scholarly journals Antiplatelet therapy may be safe in ischemic stroke patients with cerebral microbleed

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094939
Author(s):  
Ningqin Meng ◽  
Wei Zhang ◽  
Ying Su ◽  
Ziming Ye ◽  
Chao Qin
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Cerebral Infarction ◽  
Antiplatelet Therapy ◽  
Cerebral Hemorrhage ◽  
Stroke Patients ◽  
Benefit Ratio ◽  
Cerebral Microbleed ◽  
Baseline Information ◽  
Fazekas Scale

Objective We examined whether antiplatelet therapy is safe for ischemic stroke patients with cerebral microbleed. Methods We retrospectively analyzed ischemic stroke patients admitted to our hospital from 2015 to 2018. Baseline information was extracted from the computerized database. Adverse events, including symptomatic cerebral hemorrhage, recurrent cerebral infarction, and death, were collected by phone. Results A total of 184 ischemic stroke patients were examined, including 106 with and 78 without cerebral microbleed. No patient experienced symptomatic cerebral hemorrhage after discharge. Patients with cerebral microbleed had a higher prevalence of hypertension (92% vs 74%) and suffered from more serious leukoaraiosis (3.0 ± 1.7 vs 1.3 ± 1.4 points on the Fazekas scale). Leukoaraiosis scores were correlated with the number of cerebral microbleeds (r = 0.42). Conclusions Antiplatelet therapy may be safe for ischemic stroke patients with cerebral microbleed. The risk-benefit ratio should be carefully evaluated before withholding antiplatelet therapy.

Recanalization between 1 and 24 hours after t-PA therapy is a strong predictor of cerebral hemorrhage in acute ischemic stroke patients

2008 ◽  
Vol 270 (1-2) ◽  
pp. 48-52 ◽  
Author(s):  
Kazumi Kimura ◽  
Yasuyuki Iguchi ◽  
Kensaku Shibazaki ◽  
Kazuto Kobayashi ◽  
Junichi Uemura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Hemorrhage ◽  
Strong Predictor ◽  
Stroke Patients

Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amy K Starosciak ◽  
Italo Linfante ◽  
Gail Walker ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Power ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Stroke Patients ◽  
Good Outcome ◽  
Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

Abstract WP166: Dietary Nitrate Supplements and Ischemic Stroke Recovery: A Pilot Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Cheryl Bushnell ◽  
Daniel Beavers ◽  
Gary Miller ◽  
Susan Reeves ◽  
Pamela Duncan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Placebo Group ◽  
Adverse Events ◽  
Gait Speed ◽  
Stroke Recovery ◽  
Beetroot Juice ◽  
Stroke Patients ◽  
Double Blind ◽  
Dietary Nitrate ◽  
Nitrate And Nitrite

Introduction: Dietary nitrate improves cerebral blood flow and enhances physical performance by improving exercise capacity. We designed a proof-of-concept study to show increases in plasma nitrate and nitrite levels in ischemic stroke patients treated with beetroot juice shots vs placebo juice (nitrate removed). We assessed gait speed after 30 days and safety/adverse events with both groups. Methods: In a randomized placebo-controlled double-blind design, patients with NIHSS of ≥ 2 but < 20, with fair or good sitting balance and score >0 on hip flexion on the short Fugl-Meyer, within 5 days of stroke onset were enrolled. Those treated with IV alteplase or endovascular therapy, gait speed > 0.8 cm/sec, or taking nitrate-containing medications were excluded. After consent, patients were randomized to beetroot vs placebo juice. On days 1 and 30, blood was drawn for nitrate and nitrite levels before and one hour after drinking 70 cc (3.8 mM nitrate) beetroot juice (James White Fruit Juices) or an identically-appearing placebo juice, plus vitamin C 500 mg daily for 30 days in each group. On day 30, gait speed (using the 4 m walk) was assessed. Results: Eighteen participants (6 women, 12 men, 12 white, 4 African American and 2 other race-ethnicities, median age 64.6 IQR (58.7, 70.0)) were consented, 17 completed treatment (1 terminated treatment because of nausea), 16 followed for 30 days and 13 for 90 days. Baseline characteristics were balanced with regard to admission NIHSS (median 5.0 in each group), age, sex, race, risk factors, baseline gait speed (median 0.17 m/sec in active and 0.13 m/sec in placebo), and baseline nitrate/nitrite levels. There was no difference in adverse events in the two groups. The mean treatment-specific changes in nitrate were 236 micromoles/L (95% CI 170, 302) in the active and 0 (95% CI -64, 64) in the placebo group (p<0.0001). For nitrite, active group increased by 313 nanomoles/L (37, 588) and 20 nanomoles for placebo (-211, 252); p=0.045. Gait speed increased by 0.26m/sec in the active and 0.30m/sec in placebo group. Conclusions: Beetroot juice was associated with an increase in nitrate and nitrite levels, but was not associated with a change in gait speed after 30 days. Further studies with a larger population of stroke patients may be warranted.

