P.068 Discrepancy between post-treatment infarct volume and 90-day
                        outcome in ischemic stroke: A validation study in the ESCAPE-NA1 randomized
                        controlled trial

Background: Some patients do poorly despite small infarcts after endovascular therapy(EVT) whilst others with large infarcts do well. We validated exploratory findings from the ESCAPE trial regarding factors associated with such discrepancies, in the ESCAPE-NA1 trial(NCT02930018). Methods: We identified “discrepant cases” with modified Rankin Scale(mRS)≥3 despite small follow-up infarct volume(FIV≤25th-percentile) on 24-hour CT/MRI or mRS≤2 despite large FIV(volume≥75th-percentile). We compared area-under-the-curve(AUC) of pre-specified logistic models containing (a)pre-treatment factors(age/cancer/vascular risk-factors) and (b)treatment-related/post-treatment factors(serious adverse events/SAEs) in identifying small-FIV/mRS≥3 and large-FIV/mRS≤2, with stepwise regression-derived models. Results: Among 1,091 patients, 42/287(14.6%) with FIV≤7mL(25th-percentile) had mRS≥3; 65/275(23.6%) with FIV≥92mL(75th-percentile) had mRS≤2. Pre-specified pre-treatment factors(age/cancer/vascular risk-factors) were associated with FIV≤7mL/mRS≥3; stepwise models selected similar variables(similar AUCs:0.92-0.93,p=0.42). SAEs(infarct-in-new-territory/recurrent stroke/pneumonia/heart failure) were strongly associated with FIV≤7mL/mRS≥3; stepwise models also identified onset-to-needle time and hemoglobin(24-hours) as treatment-related/post-treatment factors(similar AUCs:0.92-0.94,p=0.14). Younger age was associated with FIV≥92mL/mRS≤2; stepwise models also selected diabetes absence and baseline hemoglobin(similar AUCs:0.76-0.77,p=0.82). Absence of SAEs(stroke progression/pneumonia/intracerebral hemorrhage) was strongly associated with FIV≥92mL/mRS≤2; stepwise models also identified 24-hour hemoglobin, glucose, and BP(similar AUCs:0.79-0.80,p=0.030). Conclusions: FIV-mRS discrepancies are associated with pre-treatment factors like age/comorbidities; and post-treatment complications related to stroke evolution, secondary prevention, and post-acute care quality. Optimizing thrombolysis speed, BP, glucose, and hemoglobin are modifiable factors meriting further study.

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Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial

International Journal of Stroke ◽

10.1177/1747493020929943 ◽

2020 ◽

pp. 174749302092994 ◽

Cited By ~ 1

Author(s):

Aravind Ganesh ◽

Bijoy K Menon ◽

Zarina A Assis ◽

Andrew M Demchuk ◽

Fahad S Al-Ajlan ◽

...

Keyword(s):

Risk Factors ◽

Infarct Volume ◽

Controlled Trial ◽

Post Treatment ◽

Sensitivity Analyses ◽

Vascular Risk ◽

Factors Associated ◽

Post Stroke ◽

Randomized Controlled ◽

Pre Treatment

Background Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. Aims We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. Methods We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24–48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24–48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. Results Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement ( p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age ( p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS ( p = 0.007) and post-stroke complications ( p = 0.026). Absence of vascular risk-factors ( p = 0.004), CT-based lentiform nucleus sparing ( p = 0.002), lower 24-hour NIHSS ( p = 0.001), and absence of complications ( p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. Conclusions Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01778335 .

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Effects of Exercise Intervention on Vascular Risk Factors in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000343486 ◽

2012 ◽

Vol 2 (1) ◽

pp. 445-455 ◽

Cited By ~ 11

Author(s):

Kazuki Uemura ◽

Takehiko Doi ◽

Hiroyuki Shimada ◽

Hyuma Makizako ◽

Daisuke Yoshida ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Randomized Controlled Trial ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Exercise Intervention ◽

Controlled Trial ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Randomized Controlled

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Structural MRI markers of brain aging early after ischemic stroke

Neurology ◽

10.1212/wnl.0000000000004086 ◽

2017 ◽

Vol 89 (2) ◽

pp. 116-124 ◽

Cited By ~ 21

Author(s):

Emilio Werden ◽

Toby Cumming ◽

Qi Li ◽

Laura Bird ◽

Michele Veldsman ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Brain Aging ◽

Infarct Volume ◽

Hippocampal Volume ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Total Brain Volume ◽

Brain Volumes ◽

Total Brain

Objective:To examine associations between ischemic stroke, vascular risk factors, and MRI markers of brain aging.Methods:Eighty-one patients (mean age 67.5 ± 13.1 years, 31 left-sided, 61 men) with confirmed first-ever (n = 66) or recurrent (n = 15) ischemic stroke underwent 3T MRI scanning within 6 weeks of symptom onset (mean 26 ± 9 days). Age-matched controls (n = 40) completed identical testing. Multivariate regression analyses examined associations between group membership and MRI markers of brain aging (cortical thickness, total brain volume, white matter hyperintensity [WMH] volume, hippocampal volume), normalized against intracranial volume, and the effects of vascular risk factors on these relationships.Results:First-ever stroke was associated with smaller hippocampal volume (p = 0.025) and greater WMH volume (p = 0.004) relative to controls. Recurrent stroke was in turn associated with smaller hippocampal volume relative to both first-ever stroke (p = 0.017) and controls (p = 0.001). These associations remained significant after adjustment for age, sex, education, and, in stroke patients, infarct volume. Total brain volume was not significantly smaller in first-ever stroke patients than in controls (p = 0.056), but the association became significant after further adjustment for atrial fibrillation (p = 0.036). Cortical thickness and brain volumes did not differ as a function of stroke type, infarct volume, or etiology.Conclusions:Brain structure is likely to be compromised before ischemic stroke by vascular risk factors. Smaller hippocampal and total brain volumes and increased WMH load represent proxies for underlying vascular brain injury.

