External Counterpulsation Augments Blood Pressure and Cerebral Flow Velocities in Ischemic Stroke Patients With Cerebral Intracranial Large Artery Occlusive Disease

Background: : Intake of omega-3 polyunsaturated fatty acids, such as EPA, has been reported to have protective effects on various diseases including ischemic stroke. However, there have been few studies concerning the effect of omega-3 polyunsaturated fatty acids on hemorrhagic stroke. We studied associations of serum levels of EPA with stroke subtypes including primary ICH Methods: We have examined serum EPA and arachidonic acid (AA) levels in routine practice since 2009. To calibrate the EPA values, we calculated EPA/AA ratio. A total of 212 consecutive acute stroke patients and 27 control subjects were included. The patients 40 years old or younger were excluded. Ischemic stroke subtypes were determined based on TOAST criteria. Primary ICH was classified into lobar or nonlobar types, according to the region of the brain in which it occurred. Results: Of all the 157 ischemic stroke patients (female 47, mean age 72.9 years), 62 were classified with cardioembolic stroke (CES), 25 large-artery atherosclerotic (LAA), 22 small-vessel disease (SVD), and 48 other/undetermined causes (O/U). Of all the 55 ICH patients (female 23, mean age 71.0), 34 patients had nonlobar type, and 21 had lobar one. There were no significant intergroup differences in the mean EPA/AA ratio (p=0.525) among CES (EPA/AA= 0.67±0.42), LAA (0.70±0.30), SVD (0.65±0.45), O/U (0.62±0.38), nonlobar ICH (0.51±0.30), lobar ICH (0.64±0.33), and control (0.60±0.42) groups. However, the EPA/AA ratio of the nonlobar ICH group was considerably low. The EPA/AA ratio of the nonlobar ICH group was significantly (p=0.033) lower than that of the whole other groups (0.65±0.39) and significantly (p=0.003) lower than that of the entire ischemic stroke groups (0.67±0.40). Although the significant differences between the nonlobar ICH and the whole ischemic groups were also observed in systolic and diastolic blood pressure (195±37/107±25 mmHg vs 159±35/82±19 mmHg, p<0.001), multiple linear regression analyses showed the association between the EPA/AA and nonlobar ICH was independent from the blood pressure. Conclusions: Although the strongest risk factor for nonlobar ICH is hypertension, low EPA/AA ratio might play a role in the development of nonlobar ICH.

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Abstract TP202: Increased Pulse Pressure is Related to Higher Burden of Microvascular Brain Damage in Ischemic Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.tp202 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Maria C Zurru ◽

Claudia Alonzo ◽

Laura Brescacín ◽

Natalia Balián ◽

Maria V Baroni ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

White Matter ◽

Brain Damage ◽

Pulse Pressure ◽

White Matter Hyperintensities ◽

Large Artery ◽

Vascular Risk ◽

Stroke Patients ◽

Positive Correlation

Introduction: pulse pressure (PP), a marker of arterial stiffness, is a useful tool for measuring vascular aging. White matter hyperintensities (WMH), deep and periventricular, are the expression of subclinical ischemic brain damage. Hypotesis: our objective was to evaluate the relationship between pre-stroke blood pressure and the burden of WMH. Method: acute ischemic stroke patients, excluding TIA, were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic medical records and the presence of WMH was evaluated on admission MRI. Periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) were classified according to Fazekas scale (0-3). A correlation analysis between different components of blood pressure and WMH was performed. Results: 808 patients (59% females, mean age 77±11 years) were included between January 2009 and December 2014. Main vascular risk factors were: hypertension (83%), dyslipemia (64%), obesity (52%), smoking (37%), metabolic syndrome (37%), diabetes (14%), AF (19%), CKD (45%), CHD (14%), stroke (10%), peripheral artery disease (12%). There was a positive correlation between PP values and the severity of PVH (R 0.93) and DWMH (R 0.95), but not with SBP (R 0.48 and R 0.50) and DBP (R 0.52 and 0.47). (figure) Conclusion: different blood pressure components may have different deleterious effects on large and small vessels. Pulse pressure, a pulsatile component mainly reflecting large artery stiffness and wave reflections, was the only component of blood pressure with a positive correlation with the burden of WMH in our cohort. As the world is aging, is mandatory to identify predictors of subclinical brain damage, which is related to increased risk of dementia, depression, stroke and gait disorders.

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Abstract TP160: The Increasing Treatment Pressure Of External Counterpulsation Continuously Augments Blood Pressure But Not Cerebral Blood Flow Velocity Of Ischemic Stroke Patients

Stroke ◽

10.1161/str.44.suppl_1.atp160 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

