Abstract P81: SARS-CoV-2 and Stroke Characteristics a Report From the Multinational COVID-19 Stroke Study Group

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shima Shahjouei ◽  
Georgios K Tsivgoulis ◽  
Ghasem Farahmand ◽  
Eric Koza ◽  
Ashkan Mowla ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Health Expenditure ◽  
Mechanical Thrombectomy ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Unsupervised Machine Learning ◽  
Toast Criteria

Objective and Design: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. Main Outcome Measures: We investigated the association of demographics, clinical data, geographical regions, and countries’ health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions and Relevance: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. The stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

scholarly journals SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

2020 ◽  
Author(s):  
Shima Shahjouei ◽  
Georgios Tsivgoulis ◽  
Ghasem Farahmand ◽  
Eric Koza ◽  
Ashkhan Mowla ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Health Expenditure ◽  
Mechanical Thrombectomy ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Unsupervised Machine Learning ◽  
Toast Criteria

Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

scholarly journals PARAMETERS AFFECTING STROKE SEVERITY AND OUTCOME IN ACUTE STROKE PATIENTS TREATED WITH IV THROMBOLYSIS

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Yıldız Arslan ◽  
Mesut Cilli
Keyword(s):  
Risk Factors ◽  
Hemorrhagic Transformation ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Laboratory Findings ◽  
Stroke Group ◽  
The Mean ◽  
The Impact

Aim: Our aim is to evaluate vascular risk factors and laboratory findings in patients treated with IV thrombolysis, to compare these parameters according to neurological findings scored by a National Institutes of Health Stroke Scale (NIHSS) at admission, after 7 days and to investigate the impact of these parameters on stroke severity and outcome at 3rd month. Methods: We reviewed 53 consecutive acute ischemic stroke patients admitted within 0-4.5 h after stroke onset and treated with IV thrombolysis between 2014 March-2018 May. Patients with acute posterior circulation stroke, and who underwent endovascular intervention after thrombolysis were excluded. Demographic features, vascular risk factors, laboratory findings and hemorrhagic transformation, and NIHSS scores of patients at admission and after 7 days, and also 3rd month mRS scores were recorded. Results: The mean age of patients was 64.79±12.26 and 60.37 % of them were male. Mean NIHSS score at admission was 10.60±5.16 and one week after IV r-tPA treatment, the mean score was 7.07±5.39. Hemorrhagic transformation was 18.9%. The male ratio was significantly higher in mild-moderate stroke group (p=0.008), the prevalence of hypertension, diabetes, hemorrhagic transformation and blood urea levels were also significantly higher in severe stroke group than mild-moderate group (p≤ 0.05). In addition neutrophil levels was higher in severe group, but not statistically significant. Creatine levels were significantly higher in the poor outcome group (NIHSS difference <6) after one week.   Conclusion: Female gender, hemorrhagic transformation and high neutrophil levels were found to have impact on stroke severity towards poor prognosis independently.

Temporal trends in vascular risk factors and etiology of urban Polish stroke patients from 1995 to 2013

2015 ◽  
Vol 357 (1-2) ◽  
pp. 126-130 ◽  
Author(s):  
Jan P. Bembenek ◽  
Michał Karlinski ◽  
Tadeusz A. Mendel ◽  
Maciej Niewada ◽  
Iwona Sarzynska-Dlugosz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Temporal Trends ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Patients

Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Daphne Antillon ◽  
Natalie Valle ◽  
Kaiwen Lin ◽  
Waimei Tai ◽  
Mary Ann Gallup ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Sex Differences ◽  
Alcohol Abuse ◽  
Vascular Risk Factors ◽  
Medically Underserved ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Low Hdl ◽  
History Of

Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.

scholarly journals Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients

Stroke ◽  
2021 ◽  
Author(s):  
Lindsay S. McAlpine ◽  
Adeel S. Zubair ◽  
Ilavarasy Maran ◽  
Pola Chojecka ◽  
Paul Lleva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Endothelial Activation ◽  
Vascular Risk Factors ◽  
Interquartile Range ◽  
Stroke Onset ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Markers Of Inflammation ◽  
Von Willebrand

Background and Purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor. Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause. Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13–375] versus 8 [4–11], P <0.01) and sIL (soluble IL)-2 receptor (1972 [1525–4720] versus 767 [563–1408.5], P =0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%–382%] versus 150% [128%–183%], P =0.034; von Willebrand antigen 330.0% [265%–650%] versus 152% [130%–277%], P =0.007, and factor VIII 301% [289%–402%] versus 49% [26%–94%], P <0.001). Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.

