Abstract WP44: NIHSS Score Components Predict Infarct Volume in Minor Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Charlotte Herber ◽  
Amelia K Boehme ◽  
Howard Andrews ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Language Disorder ◽  
Infarct Volume ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Lesion Volume ◽  
Nihss Score ◽  
Therapeutic Implications ◽  
Significant Relationships ◽  
Minor Ischemic Stroke

Background: Prior studies have shown a correlation between the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume on diffusion weighted imaging (DWI); however data are limited in patients with minor stroke whose treatment is controversial. Our aim is to determine the association between DWI lesion(s) volume and the (1) total NIHSS score and (2) NIHSS components in a population of patients with minor ischemic stroke. Methods: We included all patients with minor stroke (NIHSS 0-5) who were enrolled in the prospective Stroke Warning Information and Faster Treatment (SWIFT) study. All patients were admitted to the hospital with a final diagnosis of stroke. We calculated lesion(s) volume (cm 3 ) on DWI sequence using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH, Version 7.1.1). Based on the distribution of lesion volume, we summarized the explanatory value into median cm 3 . We used non-parametric tests to study the association between the primary outcome, DWI lesion(s) volume, and the predictors (NIHSS score and its components). Results: 894 patients had a discharge diagnosis of ischemic stroke; 709 underwent MRI and 510 were DWI positive. There was a weak graded relationship between NIHSS score and median DWI lesion volume in cm 3 : (NIHSS 0: 7.1, NIHSS 1: 8.0, NIHSS 2: 17.1, NIHSS 3: 11.6, NIHSS 4: 19.0, NIHSS 5: 23.6). We also noted highly significant relationships between lesion volume and certain NIHSS components. Compared to patients without the deficit, the median lesion volume was significantly higher in patients with neglect (105.6 vs. 12.5,p=0.025), language disorder (34.6 vs. 11.9,p<0.001), and visual field deficits (185.6 vs. 11.6,p<0.001). Other components of the NIHSS were not associated with lesion volume. Conclusion: In patients with minor stroke, the nature of the neurological deficit improves prediction of infarct volume when added to the total NIHSS score. This may lead to clinical and therapeutic implications.

Abstract TP209: Decreased Heart Rate Variability in Patients With Minor Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sungwook Yu ◽  
YooHwan Kim ◽  
Kyung-Hee Cho ◽  
Byung-Jo Kim
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Autonomic Dysfunction ◽  
Minor Stroke ◽  
Axon Reflex ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Major Stroke

Introduction: Minor stroke or transient ischemic attack (TIA) is considered to have little effect on autonomic functions. However, it is unclear whether autonomic dysfunction in patients with minor stroke develops during acute stroke phase. Hypothesis: We evaluated whether patients with minor stroke had autonomic dysfunction during acute stroke phase. Methods: Patients with ischemic stroke or TIA were included. Those with diabetes and urological problems were excluded. Quantitative sudomotor axon reflex test (QSART), head-up tilt test (HUTT), sympathetic skin response (SSR), and heart rate variability (HRV) were performed during admission after acute stroke onset. HRV frequency measurements included time-domain and frequency-domain parameters. We analyzed the difference of autonomic function among patients with minor stroke (NIHSS score ≤ 3), major stroke (NIHSS score≥3) and TIA. Results: Total of 81 patients was included. There were 55 with minor ischemic stroke, 15 with major ischemic stroke, and 11 with TIA. RR interval of HRV was significantly different among three groups (938.8 ± 99.1 ms in TIA, 871.4 ± 104.9 ms in minor stroke, and 832.7 ± 107.8 ms in major stroke, P = 0.042). Parameters of HRV in patients with stroke had significantly lower compared to those with TIA [high frequency (HF) 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.013; the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD), 23.5 ± 9.3 ms vs 30.7 ± 11.6 ms, respectively, P = 0.023]. Moreover, HF and RMSSD significantly decreased in patients with minor stroke compared to those with TIA (HF, 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.038; RMSSD, 23.2 ± 9.4 ms vs 30.7 ± 11.6 ms, respectively, P = 0.05). Results of QSART, HUTT and SSR were not different among three groups. Conclusion: Patients with minor stroke had decreased HRV compared to those with TIA, indicating that even minor stroke could be associated with decreased parasympathetic activity at early stroke phase. Further studies will be needed to evaluate effects of autonomic dysfunction on clinical outcome in patients with minor stroke.

