Abstract WP188: Impact of Carotid Plaque Burden on Long-Term Outcomes in Ischemic Stroke Patients With Atrial Fibrillation

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Hyungjong Park ◽  
Young Dae Kim ◽  
Ji Joe Heo ◽  
Hyo Suk Nam
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Carotid Plaque ◽  
Plaque Burden ◽  
Stroke Patients ◽  
Long Term Outcomes

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

scholarly journals Pneumonia in acute ischemic stroke patients requiring invasive ventilation: Impact on short and long-term outcomes

2019 ◽  
Vol 79 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Etienne de Montmollin ◽  
Stephane Ruckly ◽  
Carole Schwebel ◽  
Francois Philippart ◽  
Christophe Adrie ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Invasive Ventilation ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Short And Long Term

scholarly journals Impact of the Total Number of Carotid Plaques on the Outcome of Ischemic Stroke Patients with Atrial Fibrillation

2019 ◽  
Vol 8 (11) ◽  
pp. 1897 ◽  
Author(s):  
Hyungjong Park ◽  
Minho Han ◽  
Young Dae Kim ◽  
Joonsang Yoo ◽  
Hye Sun Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Intima Media Thickness ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Prognostic Utility

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

O-001 Thrombectomy for acute ischemic stroke patients aged 80 years or older: long-term outcomes in 233 patients

2011 ◽  
Vol 3 (Suppl_1) ◽  
pp. A1-A1
Author(s):  
R. Nogueira ◽  
W. Smith ◽  
T. Jovin ◽  
D. Liebeskind ◽  
R. Budzik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Long Term Outcomes

Use of Magnetic Resonance Angiography to Predict Long-Term Outcomes of Ischemic Stroke Patients with Concurrent Stenoses in Hong Kong

2009 ◽  
Vol 28 (2) ◽  
pp. 112-118 ◽  
Author(s):  
B.L. Man ◽  
Y.P. Fu ◽  
Y.Y. Chan ◽  
W. Lam ◽  
C.F. Hui ◽  
...  
Keyword(s):  
Hong Kong ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Stroke Patients ◽  
Long Term Outcomes

Abstract WP187: Subclinical Macro and Microvascular Disease in Stroke-free Subjects With Nonsustained Atrial Fibrillation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ezgi Yetim ◽  
Ethem Murat Arsava ◽  
Ugur Canpolat ◽  
Rahsan Gocmen ◽  
Kader K Oguz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
White Matter ◽  
Carotid Artery ◽  
Carotid Plaque ◽  
Microvascular Disease ◽  
Plaque Burden ◽  
White Matter Disease ◽  
Atherosclerotic Burden ◽  
Carotid Distensibility

Introduction: Prevalence of nonsustained atrial fibrillation (NSAF), described as irregular atrial runs lasting shorter than 30-seconds, is higher in patients with ischemic stroke compared to stroke-free controls. Nonetheless, its role in causality of stroke and future cerebrovascular risk is still not established. Subclinical atherosclerotic burden and vascular stiffness are more prevalent, and have been shown to modify future risk of vascular events in patients with atrial fibrillation (AF). We aimed to determine the relationship between NSAF and subclinical atherosclerosis, vascular dysfunction and cerebral microvascular disease. Methods: Sonographic carotid distensibility metrics, carotid intima-media thickness (IMT), carotid plaque burden score (Ten Cate’s), middle cerebral artery (MCA) pulsatility index (PI) and cerebral white matter disease burden (Fazekas’ periventricular and subclinical scores) were studied in 263 stroke-free control subjects. 24-hour Holter monitoring documented NSAF in 27% of study population. Abnormality limits were set as mean±standard deviation. Results: Compared to those without NSAF (age 62±8 yr, 43% male), subjects with NSAF (age 67±9 yr, 31% male) had significantly higher total carotid plaque burden score (p=0.009) and significantly lower common carotid artery carotid distensibility (p=0.019). Maximum and averaged IMT, carotid stiffness and elastic modulus, and asymptomatic significant (≥50%) carotid artery stenosis were numerically higher. Patients with NSAF had significantly higher MCA PI (p=0.007) and numerically higher white matter disease scores. Regression analysis models showed that NSAF is one independent predictors of abnormal carotid distensibility (p=0.026) and presence of carotid plaque (p=0.023); but not for carotid plaque burden score (>4), MCA PI (>1.1) and IMT max (>0.966). Conclusions: The presence of a significant relationship between NSAF and presence of carotid artery plaque and decreased cervical artery distensibility raises the possibility that NSAF might be a reflection of subclinical atherosclerotic burden. This crosstalk between surrogate markers might explain the higher prevalence of NSAF in ischemic stroke patients.

Abstract TP3: Endovascular Thrombectomy Improves Long-Term Outcomes of Acute Ischemic Stroke Patients: A Real World Observational Study

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Wenbo Zhao ◽  
Shuyi Shang ◽  
Chuanhui Li ◽  
Longfei Wu ◽  
Jian Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Endovascular Thrombectomy

Long-Term Outcomes of Ischemic Stroke Patients with Concurrent Intracranial and Extracranial Stenoses and Ischemic Heart Disease

2010 ◽  
Vol 29 (3) ◽  
pp. 236-241 ◽  
Author(s):  
B.L. Man ◽  
Y.P. Fu ◽  
Y.Y. Chan ◽  
W. Lam ◽  
C.F. Hui ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Stroke Patients ◽  
Long Term Outcomes
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