Abstract P724: Perimenopausal Women With Migraine Present With Stroke at a Younger Age and With Less Comorbid Diabetes

Introduction: Migraine is an independent risk factor for ischemic stroke. Frequency and severity increases in the perimenopausal period accompanied by marked vasomotor symptoms (VMS) such as hot flashes, flushing and night sweats. There is emerging evidence that VMS increases the risk of vascular disease including stroke. The purpose of this study was describe the demographics and co-morbidities of perimenopausal females with and without migraine that experience acute ischemic stroke (AIS). Methods: In this IRB approved study, electronic health record (EHR) data was obtained from a large, academic, comprehensive stroke center from 1/1/2015 to 1/1/2020. Inclusion criteria included female sex, age 42-65 years, and hospital diagnosis code of AIS. Hemorrhagic stroke, TIA, vasculopathy, and endocarditis associated strokes were excluded. Perimenopause was defined as age ≥42 and ≤65 years. Hormonal and menopausal status was not available in the EHR. We compared the baseline demographics and co-morbidities by ICD10 codes of subjects with and without migraine. Chi squared was used to compare categorical data and t test for continuous. Spearman rho was used to assess correlations. Results: We identified 660 subjects who met study criteria (n=83 with migraine; n=577 without migraine). Migraine positive subjects were significantly younger (mean age 58 vs 66 years, p=0.03) at time of AIS. Migraine positive subjects identified significantly more often as White (47%) compared to Black (10%), Asian (7%), Pacific Islander (1%), Native American/Alaskan (1%), Other/Mixed Race (31%), and unknown (3%), p=0.001. There was no significant difference in Hispanic ethnicity (p=0.87), hypertension (p=0.66), hyperlipidemia (p=0.12), or atrial fibrillation (p=0.84). Comorbid diabetes was significantly higher in the non-migraine group (94% vs 6%, p<0.001). Conclusion: Perimenopausal women with concomitant history of migraine present with AIS at younger ages and with lower rates of diabetes than those without a migraine history. Future research must be done to assess the correlation of menopausal symptom severity, hormone levels at time of AIS, and stroke characteristics to further understand the role of menopause in stroke risk.

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Abstract P532: Does Atrial Fibrillation Impact Rate of Symptomatic Intracranial Hemorrhage in Acute Ischemic Stroke Patients Treated With rt-PA and/or Endovascular Treatment?

Stroke ◽

10.1161/str.52.suppl_1.p532 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Reza Bavarsad Shahripour ◽

Benjamin Shifflett ◽

Edward Labin ◽

Morgan Figurelle ◽

Anna Barminova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Smoking Status ◽

Intravenous Thrombolysis ◽

Significant Difference ◽

Chi Squared ◽

Symptomatic Intracranial Hemorrhage

Background: Patients with acute ischemic stroke (AIS) due to atrial fibrillation (afib) may have increased complications from intravenous thrombolysis or endovascular treatment (ET) compared to other stroke subtypes. The purpose of this study was to compare the rates of symptomatic intracranial hemorrhage (sICH) in patients with and without a history of a fib treated with IV rt-PA and/or ET. Methods: Consecutive stroke code activations were retrospectively analyzed from January 2004-June 2020 at an academic comprehensive stroke center. Patients were included if they were treated with IV rt-PA and/or ET within 24 hours of stroke onset. Patients were stratified into the six groups:1-No hx of a fib with ET only, 2-Hx of a fib with ET only, 3-No hx of a fib with IV rt-PA plus ET, 4-Hx of a fib with IV rt-PA plus ET, 5-No hx of a fib with IV rt-PA only, 6-Hx of a fib with IV rt-PA only. Primary outcome was defined as any sICH within 72 hours of treatment using the NINDS definition. Baseline demographics were compared. Chi squared was used to assess differences in sICH rates and logistic regression to compare individual groups. Analyses were both unadjusted and adjusted for baseline NIHSS, age, sex, baseline blood pressure, pre-stroke mRS, smoking status, and baseline glucose. Results: We identified 720 AIS patients who received acute treatment (IV rt-PA: n=578; ET: n=100; IV rt-PA+ET:n=18). There was a significant difference in sex (p=0.005); Hispanic ethnicity (p=0.002); current smoking (p=<0.001); current alcohol use (p=0.03), CHF (p=0.01); and age (p<0.0001) between groups. Baseline NIHSS was significantly higher in Group 4 (23, SD 8, p=<0.001).In adjusted analysis, there was no significant difference in sICH in patients with a fib after receiving IVtPA (OR 1.53, CI 0.47-4.99, p=0.48), ET (OR 0.93 , CI 0-∞, p=1.00), or both (OR 0.25,CI 0.00-9.07, p=0.45) compared to those without afib. There was no significant difference in sICH in adjusted analyses in patients with and without a fib overall (OR 0.93, CI 0-∞, p=1.00). Conclusion: In this study, atrial fibrillation did not have a significant impact on rates of sICH in AIS patients treated with IV rt-PA, ET, or both. This study supports the safety of IV rt-PA, ET, and combination therapy in the atrial fibrillation population.

