scholarly journals Preconditioning by Preceding Ischemic Cerebrovascular Events

2021 ◽  
Author(s):  
Pamela N. Correia ◽  
Ivo A. Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Lorenz Hirt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
University Hospital ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Cerebral Ischemic ◽  
The Impact ◽  
Ischemic Events

Background Emerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long‐term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome. Methods and Results Data for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3‐month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24‐hour improvement was not significant and 3‐month outcome was unfavorable. Conclusions Preceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long‐term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.

scholarly journals Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

2021 ◽  
pp. 239698732110195
Author(s):  
P Correia ◽  
S Machado ◽  
I Meyer ◽  
M Amiguet ◽  
A Eskandari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Tobacco Use ◽  
Migraine With Aura ◽  
Hormonal Contraceptives ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Female Patients

Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

Serum calcium and long-term outcome after ischemic stroke: Results from the China National stroke registry III

2021 ◽  
Vol 325 ◽  
pp. 24-29
Author(s):  
Jun-Fang Zhang ◽  
Xia Meng ◽  
Jing Jing ◽  
Yuesong Pan ◽  
Yi-Long Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Serum Calcium ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry

The impact of predisposing factors on long-term outcome after stroke in diabetic patients: the Fukuoka Stroke Registry

2013 ◽  
Vol 20 (6) ◽  
pp. 921-927 ◽  
Author(s):  
T. Kuwashiro ◽  
H. Sugimori ◽  
T. Ago ◽  
J. Kuroda ◽  
M. Kamouchi ◽  
...  
Keyword(s):  
Predisposing Factors ◽  
Diabetic Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
The Impact

scholarly journals Associated Factors and Long-Term Prognosis of 24-Hour Worsening of Arterial Patency After Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2752-2760 ◽  
Author(s):  
João Pedro Marto ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Stefania Nannoni ◽  
Davide Strambo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Vascular Imaging ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Long Term Outcome ◽  
Long Term Prognosis ◽  
The Impact ◽  
Arterial Patency

Background and Purpose— Early arterial recanalization in acute ischemic stroke is strongly associated with better outcomes. However, early worsening of arterial patency was seldom studied. We investigated potential predictors and long-term prognosis of worsening of arterial patency at 24 hours after stroke onset. Methods— Patients from the Acute Stroke Registry and Analysis of Lausanne registry including admission and 24-hour vascular imaging (computed tomography or magnetic resonance angiography) were included. Worsening of arterial patency was defined as a new occlusion and significant stenosis in any extracranial or intracranial artery, comparing 24 hours with admission imaging. Variables associated with worsening of arterial patency were assessed by stepwise multiple logistic regression. The impact of arterial worsening on 3-month outcome was investigated with an adjusted modified Rankin Scale shift analysis. Results— Among 2152 included patients, 1387 (64.5%) received intravenous thrombolysis and endovascular treatment, and 65 (3.0%) experienced 24-hour worsening of arterial patency. In multivariable analysis, history of hypertension seemed protective (adjusted odds ratio [aOR], 0.45; 95% CI, 0.27–0.75) while higher admission National Institutes of Health Stroke Scale (aOR, 1.06; 95% CI, 1.02–1.10), intracranial (aOR, 4.78; 95% CI, 2.03–11.25) and extracranial stenosis (aOR, 3.67; 95% CI, 1.95–6.93), and good collaterals (aOR, 3.71; 95% CI, 1.54–8.95) were independent predictors of worsening of arterial patency. Its occurrence was associated with a major unfavorable shift in the distribution of the modified Rankin Scale at 3 months (aOR, 5.97; 95% CI, 3.64–9.79). Conclusions— Stroke severity and admission vascular imaging findings may help to identify patients at a higher risk of developing worsening of arterial patency at 24 hours. The impact of worsening of arterial patency on long-term outcome warrants better methods to detect and prevent this early complication.

Strokes Following Attempted Suicide: Frequency, Mechanisms, Outcome and Review of the Literature

2021 ◽  
Author(s):  
Mauro Silva ◽  
Laurent Michaud ◽  
Pamela Correia ◽  
Masaki Nishida ◽  
Patrik Michel
Keyword(s):  
World Literature ◽  
Early Mortality ◽  
Stroke Severity ◽  
Systematic Observation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Stroke Mechanism ◽  
Work Up

Abstract Background: Only a few patients with strokes following suicide attempt (SFSA) are described in the literature and dissection of cervical arteries is the best-known mechanism. We aimed to determine the frequency, clinical presentation, mechanisms and outcomes of such patients by systematic observation in a single academic institution.Method: We retrospectively identified in our acute ischemic stroke registry all SFSA over 11 years. A thorough work-up was performed to establish the stroke mechanism. We also searched all published SFSA in the world literature for further analysis of demographics, comorbidities and long-term outcome. Results: Work-up showed multiple stroke mechanisms as well as multiple psychiatric. After adding 7 already published SFSA and comparing all SFSA with our stroke registry, SFSA were younger, had similar stroke severity, higher early mortality, and similar long-term functional outcome.Conclusions: SFSA is rare, affects younger patients and may be missed without an appropriate level of suspicion and neuroimaging. Long-term outcome seems comparable to other stroke patients despite an increased early mortality.

Abstract TP421: Ischemic Preconditioning From Preceding Cerebrovascular Events in Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pamela N Correia ◽  
Ivo A Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Ischemic Stroke ◽  
Ischemic Preconditioning ◽  
Multivariate Regression Analysis ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cerebrovascular Events ◽  
Independent Association ◽  
Stroke Mechanism

Introduction: Preconditioning improves acute ischemic stroke (AIS) outcomes in animals and possibly in humans. The influence of a preceding ischemic event (PIE), such as a TIA or AIS occurring at different intervals, sites and for different durations, needs to be studied in humans. Hypothesis: We aimed to identify whether a PIE can have a preconditioning effect on a subsequent AIS. Methods: Using consecutive AIS from the ASTRAL registry we determined demographics, risk factors, past medical history,stroke mechanism,PIE and other features that were associated with initial stroke severity measured by NIHSS. We used a multivariate linear regression model with NIHSS as the dependent variable to compare groups with and without PIE. Results: Of 3501 consecutive AIS patients (43% females, median age 73 y), 996 (28.4%) had preceding PIEs (15.7% TIA, 12.9% ischemic stroke, 2.4% retinal ischemia, 8.8% multiple events). There were 162 acute PIE in the preceding 24 h, and 94 subacute PIE up to 7 d before the stroke, respectively with a median delay between the PIE and the subsequent stroke of 180 days.Results of the adjusted multivariate regression analysis are shown as forest plots below. Conclusions: In patients with AIS, we found an independent association between lesser stroke severity and PIE, suggesting a possible beneficial role of ischemic preconditioning in stroke in humans. The effect of timing, severity,location of PIE and long-term outcome of such patients needs to be analyzed in further studies.

Perinatal Care at the Threshold of Viability

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 974-976
Author(s):  
◽  
◽  
◽  
Keyword(s):  
Perinatal Care ◽  
Survival Rates ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obstetric Management ◽  
The Cost ◽  
The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis

2021 ◽  
Author(s):  
Sauson Soldozy ◽  
Kaan Yağmurlu ◽  
Pedro Norat ◽  
Mazin Elsarrag ◽  
John Costello ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Meta Analysis ◽  
Term Outcome ◽  
Long Term Outcome
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