The Essen Stroke Risk Score in One-Year Follow-Up Acute Ischemic Stroke Patients

Abstract Background The treatment of acute ischemic stroke is heavily time-dependent, and even though, with the most efficient treatment, the long-term functional outcome is still highly variable. In this current study, the authors selected acute ischemic stroke patients who were qualified for intravenous thrombolysis with recombinant tissue plasminogen activator and followed by intra-arterial thrombectomy. With primary outcome defined by the functional level in a one-year follow-up, we hypothesize that patients with older age are at a disadvantage in post-stroke recovery. However, an age-threshold should be determined to help clinicians in selection of patients to undergo such therapy. Methods This is a retrospective chart review study that include 92 stroke patients in Changhua Christian hospital with a total of 68 evaluation indexes recorded. The current study utilized the forward stepwise regression model whose Adj-R2 and p-value in search of important variables for outcome prediction. The chngpt package in R indicated the threshold point of the age factor directing the better future functionality of the stroke patients. Results Datasets revealed the threshold of the age set at 79 the most appropriate. Admission Barthel Index, Age, Ipsi ICA RI, Ipsi VA PI, Contra MCA stenosis, Contra ECA RI, and in-hospital pneumonia are the significant predicting variables. The higher the age, in-hospital pneumonia, Contra MCA stenosis, Ipsi ICA RI and Ipsi VA PI, the less likely patient to recover from functional deficits as the result of acute ischemic stroke; the higher the value of Contra ECA RI and Admission Barthel Index, the better chance to recover at one-year follow up. Conclusions Parameters of pre-intervention datasets could provide important information to aid first-line clinicians in decision making. Especially, in patients whose age is above seventy-nine receives diminish return in the benefit to undergo such intervention and should be considered seriously by both the patients and the physicians.

Download Full-text

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽

10.1161/str.45.suppl_1.176 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tae-Jin Song ◽

Jinkwon Kim ◽

Dongbeom Song ◽

Yong-Jae Kim ◽

Hyo Suk Nam ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Independent Predictor ◽

Stroke Patients ◽

Risk Of Death ◽

Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Download Full-text

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽

10.1161/circ.131.suppl_1.mp86 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Tan Xu ◽

Yonghong Zhang ◽

Yingxian Sun ◽

Chung-Shiuan Chen ◽

Jing Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

Hospital Discharge ◽

Odds Ratio ◽

Recurrent Stroke ◽

Stroke Patients ◽

Antihypertensive Medications ◽

History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Download Full-text

Abstract TP160: Predicting Bone Fracture After Stroke—The Fracture Risk After Ischemic Stroke (FRAC-Stroke) Score

Stroke ◽

10.1161/str.48.suppl_1.tp160 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Eric E Smith ◽

Jiming Fang ◽

Shabbir M Alibhai ◽

Peter M Cram ◽

Angela M Cheung ◽

...

Keyword(s):

Ischemic Stroke ◽

Fracture Risk ◽

Risk Score ◽

Cumulative Incidence ◽

Population Based ◽

World Health ◽

Stroke Severity ◽

Stroke Patients ◽

One Year ◽

Low Trauma Fracture

Background: Risk for low trauma fracture is increased by >30% after ischemic stroke. Additionally, in the IRIS trial pioglitazone therapy prevented ischemic stroke but increased fracture risk. We derived a risk score to predict risk of fracture one year after ischemic stroke. Methods: The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20,435 ischemic stroke patients from the Ontario Stroke Registry discharged from 2003-2012, using Fine-Gray competing risk regression. Candidate variables were medical conditions included in the validated World Health Organization FRAX risk score complemented by variables related to stroke severity. Registry patients were linked to population-based Ontario health administrative data to identify low trauma fractures (defined as any fracture of the femur, forearm, humerus, pelvis or vertebrae, excluding fractures resulting from trauma, motor vehicle accidents, falls from a height or in people with active cancer). The score was externally validated in 13,698 other ischemic stroke patients in the population-based Ontario stroke audit (2002-2012). Results: Mean age was 72; 42% were women. Low trauma fracture occurred within 1 year of discharge in 741/20435 (3.6%); cumulative incidence increased linearly throughout follow-up. Age, discharge modified Rankin score (mRS), and history of arthritis, osteoporosis, falls and previous fracture contributed significantly to the model. Model discrimination was good (c statistic 0.72). Including discharge mRS significantly improved discrimination (relative integrated discrimination index 8.7%). Fracture risk was highest in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile the cumulative incidence of 1-year low trauma fracture increased from 1% to 9%. Predicted and observed rates of fracture were similar in the external validation cohort. Conclusion: The FRAC-Stroke score allows the clinician to identify ischemic stroke patients at higher risk of low trauma fracture within one year. This information might be used to target patients for early bone densitometry screening to diagnose and manage osteoporosis, and to estimate baseline risk prior to starting pioglitazone therapy.

