Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Linxin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Angiography ◽  
Interobserver Agreement ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Difference ◽  
Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

scholarly journals Intracranial arterial stenosis in Caucasian versus Chinese patients with TIA and minor stroke: two contemporaneous cohorts and a systematic review

2021 ◽  
pp. jnnp-2020-325630
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Frank J Wolters ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hong Kong ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Arterial Stenosis ◽  
Chinese Patients ◽  
Minor Stroke ◽  
Vascular Risk ◽  
Intracranial Arterial Stenosis ◽  
Different Populations

BackgroundIntracranial arterial stenosis (ICAS) is an important cause of stroke worldwide. Separate reports in Caucasians and Asians with stroke/transient ischaemic attack (TIA) have suggested lower ICAS prevalence in Caucasians, but there has been no direct comparisons of the two ethnic groups with the same criteria to define ICAS.MethodsAcute minor stroke or TIA patients in two cohorts respectively recruiting patients in Oxford (2011–2018, predominantly Caucasians) and Hong Kong (2011–2015, predominantly Chinese) were compared. ICAS was defined as ≥50% stenosis/occlusion in any major intracranial artery in MR/CT angiography. Prevalence, distribution and risk factors of ICAS were compared between the two cohorts. We also systematically reviewed literature on ICAS prevalence in stroke/TIA patients in different populations.ResultsAmong 1287 patients from Oxford and 691 from Hong Kong (mean age 69 vs 66), ICAS prevalence was higher in Chinese than in Caucasians (43.0% vs 20.0%; OR 3.02; 95% CI 2.47 to 3.70; p<0.001), independent of age (age-adjusted OR 3.73; 95% CI 3.00 to 4.63; p<0.001) and vascular risk factors (multivariable-adjusted OR 3.21; 95% CI 2.56 to 4.02; p<0.001). This ethnic difference was greater (p interaction=0.005) at age <70 years (OR 5.33; 95% CI 3.79 to 7.50; p<0.001) than at ≥70 years (OR 2.81; 95% CI 2.11 to 3.74; p<0.001). ICAS prevalence increased with age and with vascular risk factors in both cohorts, with equivalent prevalence in Chinese aged <60 years and Caucasians aged ≥80, and in Chinese with no vascular risk factor and Caucasians with two vascular risk factors. ICAS locations also differed between Chinese and Caucasian patients.ConclusionsChinese are more susceptible to ICAS than Caucasians, with an earlier onset age and a higher prevalence, independent of vascular risk factors.

Abstract 176: The Feasibility of Intravenous Flat-Detector CT (IV FDCT) Angiography for Intracranial Arterial Stenosis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Seung Sheen ◽  
Jin Sue Jeon ◽  
Jeong Eun Kim ◽  
Jae Seung Bang ◽  
Young-Je Son
Keyword(s):  
Arterial Stenosis ◽  
Rank Test ◽  
Digital Subtraction ◽  
Intracranial Arterial Stenosis ◽  
Severe Stenosis ◽  
Flat Detector ◽  
Feasible Alternative ◽  
Intracranial Arteries ◽  
The Difference ◽  
Ischemic Attack

BACKGROUND AND PURPOSE: Intravenous flat-detector CT (IV FDCT) angiography is an emerging technology for the detection of intracranial vascular disease. The study was conducted to determine the feasibility of IV FDCT in estimating major atherosclerotic intracranial arteries stenosis with digital subtraction angiography (DSA) as the reference. METHODS: DSA and IV FDCT were performed simultaneously in patients with transient ischemic attack or acute cerebral infarction. The degree and length of stenosis were measured. The stenotic vessels were categorized into four groups by the grade of stenosis: normal (<30%), mild (30-49%), moderate (50-69%) or severe (>70%). The vessels of the normal group were excluded from analysis to reduce spectrum bias. Measurement of vessels was recorded using an electric ruler by a qualified endovascular neurosurgeon and a neuroradiologist. RESULTS: A total of sixty-nine patients with 842 vessel segments were calculated. Mild (n=56), moderate (n=47) and severe stenosis (n=46) groups were analyzed. IV FDCT had a sensitivity of 97.6%, specificity of 96.9%, and a negative predictive value of 96.9% for detecting ≥50% stenosis and respective values of 91.9%, 98.2%, and 97.4 % for depicting ≥70% stenosis. The difference of stenotic length between two tests was not significantly difference as an increase in the severity of stenosis (Spearman’s rank test; r = - 0.12, p=0.13) CONCLUSION: IV FDCT can be a feasible alternative as a noninvasive method for evaluating stenosis of the major intracranial arteries.

