Therapeutic Challenges in Patients With Noncardioembolic Acute Ischemic Stroke in Need of Double Antiplatelet Therapy for Coronary Artery Disease

Acute ischemic stroke and coronary artery disease are the major causes of death in Palestine and in the world. The prevalence of coronary artery disease has been reported in one fifth of stroke patients. Although high incidence rate of acute myocardial infarction after recent ischemic stroke and the high risk of acute ischemic stroke after recent myocardial infarction has been reported in several clinical or observational studies. So that acute or recent problem in the heart or brain that could result in an acute infarction of the other. In this review we describe the definition and new classification of the cardio-cerebral infarction syndrome with 3 subtypes that reflect the definition, pathophysiology and treatment options.

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Stroke of antiplatelet and anticoagulant therapy in patients with coronary artery disease: a meta-analysis of randomized controlled trials

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02384-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiao Yu Shao ◽

Zhi Jian Wang ◽

Xiao Teng Ma ◽

Xu Ze Lin ◽

Liu Pan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Randomized Controlled Trials ◽

Antiplatelet Therapy ◽

Hemorrhagic Stroke ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Artery Disease

Abstract Background We performed a meta-analysis sought to investigate the risk of stroke with antiplatelet and anticoagulant therapies among patients with coronary artery disease (CAD). Methods We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials from January 1995 to March 2020. Studies were retrieved if they reported data of stroke for patients with CAD and were randomized to receive intensive versus conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC). Analyses were pooled by random-effects modeling. A total of 42 studies with 301,547subjects were enrolled in this analysis. Results Intensive antithrombotic therapy significantly reduced risk of all stroke (RR 0.86, 95% CI 0.80–0.94) and ischemic stroke (RR 0.80, 95% CI 0.71–0.91), but increased risk of hemorrhagic stroke (RR 1.36, 95% CI 1.00–1.86) and intracranial hemorrhage (RR 1.46, 95% CI 1.17–1.81). Subgroup analyses indicated that OAC yields more benefit to all stroke than antiplatelet therapy (OAC: RR 0.73, 95% CI 0.58–0.92; Antiplatelet: RR 0.90, 95% CI 0.83–0.97; Between-group heterogeneity P value = 0.030). The benefit of antiplatelet therapy on all stroke and ischemic stroke were mainly driven by the studies comparing longer versus shorter duration of dual antiplatelet therapy (All stroke: RR 0.86, 95% CI 0.78–0.95; ischemic stroke: RR 0.84, 95% CI 0.75–0.94). Conclusions Among CAD patients who have already received antiplatelet therapy, either strengthening antiplatelet or anticoagulant treatments significantly reduced all stroke, mainly due to the reduction of ischemic stroke, although it increased the risk of hemorrhagic stroke and intracranial hemorrhage. OAC yields more benefit to all stroke than antiplatelet therapy.

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Abstract WP85: Clinical and Imaging Predictors, and Functional Outcomes, of Fast, Intermediate, and Slow Progression Among Patients With Large Vessel Occlusion Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp85 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Woo-Keun Seo ◽

David S Liebeskind ◽

Bryan Yoo ◽

Latisha Sharma ◽

Reza Jahan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Acute Ischemic Stroke ◽

Major Determinant ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Artery Disease

