Abstract 213: Cerebral Microbleeds in 1278 Lacunar Stroke Patients: The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Lesly A Pearce ◽  
Carlos Bazan ◽  
Luciana Catanese ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Recurrent Stroke ◽  
Large Population ◽  
Cerebral Microbleeds ◽  
Stroke Recurrence ◽  
Blood Pressure Target ◽  
Lacunar Stroke ◽  
Stroke Patients ◽  
Increased Risk ◽  
History Of

Background: Cerebral microbleeds (CMBs) are radiographic markers of cerebral small vessel disease (CSVD) reported to independently predict recurrent stroke and mortality. However, characterization of CMBs in a large population of pure CSVD is lacking. We aimed to characterize CMBs in a well-defined population of lacunar stroke patients, and assess the relationship between CMBs and recurrent stroke and death. Methods: SPS3 was a randomized trial investigating optimal blood pressure target and antiplatelet regimen in 3020 patients with recent, symptomatic, MRI-confirmed lacunar stroke. CMBs were rated as per the Brain Observer MicroBleed Scale in all participants who had an interpretable axial T2*- GRE sequence available as part of their baseline MRI (n=1278, intra-rater reliability for + CMB 91% agreement, Kappa = 0.82). Results: CMBs were present in 30% of 1278 patients (mean age 63 y, 65% male, 75% history of hypertension). CMBs were lobar in 21%, deep in 44%, and mixed in 35% of cases. Of patients with CMBs, most (57%) had 1-2 CMBs, 31% had 3-10, and 12% >10. Male gender (OR 1.7, 95% CI 1.3-2.3), history of hypertension (1.6, 1.2-2.3), increased systolic blood pressure (1.2 per 20 mmHg, 1.1-1.4), non-diabetic (1.4, 1.1-1.9), multiple lacunar infarcts (1.9, 1.5-2.5) and moderate (1.7, 1.2-2.3) or severe (4.2, 3.0-5.9) white matter hyperintensities on MRI were independently associated with the odds of having CMBs in multivariable logistic regression. During a mean follow-up of 3.3 y, overall stroke recurrence was 2.5% per patient-y. In comparison to patients without CMBs, those with CMBs had a two-fold increased risk of stroke (HR 2.1, 1.4-3.1), after adjusting for assigned treatments and risk factors, whereas those with >10 CMBs had a four-fold increased risk (HR 4.0, 1.8-8.7). CMBs were not a risk factor for death (HR 1.2, 0.8-2.0). There were no interactions between CMBs and treatment assignments. Conclusions: In this largest reported cohort of lacunar stroke investigating CMBs, CMBs were highly prevalent and an independent predictor of stroke recurrence. Accordingly, patients with lacunar stroke and CMBs likely represent a more aggressive form of CSVD in need of efficacious therapeutic strategies. Further research is warranted in this field.

Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Zahra Abuzaid ◽  
Sara Almuslem ◽  
Farah Aleisa
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Recurrent Stroke ◽  
Uncontrolled Hypertension ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Event ◽  
Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

scholarly journals Analisis Survival Kecepatan Kekambuhan Stroke

2018 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Karina Pramudita ◽  
Hari Basuki Notobroto
Keyword(s):  
Diabetes Mellitus ◽  
Recurrence Rate ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Secondary Data ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Cox Regression Analysis ◽  
History Of ◽  
Heart Abnormalities

The objective of this study was to apply cox regression to factor analysis of stroke recurrence rate. This type of research was applied research on secondary data. The samples were 178 first stroke patients who are enrolled in inpatient period January to December 2011 and then made observations on the incidence of recurrent strokes up in February 2017 in medical record. Analysis techniques using Cox regression analysis on risk factors of stroke recurrence rate in RSAU dr. Esnawan Antariksa Halim Perdana Kusumah Jakarta. The analysis exhibited that the rate of recurrence of stroke has the same risk between categories of obesity. Stroke patients with a history of hypertension had a risk of a stroke recurrence rate of 5.594 times more likely than stroke patients with no history of hypertension, stroke patients with a history of diabetes mellitus had a risk of stroke recurrence rate of 1.912 times more likely than stroke patients with no history of diabetes mellitus, stroke patients with a history of dyslipidemia The risk of a recurrence rate of stroke was 2.153 times more likely than stroke patients without a history of dyslipidemia, and stroke patients with a history of heart abnormalities had a risk of recurrent stroke rates of 2.321 times more likely than stroke patients without a history of heart abnormalities. For stroke patients with a history of hypertension, diabetes mellitus, dyslipidemia and a history of cardiac abnormalities, need to do regular check-ups and controls every month to avoid recurrence of stroke.

