Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

Background: Patients with a recent ischemic stroke have a higher risk of recurrent stroke compared to (ocular) transient ischemic attack (TIA) patients. Plaque microvasculature is considered as a feature of plaque vulnerability and can be quantified with carotid dynamic contrast-enhanced MRI (DCE-MRI). The purpose of this cross-sectional study was to explore the association between plaque microvasculature and the type of recent cerebrovascular events in symptomatic patients with mild-to-moderate carotid stenosis. Methods: A total of 87 symptomatic patients with a recent stroke (n = 35) or (ocular) TIA (n = 52) underwent carotid DCE-MRI examination. Plaque microvasculature was studied in the vessel wall and adventitia using DCE-MRI and the pharmacokinetic modeling parameter Ktrans. Statistical analysis was performed with logistic regression, correcting for associated clinical risk factors. Results: The 75th percentile adventitial (OR 1.97, 95% CI 1.18-3.29) Ktrans was significantly associated with a recent ischemic stroke compared to (ocular) TIA in multivariate analysis, while clinical risk factors were not significantly associated with the type of event. Conclusions: This study indicates a positive association of leaky plaque microvasculature with a recent ischemic stroke compared to (ocular) TIA. Prospective longitudinal studies are needed to investigate whether Ktrans or other plaque characteristics may serve as an imaging marker for predicting (the type of) future cerebrovascular events.

Download Full-text

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620906867 ◽

2020 ◽

Vol 26 ◽

pp. 107602962090686 ◽

Cited By ~ 6

Author(s):

Nicolas Poupore ◽

Dan Strat ◽

Tristan Mackey ◽

Thomas I. Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Transient Ischemic Attack ◽

Lipid Level ◽

Recombinant Tissue Plasminogen Activator ◽

Female Gender ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Ischemic Attack

Background: Specific clinical risk factors linked to transient ischemic attack (TIA) could affect functional ambulatory outcome following thrombolytic therapy in patients having ischemic stroke with a prior TIA (TIA-ischemic stroke). This issue was investigated in this study. Methods: We retrospectively analyzed data from 6379 ischemic stroke patients of which 1387 presented with an antecedent TIA prior to onset of stroke. We used logistic regression model to identify demographic and clinical risk factors that are associated with functional ambulatory outcome in patients with TIA-ischemic stroke treated with thrombolytic therapy. Results: In a population of TIA-ischemic stroke who received recombinant tissue plasminogen activator, patients with a history of stroke (odds ratio [OR] = 3.229, 95% confidence interval [CI] = 1.494-6.98, P = .003) were associated with increasing odds of improvement in functional ambulation, while the female gender (OR = 0.462, 95% CI = 0.223-0.956, P = .037) was associated with reducing odds of improvement. In the non-TIA group, dyslipidemia (OR = 1.351, 95% CI = 1.026-1.781, P = .032) and blood glucose (OR = 1.003, 95% CI = 1.0-1.005, P = .041) were associated with the increasing odds of improvement while older patients (OR = 0.989, 95% CI = 0.98-0.999, P = .029) with heart failure (OR = 0.513, 95% CI = 0.326-0.808, P = .004) and higher lipid level (OR = 0.834, 95% CI = 0.728-0.955, P = .009) were associated with reducing odds of improvement in ambulation. Conclusion: In a population of TIA-ischemic stroke with thrombolytic therapy and a clearly defined TIA without focal ischemic injury, regardless of associated clinical risk factors, a TIA prior to a stroke is not associated with reducing odds of improved ambulatory outcome, except in female patients with TIA-ischemic stroke.

Download Full-text

PCV44 Real-World Assessment of the Use of Anti-platelet Therapy for Recurrent Stroke Prevention in US Patients without Atrial Fibrillation with Recent Ischemic Stroke or Transient Ischemic Attack

Value in Health ◽

10.1016/j.jval.2021.04.383 ◽

2021 ◽

Vol 24 ◽

pp. S75

Author(s):

E. O'Brien ◽

D. Milentijevic ◽

R. Roychowdhury ◽

S. Mitra ◽

Y.W. Chen

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Real World ◽

Transient Ischemic Attack ◽

Stroke Prevention ◽

Recurrent Stroke ◽

Anti Platelet Therapy ◽

Ischemic Attack

Download Full-text

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

International Journal of Stroke ◽

10.1177/1747493017694391 ◽

2017 ◽

Vol 12 (3) ◽

pp. 302-320 ◽

Cited By ~ 24

Author(s):

Yongjun Wang ◽

Ming Liu ◽

Chuanqiang Pu

Keyword(s):

Ischemic Stroke ◽

Secondary Prevention ◽

Transient Ischemic Attack ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Evidence Based ◽

Cerebrovascular Disorder ◽

Level Of Evidence ◽

Vascular Stenosis ◽

Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

Download Full-text

EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

International Journal of Stroke ◽

10.1177/17474930211026519 ◽

2021 ◽

pp. 174749302110265

Author(s):

Moamina Ismail ◽

Vincent CT Mok ◽

Adrian Wong ◽

Lisa Au ◽

Brian Yiu ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Ischemic Stroke ◽

Recurrent Stroke ◽

Early Onset Dementia ◽

Delayed Onset ◽

Lower Baseline ◽

History Of ◽

Ischemic Attack ◽

Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEÎµ4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of â¥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEÎµ4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of â¥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

Download Full-text

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

10.21203/rs.2.17137/v1 ◽

2019 ◽

Author(s):

Nicolas Poupore ◽

Dan Strat ◽

Tristan Mackey ◽

Ashley Snell ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Older Patients ◽

Clinical Risk Factors ◽

Receiver Operating Curve ◽

Stroke Patients ◽

Clinical Risk ◽

Stroke Population ◽

Clinical Risks

Abstract Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

Download Full-text

Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

10.21203/rs.2.10087/v1 ◽

2019 ◽

Author(s):

Leah Wormack ◽

Brice Blum ◽

Benjamin Bailes ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Outcome ◽

Clinical Risk Factors ◽

Stroke Patients ◽

Antihypertensive Medications ◽

Clinical Risk ◽

Predictive Variables ◽

Stroke Population ◽

Thrombolysis Therapy

Abstract Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

Download Full-text