Abstract T MP58: Incidence and Etiology of Punctate Infarcts in Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamary Oliveira-Filho ◽  
Hakan Ay ◽  
Ashkan Shoamanesh ◽  
Kwang Y Park ◽  
Ross Avery ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Large Vessel ◽  
Vascular Territory ◽  
Lower Systolic Blood Pressure ◽  
Vessel Disease ◽  
High Incidence ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Large Vessel Disease

Background/Objective: Punctate infarcts (PI) are increasingly seen on DWI of patients with intracerebral hemorrhage (ICH) due to small vessel disease (SVD). We aimed to determine their incidence and potential causes in a large ischemic stroke (IS) cohort that had thorough etiologic workup. Methods: Consecutive patients with MRI-confirmed IS within 72 hours of onset were enrolled. Subjects had either a single high-risk embolic source (cardioembolic or large vessel disease) or no embolic source. PIs were classified by their relationship to the primary infarct as within or outside the same vascular territory. White matter disease burden (WMDB) and microbleed counts were obtained to be used as markers of severity of SVD. Multivariable regression models were constructed to assess the association between PIs and potential etiologies (embolism vs SVD). Results: We analyzed 946 IS patients, mean age 69 +/- 15 years, 46% female. We detected PI (≤5mm) in 269 (28%) subjects, 190 (71%) within the vascular territory of the primary infarct. Large-vessel atherosclerosis (p<0.001), cardioembolic source (p<0.001), higher WMDB (p=0.032) and lower systolic blood pressure (SBP, p=0.024) were independently associated with the presence of PI. While lower SBP was associated with PI in any location (p<0.05), WMDB was only associated with PI outside the vascular territory of the primary infarct (p=0.033); and large vessel atherosclerosis was only associated with PI within the vascular territory of the primary infarct (p=0.004). Conclusions: PIs occurring within the vascular territory of a larger infarct are more likely to have a proximal embolic source, but those occurring outside are more likely related to SVD. Their relatively high incidence and diverse etiologic associations in a cohort of IS patients emphasize the importance of research into their mechanisms.

scholarly journals High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 251 ◽  
Author(s):  
Adam Wiśniewski ◽  
Joanna Sikora ◽  
Agata Sławińska ◽  
Karolina Filipska ◽  
Aleksandra Karczmarska-Wódzka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Platelet Reactivity ◽  
Volume Measurement ◽  
Large Vessel ◽  
Vessel Disease ◽  
Fluid Attenuated Inversion Recovery ◽  
The Brain ◽  
Large Vessel Disease

Background: Excessive platelet activation and aggregation plays an important role in the pathogenesis of ischemic stroke. Correlation between platelet reactivity and ischemic lesions in the brain shows contradictory results and there are not enough data about the potential role of stroke etiology and its relationships with chronic lesions. The aim of this study is to assess the relationship between platelet reactivity and the extent of ischemic lesions with the particular role of etiopathogenesis. Methods: The study involved 69 patients with ischemic stroke, including 20 patients with large-vessel disease and 49 patients with small-vessel disease. Evaluation of platelet reactivity was performed within 24 h after the onset of stroke using two aggregometric methods (impedance and optical), while ischemic volume measurement in the brain was performed using magnetic resonance imaging (in diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences) at day 2–5 after the onset of stroke. Results: In the large-vessel disease subgroup, a correlation was found between platelet reactivity and acute ischemic focus volume (correlation coefficient (R) = 0.6858 and p = 0.0068 for DWI; R = 0.6064 and p = 0.0215 for FLAIR). Aspirin-resistant subjects were significantly more likely to have a large ischemic focus (Odds Ratio (OR) = 45.00, 95% Confidence Interval (CI) = 1.49–135.36, p = 0.0285 for DWI; OR = 28.00, 95% CI = 1.35–58.59, p = 0.0312 for FLAIR) than aspirin-sensitive subjects with large-vessel disease. Conclusion: In patients with ischemic stroke due to large-vessel disease, high on-treatment platelet reactivity affects the extent of acute and chronic ischemic lesions.

scholarly journals Association between Oxidative Stress and Outcome in Different Subtypes of Acute Ischemic Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Nai-Wen Tsai ◽  
Ya-Ting Chang ◽  
Chi-Ren Huang ◽  
Yu-Jun Lin ◽  
Wei-Che Lin ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Large Vessel ◽  
Small Vessel ◽  
Tbars Level ◽  
Vessel Disease ◽  
Free Thiol ◽  
Large Vessel Disease