scholarly journals Stroke Patients with a Past History of Cancer Are at Increased Risk of Recurrent Stroke and Cardiovascular Mortality

PLoS ONE ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. e88283 ◽  
Author(s):  
Kui-Kai Lau ◽  
Yuen-Kwun Wong ◽  
Kay-Cheong Teo ◽  
Richard Shek-Kwan Chang ◽  
Sonny Fong-Kwong Hon ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Past History ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Increased Risk ◽  
History Of ◽  
History Of Cancer

scholarly journals WMH and long-term outcomes in ischemic stroke

Neurology ◽  
2019 ◽  
Vol 92 (12) ◽  
pp. e1298-e1308 ◽  
Author(s):  
Marios K. Georgakis ◽  
Marco Duering ◽  
Joanna M. Wardlaw ◽  
Martin Dichgans
Keyword(s):  
Ischemic Stroke ◽  
Functional Impairment ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Increased Risk

ObjectiveTo investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.MethodsFollowing the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle–Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.ResultsWe included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72–2.73), cognitive impairment (RR 2.29, 95% CI 1.48–3.54), functional impairment (RR 2.21, 95% CI 1.83–2.67), any recurrent stroke (RR 1.65, 95% CI 1.36–2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26–2.88), all-cause mortality (RR 1.72, 95% CI 1.47–2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44–2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.ConclusionsPresence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.

scholarly journals Association between Modifiable Risk Factors and Stroke Recurrence in Patients with First Ever Ischemic Stroke

2017 ◽  
Vol 33 (2) ◽  
pp. 55-62
Author(s):  
Shahadat Hassan ◽  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Recurrent Stroke ◽  
Adult Population ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Mortality And Morbidity ◽  
Uncontrolled Diabetes

Background: Stroke is the third leading cause of death in adult population throughout the world and is the most common cause of severe adult physical disability. It is increasing at an alarming rate in Asia including Bangladesh. The effect of recurrent stroke is devastating on patient as it is the main reason of mortality and morbidity among patients. Methods: A longitudinal, observational study was conducted from April 2018 to October 2018 in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. All the patients of first ever ischemic stroke confirmed by neuroimaging (CT scan of head / MRI of brain), meeting the inclusion and exclusion criteria were included in the study. Our study was performed with sixty stroke patients. We followed up patient up to 90 days and observed for stroke recurrence. Results: Present study showed among the 60 stroke patients, only 4 (6.67%) suffered from stroke recurrence within 3 months. In our study, uncontrolled systolic blood pressure (p=0.04), uncontrolled diastolic blood pressure (p=0.027), dyslipidaemia (p=0.001), smoking (p=0.0003) and antiplatelet discontinuation (p=0.0001) were significantly associated with stroke recurrence whereas uncontrolled diabetes mellitus (p=0.46) and presence of atrial fibrillation (p=0.057) had no significant association. Conclusion: Smoking, hypercholesterolemia, uncontrolled systolic &/or diastolic blood pressure and discontinuation of antiplatelet therapy were significantly associated with stroke recurrence in this population. Therefore, early identification and control of these risk factors are essential to prevent recurrent stroke, thereby decrease morbidity and mortality. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 55-62

Abstract TP200: Family History and Risk of Recurrent Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jun Yup Kim ◽  
Jong-Won Chung ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Kyusik Kang ◽  
...  
Keyword(s):  
Family History ◽  
Recurrent Stroke ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Registry ◽  
First Degree Relatives ◽  
Index Stroke ◽  
History Of ◽  
Cox Proportional Hazard Models

Background: Association between family history of stroke and stroke recurrence remains unclear. Methods: Using a web-based multicenter stroke registry database, information on history of stroke in first-degree relatives was collected prospectively in ischemic stroke patients hospitalized within 7 day of onset. Collected information was categorized as follows: type of affected relatives with stroke (paternal, maternal, sibling, or two or more) and age of relative’s stroke onset in relative (< 50, 50∼59, 60∼69, and ≥ 70). Stroke recurrence was captured prospectively using predetermined protocol. Subgroup analysis was performed using categories based on patient’s age at the index stroke. Results: Among 7,642 patients, 937 (12.3%) had history of stroke in their first-degree relatives, and 475(6.2%) experienced stroke recurrence (median follow-up, 365 days). In multivariate Cox proportional hazard models, overall family history was not associated with stroke recurrence (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.80-1.41). However, the details of family history, including relative’s age at stroke onset < 50 (HR, 2.15; 95% CI, 1.01-4.57) and stroke history in sibling (HR, 1.67; 95% CI, 1.09-2.57) were independently associated with stroke recurrence after adjusting for possible confounders. The associations seemed to be stronger in stroke of young adults (age, <55) compared to older stroke patients. Conclusion: This study suggests that having relative with early onset stroke and sibling with history of stroke increase the risk of recurrent stroke and imply that additional precautions may be needed in such population.