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Abstract WP252: Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

Stroke ◽

10.1161/str.51.suppl_1.wp252 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Vaelan Molian ◽

Amir Shaban ◽

Aayushi Garg ◽

Kaustubh Limaye ◽

Kanika Sharma ◽

...

Keyword(s):

Young Adults ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Small Vessel Disease ◽

Cryptogenic Stroke ◽

Young Patients ◽

Diagnostic Studies ◽

Stroke In Young Adults ◽

Chi Squared ◽

Comprehensive Stroke Center

Introduction: Because acute ischemic stroke (AIS) in young adults is not rare, understanding trends in etiology may help decisions about evaluation and secondary stroke prevention. This study describes probable causes of AIS in a cohort of young adults and identifies changes in etiologies and diagnostic studies compared to 20 years ago. Methods: We retrospectively reviewed all patients aged 15-45 admitted to our comprehensive stroke center between 1/2010-11/2016 with AIS. Diagnostic studies and stroke etiologies for each patient were reviewed. We then compared our results to a historic sample of young patients who presented to our center in 1977-1993 using univariate chi-squared comparison for each etiology. Results: We identified 333 young adults, 169 (50.8%) were women. The mean age was 36.4±7.1 years. Vessel imaging was performed in 305 (91.3%) cases vs. 68.9% in the historic sample. Of these, 247 (81.0%) had magnetic resonance angiography (MRA). Transthoracic echocardiography (TTE) was performed in 101 (30.3%) and transesophageal echocardiography (TEE) was performed in 171 (51.4%) cases compared to 67.1% who underwent TTE in the historic sample. Etiologic comparisons to the historic sample yielded significant decline in small vessel disease ( P = .029) and a major increase in stroke of other identified cause ( P = .024). Other TOAST etiologies illustrated in Figure 1. The most common etiology for stroke in our sample was arterial dissection 84 (25.2%), whereas this was found in only 6.0% of patients in the historic sample ( P< .001). Conclusions: Using the TOAST classification, the most common subtype in young adults was stroke of other identified cause; a rate that reflects a marked increase in the diagnosis of dissection. Despite advancement in diagnostic studies, cryptogenic stroke remains a common category in young adults.

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Abstract WP14: Outcomes after Endovascular Therapy in a Population with Mild Acute Ischemic Stroke and Large Vessel Occlusion: Does Treatment Help?

Stroke ◽

10.1161/str.48.suppl_1.wp14 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Donald Frei ◽

Alessandro Orlando ◽

Richard Bellon ◽

Jeffrey Wagner ◽

Christopher V Fanale ◽

...

