Differential impact of white matter hyperintensity on the long-term outcome in ischemic stroke patients with large artery atherosclerosis according to age group

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.

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160139 ◽

2016 ◽

Vol 74 (11) ◽

pp. 881-886 ◽

Cited By ~ 2

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.

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Impact of the Total Number of Carotid Plaques on the Outcome of Ischemic Stroke Patients with Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm8111897 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1897 ◽

Cited By ~ 1

Author(s):

Hyungjong Park ◽

Minho Han ◽

Young Dae Kim ◽

Joonsang Yoo ◽

Hye Sun Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intima Media Thickness ◽

Major Adverse Cardiovascular Events ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Increased Risk ◽

Prognostic Utility

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

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Coexisting Small Vessel Disease Predicts Poor Long-Term Outcome in Stroke Patients with Intracranial Large Artery Atherosclerosis

Cerebrovascular Diseases ◽

10.1159/000319574 ◽

2010 ◽

Vol 30 (5) ◽

pp. 433-439 ◽

Cited By ~ 13

Author(s):

Jian Hui Fu ◽

Yang Kun Chen ◽

Xiang Yan Chen ◽

Vincent Mok ◽

Ka Sing Wong

Keyword(s):

Small Vessel Disease ◽

Small Vessel ◽

Large Artery ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Vessel Disease

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Abstract WP142: Low Risk Of Posterior Circulation Stroke In Ischemic Stroke Patients With Vertebral Artery Ositium Stenosis

Stroke ◽

10.1161/str.44.suppl_1.awp142 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Seung Hoon Song ◽

Joon Hwa Lee ◽

So Young Moon ◽

Hahn Young Kim

Keyword(s):

Ischemic Stroke ◽

Vertebral Artery ◽

Acute Ischemic Stroke ◽

Recurrent Stroke ◽

Posterior Circulation ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Angioplasty And Stenting

Backgrounds Atherosclerosis of vertebrobasilar artery is a major cause of the ischemic stroke in the posterior circulation. Vertebral artery ostium stenosis (VAOS) is occasionally observed in patients with acute ischemic stroke in anterior or posterior circulation. However, VAOS as a risk for stroke recurrence, especially for the posterior circulation stroke, has not been well studied. This study was performed to determine long-term outcome and clinical significance of VAOS in acute ischemic stroke patients. Methods As a prospective observational study of single stroke center registry, we studied risk of recurrent stroke and vascular outcome in acute ischemic stroke patients with VAOS, recruited consecutively from December 2007 to December 2010. VAOS was defined as more than 50% stenosis of either vertebral artery ostium on a contrast-enhanced MRA. Vascular risk factors and long-term outcome including recurrent stroke, cardiovascular event, vascular mortality, or all-cause mortality were investigated. Results Of 773 acute ischemic stroke patients, underwent contrast-enhanced MRA, 149 (19.2%) had more than 50% VAOS (age, 70±10 years). All patients had intensive medical treatment and 11 patients underwent angioplasty and stenting. During 327 patient-years of follow-up (mean, 2.2 years), there were 8 ischemic (3 in posterior circulation, 5 in anterior circulation), 5 hemorrhagic, and 2 unknown stroke. The annual rate of events were 1.36% for posterior circulation ischemic stroke, 3.64% for all ischemic stroke, 5.91% for all stroke, 1.36% for vascular death, and 9.55% for all cause mortality. Symptomatic VAOS, concomitant stenosis of other vertebrobasilar arteries or carotid arteries, or stroke subtype was not associated with long-term outcome. Conclusions Long-term outcome of acute ischemic stroke patients with more than 50% VAOS was favorable on intensive medical treatment and selective angioplasty and stenting. Vertebral artery ostium stenosis may not be a major risk factor for the recurrent ischemic stroke in the posterior circulation.

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Acute Diffusivity Biomarkers for Prediction of Motor and Language Outcome in Mild-to-Severe Stroke Patients

Stroke ◽

10.1161/strokeaha.119.024946 ◽

2019 ◽

Vol 50 (8) ◽

pp. 2050-2056 ◽

Cited By ~ 2

Author(s):

Eric Moulton ◽

Serena Magno ◽

Romain Valabregue ◽

Melika Amor-Sahli ◽

Christine Pires ◽

...

Keyword(s):

White Matter ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Arcuate Fasciculus ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Severe Stroke ◽

Language Outcome

Background and Purpose— Early severity of stroke symptoms—especially in mild-to-severe stroke patients—are imperfect predictors of long-term motor and aphasia outcome. Motor function and language processing heavily rely on the preservation of important white matter fasciculi in the brain. Axial diffusivity (AD) from the diffusion tensor imaging model has repeatedly shown to accurately reflect acute axonal damage and is thus optimal to probe the integrity of important white matter bundles and their relationship with long-term outcome. Our aim was to investigate the independent prognostic value of the AD of white matter tracts in the motor and language network evaluated at 24 hours poststroke for motor and aphasia outcome at 3 months poststroke. Methods— Seventeen (motor cohort) and 28 (aphasia cohort) thrombolyzed patients with initial mild-to-severe stroke underwent a diffusion tensor imaging sequence at 24 hours poststroke. Motor and language outcome were evaluated at 3 months poststroke with a composite motor score and the aphasia handicap scale. We first used stepwise regression to determine which classic (age, initial motor or aphasia severity, and lesion volume) and imaging (ratio of affected/unaffected AD of motor and language fasciculi) factors were related to outcome. Second, to determine the specificity of our a priori choices of fasciculi, we performed voxel-based analyses to determine if the same, additional, or altogether new regions were associated with long-term outcome. Results— The ratio of AD in the corticospinal tract was the sole predictor of long-term motor outcome, and the ratio of AD in the arcuate fasciculus—along with age and initial aphasia severity—was an independent predictor of 3-month aphasia outcome. White matter regions overlapping with these fasciculi naturally emerged in the corresponding voxel-based analyses. Conclusions— AD of the corticospinal tract and arcuate fasciculus are effective biomarkers of long-term motor and aphasia outcome, respectively.

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Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Advances in Interventional Cardiology ◽

10.5114/aic.2020.101771 ◽

2020 ◽

Vol 16 (4) ◽

pp. 452-459

Author(s):

Klaudia Nowak ◽

Justyna Derbisz ◽

Jan Pęksa ◽

Bartłomiej Łasocha ◽

Paweł Brzegowy ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Post Stroke

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Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

European Stroke Journal ◽

10.1177/23969873211019586 ◽

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.

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