Abstract P722: Triglyceride-Glucose Index is Associated With Early Neurological Deterioration in Single Subcortical Infarction

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ki-woong Nam ◽  
Keun-hwa Jung ◽  
Sang-bae Ko ◽  
Byung-woo Yoon
Keyword(s):  
Fasting Glucose ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Lipid Lowering ◽  
Vascular Territory ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Tyg Index ◽  
Early Neurological Deterioration ◽  
Subcortical Infarction

Introduction: Single subcortical infarction (SSI) has usually favorable prognosis, but early neurological deterioration (END) often occurs in their clinical courses. Fasting glucose and triglyceride are both risk factors for END. Therefore, the triglyceride-glucose (TyG) index that combines them can be a potent predictor of END. Hypothesis: We evaluated the relationship between TyG index and END in patients with SSI. Methods: We included consecutive patients with SSI within 72 hours of symptom onset between 2011 and 2015. END was defined as an increase of ≥ 2 on the total NIHSS score or ≥ 1 on the motor NIHSS score within the first 72 hours of admission. TyG index was calculated according to the following formula: TyG index = Ln [fasting triglyceride (mg/dL) x fasting glucose (mg/dL)/2]. Considering the effect directly on the formula, patients currently taking glucose- or lipid-lowering agents were excluded. Results: A total of 305 patients with SSI were included. In multivariable analysis, TyG index [adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI): 1.58-5.45] and age (aOR = 1.05, 95% CI: 1.01-1.09) were positively associated with END. In subgroup analysis based on the presence of diabetes, TyG index showed a meaningful association only in patients with diabetes history. In the analysis by type of SSI, TyG index and END were related only in patients with proximal SSI. When examined in accordance with the involved vascular territory, TyG index was associated with END in both the anterior circulation and posterior circulation. When examined in accordance with the involved vascular territory, TyG index was associated with END in both anterior circulation (aOR = 2.66, 95% CI: 1.24-5.68) and posterior circulation (aOR = 3.55, 95% CI: 1.03-12.26), but the posterior circulation had a larger aOR value. Conclusions: TyG index was associated with END in SSI patients. This tendency depends on the presence of diabetes and the location of the SSI lesion.

Abstract P665: Different Predictive Factors for Early Neurological Deterioration Based on the Location of Single Subcortical Infarction

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ki-woong Nam ◽  
Hyung-min Kwon ◽  
Yong-Seok Lee
Keyword(s):  
Multivariable Analysis ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Artery Disease ◽  
Subcortical Infarction ◽  
Anterior Posterior

Introduction: Patients with single subcortical infarction (SSI) have relatively favorable prognosis, but they often experience early neurological deterioration (END) in a clinical course. In addition, SSI is considered to differ in its prognosis and mechanism depending on the location of the lesion. Hypothesis: We compared the predictors for END in patients with SSI according to the location of the lesion. Methods: We included consecutive patients with SSI within 72 hours of symptom onset between 2010 and 2016. END was defined as an increase of ≥ 2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 hours of admission. Along with the analysis of the entire SSI patients, we also analyzed the predictors for END in the proximal/distal SSI patients and the anterior/posterior circulation SSI patients. Results: A total of 438 patients with SSI were evaluated. In multivariable analysis, initial NIHSS score [adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI): 1.15-1.60], pulsatility index (PI) (aOR = 1.25, 95% CI: 1.03-1.52), parent artery disease (PAD) (aOR = 2.14, 95% CI: 1.06-4.33), and neutrophil to lymphocyte ratio (NLR) (aOR = 1.24, 95% CI: 1.04-1.49) were positively associated with END. In patients with proximal SSI, initial NIHSS score, PI, PAD, and NLR showed positive associations with END. Meanwhile, no variable related to END was found in distal SSI. When we compared the predictors for END based on the involved vascular territory, initial NIHSS score and NLR were significantly associated with END in the anterior circulation. On the other hand, patient with SSI in the posterior circulation showed PI and PAD as independent predictors of END. Conclusions: Initial NIHSS score, PI, PAD, and NLR were associated with END in patients with SSI. The frequency and predictors for END were different depending on the location of SSI lesion.

Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions

2021 ◽  
pp. 174749302098406
Author(s):  
Ki-Woong Nam ◽  
Min K Kang ◽  
Han-Yeong Jeong ◽  
Tae J Kim ◽  
Eung-Joon Lee ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Fasting Glucose ◽  
Close Association ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Triglyceride Glucose Index ◽  
Early Neurological Deterioration ◽  
Subcortical Infarction

Background The research about the influence of triglyceride-glucose index on early prognosis in stroke is lacking. Aims In this study, we evaluated the association between triglyceride-glucose index and early neurological deterioration in patients with single subcortical infarctions. Methods Consecutive patients with single subcortical infarctions within 72 h of symptom onset between 2011 and 2015. Early neurological deterioration was defined as an increase of ≥2 in the total NIHSS score or ≥1 in the motor NIHSS score. The triglyceride-glucose index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. Results A total of 305 patients with single subcortical infarctions were evaluated. In multivariable analysis, the triglyceride-glucose index (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.58–5.45) and age (aOR = 1.05, 95% CI = 1.01–1.09) were associated with early neurological deterioration. In subgroup analysis according to the type of single subcortical infarctions, only patients with proximal single subcortical infarctions showed a significant association between the triglyceride-glucose index and early neurological deterioration (aOR = 2.92, 95% CI = 1.35–6.29). On the other hand, there was no statistical significance in patients with distal single subcortical infarctions. Patients with untreated diabetes also showed the close association between the triglyceride-glucose index and early neurological deterioration (aOR = 3.94, 95% CI = 1.47–10.52). Conclusions The triglyceride-glucose index was associated with early neurological deterioration in single subcortical infarctions. This association differed depending on the location of lesion and the presence of untreated diabetes.

scholarly journals Effect of Argatroban Combined With Dual Antiplatelet Therapy on Early Neurological Deterioration in Acute Minor Posterior Circulation Ischemic Stroke

2020 ◽  
Vol 26 ◽  
pp. 107602962090413 ◽  
Author(s):  
Ling-Shan Zhou ◽  
Xiao-Qiu Li ◽  
Zhong-He Zhou ◽  
Hui-Sheng Chen
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Dual Antiplatelet Therapy ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Safety Outcome ◽  
Early Neurological Deterioration ◽  
Symptomatic Intracranial Hemorrhage

There is a lack of studies on anticoagulant plus antiplatelet therapy for acute ischemic stroke. The present study made a pilot effort to investigate the efficacy and safety of argatroban plus dual antiplatelet therapy (DAPT) in patients with acute posterior circulation ischemic stroke (PCIS). We retrospectively collected patients diagnosed with acute PCIS according to inclusion/exclusion criteria. According to treatment drugs, patients were divided into an argatroban plus DAPT group and a DAPT group. The primary efficacy end point was the proportion of early neurological deterioration (END). The primary safety outcome was symptomatic intracranial hemorrhage. All outcomes were compared between the 2 groups before and after propensity score matching (PSM). A total of 502 patients were enrolled in the study, including 35 patients with argatroban plus DAPT and 467 patients with DAPT. There was a higher National Institutes of Health Stroke Scale (NIHSS) score in the argatroban plus DAPT group than the DAPT group before PSM (3 vs 2, P = .017). Compared with the DAPT group, the argatroban plus DAPT group had no END (before PSM: 0% vs 6.2%, P = .250; after PSM: 0% vs 5.9%, P = .298). Argatroban plus DAPT yielded a significant decrease in the NIHSS score from baseline to 7 days after hospitalization, compared with that of the DAPT group before PSM ( P = .032), but not after PSM ( P = .369). No symptomatic intracranial hemorrhage was found in any patient. A short-term combination of argatroban with DAPT appears safe in acute minor PCIS.

scholarly journals High neutrophil-to-lymphocyte ratio predicts early neurological deterioration in spontaneous intracerebral hemorrhage patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Wafaa S. Mohamed ◽  
Amr E. Kamel ◽  
Ahmed H. Abdelwahab ◽  
Mohamed E. Mahdy
Keyword(s):  
Intracerebral Hemorrhage ◽  
Complete Blood Count ◽  
Absolute Lymphocyte Count ◽  
Neurological Deterioration ◽  
University Hospital ◽  
Stroke Severity ◽  
Low Grade ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Gcs Score