Keyword(s):

Therapy Group ◽

High Volume ◽

Large Vessel ◽

Vessel Occlusion ◽

Stroke Population ◽

Significant Difference ◽

Small Patient Population ◽

Chi Squared ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Patients with mild acute ischemic strokes (NIHSS ≤7, AISs) have been excluded from intra-arterial therapy (IAT) trials, limiting our understanding of their outcomes after IAT. Mild AIS with large vessel occlusions (LVOs) represent a fragile subset of mild AISs. Despite a low NIHSS, these patients can have a sudden failure of collateral circulation and deteriorate rapidly, resulting in significant disability. The objective of this study was to compare patient outcomes between those with mild AIS and LVO who did and did not received IAT. Methods: We included all adults (≥18) with a mild AIS due to an LVO admitted over 6.5 years to a high-volume comprehensive stroke center. Patients were excluded for any contraindication to IAT (n=240). Comparison groups were IAT vs. no therapy. Outcomes were sICH, in-hospital mortality, discharge mRS ≤2, and an improvement in NIHSS at discharge (>2 vs ≤2). Fisher’s, chi-squared, and logistic regression compared outcomes between groups. Results: There were 75 patients included in the study (Table 1). Overall 21% received treatment, and a majority of patients were 55-79 years, presented with hypertension and hyperlipidemia, and arrived within 4.5h from symptom onset. 7 patients also received IV-tPA. The IAT group had a significantly larger proportion of males, and hypo-mild strokes (NIHSS 4-7). There was one sICH in the no therapy group, and overall few deaths (Table 1). There was no significant difference between groups in improvement in NIHSS, and after adjusting for admission NIHSS, there was no significant difference in favorable discharge mRS. There were no IAT procedure complications. Conclusions: It remains to be seen whether IAT is beneficial in patients with mild AIS and LVO. Future, interventional, multi-center studies are needed to definitively determine the efficacy of IAT. Though these data come from a small patient population, they offer an insight into the potential safety of IAT in a fragile stroke population.

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Abstract W P400: Headache at the Onset of Anterior versus Posterior Circulation Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp400 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Caroline Cahill ◽

Kiersten Espaillat ◽

Emily Gilchrist ◽

Michael Froehler

Keyword(s):

Ischemic Stroke ◽

Cerebral Artery ◽

Medical Center ◽

Retrospective Chart Review ◽

Posterior Circulation ◽

Anterior Circulation ◽

Pain Pathways ◽

Significant Difference ◽

Chi Squared ◽

The Rich

Background: Past evidence suggests that there is a higher incidence of onset headache with posterior rather than anterior circulation stroke. We sought to further explore this connection in order to better understand the mechanisms underlying onset headache and to examine this symptom in relation to ischemic stroke. Methods: A retrospective chart review was conducted of 253 patients who presented to Vanderbilt University Medical Center in 2013 with ischemic stroke in either the anterior or posterior circulation. The significant difference between the incidence of onset headache in the anterior and posterior circulation territories was analyzed using a chi-squared test of independence. The frequency of onset headache was compared between the two groups, as well as between more specific locations within the posterior circulation and the middle cerebral artery (MCA). Results: A total of 48 (19%) of patients reported experiencing onset headache. Of those, 12 (25%) suffered a stroke in the anterior circulation, while 28 (58%) suffered a stroke in the posterior circulation (The remaining 8 were excluded due to multiple infarcts or poorly defined territories). Analysis was done comparing the MCA, the posterior cerebral artery (PCA), and the vertebrobasilar territories. The frequency of onset headache was 21% for vertebrobasilar stroke, 6.1% for MCA stroke, and 33% for PCA stroke. Compared to the other areas, PCA stroke showed a significantly higher rate of headache as a symptom at onset (χ 2 = 18.60, p < 0.001, ϕc = 0.312). Furthermore, 20 (42%) of the 48 patients in this study who had reported onset headache were found to have suffered ischemia of the thalamus. Conclusions: Patients who suffered a stroke in the PCA territory were more likely to have experienced a headache at stroke onset. Given the rich blood supply to the thalamus from the posterior circulation, an additional mechanism linking ischemic stroke in the PCA to thalamic pain pathways should be further scrutinized as a possible cause for onset headache.

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Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014050 ◽

2018 ◽

Vol 11 (3) ◽

pp. 221-225 ◽

Cited By ~ 14

Author(s):

Tracy E Madsen ◽

Eliza DeCroce-Movson ◽

Morgan Hemendinger ◽

Ryan A McTaggart ◽

Shadi Yaghi ◽

...

