Abstract T P103: Vertebral Artery Hypoplasia Should Play Important Role for Posterior Circulation Ischemia

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Teppei Komatsu ◽  
Shinji Miyagawa ◽  
Yuki Sakamoto ◽  
Toshiaki Hirai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Vertebral Artery ◽  
Prevalence Rate ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Posterior Circulation ◽  
Large Artery ◽  
Carotid Ultrasonography ◽  
Vertebral Artery Hypoplasia

Purpose: Vertebral artery hypoplasia (VAH) is congenital anatomical variation, which is frequently observed in clinical situation. In previous reports, it was not unclear whether VAH was the independent risk factor for posterior circulation ischemia. The purpose of this study is to evaluate an impact of VAH on posterior circulation ischemia. Methods: Subjects were patients with acute ischemic stroke who underwent brain MRI and carotid ultrasonography. The diameter of vessel and flow velocities of extracranial vertebral artery (VA) was measured by carotid ultrasonography. Diagnostic criteria of VAH was as follows: 1) diameter of VA <2.5mm, 2) diameter of VA <3.0mm and a side difference equal or greater than 1:1.7, 3) diameter of VA <3.0mm, peak systolic velocity <40cm/sec, and resistance index value >0.75. We divided all patients into three groups by the location of the acute ischemic stroke evaluated by MRI: ischemic lesion on posterior circulation (P group), on anterior circulation (A group), and multiple lesions on both anterior and posterior circulation (AP group). Then, the prevalence rate of VAH was compared between P group and A+AP group. In order to evaluate independent factors of VA occlusion, we conducted multivariate regression analyses. Results: We evaluated a total of 129 consecutive patients (87 male, median age; 71 years). P group was 36 patients, and A+AP group was 93 patients. VAH was seen in 39 patients (31.5%), and VA occlusion was found in 15 patients. The prevalence rate of VAH in P group (44.4%) was significantly higher than in A+AP group (24.7%, p=0.034). In univariate analysis, the patients with VA occlusion were higher rates of hypertension (p=0.066), large artery atherosclerosis (p=0.095), posterior circulation ischemia (p=0.001), and the presence of VAH (p=0.038). Multivariate regression analysis demonstrated that large artery atherosclerosis (odds ratio, 6.3; 95% confidence interval, 1.3-30.1), posterior circulation ischemia (odds ratio, 12.0; 95% confidence interval, 2.8-51.2) and VAH (odds ratio, 4.2; 95% confidence interval, 1.2-15.0) were independently associated with the presence of VA occlusion. Conclusion: VAH was independent factor of VA occlusion, and should be associated with posterior circulation ischemia.

Possible Morphological Pathomechanisms of Ischemic Stroke in the Posterior Circulation of Patients with Vertebral Artery Hypoplasia

2014 ◽  
Vol 25 (3) ◽  
pp. 408-414 ◽  
Author(s):  
Andrea Skultéty Szárazová ◽  
Eva Bartels ◽  
Susanne Bartels ◽  
Peter Turčáni
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

scholarly journals Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke

Medicine ◽  
2021 ◽  
Vol 100 (38) ◽  
pp. e27280
Author(s):  
Yasemin Dinç ◽  
Rifat Özpar ◽  
Büşra Emir ◽  
Bahattin Hakyemez ◽  
Mustafa Bakar
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Independent Risk Factor ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

Relationship between Vertebral Artery Hypoplasia and Posterior Circulation Ischemia

2016 ◽  
Vol 25 (2) ◽  
pp. 266-269 ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Shinji Miyagawa ◽  
Teppei Komatsu ◽  
Toshiaki Hirai ◽  
Yu Kono ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Ashutosh Jadhav ◽  
Diogo C Haussen ◽  
Amin Aghaebrahim ◽  
Leticia C Rebello ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Patient Specific ◽  
Posterior Circulation Stroke ◽  
Good Outcome

Background and Purpose: Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke Methods: We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P<0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes. Conclusion: Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.

scholarly journals Geographic dissemination of endovascular stroke thrombectomy in Catalonia within the 2011–2015 period

2017 ◽  
Vol 2 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Sònia Abilleira ◽  
Cristian Tebé ◽  
Natalia Pérez de la Ossa ◽  
Marc Ribó ◽  
Pere Cardona ◽  
...  
Keyword(s):  
Primary Care ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Care Service ◽  
Primary Care Service ◽  
Large Artery ◽  
Endovascular Thrombectomy ◽  
Service Areas ◽  
Over Time

Introduction Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011–2015. Patients and methods We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). Results Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4–4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2–7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. Discussion This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. Conclusion Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.

scholarly journals Acupuncture Efficacy on Ischemic Stroke Recovery

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1301-1306 ◽  
Author(s):  
Shihong Zhang ◽  
Bo Wu ◽  
Ming Liu ◽  
Ning Li ◽  
Xianrong Zeng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Standard Care ◽  
Controlled Trial ◽  
Health Gain ◽  
Institutional Care ◽  
Stroke Recovery ◽  
Control Group ◽  
Clinical Trial Registration