scholarly journals Large Vessel Occlusion in Patients With Minor Ischemic Stroke in a Population-Based Study. The Dijon Stroke Registry

2022 ◽  
Vol 12 ◽  
Author(s):  
Gauthier Duloquin ◽  
Valentin Crespy ◽  
Pauline Jakubina ◽  
Maurice Giroud ◽  
Catherine Vergely ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Occlusion ◽  
Population Based ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Arterial Imaging

Introduction:Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS and to depict characteristics of patients according to the presence of LVO in a comprehensive population-based setting.Methods:Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as that with a National Institutes of Health Stroke Scale (NIHSS) score of &lt;6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of an LVO.Results:Nine hundred seventy-one patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients, 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation [median 3 (IQR 2–5) vs. 2 (IQR 1–3), p = 0.001] with decreased consciousness (13.0 vs. 1.6%, p&lt;0.001) and cortical signs (56.5 vs. 30.8%, p = 0.009), especially aphasia (34.8 vs. 15.4%, p = 0.013) and altered item level of consciousness (LOC) questions (26.1 vs. 11.6%, p = 0.037). In multivariable analyses, only NIHSS score (OR = 1.45 per point; 95% CI: 1.11–1.91, p = 0.007) was associated with proximal LVO in patients with minor IS.Conclusion:Large vessel occlusion (LVO) in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.

scholarly journals Early Dabigatran Treatment After Transient Ischemic Attack and Minor Ischemic Stroke Does Not Result in Hemorrhagic Transformation

2020 ◽  
Vol 47 (5) ◽  
pp. 604-611
Author(s):  
Anas Alrohimi ◽  
Kelvin Ng ◽  
Dar Dowlatshahi ◽  
Brian Buck ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Minor Stroke ◽  
Optimal Timing ◽  
Minor Ischemic Stroke ◽  
Pre Treatment ◽  
Ischemic Attack ◽  
Ischemic Events

ABSTRACT:Objectives:The optimal timing of anticoagulation after ischemic stroke in atrial fibrillation (AF) patients is unknown. Our aim was to demonstrate the feasibility and safety of initiating dabigatran therapy within 14 days of transient ischemic attack (TIA) or minor stroke in AF patients.Patients and Methods:A prospective, multi-center registry (NCT02415855) in patients with AF treated with dabigatran within 14 days of acute ischemic stroke/TIA (National Institutes of Health Stroke Scale (NIHSS) ≤ 3) onset. Baseline and follow-up computed tomography (CT) scans were assessed for hemorrhagic transformation (HT) and graded by using European Cooperative Acute Stroke Study criteria.Results:One hundred and one patients, with a mean age of 72.4 ± 11.5 years, were enrolled. Median infarct volume was 0 ml. Median time from index event onset to dabigatran initiation was 2 days, and median baseline NIHSS was 1. Pre-treatment HT was present in seven patients. No patients developed symptomatic HT. On the day 7 CT scan, HT was present in six patients (one progressing from baseline hemorrhagic infarction type 1). Infarct volume was a predictor of incident HT (odds ratio = 1.063 [1.020–1.107], p < 0.003). All six (100%) patients with new/progressive HT were functionally independent (modified Rankin Scale (mRS) = 0–2) at 30 days, which was similar to those without HT (90%, p = 0.422). Recurrent ischemic events occurred within 30 days in four patients, two of which were associated with severe disability and death (mRS 5 and 6, respectively).Conclusion:Early dabigatran treatment did not precipitate symptomatic HT after minor stroke. Asymptomatic HT was associated with larger baseline infarct volumes. Early recurrent ischemic events may be clinically more important.

Abstract 2674: DWI Reversal is associated with Small Infarct Volume and Early Reperfusion in Patients with TIA and Minor Stroke. Data from VISION and CATCH study groups

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Negar Asdaghi ◽  
Jonathan I Coulter ◽  
Jayish Modi ◽  
Abdul Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Infarct Volume ◽  
Linear Trend ◽  
Minor Stroke ◽  
Accurate Estimation ◽  
Lesion Volume ◽  
Early Reperfusion ◽  
Tissue Hypoperfusion ◽  
Minor Ischemic Stroke

