Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region—Results from the Safe Implementation of Treatments in Stroke (SITS)–Middle-East and North African (MENA)

2019 ◽  
Vol 14 (7) ◽  
pp. 715-722 ◽  
Author(s):  
Suhail Al Rukn ◽  
Michael V Mazya ◽  
Faycal Hentati ◽  
Samia Ben Sassi ◽  
Fatma Nabli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle East ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Large Artery ◽  
North African ◽  
Stroke Incidence ◽  
Stroke Units ◽  
Mena Countries ◽  
Incidence And Mortality

Background and methods Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00–18:45), a median of NIHSS 6 (3–14), and a median age of 66 (56–76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. Conclusions MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry

2019 ◽  
Vol 15 (9) ◽  
pp. 980-987 ◽  
Author(s):  
S Al-Rukn ◽  
M Mazya ◽  
N Akhtar ◽  
H Hashim ◽  
B Mansouri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle East ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Treatment Time ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Stroke Severity ◽  
University Hospitals ◽  
Mena Region

Background and methods Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. Results Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0–2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. Conclusions Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized.

Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East

2017 ◽  
Vol 12 (8) ◽  
pp. 835-843 ◽  
Author(s):  
Hamidreza Saber ◽  
Amanda G Thrift ◽  
Moira K Kapral ◽  
Ashkan Shoamanesh ◽  
Amin Amiri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle East ◽  
Incidence Study ◽  
Incidence Rates ◽  
Large Artery ◽  
Small Artery ◽  
Community Based ◽  
Stroke Incidence ◽  
Stroke Subtypes ◽  
Artery Disease

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.

scholarly journals Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

2015 ◽  
Vol 73 (8) ◽  
pp. 648-654 ◽  
Author(s):  
Marcos C. Lange ◽  
Norberto L. Cabral ◽  
Carla H. C. Moro ◽  
Alexandre L. Longo ◽  
Anderson R. Gonçalves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Population Based ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Population Based Study ◽  
Incidence And Mortality ◽  
One Year ◽  
Undetermined Etiology ◽  
And Control ◽  
Adjusted Incidence

Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

scholarly journals Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

2021 ◽  
Vol 13 (1) ◽  
pp. 46-58
Author(s):  
João Paulo Branco ◽  
Filipa Rocha ◽  
João Sargento-Freitas ◽  
Gustavo C. Santo ◽  
António Freire ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Upper Limb ◽  
Functional Recovery ◽  
Prospective Observational Study ◽  
Positive Impact ◽  
Rehabilitation Program ◽  
Patient Functioning ◽  
The Impact

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

scholarly journals FAKTOR-FAKTOR RISIKO STROKE PADA PENYAKIT GINJAL KRONIK STADIUM V YANG MENJALANI HEMODIALISIS

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Susanti Dwi Ariani ◽  
Dodik Tugasworo ◽  
Maria Imakulata Widiastuti Samekto
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Case Group ◽  
Chi Square ◽  
Stroke Incidence ◽  
Incidence And Mortality