WEN HUA LIN ◽

Li Xiong ◽

Jinghao Han ◽

Thomas Leung ◽

Yannie Soo ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Flow Velocity ◽

Blood Flow Velocity ◽

Cerebral Blood Flow Velocity ◽

Stroke Patients ◽

External Counterpulsation ◽

Treatment Pressure

Background: External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion but the optimal use of ECP in ischemic stroke has not been well documented. We aim to investigate the effects of increasing ECP treatment pressure on cerebral blood flow and blood pressure (BP). Methods: We recruited 38 acute ischemic stroke patients with large artery occlusive disease and 20 healthy elderly. Mean cerebral blood flow velocities (CBFV) of bilateral middle cerebral artery were monitored using transcranial dopper. Continuous beat-to-beat BP was measured via finger cuffs. We started ECP treatment pressure from 150mmHg, then gradually increased to 187.5mmHg, 225mmHg and 262.5mmHg. CBFV and BP were recorded before ECP and during each pressure increment respectively for 3 minutes. CBFV data of patients was analyzed based on whether it was ipsilateral or contralateral to the infarct. Results: Median NIHSS of stroke patients was 5.5 and mean time after stroke onset was 5.24 days. Mean BP was significantly elevated from baseline in both groups after ECP started. BP increase percentages of two groups similarly kept augmented following raised ECP pressure and reach maximium at 262.5mmHg (patients 16.9% vs. controls 16.52% compared with baseline). Under different ECP pressures, ipsilateral mean CBFV of stroke patients increased 5.15% (150mmHg), 4.35% (187.5mmHg), 4.55% (225mmHg) and 3.52% (262.5mmHg) from baseline. All were significantly higher than baseline but did not differ among different pressures. Contralateral mean CBFV changed likewise (5.16%, 4.02%, 3.7% and 3.34% increase from baseline). Mean CBFV of controls under ECP pressures did not increase from baseline. Conclusion: The increasing treatment pressure of external counterpulsation continuously augments blood pressure but not cerebral blood flow velocity of ischemic stroke patients with large artery occlusive disease. Cerebral blood flow velocity of stroke patients significantly increases from baseline under ECP pressure of 150mmHg but it reaches a plateau as ECP pressure further raises. Among 4 ECP pressures above, 150mmHg is the optimal treatment pressure for ischemic stroke due to higher risks of hypertension-related complications in acute stroke with higher ECP pressure.

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Preliminary Findings of External Counterpulsation for Ischemic Stroke Patient With Large Artery Occlusive Disease

Stroke ◽

10.1161/strokeaha.107.500132 ◽

2008 ◽

Vol 39 (4) ◽

pp. 1340-1343 ◽

Cited By ~ 31

Author(s):

Jing Hao Han ◽

Thomas W. Leung ◽

Wynnie W. Lam ◽

Yannie O. Soo ◽

Anne W. Alexandrov ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Patient ◽

Occlusive Disease ◽

Large Artery ◽

Ischemic Stroke Patient ◽

External Counterpulsation

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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Association of Ambulatory Blood Pressure and Heart Rate With Advanced White Matter Lesions in Ischemic Stroke Patients

American Journal of Hypertension ◽

10.1093/ajh/hpt199 ◽

2013 ◽

Vol 27 (2) ◽

pp. 177-183 ◽

Cited By ~ 11

Author(s):

Hyuk Sung Kwon ◽

Young-Hyo Lim ◽

Hyun Young Kim ◽

Hee-Tae Kim ◽

Hyung-Min Kwon ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Ischemic Stroke ◽

White Matter ◽

Ambulatory Blood Pressure ◽

White Matter Lesions ◽

Stroke Patients

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Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

PLoS ONE ◽

10.1371/journal.pone.0144260 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0144260 ◽

Cited By ~ 17

Author(s):

Wei Wu ◽

Xiaochuan Huo ◽

Xingquan Zhao ◽

Xiaoling Liao ◽

Chunjuan Wang ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

China Study

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Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽

10.1161/hyp.78.suppl_1.p132 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Zahra Abuzaid ◽

Sara Almuslem ◽

Farah Aleisa

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Recurrent Stroke ◽

Uncontrolled Hypertension ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Event ◽

Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

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Differential impact of white matter hyperintensity on the long-term outcome in ischemic stroke patients with large artery atherosclerosis according to age group

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.3335 ◽

2017 ◽

Vol 381 ◽

pp. 396-397

Author(s):

M. Baik ◽

H.C. Kim ◽

Y.D. Kim ◽

J.H. Heo ◽

H.S. Nam

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

White Matter Hyperintensity ◽

Large Artery ◽

Age Group ◽

Stroke Patients ◽

Differential Impact ◽

Term Outcome ◽

Long Term Outcome

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Analysis of microRNA signatures in ischemic stroke thrombus

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017597 ◽

2021 ◽

pp. neurintsurg-2021-017597

Author(s):

Jeong-Min Kim ◽

Jun-Soo Byun ◽

Jiah Kim ◽

Moo-Seok Park ◽

Soon Auck Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Expression Pattern ◽

Microarray Analysis ◽

Laboratory Data ◽

Microrna Expression ◽

University Hospital ◽

Large Artery ◽

Stroke Patients ◽

Qrt Pcr ◽

Functional Relevance

BackgroundWe investigated the microRNA expression pattern from thrombus retrieved by mechanical thrombectomy in acute stroke patients to understand the stroke mechanism.MethodsThis study included acute ischemic stroke patients who had undergone intra-arterial thrombectomy at Chung-Ang University Hospital in Seoul, Korea between February 2016 and March 2019. The thrombus was retrieved and stored at −70℃ after obtaining informed consent. MicroRNA microarray analysis was performed for the patients with identified stroke mechanisms including (1) large artery atherosclerosis, (2) cardioembolism with atrial fibrillation, and (3) cardioembolism with valvular heart disease. The microRNAs derived from microarray analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR) from different patient populations. The correlation analysis was performed between microRNA levels and laboratory data to understand the functional relevance of the altered microRNA.ResultsIn total, 55 thrombi were obtained from 74 patients, and the microRNAs were analyzed in 45 samples. Microarray analysis of 2578 microRNAs revealed that 50 microRNAs were significantly altered among the three groups. Validation using qRT-PCR showed that miR-378f and miR-450b-5p were significantly elevated among the cardioembolic thrombi; both microRNAs were inversely correlated with the ejection fraction from echocardiography. Thrombi from patients with early neurological deterioration exhibited higher levels of miR-93-5p and lower levels of miR-629-5p than those from neurologically stable patients.ConclusionsThe microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.

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