THE VASCULAR RISK FACTORS ASSOCIATED WITH ANTIPLATELET RESISTANCE IN ISCHEMIC STROKE PATIENTS

2020 ◽  
pp. 144-147
Author(s):  
RIZALDY TASLIM PINZON ◽  
BULAN MARCHELLIA WIJAYA
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Ischemic Heart Disease ◽  
Vascular Risk Factors ◽  
Ischemic Heart ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Elderly Age ◽  
Factors Associated

Objectives: This research is to measure the prevalence rate of antiplatelet resistance in ischemic stroke patients and measure the vascular risk factors associated with antiplatelet resistance in patients with ischemic stroke. Methods and Subjects: This was a cross-sectional study with the number of respondents in this study amounted to 155 patients who all had ischemic stroke disease at Bethesda Hospital in Yogyakarta Indonesia used stroke registry to complete the data of the risk factors. VerifyNow method is used to measure the responsiveness of antiplatelet therapy. Results: Among the 155 patients with ischemic stroke, 45 were women (29%), 110 were men (71%), and the elderly (age more than 60 years old) in 81 patients. In total 155 patients with ischemic stroke, 106 of them have hypertensive, with diabetes are 19 patients, dyslipidemia is 90 patients, and ischemic heart disease in 13 patients. The prevalence of antiplatelet resistance in risk factors, for age more than 60 years, is 21 patients (25%, RR=1.06, *p=0.96), in diabetes is 7 patients (36%, RR=1.17, **p=0.74), dyslipidemia is 19 patients (21%, RR=0.68, ***p=0.24), and ischemic heart disease is four patients (30%). Among 127 patients, 22% (28 patients) had aspirin resistance, while from 42 patients, 26.2% (11 patients) were resistant to clopidogrel. Conclusion: Antiplatelet resistance is common in ischemic stroke patients. One of five patients treated with antiplatelet showed non-responsiveness. Vascular risk factors do not increase the risk of antiplatelet resistance in ischemic stroke patients.

Abstract 7: Association Between Incidence, Severity and Recurrence of Ischemic Stroke and Risk of Dementia: The Atherosclerosis Risk in Communities Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Silvia Koton ◽  
James R Pike ◽  
Michelle C Johansen ◽  
David Knopman ◽  
Kamakshi Lakshminarayan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Expert Review ◽  
Increased Risk ◽  
Atherosclerosis Risk

Background: Ischemic Stroke (IS) is associated with an increased risk of dementia, but the relative contribution of IS severity or recurrence to cognition is not known. We aimed to determine the risk of dementia after incident IS and how it varies by stroke severity and recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Methods: 15,405 ARIC participants free of stroke and dementia at baseline (1987-9) were followed for IS and dementia through 2019. Incident and recurrent IS were classified by expert review of hospital records, with stroke severity by the National Institutes of Health Stroke Scale (NIHSS) classified as NIHSS≤5, 6-10, 11-15, ≥16. Dementia cases were adjudicated through expert review of in-person evaluations, informant interviews, phone assessments, hospitalization code or death certificates. Poisson regression models with robust error variance were used to estimate dementia incidence in participants with and without IS, and associations between time-dependent IS incidence (excluding dementia in the first year after stroke), frequency and severity, and dementia were studied with Cox proportional hazards models, adjusting for demographics, APOE ε4 and vascular risk factors . Results: 1151 IS (970 incident) and 2807 dementia cases were identified. NIHSS was available for 877 IS (76%). Adjusted incidence rates (95% CI) of dementia per 100 person-years were 0.45 (0.42-0.49) in participants without IS vs. 1.33 (1.15-1.55) in those with IS. Compared to no IS, risk of dementia (adjusted HR, 95% CI) increased with IS number and severity from 1.71 (1.47-1.99) for participants with one IS to 6.68 (3.58-12.46) for those with ≥3 events, and from 1.64 (1.36-1.98) for NIHSS≤5 to 4.43 (1.84-10.68) for NIHSS≥16 ( Table ). Conclusion: Risk of dementia is significantly increased after stroke, independent of vascular risk factors. These data suggest a dose-response relationship between number of stroke events and stroke severity, and risk of dementia.

