Abstract 207: A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Parth Dhruv ◽  
Jae Kim ◽  
Jonathan Koffel ◽  
David Anderson ◽  
Christopher Streib
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Recurrent Stroke ◽  
Fibrous Tissue ◽  
Definitive Treatment ◽  
Stroke Recurrence ◽  
Prevention Measures ◽  
Carotid Revascularization

Introduction: Carotid Web (CW) is a rare form of focal fibromuscular dysplasia that results in an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. There is uncertainty in diagnosis, prognosis, and optimal management of this uncommon entity. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods: Our literature search for CW and related terms yielded 1017 results. After a preliminary assessment of all 1017 retrieved manuscripts; 72 manuscripts were reviewed in detail. A total of 31 manuscripts met entry criteria and were included in our SLR. We present the demographics, cardiovascular (CV) risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality of CW patients. Results: Our SLR resulted in 104 patients with CW, (median age at presentation: 45.7 [IQR 45-57], 52.3% female). The majority (68.3%) of CW patients did not have CV risk factors, however, 22.2% of patients were smokers. 47.8% of patients suffered recurrent stroke. The majority of patients were ultimately treated with antiplatelet therapy (94.4%) and 21.2% underwent carotid revascularization (4.8% carotid stenting, 16.3% carotid endarterectomy). None of the patients who underwent revascularization had a reported stroke recurrence. See Table. Conclusions: CW is a rare disease leading to ischemic stroke in younger patients without typical CV risk factors. CW patients in our SLR were at extremely high risk for recurrent stroke (47.8%). Aggressive secondary stroke prevention measures are indicated in this patient population, however, the optimal treatment strategies remain unclear. Carotid revascularization may be the definitive treatment for certain patients with CW, but further studies are needed as incomplete reporting and potential publication bias limit our findings.

scholarly journals A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2872-2876 ◽  
Author(s):  
Andrew J. Zhang ◽  
Parth Dhruv ◽  
Philip Choi ◽  
Caitlin Bakker ◽  
Jonathan Koffel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Carotid Revascularization ◽  
Stroke Risk Factors ◽  
Patient Level

Background and Purpose— Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods— Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results— Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16–85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0–97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions— CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

Abstract 1122‐000169: The Carotid Web and Ischemic Stroke ‐ A Case Report

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Aravind Reddy ◽  
Neil Suryadevara ◽  
Hesham Masoud ◽  
Palma Shaw ◽  
Karen Albright
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Literature Review ◽  
Medical Therapy ◽  
Systematic Literature Review ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Patient Case

Introduction : Case report: 63 year old African American woman with history of hypertension presented with acute onset of expressive aphasia. Her neurologic exam and NIHSS was significant for moderate aphasia with paraphasic errors and impairment of repetition. She was outside the treatment window for IV thrombolytic therapy. CT angiography of the head and neck in the ED showed moderate 60–70% stenosis of the left internal carotid artery secondary to a carotid web. She was admitted to the stroke service and started on DAPT with ASA and clopidogrel. MRI brain was obtained, which confirmed a small acute infarct in the posterior margin of the left sylvian fissure. Methods : Intervention and Follow‐up: Vascular surgery and interventional neurology were consulted to discuss the treatment options for the patient’s carotid web. Give the unique nature of the patient’s web with its triple lumen appearance, carotid endarterectomy (CEA) was favored over stenting, and the patient underwent left CEA. There were no immediate complications, and she was continued on DAPT for 21 days, then ASA monotherapy. One month follow‐up carotid dopplers of the left ICA showed patent flow without significant stenosis. On follow‐up evaluations at 3 and 12 months, the patient’s speech deficits had improved significantly and she reported no new stroke‐like symptoms. Results : Literature Review: Carotid webs (CaW) may be a potentially underrecognized cause of ischemic strokes. CaW are thin, fibrous tissue that extends from the wall of the carotid artery into the lumen in a shelf‐like projection. It is believed to be a variant of fibromuscular dysplasia. It is hypothesized that blood stasis on the downstream surface of the web may result in thrombus formation and thromboembolic stroke. The optimal treatment for CaW remains unclear, however there is some evidence to suggest that antiplatelet therapy alone may be insufficient to prevent recurrent stroke, with rates of recurrent stroke of 30–50% from a systematic literature review. Furthermore, there have been no reports of CaW positive remodeling over time, so patients likely remain at elevated risk for ischemic stroke without intervention. Conclusions : Discussion: Case series as well as systematic literature review have shown high rates of stroke recurrence in CaW patients treated with medical therapy alone. Data is still limited, however, CEA and carotid artery stenting (CAS) appear to be safe and effective revascularization procedures for CaW, with potentially significant reduction in recurrent stroke risk. CEA was preferred in our patient case due to the triple‐lumen appearance of the carotid web (Figure). CaW is a relatively underappreciated cause of ischemic strokes and the optimal management is not well‐established, however medical therapy alone appears to be sub‐optimal with high rates of stroke recurrence. Our patient case shows that carotid revascularization can be safe may be effective in preventing stroke recurrence.

