Abstract TP422: Comparison of Natural History and Effect of Intracranial Stent Placement Between Patients With Intra-Dural and Those With Sub-Arachnoid Intracranial Arterial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sargun S Walia ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
Brandi R French ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Stent Placement ◽  
Cerebral Hemorrhage ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stent ◽  
Subarachnoid Spaces

Background: Intracranial stenosis can be located in intradural or subarachnoid space. It is unclear whether there are any differences in ipsilateral ischemic stroke risk, cerebral hemorrhage and death in response to stent placement in these two locations. Methods: We analyzed Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) data. We divided the patients based on location of arterial stenosis: intradural [petrous internal carotid artery (ICA), pre-cavernous ICA, cavernous ICA or pre-posterior inferior cerebellar artery (PICA) vertebral artery] and subarachnoid [post-cavernous ICA, middle cerebral artery, vertebral artery at the level of or distal to origin of PICA, or basilar artery]. Cox proportional hazards analyses were used to determine the effect of intradural versus subarachnoid location on risk of ipsilateral ischemic stroke, cerebral hemorrhage or death during the follow-up period. Results: A total of 451 patients with stenosis located in intradural (n=74, 16.4%) or subarachnoid (n=377, 83.5 %) spaces were followed for a mean (SD) period of 29.06 (15.22) months after randomization. The rate of ischemic stroke seen in intradural and subarachnoid spaces was 11.86% and 14.58%, respectively. The rate of cerebral hemorrhage in the intradural and subarachnoid spaces was 1.35% and 2.92 %, respectively. The rate of death in the intradural and subarachnoid spaces was 10.81% and 1.59%, respectively. In Cox proportional hazards analyses, the risk of ipsilateral ischemic stroke (HR 1.08, P = 0.46), cerebral hemorrhage (HR 1.05, P = 0.59) and death (HR 0.9, P = 0.9) was not significantly different between patients with intradural arterial stenosis and those with subarachnoid arterial stenosis. The interaction between location of stenosis and treatment (intracranial stent versus best medical treatment) was not significant for the either ipsilateral ischemic stroke (p= 0.21), cerebral hemorrhage (p= 0.18) or death (p=0.15). Conclusion: We did not find any evidence to suggest that there was any difference in natural history or response to intracranial stent placement in patients with intradural location of stenosis compared with those with subarachnoid location.

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.

Abstract 172: Does SAMMPRIS Support Stenting Compared to Medical Therapy for Subpopulations of Patients with Intracranial Arterial Stenosis?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Helmi L Lutsep ◽  
Michael J Lynn ◽  
George A Cotsonis ◽  
Colin P Derdeyn ◽  
Tanya N Turan ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Recurrent Stroke ◽  
Recent Change ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
P Value ◽  
Intracranial Arterial Stenosis ◽  
Baseline Factors

Objectives: To determine whether SAMMPRIS supported the use of stenting compared to medical therapy alone to prevent recurrent stroke in subpopulations of patients with symptomatic intracranial arterial stenosis. Methods: The primary outcome, 30-day stroke and death and later strokes in the territory of the qualifying artery, was compared in those with and without baseline factors in the two treatment arms, percutaneous transluminal angioplasty and stenting (PTAS) plus aggressive medical therapy (AMM) vs. AMM alone. Baseline factors included gender, age (<60 or ≥60 years), race (white or black), diabetes, hypertension, lipid disorder, smoking status, type of qualifying event (QE) (TIA, non-penetrator stroke or penetrator stroke), QE hypoperfusion symptoms (related to either change in position, exertion or recent change in antihypertensive), use of antithrombotic or proton pump inhibitor at baseline, days to enrollment (≤7 or >7), old infarcts in the same territory, percent stenosis (<80% or ≥80%), other artery stenosis and location of the symptomatic artery (internal carotid, middle cerebral, vertebral or basilar; and anterior or posterior). The subgroup analyses were conducted by fitting a Cox proportional hazards regression model that included treatment, treatment by time, the factor, and the treatment by factor interaction (p-value for which is reported). Results: A total of 451 patients were enrolled, 227 randomized to AMM and 224 to PTAS. Of all variables evaluated, the observed 2-year event rates were higher with PTAS than with AMM in the vast majority and the interaction with treatment was not statistically significant for any of the factors (Table). Conclusions: The SAMMPRIS results do not support the use of PTAS compared to medical treatment in any examined subpopulation of patients with symptomatic intracranial stenosis, including those with QE hypoperfusion symptoms.