scholarly journals Age in relation to comorbidity and outcome in patients with high-risk TIA or minor ischemic stroke: A Swedish national observational study

2020 ◽  
pp. 239698732097598
Author(s):  
Oskar Fasth ◽  
Eva Lesén ◽  
Peter Appelros ◽  
Bahman Farahmand ◽  
Jonatan Hedberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
High Risk ◽  
Observational Study ◽  
Vascular Risk Factors ◽  
Stroke Severity ◽  
Vascular Risk ◽  
Vascular Events ◽  
Risk Of Death ◽  
Minor Ischemic Stroke

Introduction Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. We aimed to investigate this population regarding influence of age on vascular risk factors, hospital stay and mortality. Patients and methods Data on patients aged 40–100 years with TIA or ischemic stroke in the Swedish Stroke Register during 2012–13 were linked with national registers. To identify patients with high-risk TIA (ABCD2 ≥6) or minor ischemic stroke (NIHSS ≤5) eligible for DAPT, we excluded patients with atrial fibrillation, anticoagulant use, prior major bleeding, or unknown stroke severity. Findings We identified 10,053 potential DAPT-candidates (mean age 72.6 years, 45.2% female, 16.4% with TIA). With advancing age, most vascular risk factors increased. Antiplatelet treatment increased from 31.9% before the event to 95.5% after discharge. Within 1 year following index event, the proportion of patients with ≥1 re-admission increased with age (29.2% in 40–64 year-olds; 47.2% in 85–100 year-olds). All-cause death per 100 person-years was 6.9 (95% CI 6.4–7.4) within 1 year, and highest in the first 30 days (15.2; 95% CI 12.8–18.2). For each year of increased age, the risk of death increased with 3.5% (p = 0.128) in patients 40–64 years and with 11.8% (p < 0.001) in those ≥85 years. Conclusions While in theory representing a subset of patients with mild injury, our observational study highlights substantial use of health-care resources and high mortality rates among patients with high-risk TIA or minor ischemic stroke assumed eligible for DAPT.

Abstract WP441: Association Between Troponin Levels and Embolic Stroke of Undetermined Source

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Santosh Murthy ◽  
Peter M Okin ◽  
Costantino Iadecola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sensitivity Analysis ◽  
Acute Stroke ◽  
Univariate Analysis ◽  
Vascular Risk Factors ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Artery ◽  
Vascular Risk ◽  
Elevated Troponin

Background: Asymptomatic elevations in serum troponin levels often occur in patients with acute ischemic stroke. We evaluated whether patients with embolic strokes of undetermined source (ESUS) have higher rates of asymptomatic elevated troponin than patients with small- or large-vessel strokes. Methods: The Cornell AcutE Stroke Academic Registry (CAESAR) prospectively enrolled all adults with acute stroke at Weill Cornell Medical Center from 2011 to 2014. The etiology of stroke was retrospectively ascertained by two independent neurologists, with a third resolving any disagreements. We included patients with ESUS and, as controls, those with small- or large-vessel strokes. We defined an asymptomatic troponin elevation as a value exceeding our laboratory’s upper limit (0.04 ng/mL) within 24 hours of presentation, in the absence of a clinically recognized acute myocardial infarction. We used the chi-square test to compare rates of elevated troponin in patients with ESUS versus controls. Multiple logistic regression was used to evaluate the association between ESUS and elevated troponin after adjustment for demographics, NIH Stroke Scale score, insular infarction, and vascular risk factors. In a sensitivity analysis, we excluded patients diagnosed with atrial fibrillation during ambulatory heart-rhythm monitoring. Results: Among 547 patients, 258 (47.3%) had ESUS and 285 (52.7%) had a small- or large-vessel stroke. Patients with ESUS were younger (mean age 65.7 vs. 69.6 years) and more often female, and had equally severe strokes, higher rates of insular infarctions, and fewer vascular risk factors. In univariate analysis, patients with ESUS more often had an elevated troponin than controls (14.7% versus 8.0%; P = 0.01). After adjustment for demographics, stroke severity, insular involvement, and vascular risk factors, ESUS remained associated with elevated troponin (OR, 2.44; 95%, 1.04-5.77). This result was unchanged in our sensitivity analysis. Conclusions: Elevations in serum troponin appear to be more common in patients with ESUS than in those with small- or large-artery strokes. Further research is required to understand the pathogenesis and significance of elevated troponin in patients with ESUS.

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