Abstract 41: Prognostic Value of Perfusion MRI in Patients with Transient Ischemic Attack or Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joon Hwa Lee ◽  
Hyunjin Jo ◽  
Jihoon Cha ◽  
Woo-Keun Seo ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Perfusion Mri ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Ischemic Attack

Background and purpose: We aimed to investigate the role of perfusion MRI parameters (TTP: time to peak, CBF: cerebral blood flow, CBV: cerebral blood volume) as a prognostic factor for the risk of stroke recurrence or cardiovascular outcome in patients with transient ischemic attack (TIA) or minor stroke. Methods: We retrospectively reviewed TIA or minor stroke patients who underwent our stroke MRI protocol (DWI, perfusion MRI, and MRA) in a consecutively collected stroke registry. Primary outcome was nonfatal stroke recurrence and secondary outcome was cardiovascular composite outcome. Multivariate analysis was used to examine the association of perfusion MRI parameters and angiographic findings with the risk of stroke recurrence and cardiovascular event. Results: Of the 326 patients who met inclusion criteria, we identified 15(4.6%) nonfatal strokes and 25(7.7%) cardiovascular composite events during the first 1 year after the index TIA or minor stroke. The presence of regional delayed perfusion on TTP maps (p=0.002) and regional hyperperfusion on CBV maps (p<0.001) were associated with recurrent stroke. In MRA images, concomitant stenosis of the intracranial arteries and/or extracranial carotid arteries was associated with cardiovascular events (p=0.009). Using multivariate cox proportional hazard analysis, presence of regional hyperperfusion on CBV remained an independent predictor of recurrent stroke (HR 10.82, 95% CI 4.19-38.67, p<0.001) and cardiovascular event (HR 6.30, 95% CI 2.67-18.25, p<0.001). The AUC of the CBV maps was also greater than other parameters for the prediction of stroke recurrence (AUC=0.701, 95% CI 0.54-0.86) and cardiovascular composite outcome (AUC=0.628, 95% CI 0.50-0.76). Conclusions: Increased CBV on perfusion MRI, representing the hemodynamic status of postischemic hyperperfusion, could be more useful than other perfusion parameters in predicting poor prognosis of TIA or minor stroke patients.

Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis

Neurology ◽  
2019 ◽  
Vol 94 (2) ◽  
pp. e181-e189 ◽  
Author(s):  
Ming Yang ◽  
Anxin Wang ◽  
Jiejie Li ◽  
Xingquan Zhao ◽  
Liping Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Antiplatelet Therapy ◽  
Proportional Hazards ◽  
Dual Antiplatelet Therapy ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Activity Levels ◽  
Intracranial Arterial Stenosis ◽  
Vascular Events

ObjectiveTo evaluate the interaction effect of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the efficacy and safety of dual/single antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) by the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial.MethodsPatients with both MRI analysis and Lp-PLA2 testing results were included in the current subanalysis. The interaction of Lp-PLA2 activity with the effects of dual and single antiplatelet therapy were analyzed through Cox proportional hazards regressions model.ResultsAmong the 797 patients, the mean age was 63.1 ± 10.8 years, 518 (65%) were men, 356 (44.7%) had ICAS, and 441 (55.3%) did not. There were significantly more patients with elevated Lp-PLA2 activity in the ICAS group than in the non-ICAS group (43.8% vs 35.4%, p = 0.02). There was significant interaction between Lp-PLA2 activity levels and the 2 antiplatelet therapies for prevention of stroke recurrences and combined vascular events even after adjustment for confounding factors exclusively for patients with ICAS (p = 0.017, 0.017, respectively), but not for those without (p = 0.332, 0.674, respectively). Compared with aspirin alone, dual antiplatelet therapy significantly reduced the risk of stroke recurrences and combined vascular events (adjusted hazard ratio 0.33 [0.12–0.89], p = 0.028; 0.33 [0.12–0.89], p = 0.028, respectively) for patients with ICAS and nonelevated Lp-PLA2 activity.ConclusionsPresence of both ICAS and nonelevated Lp-PLA2 activity may predict better response to dual antiplatelet therapy in prevention of recurrent strokes and combined vascular events for patients with minor stroke or high-risk TIA.Clinicaltrials.gov identifierNCT00979589.