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Frequency of diabetes, complications and vascular risk factors in male and female population of Al-Jouf, KSA

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.2.1.4 ◽

2018 ◽

pp. 27-32

Author(s):

Muhammad Siddiqui ◽

Aziz Siddiqui ◽

Faiz Rwelly ◽

Adam Clay

Keyword(s):

Risk Factors ◽

Diabetes Complications ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Female Population ◽

Male And Female

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The Spectrum of Cerebrovascular Disease and Associated Cognitive Decline

The Oxford Handbook of Adult Cognitive Disorders ◽

10.1093/oxfordhb/9780190664121.013.27 ◽

2019 ◽

pp. 574-599

Author(s):

Victoria J. Williams ◽

Steven E. Arnold ◽

David H. Salat

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Cerebrovascular Disease ◽

Cognitive Decline ◽

Vascular Dementia ◽

Structure And Function ◽

Vascular Risk Factors ◽

Vascular Health ◽

Vascular Risk ◽

And Function

Throughout the lifespan, common variations in systemic health and illness contribute to alterations in vasculature structure and function throughout the body, significantly increasing risk for cardiovascular and cerebrovascular disease (CVD). CVD is a prevalent cause of mortality in late life; it also promotes brain alterations, contributing to cognitive decline and, when severe, vascular dementia. Even prior to diseased states, individual variation in CVD risk is associated with structural and functional brain alterations. Yet, how cumulative asymptomatic alterations in vessel structure and function contribute to more subtle changes in brain tissue integrity and function that emerge in late life is unclear. Finally, vascular risk factors are associated with the clinical progression of neurodegenerative diseases such as Alzheimer’s disease (AD); however, recent theory posits that vascular degeneration may serve a contributory role in these conditions. This chapter reviews how lifespan changes in vascular health contribute to degenerative changes in neural tissue and the subsequent development of cognitive impairment and/or vascular dementia. It first discusses associations between vascular risk factors and cognition and also how declining vascular health may lead to cognitive impairment and dementia. Next, it identifies basic aspects of cerebrovascular anatomy and physiology sustaining tissue health and discusses how vulnerabilities of this system contribute to neurodegenerative changes. Finally, it reviews evidence of vascular contributions to AD and presents ideas for future research to better understand the full spectrum of cerebrovascular contributions to brain aging, cognitive decline, and dementia.

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The impact of vascular risk factors on the thickness and volume of the choroid in AMD patients

Scientific Reports ◽

10.1038/s41598-021-94676-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Elżbieta Krytkowska ◽

Aleksandra Grabowicz ◽

Katarzyna Mozolewska-Piotrowska ◽

Zofia Ulańczyk ◽

Krzysztof Safranow ◽

...

Keyword(s):

Risk Factors ◽

Vascular Risk Factors ◽

Age Related Macular Degeneration ◽

Control Group ◽

Vascular Risk ◽

Average Volume ◽

Central Ring ◽

Age Related ◽

The Impact ◽

Wet Amd

AbstractDisturbances in choroidal microcirculation may lead to the onset and progression of age-related macular degeneration (AMD). We aimed to assess changes in the choroidal volume and thickness in the macular region in AMD eyes and to investigate whether coexisting vascular risk factors alter choroidal status. We enrolled 354 AMD patients (175 dry, 179 wet AMD) and 121 healthy controls. All participants underwent a complete ophthalmologic examination and assessment of choroidal thickness and volume. A multivariate analysis adjusted for age, sex, and smoking status revealed that wet AMD was an independent factor associated with higher average thickness of the central ring area (ATC) and average volume of the central ring area (AVC) and lower choroidal vascularity index (CVI) compared to controls (β = + 0.18, p = 0.0007, β = + 0.18, p = 0.0008, respectively) and to dry AMD (β = + 0.17, p = 0.00003 for both ATC and AVC and β = − 0.30 p < 0.0001 for CVI). ATC, AVC and average volume (AV) were lower in AMD patients with hypertension and ischaemic heart disease (IHD). The duration of hypertension was inversely correlated with ATC, AVC and AV (Rs = − 0.13, p < 0.05; Rs = − 0.12; p < 0.05, Rs = − 0.12; p < 0.05, respectively) while IHD duration negatively correlated with AV (Rs = − 0.15, p < 0.05). No such associations were observed in the control group. Our findings show that the choroidal vascular system in eyes with AMD is much more susceptible to damage in the presence than in the absence of systemic vascular disease.

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