Introduction: One-third of patients with TIA and minor ischemic stroke (MIS) have evidence of ischemic penumbra, defined as hypoperfused regions that have not been irreversibly damaged. Diffusion weighted Imaging (DWI) lesions are thought to represent irreversibly damaged tissue. DWI reversal therefore has implications in accurate estimation of penumbra. We aimed to determine the rate of DWI reversal in this population. Methods: Patients with TIA/MIS (NIH Stroke Scale ≤ 3) were prospectively enrolled and imaged within 24 hours of symptom onset as part of two prospective imaging cohorts. Patients were included if their baseline modified Rankin scale (mRS) score was ≤1. All patients were followed clinically for 3 months and had a repeat MRI either at day 30 or 90. Baseline diffusion and perfusion lesions and follow-up FLAIR final infarct volumes were measured. Results: 418 patients were included; 55.5% had DWI lesions and 37% had PWI (Tmax+2s delay) deficits at baseline. A total of 337 (81%) patients had follow-up imaging. DWI reversal occurred in 22/192 (11.5%) of patients who had a diffusion lesion at baseline. The median time from symptom onset to follow-up imaging was not significantly different between those with or without DWI reversal (78.6 days, IQR=33.3 vs. 79.7 days, IQR= 59.4, p=0.65). The median DWI lesion volume was significantly smaller in those with reversal (0.27ml, IQR=0.75 ml) compared to those who did not reverse (1.45 ml, IQR=3.8 ml, p<0.001). Patients with concurrent perfusion deficits (Tmax+2s) were significantly less likely to have DWI reversal (6%) compared to those without evidence of tissue hypoperfusion (20%; p=0.003). DWI reversal occurred in 4% of patients with penumbral patterns ((Tmax+2s)-DWI) and 18% of those without penumbra (p=0.003).Severity of hypoperfusion defined as greater prolongation of Tmax (+2,+4, +6, +8s) did not affect the likelihood of DWI reversal (linear trend p=0.147). No patient with DWI reversal had a mRS of ≥2 at 90 day, compared to 19% of those with evidence of infarction on follow-up imaging (p= 0.02). Conclusion: DWI reversal is common in patients with TIA/MIS and is more likely to occur in those with smaller baseline lesions without concurrent tissue hypoperfusion. DWI reversal therefore should not have a significant effect on the accuracy of penumbra definition. These data suggest early reperfusion is correlated with DWI reversal and better clinical outcome as measured by mRS.

Abstract P592: Admission Hyperglycemia is Associated With Subsequent Ischemic Stroke After Transient Ischemic Attack or Minor Stroke: A Secondary Analysis of the POINT Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian C Mac Grory ◽  
Shadi Yaghi ◽  
Shreyansh Shah ◽  
Pratik Y Chhatbar ◽  
Carmelo Graffagnino ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Sensitivity Analyses ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Diabetic Patients ◽  
Lesion Volume ◽  
Minor Ischemic Stroke

Introduction: Hyperglycemia is associated with increased lesion volume and worse functional outcome after acute ischemic stroke, however, it is not known whether it is associated with further cerebrovascular events. The aim of this study was to examine the association between admission hyperglycemia and subsequent ischemic stroke. Methods: This was an exploratory analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which compared combined clopidogrel/aspirin with aspirin alone with respect to the primary outcome of subsequent ischemic stroke, myocardial infarction, or vascular death. We dichotomized patients based on a serum glucose threshold of 180mg/dl (chosen a priori based on the upper boundary of the active control arm of SHINE). We calculated hazard ratios (HR) for subsequent ischemic stroke at 90 days via a Cox proportional hazards model adjusting for age, sex, study treatment assignment and vascular risk factors. We performed sensitivity analyses excluding patients with a known history of diabetes and in patients whose index event was a TIA vs. minor stroke. Results: Of 4,878 patients in this analysis (mean age 64.6 years), 594 (12.2%) were hyperglycemic on presentation and 267 (5.5%) had a subsequent ischemic stroke within 90 days. Admission hyperglycemia was associated with subsequent ischemic stroke (HR 1.88; 95% CI:1.39-2.53, p<0.01). This association persisted after adjustment for relevant covariates (aHR 1.86, 95% CI: 1.37-2.52, p<0.01), in non-diabetic patients (n=3,529, aHR 3.1, 95% CI:1.7-5.7, p<0.01), in patients with TIA (n=2,327, aHR 2.2, 95% CI: 1.2-4.1, p<0.01), and in patients with minor ischemic stroke (n=2,304, aHR = 1.5, 95% CI: 1.1-2.2, p=0.02). Conclusions: Hyperglycemia portends a higher risk of subsequent ischemic stroke after adjusting for known predictors of stroke recurrence. This study may provide further support to pursuing aggressive secondary prevention strategies in this population.