Background and Purpose— Acupuncture is a frequently used complementary treatment for ischemic stroke in China but the evidence available from previous randomized trials is inconclusive. The objective of this study was to assess the efficacy and safety of acupuncture in a more robustly designed larger scale trial. Methods— This is a multicenter, single-blinded, randomized controlled trial. Eight hundred sixty-two hospitalized patients with limb paralysis between 3 to 10 days after ischemic stroke onset were allocated acupuncture plus standard care or standard care alone. The acupuncture was applied 5 times per week for 3 to 4 weeks. The primary outcomes were defined as follows: (1) death/disability according to Barthel index and (2) death/institutional care at 6 months. Results— There was a tendency of fewer patients being dead or dependent in acupuncture group (80/385, 20.7%) than in control group (102/396, 25.8%) at 6 months (odds ratio, 0.75; 95% confidence interval, 0.54–1.05). The benefit was noted in subgroup receiving ≥10 sessions of acupuncture (odds ratio, 0.68; 95% confidence interval, 0.47–0.98). There was no statistical difference in death or institutional care between the 2 groups (odds ratio, 1.06; 95% confidence interval, 0.63–1.79). Severe adverse events occurred in 7.6% and 8.3% of patients in the 2 groups, respectively. Conclusions— Acupuncture seemed to be safe in the subacute phase of ischemic stroke. If the potential benefits observed are confirmed in future larger study, the health gain from wider use of the treatment could be substantial. Clinical Trial Registration— URL: http://www.chictr.org/en/ . Unique identifier: ChiCTR-TRC-11001353.

scholarly journals Carotid artery web and ischemic stroke

Neurology ◽  
2016 ◽  
Vol 88 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Jonathan M. Coutinho ◽  
Sheldon Derkatch ◽  
Alphonse R.J. Potvin ◽  
George Tomlinson ◽  
Leanne K. Casaubon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Confidence Interval ◽  
Atherosclerotic Plaque ◽  
Odds Ratio ◽  
Conditional Logistic Regression ◽  
Cerebral Aneurysms ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Significant Difference

Objective:To determine whether there is an association between carotid artery web and ischemic stroke.Methods:This was a single-center, age- and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age <60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness ≥3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval.Results:Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio = 8.0, 95% confidence interval = 1.2–67, p = 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen κ for interobserver agreement was 0.93.Conclusions:There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke.

scholarly journals Vertebral Artery Ostium Atherosclerotic Plaque as a Potential Source of Posterior Circulation Ischemic Stroke

Stroke ◽  
2011 ◽  
Vol 42 (9) ◽  
pp. 2544-2549 ◽  
Author(s):  
Firas Al-Ali ◽  
Tom Barrow ◽  
Li Duan ◽  
Anne Jefferson ◽  
Susan Louis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Atherosclerotic Plaque ◽  
Posterior Circulation ◽  
Potential Source

Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (11) ◽  
pp. e1067-e1076 ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Nitin Goyal ◽  
Ali Kerro ◽  
Aristeidis H. Katsanos ◽  
Rashi Krishnan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Dual Antiplatelet Therapy ◽  
Safety And Efficacy ◽  
Favorable Functional Outcome

ObjectiveWe sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study.MethodsWe compared the following outcomes between DAPP+ and DAPP− IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0–1), and 3-month mortality.ResultsAmong 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP− patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47–8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06–5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP− patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes.ConclusionsDAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates.Classification of evidenceThis study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

scholarly journals Predictors of Finding Occult Atrial Fibrillation After Cryptogenic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1210-1215 ◽  
Author(s):  
Christopher G. Favilla ◽  
Erin Ingala ◽  
Jenny Jara ◽  
Emily Fessler ◽  
Brett Cucchiara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Cerebellar Infarction ◽  
Acute Infarction ◽  
Ischemic Attack ◽  
Low Prevalence

Background and Purpose— Occult paroxysmal atrial fibrillation (AF) is found in a substantial minority of patients with cryptogenic stroke. Identifying reliable predictors of paroxysmal AF after cryptogenic stroke would allow clinicians to more effectively use outpatient cardiac monitoring and ultimately reduce secondary stroke burden. Methods— We analyzed a retrospective cohort of consecutive patients who underwent 28-day mobile cardiac outpatient telemetry after cryptogenic stroke or transient ischemic stroke. Univariate and multivariable analyses were performed to identify clinical, echocardiographic, and radiographic features associated with the detection of paroxysmal AF. Results— Of 227 patients with cryptogenic stroke (179) or transient ischemic stroke (48), 14% (95% confidence interval, 9%–18%) had AF detected on mobile cardiac outpatient telemetry, 58% of which was ≥30 seconds in duration. Age >60 years (odds ratio, 3.7; 95% confidence interval, 1.3–11) and prior cortical or cerebellar infarction seen on neuroimaging (odds ratio, 3.0; 95% confidence interval, 1.2–7.6) were independent predictors of AF. AF was detected in 33% of patients with both factors, but only 4% of patients with neither. No other clinical features (including demographics, CHA 2 DS 2 -VASc [combined stroke risk score: congestive heart failure, hypertension, age, diabetes, prior stroke/transient ischemic attack, vascular disease, sex] score, or stroke symptoms), echocardiographic findings (including left atrial size or ejection fraction), or radiographic characteristics of the acute infarction (including location, topology, or number) were associated with AF detection. Conclusions— Mobile cardiac outpatient telemetry detects AF in a substantial proportion of cryptogenic stroke patients. Age >60 years and radiographic evidence of prior cortical or cerebellar infarction are robust indicators of occult AF. Patients with neither had a low prevalence of AF.

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