scholarly journals Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

2021 ◽  
Vol 23 (1) ◽  
pp. 51-60
Author(s):  
Yuesong Pan ◽  
Zixiao Li ◽  
Jiejie Li ◽  
Aoming Jin ◽  
Jinxi Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Antihypertensive Agents ◽  
Residual Risk ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Abstract 236: Poor Recurrent Stroke Prevention Knowledge in High Risk Stroke Survivors

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Janice V Scobie ◽  
Kezhen Fei ◽  
Rennie Negron ◽  
Stanley Turhim ◽  
Bernadette Boden-Albala ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Baseline Survey ◽  
Stroke Survivors ◽  
Prevention Measures ◽  
Cross Sectional ◽  
Stroke Knowledge

Stroke is highly prevalent. Control of hypertension, hyperlipidemia and appropriate antithrombotic use are important in preventing recurrent stroke. Inadequate control of cardiovascular (CV) risk factors and poor stroke knowledge among transient ischemic attack (TIA) and stroke survivors impact stroke recurrence. We used a community-based participatory approach to recruit TIA/stroke survivors from community and clinical sites into a randomized controlled stroke prevention educational intervention trial. We conducted a cross-sectional analysis of baseline survey responses describing demographics, clinical characteristics, and stroke knowledge. The sample (n=600) had a mean age of 63 and was mostly female (60%), Black or Hispanic (81%), and insured (98%). 72% had 2 or more CV risk factors: hypertension (33%), high low-density lipoprotein levels (43%), obesity (41%), and tobacco use (17%). 47% had 2 or more poorly controlled risk factors, and 65% did not have controlled blood pressure and cholesterol levels and antithrombotic use. Stroke knowledge of effective stroke prevention measures was poor. Most believed that diet (60%), exercise (36%), and stress reduction (36%) were most important for stroke prevention. Despite poor risk factor control and stroke prevention knowledge, 82% had a doctor and 2 or more visits in the past 6 months. Inadequate control of CV risk factors and poor stroke knowledge is widely prevalent among TIA/stroke survivors. A silent high risk for progression of recurrent strokes and CV comorbidities persists despite regular medical care. Interventions that improve knowledge, support behavioral change, and improve patient self-management skills are critical for effective secondary stroke prevention.