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

scholarly journals Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without Thrombolysis

2015 ◽  
Vol 12 (3) ◽  
pp. 277-282 ◽  
Author(s):  
Chia-Yu Hsu ◽  
Chun-Yu Cheng ◽  
Yuan-Hsiung Tsai ◽  
Jiann-Der Lee ◽  
Jen-Tsung Yang ◽  
...  
Keyword(s):  
Neurological Deterioration ◽  
Anterior Circulation ◽  
Early Neurological Deterioration

scholarly journals Permanent Deployment of the Solitaire FR™ Device in the Basilar Artery in an Acute Stroke Scenario

2017 ◽  
Vol 7 (1-2) ◽  
pp. 6-11
Author(s):  
Miguel S. Litao ◽  
Erez Nossek ◽  
Keith DeSousa ◽  
Albert Favate ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Effective Means ◽  
Posterior Circulation ◽  
National Institutes Of Health ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Vessel Patency ◽  
Solitaire Fr

Background: Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary: We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages: Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.

Different Predictive Factors for Early Neurological Deterioration Based on the Location of Single Subcortical Infarction: Early Prognosis in Single Subcortical Infarction

Stroke ◽  
2021 ◽  
Author(s):  
Ki-Woong Nam ◽  
Hyung-Min Kwon ◽  
Yong-Seok Lee
Keyword(s):  
Odds Ratio ◽  
Pulsatility Index ◽  
Adjusted Odds Ratio ◽  
Neutrophil To Lymphocyte Ratio ◽  
Parent Artery ◽  
Nihss Score ◽  
Lymphocyte Ratio ◽  
Early Neurological Deterioration ◽  
Artery Disease ◽  
Subcortical Infarction

Background and Purpose: Patients with single subcortical infarctions (SSIs) have relatively a favorable prognosis, but they often experience early neurological deterioration (END). In this study, we compared the predictors for END in patients with SSI according to the location of the lesion. Methods: We included consecutive patients with SSIs within 72 hours of symptom onset presenting between 2010 and 2016. END was defined as an increase of ≥2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 in the motor NIHSS score within the first 72 hours of admission. Along with the analysis of all patients with SSI, we also analyzed the predictors for END in proximal/distal SSI patients and anterior/posterior circulation SSI patients. Results: A total of 438 patients with SSI were evaluated. In multivariable analysis, initial NIHSS score (adjusted odds ratio, 1.36 [95% CI, 1.15–1.60]), pulsatility index (adjusted odds ratio, 1.25 [95% CI, 1.03–1.52]), parent artery disease (adjusted odds ratio, 2.14 [95% CI, 1.06–4.33]), and neutrophil-to-lymphocyte ratio (adjusted odds ratio, 1.24 [95% CI, 1.04–1.49]) were positively associated with END. In patients with proximal SSI, initial NIHSS score, pulsatility index, parent artery disease, and neutrophil-to-lymphocyte ratio showed positive associations with END. Meanwhile, no variable related to END was found in the distal SSI group. When we compared the predictors for END based on the involved vascular territory, higher initial NIHSS score and neutrophil-to-lymphocyte ratio were significantly associated with END in patients with anterior circulation SSIs. On the contrary, higher pulsatility index values and the presence of parent artery disease were independent predictors for END in patients with SSIs in the posterior circulation. Conclusions: Initial NIHSS score, pulsatility index, parent artery disease, and neutrophil-to-lymphocyte ratio are associated with END in patients with SSIs. The frequency and predictors for END differ depending on the location of the SSI.

scholarly journals Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Seungyon Koh ◽  
Sung Eun Lee ◽  
Woo Sang Jung ◽  
Jin Wook Choi ◽  
Jin Soo Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Confidence Interval ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Multivariate Analyses ◽  
Multivariable Analysis ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Early Neurological Deterioration ◽  
Basilar Occlusion

Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups.Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group.Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4–154.4]) and reperfusion failure (eTICI < 2b67 (OR, 5.0 [95% CI, 1.3–19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1–2.0]), stroke onset-to-door time <24 h (OR, 5.3 [95% CI, 1.1–2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2–19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0–2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1–2.2]) were predictive of END-IP.Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.

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