scholarly journals Metabolic Abnormalities Rather Than BMI, Associated With Increased Risk of Recurrent Stroke in Chinese Hospitalized Stroke Patients: A Retrospective Study

2021 ◽  
Author(s):  
Xiaolin Huang ◽  
Jiaojiao Zhou ◽  
Hong Zhang ◽  
Pei Gao ◽  
Long Wang ◽  
...  
Keyword(s):  
Factor Model ◽  
Recurrent Stroke ◽  
Population Based ◽  
Metabolic Abnormalities ◽  
Stroke Patients ◽  
Conventional Risk Factor ◽  
Metabolic Phenotypes ◽  
Risk Factor Model ◽  
Increased Risk ◽  
History Of

Abstract Background Metabolic abnormalities and body mass index (BMI) are known as apparent risk factors of recurrent stroke, but which one is more likely related to recurrent stroke remains uncertain. This study aimed to compare the metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. Methods In this retrospective population-based study, 856 hospitalized stroke patients from the Third Affiliated Hospital of Soochow University were enrolled. Recurrent stroke was defined as newly-onset stroke patients with a history of previous stroke. Metabolic phenotypes were categorized based on Adult Treatment Panel III criteria. BMI ≥ 25kg/m2 was defined as obesity. Results Among the hospitalized stroke patients, the prevalence of recurrent stroke was 21.9%. Metabolic abnormalities rather than BMI were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy ones had 72% (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.01–2.68) increased risk of recurrent stroke, regardless of BMI and other confounding factors. Whereas, no statistical association between BMI and recurrent stroke were found. Metabolic status significantly improved risk prediction of recurrent stroke when adding to the conventional-risk-factor model (net reclassification index 17.6%, P = 0.0047; integrated discrimination improvement 0.7%, P = 0.014), while BMI did not. Conclusions Recurrent stroke is likely associated with metabolic abnormalities rather than with BMI. For the secondary prevention of stroke, controlling metabolic abnormalities is a more crucial method then BMI controlling in stroke patients.

Abstract 1: Dual Antiplatelet Therapy is More Effective for Multiple Acute Infarcts: Subgroup Analysis of Chance

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yilong Wang ◽  
Jing Jing ◽  
Yongjun Wang
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Recurrent Stroke ◽  
Bleeding Event ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Severe Bleeding ◽  
Stroke Patients ◽  
Acute Infarction ◽  
Increased Risk

Background and Purpose: TIAregistry.org project showed that TIA and minor stroke patients with multiple acute infarctions (MAIs), which represent mechanisms of embolism, are at higher risk of recurrent stroke as compared to those with none or single acute infarction (SAI). We hypothesis that patient with MAIs may be more susceptible to dual antiplatelet therapy. Methods: We compared clopidogrel plus aspirin with aspirin alone with regard to their effectiveness and safety for prevention of stroke recurrence among non-cardiac TIA and minor ischemic stroke patients with different infarction patterns (no acute infarction, SAI, or MAIs) in the imaging subgroup from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. The efficacy and safety outcome were stroke recurrence and moderate-to-severe bleeding event at 90 days respectively. Results: Overall, 1089 patients at 45 centers in CHANCE trial were included. The rate of recurrent stroke was 14.2%, 8.7%, and 2.0% in patients with MAIs, SAI and no infarction respectively at 90 days. Increased risk of stroke recurrence was observed in patients with MAIs (HR, 5.9; 95% CI, 2.3-15.2) and SAI (HR, 4.1; 95% CI, 1.6-10.7) (Figure A) as compared to those without infarction. The dual antiplatelet treatment was superior to aspirin alone for reducing the risk of recurrent stroke in patients with MAIs (HR 0.48; 95% CI, 0.25- 0.92; P = 0.03) but not in patients with SAI and without acute infarction with P=0.046 for interaction (Figure B-D). The effect of treatment assignment on bleeding did not vary among groups with different infarction patterns ( P >0.05 for all). Conclusions: Patients with MAIs had the highest risk for stroke recurrence among patients with different infarction patterns. Patients with MAIs may benefit the most clinically from dual antiplatelet therapy and dual antiplatelet therapy does not increase the risk of hemorrhage among any groups.

