Progression of Large Vessel Disease in Patients With Giant Cell Arteritis–Associated Ischemic Stroke

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Daniel Guisado-Alonso ◽  
M. Carmen Edo ◽  
Paula Valentina Estrada Alarcón ◽  
Sonia María García-Sánchez ◽  
Maria Àngels Font ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Large Vessel ◽  
Vessel Disease ◽  
Large Vessel Disease

scholarly journals High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 251 ◽  
Author(s):  
Adam Wiśniewski ◽  
Joanna Sikora ◽  
Agata Sławińska ◽  
Karolina Filipska ◽  
Aleksandra Karczmarska-Wódzka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Platelet Reactivity ◽  
Volume Measurement ◽  
Large Vessel ◽  
Vessel Disease ◽  
Fluid Attenuated Inversion Recovery ◽  
The Brain ◽  
Large Vessel Disease

Background: Excessive platelet activation and aggregation plays an important role in the pathogenesis of ischemic stroke. Correlation between platelet reactivity and ischemic lesions in the brain shows contradictory results and there are not enough data about the potential role of stroke etiology and its relationships with chronic lesions. The aim of this study is to assess the relationship between platelet reactivity and the extent of ischemic lesions with the particular role of etiopathogenesis. Methods: The study involved 69 patients with ischemic stroke, including 20 patients with large-vessel disease and 49 patients with small-vessel disease. Evaluation of platelet reactivity was performed within 24 h after the onset of stroke using two aggregometric methods (impedance and optical), while ischemic volume measurement in the brain was performed using magnetic resonance imaging (in diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences) at day 2–5 after the onset of stroke. Results: In the large-vessel disease subgroup, a correlation was found between platelet reactivity and acute ischemic focus volume (correlation coefficient (R) = 0.6858 and p = 0.0068 for DWI; R = 0.6064 and p = 0.0215 for FLAIR). Aspirin-resistant subjects were significantly more likely to have a large ischemic focus (Odds Ratio (OR) = 45.00, 95% Confidence Interval (CI) = 1.49–135.36, p = 0.0285 for DWI; OR = 28.00, 95% CI = 1.35–58.59, p = 0.0312 for FLAIR) than aspirin-sensitive subjects with large-vessel disease. Conclusion: In patients with ischemic stroke due to large-vessel disease, high on-treatment platelet reactivity affects the extent of acute and chronic ischemic lesions.

scholarly journals The Apolipoprotein E and β-Fibrinogen G/A-455 Gene Polymorphisms Are Associated With Ischemic Stroke Involving Large-Vessel Disease

1997 ◽  
Vol 17 (11) ◽  
pp. 2880-2884 ◽  
Author(s):  
Christof Kessler ◽  
Carsten Spitzer ◽  
Dorothea Stauske ◽  
Sabine Mende ◽  
Jörg Stadlmüller ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Apolipoprotein E ◽  
Gene Polymorphisms ◽  
Large Vessel ◽  
Vessel Disease ◽  
Large Vessel Disease

Abstract W P54: Cardioembolic Strokes Have an Improved Clinical Outcome Following Intravenous Thrombolysis in Comparison With Strokes Caused by Large Vessel Disease

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marie Louise Schmitz ◽  
Claus Z. Simonsen ◽  
Irene K. Mikkelsen ◽  
Marie Louise Svendsen ◽  
Heidi Larsson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
Large Vessel ◽  
Stroke Subtype ◽  
Neurological Improvement ◽  
Vessel Disease ◽  
Ischemic Stroke Subtype ◽  
Large Vessel Disease ◽  
Iv Tpa

Introduction: Ischemic stroke prognosis given standard therapy differs according to the underlying pathophysiology. In contrast, the impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is less clear. Objectives: We examined the association between ischemic stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-selected patients treated with IV-tPA. Methods: We included consecutive MRI-evaluated patients treated with IV-tPA in a Danish stroke center between 2004 and 2010. Patients with DWI lesions >1/3 of the middle cerebral artery territory were excluded from treatment. The TOAST criteria were used to classify patients into a stroke subtype based on the results of the complete diagnostic work-up available at three months. A favorable 90-day outcome was defined as a modified Rankin Scale score of 0 to 1. Early neurological improvement was defined as complete remission of the neurologic deficit or an improvement of ≥4 on the NIHSS at 24 hours. Multivariable logistic regression analyses were used to compare outcomes among stroke subtypes adjusted for clinical and imaging characteristics. Results: A total of 557 patients were analyzed: 202 (36%) had large vessel disease, 153 (27%) had cardioembolic stroke, 109 (20%) had small vessel disease and 93 (17%) were of other or undetermined etiology. A favorable outcome was achieved by 361 (64.8%) patients. Patients with cardioembolic strokes were more likely to achieve a favorable outcome as opposed to large vessel disease patients (adjusted OR, 2.9 (95% confidence interval, 1.1-7.4)). Similarly, the probability of an early neurological improvement was increased in cardioembolic stroke patients in comparison with large vessel disease patients (adjusted OR, 3.5 (95% confidence interval, 1.6-7.6)). Conclusions: The ischemic stroke subtype influenced early as well as late clinical outcome after treatment with IV-tPA in MRI-selected patients. Our findings argue for a potentially more successful IV-tPA-induced recanalization in strokes of cardioembolic origin in comparison with large vessel disease strokes.