Download Full-text

Clinical analysis of first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries

Open Medicine ◽

10.2478/s11536-007-0001-y ◽

2007 ◽

Vol 2 (1) ◽

pp. 37-46 ◽

Cited By ~ 1

Author(s):

Peterus Thajeb ◽

Teguh Thajeb ◽

Dao-Fu Dai

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Age Of Onset ◽

Clinical Analysis ◽

Clinical Triad ◽

One Year ◽

Associated Risk Factors ◽

A Prospective Study ◽

Bilateral Lesions

AbstractTo determine one-year clinical outcome of patients with first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries (PMAS), we conducted a prospective study evaluating the cognitive functions of 28 patients with PMAS. Neuropsychological tests were performed during the first month of stroke onset and at the 12th month of follow-up. There were 12 women and 16 men. Mean age of onset for women and men was 70 years and 65 years, respectively. Progressing strokes occurred in 62% of patients and 96% developed a full-blown picture of the clinical triad of akinetic mutism, hypersomnolence, and bilateral blepharoptosis and ophthalmoparesis. Involuntary movements occurred in 6, and focal myoclonus in 4 patients. The top four associated risk factors were hypertension (68%), hyperlipidemia (57%), diabetes mellitus (46%), and atrial fibrillation (36%). Unilateral midbrain infarctions occurred in 12 patients and bilateral lesions in 16. Thalamic infarctions were unilateral in 10 and bilateral in 13 cases. Three of the 28 (11%) patients died of recurrent cerebral infarctions within 1 year of the onset of PMAS. The recurrent infarctions involved the basilar artery territory in two cases and the carotid system in another. One patient died of acute myocardial infarction. Of the 24 patients who had survived the stroke by 1 year, 20 (71%) developed dementia. We conclude that first-ever ischemic stroke with PMAS is not a benign syndrome. Most patients developed dementia by 1 year after the stroke.

Download Full-text

A modified Essen Stroke Risk Score for predicting recurrent ischemic stroke at one year

Neurological Research ◽

10.1080/01616412.2018.1428389 ◽

2018 ◽

Vol 40 (3) ◽

pp. 204-210 ◽

Cited By ~ 4

Author(s):

Xia Ling ◽

Shuang-Mei Yan ◽

Bo Shen ◽

Xu Yang

Keyword(s):

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk ◽

One Year

Download Full-text

Treatment Efficacy Analysis in Acute Ischemic Stroke Patients Using In Silico Modeling Based on Machine Learning: A Proof-of-Principle

Biomedicines ◽

10.3390/biomedicines9101357 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1357

Author(s):

Anthony Winder ◽

Matthias Wilms ◽

Jens Fiehler ◽

Nils D. Forkert

Keyword(s):

Machine Learning ◽

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

In Silico ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

New Devices

Interventional neuroradiology is characterized by engineering- and experience-driven device development with design improvements every few months. However, clinical validation of these new devices requires lengthy and expensive randomized controlled trials. This contribution proposes a machine learning-based in silico study design to evaluate new devices more quickly with a small sample size. Acute diffusion- and perfusion-weighted MRI, segmented one-week follow-up imaging, and clinical variables were available for 90 acute ischemic stroke patients. Three treatment option-specific random forest models were trained to predict the one-week follow-up lesion segmentation for (1) patients successfully recanalized using intra-arterial mechanical thrombectomy, (2) patients successfully recanalized using intravenous thrombolysis, and (3) non-recanalizing patients as an analogue for conservative treatment for each patient in the sample, independent of the true group membership. A repeated-measures analysis of the three predicted follow-up lesions for each patient revealed significantly larger lesions for the non-recanalizing group compared to the successful intravenous thrombolysis treatment group, which in turn showed significantly larger lesions compared to the successful mechanical thrombectomy treatment group (p < 0.001). A groupwise comparison of the true follow-up lesions for the three treatment options showed the same trend but did not reach statistical significance (p = 0.19). We conclude that the proposed machine learning-based in silico trial design leads to clinically feasible results and can support new efficacy studies by providing additional power and potential early intermediate results.