Abstract 104: Disability After Minor Stroke and TIA in the POINT Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Brett L Cucchiara ◽  
Jordan Elm ◽  
J Donald Easton ◽  
Shelagh Coutts ◽  
Joshua Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Antiplatelet Therapy ◽  
Primary Outcome ◽  
Dual Antiplatelet Therapy ◽  
Recurrent Stroke ◽  
Primary Outcome Measure ◽  
Minor Stroke ◽  
Serious Adverse Events ◽  
Index Event

Background and Purpose: To assess the effect of combination antiplatelet therapy with aspirin and clopidogrel versus aspirin alone on disability following TIA or minor stroke and to identify factors associated with disability. Methods: The POINT trial randomized patients with TIA or minor stroke (NIHSS≤3) within 12 hours of onset to dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel versus aspirin alone. The primary outcome measure was a composite of stroke, MI, or vascular death. We performed a post-hoc exploratory analysis to examine the effect of treatment on overall disability (defined as mRS>1) at 90 days as well as disability ascribed by the local investigator to index or recurrent stroke. We also evaluated predictors of disability. Results: At 90 days, 188/1964 (9.6%) of patients enrolled with TIA and 471/2586 (18.2%) of those enrolled with stroke were disabled. Overall disability was similar between patients assigned DAPT versus aspirin alone (14.7% vs. 14.3%, OR 0.97, 95%CI 0.82-1.14, p=0.69). However, there were numerically fewer patients with disability in conjunction with a primary outcome event in the DAPT arm (3.0% vs. 4.0%, OR 0.73, 95%CI 0.53-1.01, p=0.06), and significantly fewer patients in the DAPT arm with disability attributed by the investigators to either the index event or recurrent stroke (5.9% vs. 7.4%, OR 0.78, 95% CI 0.62-0.99, p=0.04). Notably, disability attributed to the index event accounted for the majority of this difference (4.5% vs. 6.0%, OR 0.74 95% CI 0.57-0.96, p=0.02). In multivariate analysis of patients enrolled with TIA, disability was significantly associated with age, subsequent ischemic stroke, serious adverse events, and major bleeding. In patients enrolled with stroke, disability was associated with female sex, hypertension, diabetes, NIHSS score, recurrent ischemic stroke, subsequent myocardial infarction, and serious adverse events. Conclusions: In addition to reducing recurrent stroke in patients with acute minor stroke and TIA, dual antiplatelet therapy might reduce stroke-related disability.

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

2019 ◽  
Vol 47 (1-2) ◽  
pp. 80-87 ◽  
Author(s):  
BaiLi Song ◽  
YuKai Liu ◽  
Linda Nyame ◽  
XiangLiang Chen ◽  
Teng Jiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Valvular Heart Disease ◽  
Cerebral Hemorrhage ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Lemeshow Test

Background: Accurate prognostication of unfavorable outcome made at the early onset of stroke is important to both the clinician and the patient management. This study was aimed to develop a nomogram based on the integration of parameters to predict the probability of 3-month unfavorable functional outcome in Chinese acute ischemic stroke patients. Methods: We retrospectively collected patients who underwent acute ischemic stroke at Stroke Center of the Nanjing First Hospital (China) between May 2013 and May 2018. After exclusion, the study population includes 1,025 patients for nomogram development. The main outcome measure was 3-month unfavorable outcome (modified Rankin Scale > 2). Multivariable logistic regression analysis was used to develop the predicting model, and stepwise logistic regression with the Akaike information criterion was utilized to find best-fit nomogram model. We incorporated the creatinine, fast blood glucose, age, previous cerebral hemorrhage, previous valvular heart disease, and NHISS score (COACHS), and these factors were presented with a nomogram. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Results: Multivariate analysis of the 1,025 patients for logistic regression helped identify the independent factors as National Institutes of Health Stroke Scale score on admission, age, previous valvular heart disease, fasting blood glucose, creatinine, and previous cerebral hemorrhage, which were included in the COACHS nomogram. The AUC-ROC of nomogram was 0.799. Calibration was good (p = 0.1376 for the Hosmer-Lemeshow test). Conclusions: The COACHS nomogram may be used to predict unfavorable outcome at 3 months after acute ischemic stroke in Chinese population. It may be also a reliable tool that is effective in its clinical utilization to risk-stratify acute stroke patients.