scholarly journals Association between Oxidative Stress and Outcome in Different Subtypes of Acute Ischemic Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Nai-Wen Tsai ◽  
Ya-Ting Chang ◽  
Chi-Ren Huang ◽  
Yu-Jun Lin ◽  
Wei-Che Lin ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Large Vessel ◽  
Small Vessel ◽  
Tbars Level ◽  
Vessel Disease ◽  
Free Thiol ◽  
Large Vessel Disease

Objectives. This study investigated serum thiobarbituric acid-reactive substances (TBARS) and free thiol levels in different subtypes of acute ischemic stroke (AIS) and evaluated their association with clinical outcomes.Methods. This prospective study evaluated 100 AIS patients, including 75 with small-vessel and 25 with large-vessel diseases. Serum oxidative stress (TBARS) and antioxidant (thiol) were determined within 48 hours and days 7 and 30 after stroke. For comparison, 80 age- and sex-matched participants were evaluated as controls.Results. Serum TBARS was significantly higher and free thiol was lower in stroke patients than in the controls on days 1 and 7 after AIS. The level of free thiol was significantly lower in the large-vessel disease than in the small-vessel disease on day 7 after stroke. Using the stepwise logistic regression model for potential variables, only stroke subtype, NIHSS score, and serum TBARS level were independently associated with three-month outcome. Higher TBARS and lower thiol levels in the acute phase of stroke were associated with poor outcome.Conclusions. Patients with large-vessel disease have higher oxidative stress but lower antioxidant defense compared to those with small-vessel disease after AIS. Serum TBARS level at the acute phase of stroke is a potential predictor for three-month outcome.

Abstract T MP58: Incidence and Etiology of Punctate Infarcts in Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamary Oliveira-Filho ◽  
Hakan Ay ◽  
Ashkan Shoamanesh ◽  
Kwang Y Park ◽  
Ross Avery ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Large Vessel ◽  
Vascular Territory ◽  
Lower Systolic Blood Pressure ◽  
Vessel Disease ◽  
High Incidence ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Large Vessel Disease

Background/Objective: Punctate infarcts (PI) are increasingly seen on DWI of patients with intracerebral hemorrhage (ICH) due to small vessel disease (SVD). We aimed to determine their incidence and potential causes in a large ischemic stroke (IS) cohort that had thorough etiologic workup. Methods: Consecutive patients with MRI-confirmed IS within 72 hours of onset were enrolled. Subjects had either a single high-risk embolic source (cardioembolic or large vessel disease) or no embolic source. PIs were classified by their relationship to the primary infarct as within or outside the same vascular territory. White matter disease burden (WMDB) and microbleed counts were obtained to be used as markers of severity of SVD. Multivariable regression models were constructed to assess the association between PIs and potential etiologies (embolism vs SVD). Results: We analyzed 946 IS patients, mean age 69 +/- 15 years, 46% female. We detected PI (≤5mm) in 269 (28%) subjects, 190 (71%) within the vascular territory of the primary infarct. Large-vessel atherosclerosis (p<0.001), cardioembolic source (p<0.001), higher WMDB (p=0.032) and lower systolic blood pressure (SBP, p=0.024) were independently associated with the presence of PI. While lower SBP was associated with PI in any location (p<0.05), WMDB was only associated with PI outside the vascular territory of the primary infarct (p=0.033); and large vessel atherosclerosis was only associated with PI within the vascular territory of the primary infarct (p=0.004). Conclusions: PIs occurring within the vascular territory of a larger infarct are more likely to have a proximal embolic source, but those occurring outside are more likely related to SVD. Their relatively high incidence and diverse etiologic associations in a cohort of IS patients emphasize the importance of research into their mechanisms.

scholarly journals Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

2020 ◽  
Vol 5 (3) ◽  
pp. 252-261
Author(s):  
Jan H Schaefer ◽  
Christoph Stephan ◽  
Christian Foerch ◽  
Waltraud Pfeilschifter
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Onset ◽  
Large Vessel ◽  
Control Group ◽  
Vessel Disease ◽  
Immunodeficiency Virus ◽  
Large Vessel Disease