Characteristics and management of stroke in Korea: 2014–2018 data from Korean Stroke Registry

2019 ◽  
Vol 15 (6) ◽  
pp. 619-626 ◽  
Author(s):  
Han-Yeong Jeong ◽  
Keun-Hwa Jung ◽  
Heejung Mo ◽  
Chan-Hyuk Lee ◽  
Tae Jung Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Reperfusion Therapy ◽  
Lifestyle Changes ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Aging Populations ◽  
Care Patterns ◽  
Ischemic Attack

Background Lifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population. Aims We aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time. Methods This study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis. Results A total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060–1.131), p < 0.001). Conclusions This study provided analysis of nationwide, hospital-based, quality-controlled data from the Korean Stroke Registry database regarding changes in the characteristics, risk factors, and treatments of strokes in Korea.

scholarly journals Multiple Factor Analysis of Symptomatic Intracranial Arterial Stenosis

2017 ◽  
Vol 3 (2) ◽  
pp. 84-89
Author(s):  
Chuanqiang Qu ◽  
Yuanyuan Zhao ◽  
Qinjian Sun ◽  
Yifeng Du
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Protective Factor ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Group A ◽  
Group B

Objective To discuss the correlation among intracranial arterial stenosis and its risk factors. Methods A total of 486 patients with transient ischemic attack (TIA) or ischemic cerebral infarction were examined using color doppler flow imaging (CDFI) and transcranial doppler ultrosonography (TCD). According to the degrees of extracranial arterial stenosis, patients with mild-to-moderate extracranial stenosis were classified into group A (435 cases) while those with constant severe stenosis or occlusion were classified into group B (51 cases). The differences between the two groups of risk factors were compared, and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed. Results ① The risk factors that were significantly associated with intracranial arterial stenosis included age (P = 0.034) and gender (P = 0.044). ② Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension, diabetes, and coronary heart disease respectively (P < 0.05). ③ Compared with group A, patients in group B were older (P = 0.000), with a higher proportion of men (P = 0.037), and the intracranial arterial stenosis degrees were significantly higher (P = 0.013). ④ Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis (P < 0.05), and hyperlipidemia is a protective factor (P = 0.012). Conclusions Age, gender, hypertension, diabetes, coronary heart disease, and smoking are risk factors for the distribution of intracranial arterial stenosis. The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis. Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.

scholarly journals Poststroke Cognitive Decline: A Longitudinal Study from a Tertiary Care Center

2019 ◽  
Vol 10 (03) ◽  
pp. 459-464 ◽  
Author(s):  
Rameshwar Nath Chaurasia ◽  
Jitendra Sharma ◽  
Abhishek Pathak ◽  
Vijay Nath Mishra ◽  
Deepika Joshi
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Care Center ◽  
Tertiary Care ◽  
Rank Test ◽  
P Value ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Chi Squared ◽  
The Difference

Abstract Objectives Poststroke cognitive decline (PSCD) is a serious disabling consequence of stroke. The purpose of this study is to find the prevalence of PSCD and sociodemographic and clinical determinants of risk factors of PSCD. Materials and Methods This study was a prospective, hospital-based study conducted on 200 stroke patients from stroke registry during October 2015 to April 2017. Detailed clinical evaluation was done. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were used to determine PSCD after 3 and 6 months as per the Diagnostic and Statistical Manual of Mental Disorders V. Chi-squared test was used to find the association between two variables. The Wilcoxon signed-rank test was used to compare the difference in cognitive impairment between two follow-ups at 3 and 6 months, respectively. A p-value < 0.05 was considered statistically significant. Results The prevalence of PSCD measured by MoCA scale at 3 and 6 months was 67 and 31.6%, respectively. By MMSE scale, cognitive decline prevalence at 3 months was found to be 87 (46.3%), which reduced to 22 (17.1%) at 6 months. The association between MMSE scale and type of stroke was significant at 3 months. Conclusion One-third of the stroke patients developed PSCD within 3 months of onset of stroke, with different levels of severity. The major predictors of new-onset poststroke cognitive impairment were diabetes and hypertension. The prevalence of PSCD reduced significantly at 6 months of stroke on follow-up.

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