Antiplatelet therapy in diabetic ischemic stroke patients: associated factors and outcomes

2011 ◽  
Vol 49 (10) ◽  
pp. 605-613
Author(s):  
Y. Hassan ◽  
S.W. Al-Jabi ◽  
N. Abd Aziz ◽  
I. Looi ◽  
S.H. Zyoud
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Associated Factors ◽  
Stroke Patients

Abstract 58: Rates of In-Hospital Adverse Events and Discharge Outcomes Among Ischemic Stroke Patients Admitted to Joint Commission Primary Stroke Centers in United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Taqi T Zafar ◽  
Muhammad Umair ◽  
Gautam Sachdeva ◽  
Mohammad Afzal ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Adverse Events ◽  
Nationwide Inpatient Sample ◽  
Joint Commission ◽  
Principal Diagnosis ◽  
Stroke Patients ◽  
Discharge Outcomes ◽  
Beneficial Impact ◽  
To Receive

Background: The beneficial impact of certification by Joint Commission (JC) for primary stroke centers (PSCs), on in hospital adverse events and outcomes remains unproven. Objective: To compare the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients between PSC and no PSC hospitals in United States. Methods and Results: We obtained the data from Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the NIS hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (ICD9 codes 433.x1, 434.x1, 436). Results: We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted at PSCs. Patients admitted at PSCs were more likely to be men (48.3 vs. 46.7, p<0.0001), white (75.2 vs. 73.3, p<0.0001) and younger in age (71.1±14.7 vs. 72.3±14.3 p<0.0001. Total length of stay was similar among PSCs and non-PSCs (5.09±6. vs. 5.14±6.15 p<0.0001), while total charges were higher at PSCs ($48828 vs. $35946±14.3 p<0.0001). After adjusting for age, sex, race co-morbidities, DRG-based disease severity, and hospital characteristics, patients admitted at PSCs were at lower risk of in hospital adverse events complications; pneumonia (OR, 0.8; 95% CI, 0.7 to 0.9)-, urinary tract infection (OR, 0.97; 95% CI, 0.0.92 to 1.02), sepsis (OR, 0.65; 95% CI, 0..56 to 0..76), deep venous thrombosis (OR, 1.0; 95% CI, 0.76 to 1.33) and pulmonary embolism (OR, 0.58; 95% CI, 0.43 to 0.72). Patients evaluated at PSCs were more likely to receive rt-PA (OR, 1.32; 95% CI, 1.19 to 1.45) with less impatient mortality (OR, 0.88; 95% CI, 0.81 to 0.96) and more likely to get discharge to home (OR, 1.11; 95% CI, 1.07 to 1.15). Conclusions: Patients admitted to PSCs are less likely to have in hospital adverse events and better discharge outcomes.

Abstract WP424: Efficacy Of Antiplatelet Therapy For Secondary Stroke Prevention Following Lacunar Stroke: A Meta-analysis And Pooled Analysis Of Randomized Controlled Trials

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Chun Shing Kwok ◽  
Phyo K Myint ◽  
Yoon K Loke ◽  
Hannah Copley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Antiplatelet Agents ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Lacunar Stroke ◽  
Stroke Patients

INTRODUCTION: The predominant underlying mechanism of lacunar stroke differs from that of other ischemic stroke subtypes. Accordingly, so may the ideal stroke prevention regimen. We aimed to evaluate the efficacy of different antiplatelet agents in lacunar stroke patients. Method: We searched MEDLINE, EMBASE and the Cochrane library for RCTs that evaluated antiplatelet therapy in patients with ischemic stroke. Trials which provided stroke recurrence rates in patients presenting with lacunar stroke, or where the data was obtainable from manuscript authors were included. In addition, we included the novel SPS3 trial’s antiplatelet arm data presented at the 2011 ISC. We performed pooled analysis to assess the crude frequency of recurrent stroke and a random effects meta-analysis. Results: Lacunar stroke data was available for 12 trials encompassing 35, 218 participants (mean age 65, 65% male). The pooled crude recurrent stroke rate was least for cilostazol monotherapy (6.2%), followed by ASA monotherapy (7.4%), clopidogrel monotherapy (8.6%), ASA/dipyridamole (8.6%) and greatest for ASA/clopidogrel therapy (9.1%). Rate ratios of lacunar stroke patients suggest no significant efficacy advantage for ASA [ASA vs placebo (RR 0.72, 95% CI 0.34-1.50; p=0.38)], ASA/clopidogrel [ASA/clopidogrel vs ASA (RR 0.80, 95% CI 0.62-1.03; p=0.08), ASA/clopidogrel vs clopidogrel (RR 0.95, 95% CI 0.79-1.15; p=0.63)], sarpogrelate [sarpogrelate vs ASA (RR 1.31, 95% CI 0.84-2.04; p=0.23)] and ASA/dipyridamole [ASA/dipyridamole vs ASA (RR 0.90, 95% CI 0.70-1.16; p=0.042)] for recurrent stroke. The results from Japanese trials evaluating the efficacy of cilostazol found that it is significantly better than both placebo (RR 0.51, 95% CI 0.30-0.85; p=0.01) and ASA (RR 0.70, 95% CI 0.51-0.96; p=0.03) in the secondary prevention of stroke. Conclusions: There seems to be no significant advantage among the various antiplatelet agents studied in lacunar stroke patients apart for cilostazol. However, this requires confirmation within large randomized trials outside of Japanese populations.

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