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

scholarly journals Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

2021 ◽  
pp. 239698732110585
Author(s):  
Elora Basu ◽  
Setareh Salehi Omran ◽  
Hooman Kamel ◽  
Neal S Parikh
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Stroke Risk Factors ◽  
Minor Ischemic Stroke ◽  
Using Data

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

scholarly journals Risk factors for orthodontic mini-implants in skeletal anchorage biological stability: a systematic literature review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
María Dolores Casaña-Ruiz ◽  
Carlos Bellot-Arcís ◽  
Vanessa Paredes-Gallardo ◽  
Verónica García-Sanz ◽  
José Manuel Almerich-Silla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Skeletal Anchorage ◽  
Biological Stability ◽  
Mini Implants

scholarly journals AB0602 IMPACT OF SOCIOECONOMIC FACTORS ON PAIN AND FUNCTION IN KNEE OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1337.2-1337
Author(s):  
T. W. Swinnen ◽  
M. Willems ◽  
I. Jonkers ◽  
F. P. Luyten ◽  
J. Vanrenterghem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Knee Osteoarthritis ◽  
Socioeconomic Factors ◽  
Systematic Literature Review ◽  
Intervention Effects ◽  
Socioeconomic Outcomes ◽  
And Function ◽  
The Impact

Background:The personal and societal burden of knee osteoarthritis (KOA) urges the research community to identify factors that predict its onset and progression. A mechanistic understanding of disease is currently lacking but needed to develop targeted interventions. Traditionally, risk factors for KOA are termed ‘local’ to the joint or ‘systemic’ referring to whole-body systems. There are however clear indications in the scientific literature that contextual factors such as socioeconomic position merit further scientific scrutiny, in order to justify a more biopsychosocial view on risk factors in KOA.Objectives:The aims of this systematic literature review were to assess the inclusion of socioeconomic factors in KOA research and to identify the impact of socioeconomic factors on pain and function in KOA.Methods:Major bibliographic databases, namely Medline, Embase, CINAHL, Web of Science and Cochrane, were independently screened by two reviewers (plus one to resolve conflicts) to identify research articles dealing with socioeconomic factors in the KOA population without arthroplasty. Included studies had to quantify the relationship between socioeconomic factors and pain or function. Main exclusion criteria were: a qualitative design, subject age below 16 years and articles not written in English or Dutch. Methodological quality was assessed via the Cochrane risk of bias tools for randomized (ROB-II) and non-randomized intervention studies (ROBIN-I) and the Newcastle-Ottawa Scale for assessing the quality of non-randomised studies. Due to heterogeneity of studies with respect to outcomes assessed and analyses performed, no meta-analysis was performed.Results:Following de-duplication, 7639 articles were available for screening (120 conflicts resolved without a third reader). In 4112 articles, the KOA population was confirmed. 1906 (25%) were excluded because of knee arthroplasty and 1621 (21%) because of other issues related to the population definition. Socioeconomic factors could not be identified in 4058 (53%) papers and were adjusted for in 211 (3%) articles. In the remaining papers covering pain (n=110) and/or function (n=81), education (62%) and race (37%) were most frequently assessed as socioeconomic factors. A huge variety of mainly dichotomous or ordinal socioeconomic outcomes was found without further methodological justification nor sensitivity analysis to unravel the impact of selected categories. Although the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was the most popular instrument to assess pain and function, data pooling was not possible as socioeconomic factors estimates were part of multilevel models in most studies. Overall results showed that lower education and African American race were consistent predictors of pain and poor function, but those effects diminished or disappeared when psychological aspects (e.g. discrimination) or poverty estimates were taken into account. When function was assessed using self-reported outcomes, the impact of socioeconomic factors was more clear versus performance-based instruments. Quality of research was low to moderate and the moderating or mediating impact of socioeconomic factors on intervention effects in KOA is understudied.Conclusion:Research on contextual socioeconomic factors in KOA is insufficiently addressed and their assessment is highly variable methodologically. Following this systematic literature review, we can highlight the importance of implementing a standardised and feasible set of socioeconomic outcomes in KOA trials1, as well as the importance of public availability of research databases including these factors. Future research should prioritise the underlying mechanisms in the effect of especially education and race on pain and function and assess its impact on intervention effects to fuel novel (non-)pharmacological approaches in KOA.References:[1]Smith TO et al. The OMERACT-OARSI Core Domain Set for Measurement in Clinical Trials of Hip and/or Knee Osteoarthritis J Rheumatol 2019. 46:981–9.Disclosure of Interests:None declared.

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