Download Full-text

Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0282 ◽

2018 ◽

Vol 56 (2) ◽

pp. 350-355 ◽

Cited By ~ 9

Author(s):

Tian Xu ◽

Peng Zuo ◽

Yuqin Wang ◽

Zhiwei Gao ◽

Kaifu Ke

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Logistic Model ◽

Critical Role ◽

Stroke Onset ◽

Stroke Patients ◽

Multivariable Logistic Regression Model ◽

Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

Download Full-text

Abstract WMP15: A Simple Tool to Predict Target Mismatch in Ischemic Stroke Patients with Anterior Circulation Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wmp15 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adam de Havenon ◽

Steve O’Donnell ◽

Alex Linn ◽

Scott McNally ◽

Bailey Dunleavy ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Perfusion Imaging ◽

Time Window ◽

Ct Perfusion ◽

Volumetric Analysis ◽

Stroke Patients ◽

Anterior Circulation ◽

Ct Angiogram

Introduction: The efficacy of endovascular thrombectomy in an extended time window for acute ischemic stroke patients with Target Mismatch (TM) on perfusion imaging was shown in a recent study and the ongoing DEFUSE-3 trial is studying thrombectomy in a 6-16 hour window for TM patients. A limitation of TM is that perfusion imaging is not widely available. We sought to identify a tool to predict TM based on clinical factors and CT angiogram (CTA) imaging, which is available at most hospitals. Methods: We reviewed acute ischemic stroke patients from 2010-2014 with proximal middle cerebral artery occlusion, CTA and CT perfusion (CTP) at hospital admission. TM was identified on CTP using the Olea Sphere volumetric analysis software with Bayesian deconvolution. TM was defined by the DEFUSE-3 criteria. ASPECTS was derived from the non-contrast CT head and the CTA source images (CTA-ASPECTS). Two collateral scores were derived from CTA source images. Results: 61 patients met inclusion criteria. The mean±SD age was 61±18 years and 61% were male. Mean NIH Stroke Scale (NIHSS) was 14.1±8.0 and median (IQR) follow-up modified Rankin Scale was 3 (1,6). TM was present in 35/61 (57%), who had lower mRS at follow-up (z=3.5, p<0.001). The predictor variables are shown in Table 1. The best combination of predictors was CTA-ASPECTS >4 and NIHSS <16, which had a sensitivity of 80% and specificity of 85% for TM (Figure 1). Discussion: We report a reliable, accessible, and clinically useful tool for predicting TM. This score warrants further study as a tool to guide transfer decisions from primary or secondary stroke centers to tertiary centers where endovascular intervention would be possible for selected patients.

Download Full-text

Abstract WP307: Social Factors That influence Follow-up in Stroke Clinic

Stroke ◽

10.1161/str.47.suppl_1.wp307 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nicholas Osteraas ◽

Sarah Song ◽

Bichun Ouyang ◽

Vivien Lee ◽

Laurel Cherian ◽

...

Keyword(s):

Ischemic Stroke ◽

Marital Status ◽

Acute Ischemic Stroke ◽

Living Arrangement ◽

Academic Medical Center ◽

Univariate Analysis ◽

Stroke Patients ◽

Insurance Type ◽

Race Ethnicity

Background and Objective: Follow-up in outpatient stroke clinic after hospitalization for ischemic stroke is an integral aspect of the management of stroke patients. This study sought to investigate predictors of risk of not following up in outpatient stroke clinic. Methods: We reviewed consecutive acute ischemic stroke patients admitted to an urban academic medical center from 4/2013 to 4/2014. On discharge, all stroke patients except those going to long term acute care received notice of scheduled follow-up stroke clinic appointment date; they also received a phone call 2-3 days prior to the appointment. Univariate analysis examined the relationship between race, ethnicity, marital status, insurance type, and living arrangement with stroke clinic follow up status. Multivariate analysis was performed with logistic regression controlling for significant factors found in our previous study including discharge location, previously documented diagnosis of depression and outpatient physicians at same institution. Results: Among 355 acute ischemic stroke patients, 49% were female and mean age was 65 years. The follow-up rate in stroke clinic was 53%. In univariate analysis, race, ethnicity, marital status, employment status, and insurance type (i.e. self-pay) were not significantly associated with compliance with stroke clinic follow-up. In logistical regression, patients who lived alone were significantly less likely to follow up in stroke clinic compared with those living with family (OR=2.18, 95% CIs=[1.18, 4.03], p=0.01) as were patients who were depressed, (OR=5.99, CIs =[1.47, 24.4], p=0.01) who did not have other doctors at the same institution, (OR=2.23 CIs = [1.31, 3.70] p=0.003] and who were discharged to a facility other than home or acute rehab (OR=4.38, CIs [1.74, 11.03], p=0.003). Conclusions: Institutions taking care of patients with ischemic strokes should be aware that certain patients may be less likely to follow up in clinic and merit additional efforts in order to ensure that they are not lost to follow up.

Download Full-text