Sex and Race Differences in the Risk of Ischemic Stroke Associated With Fasting Blood Glucose in REGARDS

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012296
Author(s):  
Tracy E. Madsen ◽  
D. Leann Long ◽  
April P. Carson ◽  
George Howard ◽  
Dawn O. Kleindorfer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Proportional Hazards ◽  
Fasting Blood Glucose ◽  
Cox Proportional Hazards ◽  
Race Differences ◽  
Prospective Longitudinal

Background:To investigate sex and race differences in the association between fasting blood glucose (FBG) and risk of ischemic stroke (IS).Methods:This prospective longitudinal cohort study included adults age ≥45 years at baseline in the Reasons for Geographic And Racial Differences in Stroke Study, followed for a median of 11.4 years. The exposure was baseline FBG (mg/dL); suspected IS events were ascertained by phone every 6 months and were physician-adjudicated. Cox proportional hazards were used to assess the adjusted sex/race-specific associations between FBG (by category and as a restricted cubic spline) and incident IS.Results:Of 20,338 participants, mean age was 64.5(SD 9.3) years, 38.7% were Black, 55.4% were women, 16.2% were using diabetes medications, and 954 IS events occurred. Compared to FBG <100, FBG ≥150 was associated with 59% higher hazards of IS (95%CI 1.21-2.08) and 61% higher hazards of IS among those on diabetes medications (95%CI 1.12-2.31). The association between FBG and IS varied by race/sex (HR, FBG ≥ 150 vs. FBG <100: White women 2.05 (95% CI 1.23-3.42), Black women 1.71 (95%CI 1.10-2.66), Black men 1.24 (95%CI 0.75-2.06), White men 1.46 (95%CI 0.93-2.28), pFBG*race/sex=0.004). Analyses using FBG splines suggest that sex was the major contributor to differences by race/sex subgroups.Conclusions:Sex differences in the strength and shape of the association between FBG and IS are likely driving the significant differences in the association between FBG and IS across race/sex subgroups. These findings should be explored further and may inform tailored stroke prevention guidelines.

Abstract 2646: Aortic Arch Plaques and Risk of Vascular Events in Subjects Without Prior Stroke

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Cesare Russo ◽  
Zhezhen Jin ◽  
Ralph L Sacco ◽  
Shunichi Homma ◽  
Tatjana Rundek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Aortic Arch ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Vascular Events ◽  
Increased Risk ◽  
Prior Stroke

BACKGROUND: Aortic arch plaques (AAP) are a risk factor for cardiovascular embolic events. However, the risk of vascular events associated with AAP in the general population is unclear. AIM: To assess whether AAP detected by transesophageal echocardiography (TEE) are associated with an increased risk of vascular events in a stroke-free cohort. METHODS: The study cohort consisted of stroke-free subjects over age 50 from the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study. AAP were assessed by multiplane TEE, and considered large if ≥ 4 mm in thickness. Vascular events including myocardial infarction, ischemic stroke and vascular death were recorded during the follow-up. The association between AAP and outcomes was assessed by univariate and multivariate Cox proportional hazards models. RESULTS: A group of 209 subjects was studied (mean age 67±9 years; 45% women; 14% whites, 30% blacks, 56% Hispanics). AAP of any size were present in 130 subjects (62%); large AAP in 50 (24%). Subjects with AAP were older (69±8 vs. 63±7 years), had higher systolic BP (146±21 vs.139±20 mmHg), were more often white (19% vs. 8%), smokers (20% vs. 9%) and more frequently had a history of coronary artery disease (26% vs. 14%) than those without AAP (all p<0.05). Lipid parameters, prevalence of atrial fibrillation and diabetes mellitus were not significantly different between the two groups. During the follow up (94±29 months) 30 events occurred (13 myocardial infarctions, 11 ischemic strokes, 6 vascular deaths). After adjustment for other risk factors, AAP of any size were not associated with an increased risk of combined vascular events (HR 1.07, 95% CI 0.44 to 2.56). The same result was observed for large AAP (HR 0.94, CI 0.34 to 2.64). Age (HR 1.05, CI 1.01 to 1.10), body mass index (HR 1.08, CI 1.01 to 1.15) and atrial fibrillation (HR 3.52, CI 1.07 to 11.61) showed independent association with vascular events. In a sub-analysis with ischemic stroke as outcome, neither AAP of any size nor large AAP were associated with an increased risk. CONCLUSIONS: In this cohort without prior stroke, the incidental detection of AAP was not associated with an increased risk of future vascular events. Associated co-factors may affect the AAP-related risk of vascular events reported in previous studies.

Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Faye L Norby ◽  
Lindsay G Bengtson ◽  
Lin Y Chen ◽  
Richard F MacLehose ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Real World ◽  
Proportional Hazards ◽  
Large Population ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Gi Bleeding ◽  
Cox Proportional Hazards Models ◽  
The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

scholarly journals Traffic-borne pollution as a risk factor for acute vascular events: a population study in Milan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Magnoni ◽  
R Murtas ◽  
A G Russo
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Proportional Hazards ◽  
Traffic Noise ◽  
Cox Proportional Hazards ◽  
Positive Trend ◽  
Traffic Intensity ◽  
Vascular Events ◽  
Remarkable Effect

Abstract Background Traffic-borne noise and air pollution have both been associated with cardiovascular and cerebrovascular diseases, albeit with inconsistent findings and issues of collinearity/mutual confounding. The present study aims at evaluating the role of long-term exposure to traffic-borne pollution as a risk factor for acute vascular events in a highly urbanized setting. Methods This is a population-based retrospective dynamic cohort study including all residents aged &gt;35 years in the municipality of Milan over the years 2011-2018 (N = 1087110). A noise predictive model and a NO2 land-use regression model were used to assign mean values of traffic noise at the day-evening-night level (Lden, dB) and NO2 concentration (µg/m3) to the residential address of each subject. Cox proportional hazards models were performed to assess the incidence of acute vascular events, with adjustment for potential confounders (age, sex, nationality, a socio-economic deprivation index) and sub-analyses for different outcomes (acute myocardial infarction, ischemic stroke, hemorrhagic stroke). Results A total of 27282 subjects (2.5%) had an acute vascular event. Models using NO2 yielded inconsistent results. When using Lden as a proxy of traffic intensity, there was a positive trend in risk with increasing levels of exposure, with an optimal cut-off for dichotomization set at 70 dB (HR 1.025, 95% C.I. 1.000-1.050). The association was observed specifically for ischemic stroke (HR 1.043, 95% C.I. 1.003-1.085) and hemorrhagic stroke (HR 1.036, 95% C.I. 0.969-1.107). When stratifying by age group and sex, a remarkable effect was found for hemorrhagic stroke in men aged &lt;60 (HR 1.439, 95% C.I. 1.156-1.792). Conclusions Living close to high-traffic roads was found to exert a small but tangible effect on the risk of stroke. The varying effects observed for specific outcomes and in different age and sex groups are likely due to different pathogenetic mechanisms at play, which warrant further investigation. Key messages Residential proximity to roads with high traffic intensity (mean traffic noise level over 70 dB) is a risk factor for stroke, especially for hemorrhagic stroke in middle-aged men. Further interventions aimed at reducing traffic intensity in highly urbanized cities may be justified in order to reduce morbidity and mortality from stroke.

scholarly journals Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients

2020 ◽  
Vol 9 (12) ◽  
Author(s):  
Jiancheng Wang ◽  
Xianglin Zhang ◽  
Zhuxian Zhang ◽  
Yuanyuan Zhang ◽  
Jingping Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Cox Proportional Hazards ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Inverse Association ◽  
Baseline Serum ◽  
Hypertensive Patients

Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.

One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

2019 ◽  
Vol 47 (1-2) ◽  
pp. 40-47 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Mushtaq H. Qureshi ◽  
Li-Ming Lien ◽  
Jiunn-Tay Lee ◽  
Jiann-Shing Jeng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Large Artery ◽  
Stroke Registry ◽  
Risk Of Death ◽  
Vertebrobasilar Artery

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0–49%; moderate to severe: 50–99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Results: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01–1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99–2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72–2.83), among patients with VBA occlusion after adjustment of potential confounders. Conclusions: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

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