Associations between Uric Acid Level and 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with/without Edaravone

2018 ◽  
Vol 45 (3-4) ◽  
pp. 115-123
Author(s):  
Masaki Naganuma ◽  
Yuichiro Inatomi ◽  
Makoto Nakajima ◽  
Toshiro Yonehara ◽  
Yukio Ando
Keyword(s):  
Uric Acid ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Free Radical Scavenger ◽  
Radical Scavenger ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Treatment Results ◽  
Neuroprotective Effects ◽  
The Relationship

Background: Uric acid (UA), an antioxidant with neuroprotective effects, favorably affects stroke outcome. However, the effect has not been examined in patients treated with edaravone, a frequently used free radical scavenger. We investigated whether the use of edaravone affected the relationship between UA levels and outcome in acute ischemic stroke. Methods: We retrospectively evaluated 1,114 consecutive ischemic stroke patients with premorbid modified Rankin Scale (mRS) scores <2 admitted within 24 h of onset (mean, 74 years; median UA levels, 333 μmol/L). We divided the patients into 2 groups using the median UA value as a cutoff, a low UA group (≤333 μmol/L; n = 566) and a high UA group (>333 μmol/L; n = 548), and compared their clinical characteristics and favorable outcomes (mRS <2) at 90 days. We investigated the associations between UA levels and 90-day stroke outcome in patients with and without edaravone treatment. Results: The high UA group had a higher proportion of men, hypertension, atrial fibrillation, and cardioembolic stroke than the low UA group. The high UA group also had a higher proportion of patients with mRS <2 at 90 days (61.5 vs. 54.1%, p = 0.013), but the significance was diminished in multivariate analysis (OR 1.30, 95% CI 0.94–1.71). In subgroup analysis, the high UA group without edaravone exhibited a higher proportion of patients with mRS <2 at 90 days than the low UA group (OR 2.87, 95% CI 1.20–7.16). The high UA group with edaravone did not exhibit this difference. Conclusions: In acute ischemic stroke, the favorable association between high UA levels and outcome at 90 days was not evident in patients treated with edaravone.

scholarly journals Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Author(s):  
Xuting Zhang ◽  
Shenqiang Yan ◽  
Wansi Zhong ◽  
Yannan Yu ◽  
Min Lou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Median Serum ◽  
The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

scholarly journals The relationship between the platelet to leukocyte ratio and mechanical thrombectomy outcomes in acute ischemic stroke patients

2020 ◽  
Vol 42 (10) ◽  
pp. 890-896
Author(s):  
Ling Wang ◽  
Qiantao Cheng ◽  
Min Peng ◽  
Daping Lv ◽  
Wenjie Zi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Patients ◽  
The Relationship

Abstract W P165: Predictors of Cerebral Microbleeds in Patients With Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Maria C Zurru ◽  
Claudia Alonzo ◽  
Laura Brescacin ◽  
Santiago Pigretti ◽  
Ariel Luzzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Kidney Function ◽  
Univariate Analysis ◽  
Stroke Patients ◽  
Microvascular Damage ◽  
Vascular Beds ◽  
Dichotomous Variables ◽  
The Relationship

Background and purpose: similarities in renal and vascular beds could explain the relationship between impaired glomerular filtration rate (iGFR) and leukoaraiosis, white matter hiperintensities (WMH), and lacunar infarcts. We evaluated the association between microbleeds (MB) and impaired kidney function in patients with acute ischemic stroke. Methods: acute ischemic stroke patients were prospectively included. Pre-stroke vascular risk factors were obtained and the presence of MB and WMH were evaluated on admission MRI and analyzed as dichotomous variables. Results: MB were present in 128 (19%) of the 663 patients evaluated.. Table shows risk factors and comorbidities associated with MB in the univariate analysis. Only leukoaraiosis (OR 3.3; CI 95% 1.5-3.3; p 0.0001), age older than 80 years (OR 1.90; CI 95% 1.10-2.8; p 0.01), WMH (OR 9.4; CI 95% 5.6-15.6; p 0.0001) and iGFR (OR 2.2; CI 95% 1.3-3.3; p 0.01) were associated with the presence of MB in the multivariate analysis. Conclusion: Besides age and WMH, well-known risk factors for MB, impaired kidney function doubles the risk these lesions in a cohort of ischemic stroke patients, reassuring the hypothesis of a common pathophysiological pathway for renal and cerebral microvascular damage.