Abstract 137: Noninvasive Fractional Flow on MRA and Recurrent Stroke: SPS3 Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Makoto Nakajima ◽  
Nobuyuki Ohara ◽  
Lesly A Pearce ◽  
Edward Feldmann ◽  
Carlos Bazan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards ◽  
Blood Pressure Target ◽  
Lacunar Stroke ◽  
Vascular Territory ◽  
Fractional Flow ◽  
Stroke Patients ◽  
Tof Mra ◽  
Flow Reserve

Background and Purpose: Noninvasive fractional flow reserve (FFR) on time-of-flight magnetic resonance angiography (TOF-MRA) may be used to identify high-risk intracranial lesions. We tested whether FFR was associated with vascular territory of the qualifying lacunar stroke in participants of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial and the utility of FFR for predicting recurrent stroke during the trial. Methods: SPS3 was a randomized trial investigating optimal blood pressure target and antiplatelet regimen in patients with recent, symptomatic, MRI-confirmed lacunar stroke patients TOF-MRA proximate to study entry was adequate and available for 2169 of 3020 study patients. Signal intensity (SI) was measured in the background, and proximal and distal aspects of 7 intracranial arteries (internal carotid, middle cerebral, basilar, and vertebral). Adjusted FFR was then calculated in each artery: FFR = [distal SI - background SI] / [proximal SI - background SI] and divided into quartiles by artery. Associations between the vascular territory of the qualifying infarct and the FFR quartile of the relevant artery were investigated using contingency tables and chi-square tests. Risks for recurrent stroke associated with FFR quartiles were evaluated using Cox Proportional Hazards models (model adjusted for assigned treatment groups). Results: Mean age of the 2169 patients included was 63 yr with 63% male; hypertension, diabetes, and prior lacunar stroke were present in 75%, 36%, and 10% respectively. Median FFRs varied by artery with the lowest in the basilar (0.793) and highest in the middle cerebral arteries (left 1.154; right 1.176). A recurrent stroke occurred in 195 patients during a mean follow-up of 3.5 years (annualized rate 2.5% per patient-year).No significant association was found between the FFR tertiles and the vascular territory of the qualifying infarct. Quartiles of adjusted FFR in any of the 7 arteries were not found to be predictive of recurrent stroke. Conclusion: In this large well-characterized cohort of lacunar stroke patients, FFR was not associated with the location of the qualifying subcortical infarct and did not predict the risk of recurrent stroke.

Abstract 67: HsCRP Predicts Recurrent Stroke and Vascular Events among Patients with Lacunar Stroke: The Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mitchell S Elkind ◽  
Yu Zhang ◽  
Leslie A McClure ◽  
Christopher S Coffey ◽  
Carole White ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Recurrent Stroke ◽  
Recurrence Risk ◽  
Prior History ◽  
Lacunar Stroke ◽  
Stroke Patients ◽  
Antiplatelet Treatment ◽  
Vascular Events ◽  
Increased Risk ◽  
Statin Use

Objective: To determine whether high sensitivity C-reactive protein (hsCRP) predicts recurrent stroke and other vascular events among recent lacunar stroke patients. Background: Inflammatory markers have been associated with risk of first stroke. Their role in predicting recurrence is unclear. Methods: The Levels of Inflammatory Markers in the Treatment of Stroke study is an international prospective study of inflammatory markers among recent lacunar stroke patients enrolled in the NIH-funded randomized Secondary Prevention of Small Subcortical Strokes trial. Patients had blood samples drawn, saved at -80 degrees C, and run at a central lab for hsCRP using nephelometry. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (HR, 95% CI) for associations of hsCRP with recurrence risk before and after adjusting for demographics, comorbidities, and statin use. Results: Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L (interquartile range 0.93-4.86), and levels differed by age, sex, smoking, and LDL. Median time between stroke and hsCRP measurement was 60 days, and levels were inversely and weakly correlated with proximity to stroke date (r=-0.06, p=0.039). There were 83 recurrent ischemic strokes (45 lacunes), 16 hemorrhages, and 115 major vascular events (stroke, MI, vascular death). Compared to the bottom quartile, those in the top quartile of hsCRP (>4.86 mg/dl) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95% CI 1.30-4.96), and the risk persisted after adjusting for age, sex, race, region, hypertension, smoking, prior history of stroke, diabetes, lipid levels, and statin use (adjusted HR 2.28, 95% CI 1.14-4.57). HsCRP was associated with an increased risk of major vascular events (top quartile adjusted HR 1.98, 95% CI 1.11-3.54). Results were similar using clinical thresholds of high risk hsCRP (> 3 mg/dl). There was no interaction of randomized antiplatelet treatment with hsCRP levels for stroke risk. Conclusions: Among recent lacunar stroke patients, elevated hsCRP levels predict increased risk of recurrent strokes and other vascular events. Levels of inflammatory markers did not predict a response to dual antiplatelet treatment.

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