Abstract W P26: Itemized NIHSS Subsets Predict MRI Positive Strokes In Patients With Mild Deficits

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Charlotte Herber ◽  
Joshua Z Willey ◽  
Howard Andrews ◽  
Randolph S Marshall ◽  
...  
Keyword(s):  
Visual Field ◽  
Infarct Volume ◽  
Final Diagnosis ◽  
Motor Deficits ◽  
Lesion Volume ◽  
Nihss Score ◽  
Visual Deficits ◽  
Multivariable Regression ◽  
The Mean ◽  
Attending Physician

Background: While imaging is useful in confirming the diagnosis of ischemic stroke, negative diffusion weighted imaging (DWI) is reported in up to 10% of patients. We aim to (1) identify predictors of MRI-positive stroke from the itemized NIHSS, and (2) to correlate subsets with infarct volume. Methods: Data were derived from the Stroke Warning Information and Faster Treatment study from 2006 to 2009 among patients with mild deficits (NIHSS 0-5) and attending physician final diagnosis of stroke. Using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH) (Version 7.1.1), we calculated lesion volume (cm3) from DWI sequence. Univariate models studied the association between itemized NIHSS subsets, including cortical deficits (visual field cut, aphasia, or neglect), and presence of DWI hyperintensity and lesion volume. Multivariable regression assessed factors predicting DWI-positive strokes; p<0.05 was considered significant. Results: Of 611 patients with a discharge diagnosis of stroke, 498 underwent MRI and 29.5% were DWI negative. On multivariate analysis, predictors of a positive DWI were NIHSS score of 3-5 (OR= 2.5, 95%CI:1.1-5.5), motor deficits (OR= 1.9, 95%CI:1.1-3.4), and ataxia (OR=3.0, CI:1.5-6.1). All patients with neglect and visual deficits were DWI positive (table). The mean lesion volume in cm3 was larger in patients with NIHSS 3-5 vs. NHSS 0-2 (49.0 vs. 17.3, p=0.002), cortical deficits (112.6 vs. 22.9, p<0.001), neglect (236.6 vs. 29.7, p<0.001), and visual deficits (245.7 vs. 26.4, p<0.001). Other subsets showed no differences. Conclusion: NIHSS score subsets predict DWI positivity and lesion volume in mild strokes. The presence of neglect or visual field deficit on the NIHSS subsets is highly likely to have an MRI correlate even in patients with low NIHSS.

Abstract WP47: Reperfusion Following Ischemic Stroke is Associated with Reduced Brain Edema

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hannah J Irvine ◽  
Thomas W Battey ◽  
Ann-Christin Ostwaldt ◽  
Bruce C Campbell ◽  
Stephen M Davis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Edema ◽  
Infarct Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Early Reperfusion ◽  
Echoplanar Imaging ◽  
Swelling Volume

Introduction: Revascularization is a robust therapy for acute ischemic stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. In stroke patients, early reperfusion consistently reduces infarct volume and improves long-term functional outcome, but there is little clinical data available regarding reperfusion edema. We sought to elucidate the relationship between reperfusion and brain edema in a patient cohort of moderate to severe stroke. Methods: Seventy-one patients enrolled in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) with serial brain magnetic resonance imaging and perfusion-weighted imaging (PWI) were analyzed. Reperfusion percentage was calculated based on the difference in PWI lesion volume at baseline and follow-up (day 3-5). Midline shift (MLS) was measured on the day 3-5 fluid attenuated inversion recovery (FLAIR) sequence. Swelling volume and infarct growth volume were assessed using region-of-interest analysis on the baseline and follow-up DWI scans based on our prior methods. Results: Greater percentage of reperfusion was associated with less MLS (Spearman ρ = -0.46; P <0.0001) and reduced swelling volume (Spearman ρ = -0.56; P <0.0001). In multivariate analysis, reperfusion was an independent predictor of less MLS ( P <0.006) and decreased swelling volume ( P <0.0054), after adjusting for age, baseline NIHSS, admission blood glucose, baseline DWI volume, and IV tPA treatment. Conclusions: Reperfusion is associated with reduced brain edema as measured by MLS and swelling volume. While our data do not exclude the possibility of reperfusion edema in certain circumstances, in stroke patients, reperfusion following acute stroke is predominantly linked to less brain swelling.