Abstract WP60: Evaluation of Tissue Reversibility by Relative Apparent Diffusion Coefficient Value in Acute Ischemic Stroke Patients Treated With Successful Thrombectomy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Toshihiro Ueda ◽  
Tatsuro Takada ◽  
Shinji Nogoshi ◽  
Satoshi Takaishi ◽  
Tomohide Yoshie ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Ischemic Stroke ◽  
Apparent Diffusion Coefficient ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Infarcted Area ◽  
Apparent Diffusion Coefficient Value ◽  
Apparent Diffusion ◽  
The Mean ◽  
The Relationship

Background: By recent advance of endovascular thrombectomy, we have often experienced acute ischemic patients who have diffusion weighted imaging (DWI) reversal lesions after earlier successful recanalization. We retrospectively investigated the relationship between apparent diffusion coefficient (ADC) thresholds of tissue infarction and time from onset to recanalization in acute ischemic stroke patients. Methods: We assessed 24 patients who have occlusion of internal carotid artery (n=11) and the main trunk of middle cerebral artery (n=13) and obtained recanalization of TICI2b (n=12) and TICI3 (n=12) by thrombectomy and performed MRI before and after treatment. Relative ADC (rADC) value were calculated for initial DWI lesions and around hypoperfused regions. We evaluated rADC values in infarcted and non-infarcted area and analyzed the relationship between rADC thresholds of tissue infarction and time. Results: The mean time from onset to recanalization was 209 minutes and mean initial NIHSS was 15.4. The mean rADC value was 0.633 in infarcted lesions and 0.905 in non-infarcted area (p<0.001). The thresholds for rADC value for infarction by the area under the curve derived from receiver operating characteristic curve analysis were 0.769 in the area which recanalized under 180 minutes form the onset, 0.792 in that from 180 to 240 minutes, and 0.798 in that over 240 minutes. Conclusion: The estimation of rADC value may be useful in predicting the likelihood of DWI lesion reversal. Marked decreasing of rADC value which is under thresholds of infarction indicated irreversible damage of ischemic tissue regardless of early successful recanalization.

Abstract P246: Hospital Acquired Pneumonia and Dysphagia Screening in Patients With Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Shihab Masrur ◽  
Eric E Smith ◽  
Mathew Reeves ◽  
Xin Zhao ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Intake ◽  
Stroke Patients ◽  
Chi Square ◽  
Hospital Acquired Pneumonia ◽  
Get With The Guidelines ◽  
Hospital Acquired ◽  
The Relationship ◽  
Hospital Characteristics

National guidelines recommend dysphagia screening (DS) before any oral intake in hospitalized stroke patients to reduce the risk of hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP in acute ischemic stroke patients in the Get With the Guidelines-Stroke (GWTG-S) program. Methods: Data from 1251 GWTG-S hospitals from 04/01/2003 to 03/01/2009 were analyzed. GWTG-S defines HAP as a clinical diagnosis of pneumonia requiring antibiotics. Use of a bedside, evidence-based swallow screen prior to any oral intake qualified as a DS. Univariate analyses (chi-square for categorical variables or Wilcoxon for continuous variables) and multivariate logistic regression analyses were performed to examine the relationship between DS and HAP, adjusting for patient and hospital characteristics Results: Among 365,726 ischemic stroke patients, 213097 (59.83%) underwent DS, and 25,166 (6.88%) developed HAP. When compared to patients without pneumonia ( Table 1 ), patients with HAP were older and more frequently had CAD/MI, diabetes, prior stroke/TIA, dyslipidemia, atrial fibrillation. They, underwent DS less often, and had increased length of stay, morbidity and in-hospital mortality. Among the subgroup who had NIHSS recorded (n=160,837, 44%), HAP patients had higher median NIHSS (13 vs. 5). Among patients with NIHSS<2, 3.3% developed HAP. In multivariate analysis, factors independently associated with a lower risk of HAP were DS (OR 0.86 [0.83-0.90]), female (OR 0.83 [0.81-0.85]), dyslipidemia (OR 0.84 [0.82-0.86]), and hypertension (OR 0.96 [0.94-0.98]). Discussion: Our data suggests that dysphagia screening is associated with a lower likelihood of HAP, but screening rates remain low. Strategies that increase the rate of dysphagia screening among all stroke patients, even those with mild strokes, should be more broadly implemented. Prospective validation of these findings is warranted. Table 1. Unadjusted associations between patient and hospital characteristics and clinical outcomes Overall(% or value) HAP(% or value) No HAP(% or value) Study Population 365726 (100%) 25166(6.9%) 340560(93.1%) Age (years) Median (IQR) 73(61, 82) 77(66, 85) 73(61,82) Female 52.5 49.2 52.8 Dysphagia Screen Performed 59.8 54.8 60.2 In Hospital Death 5.7 18.1 4.8 P-values are <.0001 for all comparisons and are based on Chi-square test (for dichotomous and nominal factors) or Wilcoxon test (for ordinal and continuous factors)

scholarly journals Edaravone (Radicut), a free radical scavenger, is a potentially useful addition to thrombolytic therapy in patients with acute ischemic stroke

2012 ◽  
Vol 1 (1) ◽  
pp. 7-12 ◽  
Author(s):  
KIYOSHI KIKUCHI ◽  
NAOKI MIURA ◽  
KO-ICHI KAWAHARA ◽  
YOSHINAKA MURAI ◽  
MOTOHIRO MORIOKA ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Free Radical ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Free Radical Scavenger ◽  
Radical Scavenger
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