Keyword(s):

Sex Differences ◽

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Future Research ◽

Post Discharge ◽

Vessel Occlusion ◽

Males And Females ◽

Comprehensive Stroke Center ◽

Stroke Center

BackgroundIt is largely unknown whether functional outcomes after mechanical thrombectomy for large vessel occlusion (LVO) ischemic strokes differ by sex in non-clinical trial populations. We investigated sex differences in 90-day outcomes among ischemic stroke patients receiving mechanical thrombectomy.MethodsThis was a prospective cohort of adults treated with mechanical thrombectomy for LVO at a single academic comprehensive stroke center from July 2015 to April 2017. Data on independence (mRS ≤2) at hospital discharge and 90 days were collected prospectively. Multiple logistic regression was used to determine the association between sex and 90-day independence, first adjusting for demographics, pre-stroke mRS, and NIHSS, then by co-morbidities and time to thrombectomy, and finally by vessel recanalization and use of intravenous thrombolysis.ResultsWe included 279 patients, 52% of whom were female. Compared with males, females were older (median years (IQR) 81 (75–88) vs. 71.5 (60–81), P<0.001) and had higher baseline NIHSS (mean SD 18.2±7.5 vs . 16.0±7.1, P=0.02). Similar proportions of males and females had pre-stroke mRS ≤2 (73.3% vs.67.1%, P=0.27). In multivariate analyses, males and females had a similar likelihood of being independent at discharge (aOR 0.71 (95%CI 0.32 to 1.58)), but females were less likely to be independent at 90 days (aOR 0.37 95% CI 0.16 to 0.87).ConclusionsIn patients treated with mechanical thrombectomy for LVOs at a large comprehensive stroke center, females were less likely to be independent at 90 days. Future research should investigate contributors to poor outcomes post-discharge in females with LVOs, along with potential interventions to improve outcomes.

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Drip-and-Ship for Thrombectomy Treatment in Patients With Acute Ischemic Stroke Leads to Inferior Clinical Outcomes in a Stroke Network Covering Vast Rural Areas Compared to Direct Admission to a Comprehensive Stroke Center

Frontiers in Neurology ◽

10.3389/fneur.2021.743151 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christian A. Taschner ◽

Alexandra Trinks ◽

Jürgen Bardutzky ◽

Jochen Brich ◽

Ralph Hartmann ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Rural Areas ◽

Mortality Rates ◽

Functional Independence ◽

Stroke Onset ◽

Significant Difference ◽

Direct Admission ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Organizing regional stroke care considering thrombolysis as well as mechanical thrombectomy (MTE) remains challenging in light of a wide range of regional population distribution. To compare outcomes of patients in a stroke network covering vast rural areas in southwestern Germany who underwent MTE via direct admission to a single comprehensive stroke center [CSC; mothership (MS)] with those of patients transferred from primary stroke centers [PSCs; drip-and-ship (DS)], we undertook this analysis of consecutive stroke patients with MTE.Materials and Methods: Patients who underwent MTE at the CSC between January 2013 and December 2016 were included in the analysis. The primary outcome measure was 90-day functional independence [modified Rankin score (mRS) 0–2]. Secondary outcome measures included time from stroke onset to recanalization/end of MTE, angiographic outcomes, and mortality rates.Results: Three hundred and thirty-two consecutive patients were included (MS 222 and DS 110). Median age was 74 in both arms of the study, and there was no significant difference in baseline National Institutes of Health Stroke Scale scores (median MS 15 vs. 16 DS). Intravenous (IV) thrombolysis (IVT) rates differed significantly (55% MS vs. 70% DS, p = 0.008). Time from stroke onset to recanalization/end of MTE was 112 min shorter in the MS group (median 230 vs. 342 min, p < 0.001). Successful recanalization [thrombolysis in cerebral infarction (TICI) 2b-3] was achieved in 72% of patients in the MS group and 73% in the DS group. There was a significant difference in 90-day functional independence (37% MS vs. 24% DS, p = 0.017), whereas no significant differences were observed for mortality rates at 90 days (MS 22% vs. DS 17%, p = 0.306).Discussion: Our data suggest that patients who had an acute ischemic stroke admitted directly to a CSC may have better 90-day outcomes than those transferred secondarily for thrombectomy from a PSC.

