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.

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.

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

Abstract 40: The Disappearing Core: Time to Re-think Irreversible Injury in This Era of Endovascular Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Amie W Hsia ◽  
Marie Luby ◽  
Rocco Armonda ◽  
Ai-hsi Liu ◽  
Richard T Benson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Good Clinical Outcome ◽  
New Era ◽  
Neurological Improvement ◽  
Acute Lesion ◽  
Ischemic Core ◽  
Irreversible Injury ◽  
Iv Tpa

Background and Purpose: Early and complete recanalization achieved in this new era of endovascular therapy (ET) can result in nearly imperceptible lesions on post-treatment MRI. In this context we have observed a pattern of lesion evolution on MRI that is atypical from that seen following IV tPA alone, including striking reversal of the ischemic core. We sought to determine the frequency of acute lesion reversal following ET, and its association with sustained reversal and clinical outcome. Methods: Patients were included in this study if: 1) ET for anterior territory ischemic stroke from Jan 2015 to July 2016, 2) baseline pre-ET and 24h MRI, and 3) consent for research. Two raters evaluated ADC maps for early “reversal” (defined visually as >50%) by comparing 24h to baseline. FLAIR MRI at 30d were later assessed for reversal from baseline, blinded to 24h scan. Early neurological improvement (ENI) was defined as decrease in NIHSS≥8 at 24h. Good clinical outcome defined as mRS≤2. Results: Twenty-two patients were included: median age 68.5 years, 73% women, median baseline NIHSS 19. Median time from last known well to recanalization 254 min. TICI 2b/3 in 91%. ADC reversal in 12 of 22 (55%) at 24h. Reversal at 30d was associated with 24hr (p=0.002) with two having no visually appreciable infarct at 30d. Baseline NIHSS did not differ for early reversal versus without (18.5 vs. 19.5), however NIHSS differed at discharge (1.5 vs. 8.5, p=0.003); early reversal is significantly associated with ENI (83% vs. 30%, p=0.027), but not with good clinical outcome at 30-90d (50% vs. 30%, p=0.415). Conclusions: In this new era of consistently effective ET, salvageable tissue includes not just penumbra but ischemic core, previously considered irreversibly injured. Despite lesion reversal and ENI, for some patients, independent outcome is not achieved, a finding that reinforces the need for adjunctive treatments to build upon the success of ET. Figure: Example of a patient with early ADC reversal.

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

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.

Blood pressure levels and the risk of intracerebral hemorrhage after ischemic stroke

Neurology ◽  
2016 ◽  
Vol 88 (2) ◽  
pp. 177-181 ◽  
Author(s):  
Nina A. Hilkens ◽  
Jacoba P. Greving ◽  
Ale Algra ◽  
Catharina J.M. Klijn
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Incidence Rate ◽  
Hazard Ratio ◽  
Stroke Subtype ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Ischemic Stroke Subtype

Objective:To investigate the association between blood pressure (BP) levels and risk of intracerebral hemorrhage (ICH) after ischemic stroke.Methods:We performed a post hoc analysis of data from the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a randomized clinical trial including 20,332 patients with recent noncardioembolic ischemic stroke. BP measurements were divided into predefined categories. We calculated incidence rates per BP category and performed multivariable Cox regression analysis with systolic blood pressure (SBP) and diastolic blood pressure (DBP) categories as time-dependent covariables.Results:One hundred thirty-three ICHs occurred during 50,778 person-years of follow-up, resulting in an incidence rate of 2.6 per 1,000 person-years. The incidence rate of ICH increased with increasing SBP and DBP categories. Risk of ICH was significantly higher in patients with SBP ≥160 mm Hg (hazard ratio 2.27, 95% confidence interval 1.34–3.86) compared with those with SBP of 130–<140 mm Hg and in patients with DBP ≥100 mm Hg (hazard ratio 3.08, 95% confidence interval 1.78–5.34) compared with those with DBP of 80–<90 mm Hg. The association between SBP or DBP and ICH did not differ by ischemic stroke subtype (p = 0.55 and 0.93).Conclusions:Among patients with recent noncardioembolic ischemic stroke, the risk of ICH is high. High SBP and DBP are associated with an increased risk of ICH. The association between BP and ICH is not dependent on ischemic stroke subtype.

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.

Sign in / Sign up

Export Citation Format

Share Document