Background: Speed of infarct progression varies widely in acute ischemic stroke and is a major determinant of outcome. Patient demographic, clinical, and imaging features associated with slow, intermediate, and rapid infarct growth have not been well delineated. Methods: In a prospectively maintained stroke center registry, we analyzed consecutive patients with anterior circulation large vessel occlusion who underwent first multimodal MRI or CT imaging within 24 hours of onset. The speed of initial infarct progression was calculated as ischemic core volume at first imaging divided by the time from stroke onset to imaging. Results: Among the 88 patients, age was mean 71.6 ± 15.0; 51% were women; initial NIHSS was 16.1 ± 6.5), and time from onset to first imaging was median 3.3h (full range 0.6 - 23.0). The speed of infarct progression was median 2.2 cc/hr (interquartile range 0 - 8.7), ranging most widely among patients imaged within the first 6 hours after onset. Faster speed of infarct progression was positively independently associated with low collateral score (OR 3.30, 95%CI 1.25 - 10.49) and arrival by emergency medical services rather than transfer (OR 3.34, 95% CI 1.06 - 10.49) and negatively independently associated with prior ischemic stroke (OR 0.12, 95%CI 0.03 - 0.50) and coronary artery disease (OR 0.32, 95%CI 0.10 - 1.00). Among the 67 patients who underwent endovascular thrombectomy, slower speeds of infarct progression were associated with shift to reduced levels of disability at discharge (OR 3.26, 95% CI 1.02 - 10.45). In addition, slower speed of infarct progression was associated with favorable shift to recanalization by thrombectomy (OR 8.30, 95%CI 0.97 - 70-.87) and reduced radiologic hemorrhagic transformation (OR 0.34, 95% CI 0.12 - 0.94). Conclusion: Slower speed of initial infarct progression is associated with high collateral score, prior ischemic stroke, and coronary artery disease, supporting roles for both collateral robustness and ischemic precondition in fostering tissue resilience to ischemia. Among patients undergoing endovascular thrombectomy, speed of initial infarct progression is a major determinant of clinical outcome.

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Predıctors Coronary Artery Dısease in Patıents With Acute Ischemıc Stroke

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.300 ◽

2018 ◽

Vol 121 (8) ◽

pp. e131

Author(s):

Cigdem Ileri ◽

Burcu Bulut ◽

Zekeriya Dogan ◽

Ipek Midi ◽

Beste Ozben Sadic

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Acute Ischemic Stroke ◽

Artery Disease

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Clinical Relevance of Coronary Artery Disease in Acute Ischemic Stroke

Neurology India ◽

10.4103/0028-3886.325337 ◽

2021 ◽

Vol 69 (4) ◽

pp. 923

Author(s):

Adrià Arboix ◽

MaríaJosé Sánchez-López

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Acute Ischemic Stroke ◽

Clinical Relevance ◽

Artery Disease

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Physical activity, sedentary behavior and risk of coronary artery disease, myocardial infarction and ischemic stroke: a two-sample Mendelian randomization study

Clinical Research in Cardiology ◽

10.1007/s00392-021-01846-7 ◽

2021 ◽

Author(s):

Martin Bahls ◽

Michael F. Leitzmann ◽

André Karch ◽

Alexander Teumer ◽

Marcus Dörr ◽

...

Keyword(s):

Physical Activity ◽

Myocardial Infarction ◽

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Sedentary Behavior ◽

Mendelian Randomization ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Artery Disease

Abstract Aims Observational evidence suggests that physical activity (PA) is inversely and sedentarism positively related with cardiovascular disease risk. We performed a two-sample Mendelian randomization (MR) analysis to examine whether genetically predicted PA and sedentary behavior are related to coronary artery disease, myocardial infarction, and ischemic stroke. Methods and results We used single nucleotide polymorphisms (SNPs) associated with self-reported moderate to vigorous PA (n = 17), accelerometer based PA (n = 7) and accelerometer fraction of accelerations > 425 milli-gravities (n = 7) as well as sedentary behavior (n = 6) in the UK Biobank as instrumental variables in a two sample MR approach to assess whether these exposures are related to coronary artery disease and myocardial infarction in the CARDIoGRAMplusC4D genome-wide association study (GWAS) or ischemic stroke in the MEGASTROKE GWAS. The study population included 42,096 cases of coronary artery disease (99,121 controls), 27,509 cases of myocardial infarction (99,121 controls), and 34,217 cases of ischemic stroke (404,630 controls). We found no associations between genetically predicted self-reported moderate to vigorous PA, accelerometer-based PA or accelerometer fraction of accelerations > 425 milli-gravities as well as sedentary behavior with coronary artery disease, myocardial infarction, and ischemic stroke. Conclusions These results do not support a causal relationship between PA and sedentary behavior with risk of coronary artery disease, myocardial infarction, and ischemic stroke. Hence, previous observational studies may have been biased. Graphic abstract

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