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Abstract TP253: Ongoing Quality Improvement for Acute Ischemic Stroke at Comprehensive Stroke Center

Stroke ◽

10.1161/str.51.suppl_1.tp253 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shimeng Liu ◽

Zhu Zhu ◽

Mohammad Shafie ◽

Hermelinda Abcede ◽

Jay Shah ◽

...

Keyword(s):

Quality Improvement ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hospital Discharge ◽

Symptomatic Intracerebral Hemorrhage ◽

Significant Difference ◽

Time Periods ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Iv Tpa

Background: Ongoing quality improvement is essential for better outcomes and healthcare cost control. The aim of this study is to examine the progressive quality benchmarks for acute ischemic stroke (AIS) at an academic comprehensive stroke center (CSC). Methods: We retrospectively analyzed consecutive patients with AIS at University of California Irvine Medical Center from Jan 1 st , 2013 to Dec 31 th , 2018.Demographics and clinical data were collected from the Get-With-The-Guideline (GWTG) -Stroke registry and electronic medical records. Patients were stratified into 3 time periods according to their admission dates: 2013 to 2014; 2015 to 2016; and 2017 to 2018. Quality benchmarks for AIS, including door-to-needle (DTN) times, rates of receiving IV tPA and/or endovascular thrombectomy (EVT), rate of symptomatic intracerebral hemorrhage (sICH), and outcomes at hospital discharge were analyzed to identify trends of quality improvement in the last 6 years. Results: A total of 1369 patients were included in the study; 398 (29%) patients received acute reperfusion therapy, with 231 (17%) receiving IV tPA, 97 (7%) receiving both IV tPA and EVT, 70 (5%) receiving EVT only. There was no significant difference in baseline characteristics of the patients during the 3 time periods. IV tPA rates were 20% in 2013-2014, 30% in 2015-2016, and 22% in 2017-2018 ( p =0.0005). The EVT rates in 2017-2018 (15% vs. 9%; OR: 1.77; 95% CI: 1.16 - 2.68; p = 0.008) and 2015-2016 (14% vs. 9%; OR: 1.70; 95% CI: 1.11 - 2.59; p = 0.01) were significantly higher than in 2013-2014. There were significant ongoing improvements in median DTN times, with 57 minutes in 2013-2014, 45 minutes in 2015-2016, and 39 minutes in 2017-2018. Among patients receiving IV tPA, significantly more patients had favorable outcomes (mRS score 0-3) at hospital discharge in 2015-2016 (67% vs. 42%; OR: 2.80; 95% CI: 1.46 - 5.40; p =0.002) than in 2013-2014. Conclusions: We demonstrate ongoing improvement in rates of IV tPA and EVT as well as DTN times for IV tPA in patients with AIS.

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Abstract WP304: Real-World Experience with the RAPID Platform to Screen Acute Ischemic Stroke Patients at a U.S. Comprehensive Stroke Center

Stroke ◽

10.1161/str.51.suppl_1.wp304 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Rami-James Assadi ◽

Julia Henn ◽

Ajlana Varmaz ◽

Peter Panagos ◽

Michelle Miller-Thomas ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Real World ◽

Perfusion Imaging ◽

Number Needed To Screen ◽

Significant Difference ◽

Screening Efficiency ◽

Rapid Perfusion ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Mechanical thrombectomy (MT) is an important part of acute ischemic stroke (AIS) treatment. Recent trials of MT beyond the 6-hour window have utilized RAPID perfusion imaging for patient selection. The utility of this method is established in patients with large vessel occlusions (LVO) but screening efficiency in real-world practice remains unknown. We present the experience of a single, large volume, Comprehensive Stroke Center (CSC) utilizing RAPID to screen patients for LVO and MT. Methods: We performed a retrospective analysis of prospectively collected consecutive patients who presented to our emergency department (ED) between 01/2018 to 06/2019 with suspected LVO. Protocol was based on 2018 AHA guideline Level IA recommendations and followed DAWN and DEFUSE-3 time and imaging parameters. Patients who underwent RAPID imaging were selected for inclusion. Results: 865 patients met criteria for RAPID perfusion imaging (median age 67, females 52%, outside hospital transfers 29%). Of these, 178 (21% of total) were confirmed to have an LVO (40% ED presentation, 10% inpatient, 50% transfer). For patients presenting to the ED (N=509), 14% had an LVO (median NIHSS 13 [IQR 8-19]), of which 41% underwent MT. Mean CTP core and penumbra volume was 25mL and 100mL respectively. Number needed-to-screen in the ED cohort was 7 to detect LVO and 17 to perform MT. Transfer patients showed no significant difference in LVO detection or MT rates compared to ED patients (56%, p=0.3). Conclusions: In ED-presenting patients at a CSC, the number of RAPID perfusion imaging studies needed to detect an additional case of LVO was 7.1, and to perform an additional MT was 17.4. Current AHA Class IA recommendations for evaluation and treatment of AIS yield a reasonably high rate of LVO detection and subsequent MT in real-world practice. Additional multicenter data will be useful to establish benchmarks and improve screening efficiency.

