epilepsy and seizure recurrence after AIS, as well as their impact on the functional outcome at 12-month follow-up. Methods: This is a cohort study on 1,246 non-epileptic patients with AIS included in a multicenter Mexican registry; who received 12-month follow-up after a first-ever or recurrent AIS. Multivariate analyses were performed to evaluate factors associated with acute seizures and the functional outcome at 12 months of follow-up. Results: The frequency of acute seizures (within 7 days after stroke onset) after AIS was 8.1% [95% confidence interval (CI): 6.7% to 9.8%]. In all, 12-month seizure recurrence rate was 4.8% (95% CI: 3.7% to 6.1%). In a binary logistic regression model, risk factors significantly associated with seizures were >10 scoring of the National Institutes of Health Stroke Scale (NIHSSS, US) [odds ratio (OR): 2.21, 95% CI: 1.40-3.47], recurrent ischemic stroke (OR: 2.17, 95% CI: 1.34-3.53) and age <65 years (OR: 1.69, 95% CI: 1.09-2.62). After a Cox-proportional hazards model and Kaplan-Meier actuarial analyses, the presence of acute seizures was significantly associated with the risk of functional disability or death (a modified Rankin scale >3) at 12 months of follow-up [hazard ratio (HR): 1.37, 95% CI: 1.04-1.83], as well as NIHSS >10 (HR: 4.47, 95% CI: 3.53-5.65), age ≥65 years (HR: 1.74, 95% CI: 1.38-2.20), heart failure (HR: 1.61, 95% CI: 1.22-2.13) and atrial fibrillation (HR: 1.35, 95% CI: 1.05-1.74). Conclusions: The frequency of provoked seizures after acute ischemic stroke in this cohort was 8%. Age <65 years and severity of the brain infarction are the main factors associated with seizures, which in turn represent an important risk factor for functional disabilities or death one year after the acute event.

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Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness

Stroke ◽

10.1161/strokeaha.120.033124 ◽

2021 ◽

Author(s):

Manon Kappelhof ◽

Manon L. Tolhuisen ◽

Kilian M. Treurniet ◽

Bruna G. Dutra ◽

Heitor Alves ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Odds Ratio ◽

Infarct Volume ◽

Treatment Allocation ◽

Common Odds Ratio

Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

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Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0282 ◽

2018 ◽

Vol 56 (2) ◽

pp. 350-355 ◽

Cited By ~ 9

Author(s):

Tian Xu ◽

Peng Zuo ◽

Yuqin Wang ◽

Zhiwei Gao ◽

Kaifu Ke

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Logistic Model ◽

Critical Role ◽

Stroke Onset ◽

Stroke Patients ◽

Multivariable Logistic Regression Model ◽

Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

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Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke

JAMA Neurology ◽

10.1001/jamaneurol.2018.3661 ◽

2019 ◽

Vol 76 (2) ◽

pp. 194 ◽

Cited By ~ 16

Author(s):

Anna M. M. Boers ◽

Ivo G. H. Jansen ◽

Scott Brown ◽

Hester F. Lingsma ◽

Ludo F. M. Beenen ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Endovascular Therapy ◽

Infarct Volume ◽

The Relationship

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Abstract W P160: Elevated Lipoprotein A Levels Predict Worse Short-term Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp160 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Alyana A Samai ◽

Dominique J Monlezun ◽

Amir Shaban ◽

Alexander George ◽

Janelle Cyprich ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Serum Levels ◽

Stroke Severity ◽

Short Term ◽

Poor Functional Outcome ◽

Lipoprotein A ◽

Stroke Registry ◽

History Of

Background: Lipoprotein A (Lp(a)) is a risk factor for vascular disease; however, few studies have examined the relationship between serum levels of Lp(a) and patient outcomes in acute ischemic stroke (AIS). In this study, we sought to assess whether AIS patients with elevated Lp(a) levels exhibit characteristic differences in stroke severity, in-hospital complications, and short-term outcomes as compared to patients with normal Lp(a) levels. Methods: From our prospective stroke registry, patients consecutively admitted and diagnosed with AIS 07/2008-10/2013 were included if Lp(a) levels were measured during admission. Regressions, adjusting for key covariates, analyzed outcomes in patients with elevated (+) and severely elevated (++) Lp(a) with respect to normal (-) Lp(a). The primary outcome was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: Among the 1,453 patients in our stroke registry, 159 patients met our inclusion criteria; 24 patients (15.1%) were in the +Lp(a) group and 37 patients (23.3%) in the ++Lp(a) group. After adjustment for total cholesterol, LDL, HDL, and triglycerides, patients with ++Lp(a) were more than twice as likely to experience poor functional outcome (OR=2.48, 95% CI 1.0781-5.7231, p=0.033) as those with -Lp(a). Adjusting for age, NIHSS baseline, history of diabetes, admission glucose level, and tPA administration, patients with ++Lp(a) were more than 2.5 times more likely to experience poor functional outcome (OR=2.59, 95% CI 1.0129-6.6282, p=0.047) as compared to those with -Lp(a). Conclusions: Lp(a) elevation predicts higher odds of poor functional outcomes for patients with AIS compared to patients with normal levels. Our findings support the utility of Lp(a) level as a clinically useful biomarker in the development of patient risk profiles.

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