Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease

2015 ◽  
Vol 359 (1-2) ◽  
pp. 381-388 ◽  
Author(s):  
Hyun Jin Noh ◽  
Suk Jae Kim ◽  
Jong Soo Kim ◽  
Seung-Chyul Hong ◽  
Keon Ha Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Moyamoya Disease ◽  
Stroke Recurrence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adult Moyamoya Disease

scholarly journals Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

2021 ◽  
pp. 239698732110195
Author(s):  
P Correia ◽  
S Machado ◽  
I Meyer ◽  
M Amiguet ◽  
A Eskandari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Tobacco Use ◽  
Migraine With Aura ◽  
Hormonal Contraceptives ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Female Patients

Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

Abstract TP127: Mortality and Recurrence in Atherosclerotic Ischemic Stroke: Long-term Follow-up

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Miguel A Barboza ◽  
Rodrigo Uribe ◽  
Fabiola Serrano ◽  
Luis C Becerra-Pedraza ◽  
D. K Mantilla-Barbosa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Median Time ◽  
Smoking History ◽  
Stroke Recurrence ◽  
Active Smoking ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background and purpose: Atherosclerotic ischemic stroke is the second most frequent etiology of stroke in the adult population. Functional outcome, mortality and recurrence of stroke rates on the long-term follow-up are poorly studied. This study investigates long-term outcome among patients with ischemic stroke secondary to atherosclerotic causality, and identifies the main factors associated with poor outcome, recurrence, and death. Methods: We analyzed data from our consecutive acute ischemic stroke database, over a period of 25 years (1990-2015). The endpoints were: bad outcome (Modified Rankin Score ≥3), recurrence and mortality at discharge, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death and recurrence. Results: A total of 946 consecutive atherosclerotic stroke patients were included (571 [60.4%] males, median age 65 years [interquartile range 57-73 years] for the entire population); dyslipidemia (64.2%), hypertension (63.3%), diabetes (35.0%), and active smoking history (31.8%) were the most prevalent risk factors.After a median follow-up of 38 months (IQR 12-75 months), 59.3% patients had a bad outcome at discharge. A result of 26.1% had stroke recurrence (median time until recurrence: 9 months [IQR 12-84 months], with 12.9% cases presenting ≥2 recurrences), and 24.1% were dead (median time to death: 18.5 months [IQR 11-74 months]) at the final follow-up period. After multivariate adjustment, hypertension (HR 4.2, CI 95% 2.8-6.1; p<0.001) was the strongest predictor of recurrence. Additionally, diabetes (HR 2.6, CI 95% 2.0-3.5; p<0.001), bad functional outcome after recurrence (HR 2.3, CI 95% 1.9-2.9; p<0.001), age ≥65 years (HR 2.2, CI 95% 1.7-2.9; p<0.001), and active smoking (HR 1.8, CI 95% 1.3-2.3; p<0.001) were the strongest predictors of mortality. Conclusions: Atherosclerotic ischemic stroke has a high rate of recurrence, associated mainly with hypertension. Mortality is predicted by diabetes, bad functional outcome at recurrence, and older age.

Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis

2021 ◽  
Author(s):  
Sauson Soldozy ◽  
Kaan Yağmurlu ◽  
Pedro Norat ◽  
Mazin Elsarrag ◽  
John Costello ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Meta Analysis ◽  
Term Outcome ◽  
Long Term Outcome

Abstract TP448: High Residual Platelet Reactivity (hrpr) for Adenosine Diphosphate (adp) Stimuli is a Determinant Factor for Long-term Outcomes in Acute Ischemic Stroke With Anti-platelet Agents

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jae-Kwan Cha ◽  
Eun-Kyu Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Endpoint ◽  
Platelet Reactivity ◽  
Large Artery ◽  
Vascular Events ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Platelet Aggregometry

Background and Purpose: High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. Methods: We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70% or greater according to OPA after 10 μM ADP stimuli. Results: The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3% (109/968). Its rate was significantly higher in the patients with HRPR (16.7%) than in those without (9.7%). HPRP was independently associated with the primary endpoint (OR=1.97, CI 1.22 to 3.18, p<0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR=2.26, CI 1.15 to 4.45, P=0.02). Conclusions: In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.

Abstract T P98: Effect of Atrial Fibrillation and/or Large Artery Atherosclerosis on Stroke Recurrence and Long-term Outcome in Japanese Minor Stroke ~Fukuoka Strok Registry~

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shigeru Fujimoto ◽  
Masato Ohsaki ◽  
Masaya Kumamoto ◽  
Takao Ishitsuka ◽  
Takanari Kitazono
Keyword(s):  
Scale Score ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Good Outcome ◽  
Group A ◽  
Group D