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Abstract W P33: Functional MRI and CBF Responses to Transient Oxygen Challenges in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.45.suppl_1.wp33 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ona Wu ◽

Marjorie Villien ◽

Tijy Thankachan ◽

Steven Mocking ◽

William A Copen ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Experimental Stroke ◽

Future Research ◽

Z Score ◽

Strong Response ◽

Significant Difference ◽

Bold Responses ◽

Z Scores ◽

Negative Bold

Background: There is increasing interest in using oxygen challenges during MRI to image metabolic dysfunction in acute ischemic stroke. Methods: Subjects enrolled in a prospective MRI study of patients imaged within 48 h of stroke onset underwent arterial spin labeling (ASL) MRI for 10-12 min, while receiving a transient normobaric oxygen (NBO) challenge, according to this protocol: (1) Room air (RA) for 2-5 min; (2) NBO at 10-12 L/min via nonrebreather mask for 4 min; (3) RA for 2-4 min. ASL data were motion corrected and used to calculate CBF. Changes of blood-oxygen level dependent (BOLD) and perfusion MRI signal intensities during NBO were calculated (along with Z-scores) using FEAT. Mean changes within the DWI lesion (Core), ipsilateral normal tissue (IPS) and contralesional hemisphere (CNL) were compared. Results: Patient characteristics (N=19) were age 62±13 years, median admission NIHSS 12 [IQR 3-12], time-to-MRI 33±13 h, median Core volume 31.2 [IQR 14.3-68] cc. 6 patients were imaged after tPA therapy. One subject’s CBF data were unusable due to artifacts. Both hyperemia (N=8) and hypoperfusion (N=12) were observed in areas in and around the DWI lesion. Baseline CBF in Core was significantly higher than in CNL (P=0.01) and IPS (P=0.03), indicative of hyperemia. No significant difference was found for perfusion change in response to NBO (mean Z-score < 1.1 for all regions). In contrast, strong positive and negative BOLD responses were found both ipsilaterally and contralaterally. Negative BOLD responses were significantly smaller (P<0.01) in the Core (Z-score 1.3±1.6) than in either IPS (2.5±1.6) or CNL (2.5±1.4). Positive BOLD responses did not significantly differ across regions, but had high Z-scores (Core: 5.2±2.6, IPS: 5.8±2.7, CNL:5.8±2.9), indicating strong response to NBO. Discussion: Our results confirm previous reports in both human and experimental stroke models of strong increases in BOLD signal in response to NBO challenges. In addition, we found negative BOLD responses both ipsilesionally and contralesionally, often in conjunction with hyperemia, perhaps suggesting a steal effect. Future research may further elucidate the complexities of oxygen metabolism in stroke, perhaps encouraging the development of novel therapies.

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Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽

10.1024/0301-1526/a000656 ◽

2017 ◽

Vol 46 (6) ◽

pp. 484-489 ◽

Cited By ~ 7

Author(s):

Tom Barker ◽

Felicity Evison ◽

Ruth Benson ◽

Alok Tiwari

Keyword(s):

Venous Thromboembolism ◽

Varicose Vein ◽

Lower Incidence ◽

Varicose Veins ◽

Secondary Data ◽

Foam Sclerotherapy ◽

Increased Risk ◽

Significant Difference ◽

Chi Squared ◽

One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

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