Objectives. This study investigated serum thiobarbituric acid-reactive substances (TBARS) and free thiol levels in different subtypes of acute ischemic stroke (AIS) and evaluated their association with clinical outcomes.Methods. This prospective study evaluated 100 AIS patients, including 75 with small-vessel and 25 with large-vessel diseases. Serum oxidative stress (TBARS) and antioxidant (thiol) were determined within 48 hours and days 7 and 30 after stroke. For comparison, 80 age- and sex-matched participants were evaluated as controls.Results. Serum TBARS was significantly higher and free thiol was lower in stroke patients than in the controls on days 1 and 7 after AIS. The level of free thiol was significantly lower in the large-vessel disease than in the small-vessel disease on day 7 after stroke. Using the stepwise logistic regression model for potential variables, only stroke subtype, NIHSS score, and serum TBARS level were independently associated with three-month outcome. Higher TBARS and lower thiol levels in the acute phase of stroke were associated with poor outcome.Conclusions. Patients with large-vessel disease have higher oxidative stress but lower antioxidant defense compared to those with small-vessel disease after AIS. Serum TBARS level at the acute phase of stroke is a potential predictor for three-month outcome.

LDL phenotype B and other lipid abnormalities in patients with large vessel disease and small vessel disease

2003 ◽  
Vol 214 (1-2) ◽  
pp. 11-16 ◽  
Author(s):  
Agnieszka Slowik ◽  
Tomasz Iskra ◽  
Wojciech Turaj ◽  
Jadwiga Hartwich ◽  
Aldona Dembinska-Kiec ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Large Vessel ◽  
Small Vessel ◽  
Vessel Disease ◽  
Lipid Abnormalities ◽  
Large Vessel Disease

scholarly journals Pre-micro RNA polymorphism detection in small versus large vessel disease in stroke patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H H Elkhawas ◽  
H H Afify ◽  
H Shokri ◽  
E Hassan ◽  
A Alzahaby
Keyword(s):  
Small Vessel Disease ◽  
Susceptibility Gene ◽  
Large Vessel ◽  
Small Vessel ◽  
Stroke Patients ◽  
Functional Polymorphisms ◽  
Vessel Disease ◽  
Stroke Subtypes ◽  
Micro Rnas ◽  
Large Vessel Disease

Abstract Article Outline Abstract Introduction Patients and methods Procedure Statistical analysis Results Discussion Conclusion References Background Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. The methods currently available for diagnosis and prognosis of cerebral ischaemia still require further improvements. Micro-RNAs (small non-coding RNAs) have been recently reported as useful biomarkers in diseases such as cancer and diabetes. Further research concerned with microRNA (miRNA) profiling from peripheral blood to detect and identify characteristic patterns in ischaemic stroke is crucial. Aim of the work This study aims to investigate the association between three potentially functional polymorphisms in pre-miRNAs and stroke subtypes (small vessel disease and large vessel disease) in a sample of Egyptian stroke patients. Patients and Methods This is a cross sectional study conducted in Ain Shams University Hospitals in which 81 patients presenting with cerebrovascular stroke fulfilling criteria of small vessel disease (SVD) or large vessel disease (LVD) according to TOAST [2] classification in the period from March 2018 to August 2018 were included. Blood samples were withdrawn for DNA extraction to investigate the association between three potentially functional polymorphisms (rs2910164, rs11614913, and rs3746444) in pre-miRNAs (hsamiR-146a, hsa-miR-196a2, and hsa-miR-499, respectively). Results Smoking, hypertension and diabetes were significant value in both stroke subtypes. Meanwhile, age and gender showed no significance between both stroke subtypes. Conclusion Ischemic stroke has polygenic basis, but identification of stroke susceptibility gene and quantification of associated risks has been hindered by conflicting results from different studies.