Background & Purpose: Atrial fibrillation (AF) and large artery atherosclerosis (LAA) can be associated with a bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or LAA. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 3725 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. In accordance with AF and intracranial or extracranial LAA (stenosis of 50% or more in diameter), they were classified into 4 subgroups: patients without both AF and LAA (Group A, n=2154), patients with only AF (Group B, n=475), patients with only LAA (Group C, n=937), and patients with both AF and LAA (Group D, n=159). We observed stroke recurrence and outcome during one year. Results: On the multivariate analysis, age (OR, 0.94; 95%CI 0.93~0.95), initial NIH stroke scale score (OR, 0.70; 95%CI, 0.67~0.74), chronic kidney disease (OR, 0.72; 95%CI, 0.55~0.95), initial HbA1c value (OR 0.87, 95%CI 0.79~0.95), and LAA (OR 0.70, 95%CI 0.55~0.88) had a negative association with a good outcome. Acute stroke recurrences within 3 weeks after the onset were observed in 2.0%, 2.5%, 6.1%, and 9.4% in Group A-D patients respectively (p<0.0001). Stroke recurrences during 1 year were observed 7.0%, 10.7%, 11.6%, and 13.8% in Group A-D patients respectively (p<0.0001). A good outcome (mRS of 0-1) 1 year after the onset was observed in 77.0%, 6.4%, 67.9%, and 65.8% in Group A-D patients respectively (p<0.0001). With regard to the Kaplan-Meier method, there was a significant difference in stroke recurrence among the 4 subgroups, and stroke recurrences were most frequent in Group D (p<0.0001, Log-rank test). Conclusions: In Japanese minor stroke, age, NIH stroke scale score, chronic kidney disease, HbA1c, and LAA were significant predictors for the long-term outcome. In patients with both AF and LAA, stroke recurrences were most frequent, especially in the acute phase, and a long-term good outcome was least frequent consequently.

scholarly journals Polymorphism of the complement 5 gene is associated with large artery atherosclerosis stroke in Chinese patients

2016 ◽  
Vol 74 (11) ◽  
pp. 881-886 ◽  
Author(s):  
Hui Wu ◽  
Yingfeng Weng ◽  
Lan Zheng ◽  
Huanyin Li ◽  
Qi Gong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Chinese Patients ◽  
Large Artery ◽  
Nucleotide Polymorphism ◽  
Term Outcome ◽  
Single Nucleotide ◽  
Long Term Outcome ◽  
Risk Predictors ◽  
The Complement System

ABSTRACT The complement system has been confirmed to play an increasingly important role in ischemic stroke (IS). This study aimed to determine whether the single-nucleotide polymorphism of the complement 5 (C5) gene independently influences the occurrence, severity, and long-term outcome of IS in Chinese patients. Methods C5 rs17611 genetic variants were investigated in 494 IS patients and 330 control individuals .Ischemic stroke was classified into subtypes and patients were assessed 90 days post-stroke with the modified Rankin Scale to determine stroke outcome. Results The presence of C5 polymorphism was associated with the incidence of large artery atherosclerosis (LAA)-subtype IS (n =2 00; p = 0.031), which even persisted after adjustment for covariates (OR = 1.518; 95%CI = 1.093–2.018; p = 0.013). However, no association was found between genotypes and the severity and outcome of stroke (p = 0.978; p = 0.296). Conclusions The C5 polymorphism might contribute to the risk of LAA-subtype IS independently of other known risk predictors.

scholarly journals Functional Inflammatory Genotypes in Ischemic Stroke: Could We Use Them to Predict Age of Onset and Long-Term Outcome?

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Stella Marousi ◽  
Anna Antonacopoulou ◽  
Haralambos Kalofonos ◽  
Panagiotis Papathanasopoulos ◽  
Marina Karakantza ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cox Regression ◽  
Age Of Onset ◽  
Adverse Outcome ◽  
Nucleotide Polymorphisms ◽  
Term Outcome ◽  
Single Nucleotide ◽  
Long Term Outcome ◽  
Tnf Α

Functional single-nucleotide polymorphisms (SNPs) of inflammatory cytokines have been previously related to the occurrence of an ischemic stroke (IS). We investigated whether five functional SNPs (i.e., TNF-α-308G>A, IL6-174G>C, IL12B 1188A>C, IL4-589C>T, and IL10-1082G>A) might be associated with the age of onset and 6-month outcome of an acute IS. A probe-free real-time PCR methodology was used to genotype 145 consecutively admitted cases with a first-ever IS. Simple Kaplan-Mayer and adjusted Cox regression analyses showed no association between inflammatory genotypes and the age of IS onset. IL6-174G>C, IL12B 1188A>C, IL4-589C>T, and IL10-1082G>A were not found to significantly contribute to the long-term outcome of the disease. However, carriage of the TNF-α-308 GG genotype was significantly associated with reduced odds for an adverse outcome. Larger studies are needed to confirm our results.

Hypertension at time of diagnosis and long-term outcome after childhood ischemic stroke

Neurology ◽  
2013 ◽  
Vol 80 (13) ◽  
pp. 1225-1230 ◽  
Author(s):  
L. N. Brush ◽  
P. T. Monagle ◽  
M. T. Mackay ◽  
A. L. Gordon
Keyword(s):  
Ischemic Stroke ◽  
Term Outcome ◽  
Long Term Outcome
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