Introduction The global incidence of ischemic stroke among patients with human immunodeficiency virus is increasing. The aim of this controlled case analysis was to study patient characteristics, stroke etiologies, and risk factors in human immunodeficiency virus-positive patients in a medical system with easy access to antiretroviral therapies. Patients and methods We conducted a retrospective, observational study of human immunodeficiency virus-positive patients treated in our stroke unit and outpatient clinic in Germany between 2012 and 2018. A control group of all patients treated for acute ischemic stroke in 2018 was used to elicit possible differences in stroke localization, etiology, and distribution of risk factors. Results Out of 3615 patients with an acute ischemic stroke, 24 (0.7%) were newly or previously diagnosed as human immunodeficiency virus-positive. Strokes in this cohort were caused by large-vessel disease (37.5%), small-vessel disease (20.8%), cryptogenic-embolism (20.8%), vasculitis (16.7%), and cardio-embolism (4.2%). Large-vessel disease-related strokes were more often located in the posterior circulation (77.8%). Compared to the control group, cardio-embolic strokes were less and vasculitis and large-vessel disease more frequent. Human immunodeficiency virus-positive patients were younger at stroke onset (53.7 ± 12.8 vs. 70.2 ± 14.6 years, p = 0.05). Discussion Although the prevalence of human immunodeficiency virus-infection among patients treated for acute ischemic strokes appears low, this collective merits special attention due to a high burden of potentially modifiable risk factors and vasculitis. Conclusion Compared to previous studies, age at stroke onset was one of the highest, supporting the hypothesis that as antiretroviral therapy increases the life expectancy of people living with HIV/AIDS, they will be increasingly affected by cardiovascular disease. Human immunodeficiency virus-related cerebral vasculitis was associated with high mortality (75%).

scholarly journals Thrombolysis in acute ischemic stroke: Experience from a tertiary care centre in India

2014 ◽  
Vol 5 (01) ◽  
pp. 25-30 ◽  
Author(s):  
Vikram Huded ◽  
Romnesh De Souza ◽  
Rajesh Karalumangala Nagarajaiah ◽  
Syed Moeed Zafer ◽  
Rithesh Nair ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Vessel Disease ◽  
Significant Difference ◽  
Large Vessel Disease

ABSTRACTThe management of acute ischemic stroke has undergone a sea of change with the introduction of intravenous thrombolysis (IVT). Current guidelines state that the window period for IVT using rTPA is 4.5 hours. The MERCI, Multi Merci, and Penumbra trials in which patients with acute ischemic stroke were treated using endovascular treatment demonstrated better recanalisation in patients having a large vessel occlusion. However, recently published data from the three large trials IMS 3, Synthesis Expansion, and MR rescue, which compared endovascular treatment with intravenous therapy, failed to demonstrate superiority of endovascular treatment over IVT. In these trials, stent retrievers were used in very few patients. We present our results from a tertiary care center in India where patients are treated using intravenous as well as endovascular modalities. Among the 53 patients with acute ischemic stroke treated between 2010 and 2012, 23 were treated with IVT and 30 with endovascular methods. Stent retriever was used in majority of the endovascular cases. Aims: To compare the outcomes of acute ischemic stroke patients treated with IVT versus those who were managed using endovascular therapy. To evaluate outcomes of patients with acute ischemic stroke with a large vessel occlusion in whom endovascular modalities were used and to compare them with those of patients who were treated with IVT in presence of a large vessel occlusion. Settings and Design: Data of patients who underwent thrombolysis at our centre was collected over a 3-year period, that is, from 2010 to 2012. Endovascular treatment was done by an interventional neurologist. Materials and Methods: Data of patients with acute ischemic stroke who underwent IVT or endovascular treatment at our centre between 2010 and 2012 was analyzed. Parameters included age, National Institutes of Health Stroke Scale (NIHSS) on admission, door to needle time, stroke subtype, modality of treatment, outcome based on modified Rankin Scale (mRS) Score at 90 days follow up and mortality rates at 90 days. Statistical Analysis: Tabulated results were analysed using INSTAT Graphpad analyser. Data were analysed using paired and unpaired t-test, Chi-square test, and Fishers test as applicable. P value was considered significant when it was <0.05. Results: Upon comparison of the outcomes of patients with acute ischemic stroke and large vessel disease treated with endovascular therapy with those treated with IVT, it was found that the former group had better outcomes. We also found that in spite of there being a significant difference in the NIHSS on admission and a significant difference in the door to needle time, the outcomes of patients treated using intravenous or endovascular therapy were similar. There was no statistically significant difference in mortality rates between intravenous and endovascular groups. Conclusions: IVT is currently the standard of care in the management of acute ischemic stroke. Endovascular treatment during the window period is reserved for those patients with contraindication to IVT. In this study, we found that patients with documented large vessel disease with no evidence of cross flow through Willisian collaterals benefit from endovascular treatment. We recommend that all patients of acute ischemic stroke, be subjected to a baseline angiogram either computed tomography (CT) or magnetic resonance imaging (MRI) to document vessel status. This will help in identifying patients who may benefit from early endovascular treatment, if they fail to improve with IVT. Further, large trials using stent retrievers are needed, to prove that endovascular treatment is superior to IVT, in presence of documented large vessel disease.

Sign in / Sign up

Export Citation Format

Share Document