Progression of Large Vessel Disease in Patients With Giant Cell Arteritis–Associated Ischemic Stroke

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Daniel Guisado-Alonso ◽  
M. Carmen Edo ◽  
Paula Valentina Estrada Alarcón ◽  
Sonia María García-Sánchez ◽  
Maria Àngels Font ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Large Vessel ◽  
Vessel Disease ◽  
Large Vessel Disease

scholarly journals The Apolipoprotein E and β-Fibrinogen G/A-455 Gene Polymorphisms Are Associated With Ischemic Stroke Involving Large-Vessel Disease

1997 ◽  
Vol 17 (11) ◽  
pp. 2880-2884 ◽  
Author(s):  
Christof Kessler ◽  
Carsten Spitzer ◽  
Dorothea Stauske ◽  
Sabine Mende ◽  
Jörg Stadlmüller ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Apolipoprotein E ◽  
Gene Polymorphisms ◽  
Large Vessel ◽  
Vessel Disease ◽  
Large Vessel Disease

Abstract W P54: Cardioembolic Strokes Have an Improved Clinical Outcome Following Intravenous Thrombolysis in Comparison With Strokes Caused by Large Vessel Disease

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marie Louise Schmitz ◽  
Claus Z. Simonsen ◽  
Irene K. Mikkelsen ◽  
Marie Louise Svendsen ◽  
Heidi Larsson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
Large Vessel ◽  
Stroke Subtype ◽  
Neurological Improvement ◽  
Vessel Disease ◽  
Ischemic Stroke Subtype ◽  
Large Vessel Disease ◽  
Iv Tpa

Introduction: Ischemic stroke prognosis given standard therapy differs according to the underlying pathophysiology. In contrast, the impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is less clear. Objectives: We examined the association between ischemic stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-selected patients treated with IV-tPA. Methods: We included consecutive MRI-evaluated patients treated with IV-tPA in a Danish stroke center between 2004 and 2010. Patients with DWI lesions >1/3 of the middle cerebral artery territory were excluded from treatment. The TOAST criteria were used to classify patients into a stroke subtype based on the results of the complete diagnostic work-up available at three months. A favorable 90-day outcome was defined as a modified Rankin Scale score of 0 to 1. Early neurological improvement was defined as complete remission of the neurologic deficit or an improvement of ≥4 on the NIHSS at 24 hours. Multivariable logistic regression analyses were used to compare outcomes among stroke subtypes adjusted for clinical and imaging characteristics. Results: A total of 557 patients were analyzed: 202 (36%) had large vessel disease, 153 (27%) had cardioembolic stroke, 109 (20%) had small vessel disease and 93 (17%) were of other or undetermined etiology. A favorable outcome was achieved by 361 (64.8%) patients. Patients with cardioembolic strokes were more likely to achieve a favorable outcome as opposed to large vessel disease patients (adjusted OR, 2.9 (95% confidence interval, 1.1-7.4)). Similarly, the probability of an early neurological improvement was increased in cardioembolic stroke patients in comparison with large vessel disease patients (adjusted OR, 3.5 (95% confidence interval, 1.6-7.6)). Conclusions: The ischemic stroke subtype influenced early as well as late clinical outcome after treatment with IV-tPA in MRI-selected patients. Our findings argue for a potentially more successful IV-tPA-induced recanalization in strokes of cardioembolic origin in comparison with large vessel disease strokes.

Changes in Performance on Wais, Trail Making Test and Finger Tapping Test Associated with Carotid Artery Surgery

1968 ◽  
Vol 26 (2) ◽  
pp. 399-404 ◽  
Author(s):  
Robert B. Duke ◽  
Byron M. Bloor ◽  
G. Robert Nugent ◽  
Hisham S. Majzoub
Keyword(s):  
Small Vessel Disease ◽  
Large Vessel ◽  
Finger Tapping ◽  
Trail Making Test ◽  
Vessel Disease ◽  
Trail Making ◽  
Finger Tapping Test ◽  
The Right ◽  
Large Vessel Disease

47 patients with vascular disease were divided into small vessel disease group (SVD), large vessel disease operated group (LVD-O) and large vessel disease nonoperated group (LVD-N). They were tested during their first hospitalization and at a follow-up some months later. There were no significant changes for any group on the Trail Making Test and on the Finger Tapping Test. On the WAIS the SVD made significant gains on the Verbal IQ (VIQ), Performance IQ (PIQ) and Full Scale IQ (FSIQ); the LVD-O made significant gains on PIQ and FSIQ; and the LVD-N made no significant gains on any of the three scores. Dividing the LVD-O by lesion laterality, the leftside lesioned group made significant gains on PIQ and FSIQ, while the right-side lesioned group made significant gains on all three measures.

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