Abstract 3681: Early Anticoagulation Is Not Associated With Hemorrhagic Transformation Of Ischemic Stroke In Patients With Atrial Fibrillation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
H. B Brouwers ◽  
Svetlana Lorenzano ◽  
Lyndsey H Starks ◽  
David M Greer ◽  
Steven K Feske ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Data ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
P Value ◽  
Long Term Outcome ◽  
Nihss Score

Purpose: Hemorrhagic transformation (HT) is a common and potentially devastating complication of ischemic stroke, however its prevalence, predictors, and outcome remain unclear. Early anticoagulation is thought to be a risk factor for HT which raises the clinical question when to (re)start anticoagulation in ischemic stroke patients who have a compelling indication, such as atrial fibrillation. We conducted a prospective cohort study to address this question and to identify association of hemorrhagic transformation with outcome measures in patients with atrial fibrillation in the setting of acute ischemic stroke. Materials and Methods: We performed a prospective study which enrolled consecutive patients admitted with acute ischemic stroke presenting to a single center over a three-year period. As part of the observational study, baseline clinical data and stroke characteristics as well as 3 month functional outcome were collected. For this sub-study, we restricted the analysis to subjects diagnosed with atrial fibrillation. CT and MRI scans were reviewed by experienced readers, blinded to clinical data, to assess for hemorrhagic transformation (using ECASS 2 criteria), microbleeds and infarct volumes in both admission and follow-up scans. Clinical and outcome data were analyzed for association with hemorrhagic transformation. Results: Of 94 patients, 63 had a history of atrial fibrillation (67.0%) and 31 had newly discovered atrial fibrillation (33.0%). We identified HT in 3 of 94 baseline scans (3.2%) and 22 of 48 follow-up scans (45.8%) obtained a median of 3 days post-stroke. In-hospital initiation of either anti-platelet (n = 36; OR 0.34 [95% CI 0.10-1.16], p-value = 0.09) or anticoagulation with unfractionated intravenous heparin or low molecular weight heparin (n = 72; OR 0.25 [95% CI 0.06-1.15], p-value = 0.08) was not associated with HT. Initial NIH Stroke Scale (NIHSS) score (median 13.0 [IQR 15.0] vs. 7.0 [IQR 10.0], p-value = 0.029) and baseline infarct volume (median 17 [IQR 42.03] vs. 5 [IQR 10.95], p-value = 0.011) were significantly higher in patients with HT compared to those without. Hemorrhagic transformation was associated with a significantly higher 48-hour median NIHSS score (20 [IQR 3.0] vs. 2 [IQR 3.25], p-value = 0.007) and larger final infarct volume (81.40 [IQR 82.75] vs. 9.95 [IQR 19.73], p-value < 0.001). Finally, we found a trend towards poorer 3-month modified Rankin Scale scores in subjects with HT (OR 11.25 [95% CI 0.97-130.22], p-value = 0.05). Conclusion: In patients with atrial fibrillation, initial NIHSS score and baseline infarct volume are associated with hemorrhagic transformation in acute ischemic stroke. Early initiation of antithrombotic therapy was not associated with hemorrhagic transformation. Patients with hemorrhagic transformation were found to have a poorer short and long term outcome and larger final infarct volumes.

scholarly journals Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi’an stroke registry study of China[1]

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Factors Affecting ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.

Abstract TP315: D-dimer is Associated With 30-day Mortality in Acute Ischemic Stroke With Active Cancer

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ki Woong Nam ◽  
Chi Kyung Kim ◽  
Tae Jung Kim ◽  
Sang Joon An ◽  
Kyungmi Oh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Nihss Score ◽  
Patients With Cancer ◽  
Advanced Stages ◽  
D Dimer ◽  
Active Cancer

Background: Stroke in cancer patients is not rare, but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods: We included 210 ischemic stroke patients with active cancer. The data of 30-day mortality were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results: Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS score, D-dimer levels, CRP levels, frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. Initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independently from D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease of D-dimer levels, despite treatment, while the survivor group showed opposite responses. Conclusions: D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

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