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

2010 ◽  
Vol 30 (5) ◽  
pp. 433-439 ◽  
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

Comparison Study of ASCO and TOAST Classification System in Chinese Minor Stroke Patients

2019 ◽  
Vol 47 (1-2) ◽  
pp. 95-100 ◽  
Author(s):  
Xiao-Yu Xin ◽  
Lin Cheng ◽  
Zhao Yang ◽  
Yu Zhang ◽  
Li-Li Zeng ◽  
...  
Keyword(s):  
Classification System ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Minor Stroke ◽  
Large Artery ◽  
Stroke Patients ◽  
Vessel Disease ◽  
Small Artery Occlusion ◽  
Toast Classification ◽  
The Impact

Background: Precise subtype classification based on underlying pathophysiology is important to prevent recurrent attack in minor stroke patients. A newly developed Atherosclerosis, Small vessel disease, Cardiac source, Others (ASCO) phenotypic classification system aims to characterize patients using different grades of evidence for stroke subtypes. However, this system has not been specifically applied to minor stroke population. In our study, the impact of using the newer ASCO criteria on minor stroke etiologies was investigated, and compared with that of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Methods: Consecutive patients with minor ischemic stroke (NIHSS ≤3) were assessed and subtyped by the ASCO and TOAST systems. Stroke etiologies were presented and compared. The McNemar test and k statistic were used to analyze the difference and concordance between the 2 algorithms, respectively. Results: A total of 604 first-ever minor stroke patients were analyzed in the present study. Using TOAST classification, large artery atherosclerosis was the most frequent subtype (281, 46.5%), followed by small artery occlusion category (165, 27.3%). When ASCO was applied, 37 different profiles of stroke etiologies were identified. Using grade 1 of evidence, atherosclerosis (A1) was the most frequent subtype (308, 51.0%), followed by small vessel disease (S1, 178, 29.5%). Under consideration of grades 1 and 2, 239 (39.6%) patients were classified into more than 1 category. The ASCO system revealed determined etiologies in 104 of the 137 patients classified to cause undetermined subtype by TOAST classification. Good to very good accordance was observed between ASCO grade 1 and TOAST schemes across etiologic subtypes (κ = 0.719–0.832) except cause undetermined category (κ = 0.470). Conclusion: Application of ASCO decreased the proportion of patients assigned to cause undermined category compared to TOAST system. Comprehensive characteristics of ASCO system might be helpful in the personalized therapy or secondary prevention for individual patients in the future.

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.

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