RISK FACTORS OF STROKE IN STAGE V CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSISABSTRACTIntroduction: Chronic kidney disease (CKD) and end-stage renal disease are associated with a significantly in- creased risk of stroke. Incidence and mortality of stroke in CKD patients is higher rather than among the general popula- tion. Stroke in hemodialysis patients is also associated with high mortality.Aims: To analyze risk factors that have a relationship with the occurrence of stroke in patients with stage V CKD who underwent hemodialysis in Dr. Kariadi Hospital, Semarang.Method: A case control with retrospective cohort study of patients diagnosed with stage V CKD undergoing hemo- dialysis in Dr. Kariadi Hospital, Semarang, from March 2016 to August 2017. Subject was divided into case group, who experienced stroke, and control group, who did not experience stroke. Bivariate analysis was performed with Chi-square test, multivariate analysis with logistic regression test and rasio Odds.Results: There were 140 subjects with stage V CKD, 70 subjects in each groups. In case group, 85.7% experienced ischemic stroke while the rest hemorrhagic stroke. The duration of hemodialysis was related to the incidence of stroke. In multivariate analysis, patients with diabetes mellitus were more likely to have a stroke by 0.14 times compared to patients who did not have diabetes mellitus, and patients who underwent hemodialysis >12 months, were more likely to have a stroke 4.05 times greater than patients who underwent hemodialysis <12 months.Discussion: There is a relationship between diabetes mellitus and duration of hemodialysis with the occurrence of ischemic stroke, in stage V CKD patients who underwent hemodialysis.Keywords: Chronic kidney disease, hemodialysis, strokeABSTRAKPendahuluan: Penyakit ginjal kronik (PGK) dan penyakit ginjal stadium akhir terkait dengan peningkatan risiko yang signifikan dari stroke. Insiden dan mortalitas stroke pada pasien PGK lebih tinggi dibandingkan populasi umum. Stroke pada pasien dialisis juga dihubungkan dengan mortalitas yang tinggi.Tujuan: Untuk menganalisis faktor-faktor risiko yang memengaruhi terjadinya stroke pada pasien dengan PGK stadium V yang menjalani hemodialisis (HD) di RSUP Dr. Kariadi, Semarang.Metode: Penelitian kasus kontrol dengan pendekatan kohort retrospektif terhadap pasien penyakit ginjal kronik stadium V yang menjalani HD di RSUP Dr. Kariadi, Semarang dari bulan Maret 2016 hingga Agustus 2017. Subjek dibagi ke dalam kelompok kasus, yaitu yang mengalami stroke dan kelompok kontrol yang tidak mengalami stroke. Dilakukan analisis bivariat dengan uji Chi-square dan analisis multivariat dengan uji regresi logistik serta rasio Odds.Hasil: Didapatkan 140 subjek dengan PGK stadium V yang masing-masing kelompok terdiri dari 70 orang. Pada kelompok kasus, sebanyak 85,7% adalah stroke iskemik dan sisanya stroke hemoragik. Lama HD berhubungan dengan kejadian stroke. Pada uji multivariat, subjek yang menderita diabetes melitus (DM) berisiko mengalami stroke sebesar 0,14 kali dibandingkan yang tidak DM dan subjek yang menjalani HD >12 bulan berisiko mengalami stroke 4,05 kali lebih besar dibandingkan yang menjalani HD <12 bulan.Diskusi: Terdapat pengaruh faktor risiko DM dan lama hemodialisis terhadap kejadian stroke iskemik pada pasien PGK stadium V yang menjalani HD.Kata kunci: Hemodialisis, penyakit ginjal kronik, stroke

Abstract TMP11: Endovascular Treatment for Acute Ischemic Stroke in the Within 6-Hour versus 6-24-Hour Window: Simple Imaging Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Trung Nguyen ◽  
Huong Nguyen ◽  
Thanh Nguyen ◽  
Triet Ngo ◽  
Binh Pham ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Endovascular Treatment ◽  
Real World ◽  
Infarct Volume ◽  
Functional Independence ◽  
Large Artery ◽  
Advanced Imaging ◽  
Escape Trial ◽  
Imaging Protocol

Introduction: DAWN and DEFUSE 3 trials utilized advanced imaging to prove the benefit of endovascular treatment (EVT) in patients within 6-24 hours. There is increasing evidence to suggest the limitations of advanced imaging in real-world practice. Non-contrast-enhanced computed tomography (NCCT) has proved with good sensitivity and specificity in the definition of infarct core. It is still unknown if a simpler and faster protocol may adequately select patients within 6-24 hours for EVT. Hypothesis: To compare outcomes of patients submitted to EVT presenting within 6 hours or 6-24 hours, selected using simple imaging protocol. Methods: An observational study was performed, which included consecutive patients with anterior circulation ischemic stroke eligible for EVT within 6 hours or 6-24 hours. Patients within early window received routine treatment, while patients presenting within late window were treated if they had a mismatch between the clinical deficit, the infarct volume, and collateral blood blow: (NIHSS score was ≥10 and ASPECTS was ≥7) or (ASPECTS was =6, and the collateral score was ≥2). ASPECTS of NCCT/DWI-MRI and collateral status on CTA/DSA were assessed by a blinded neuroradiologist. The collateral grading system was scored on a scale of 0-3 as in the ESCAPE trial. Results: Of the 184 patients were included, 77 (41,8%) received thrombectomy in late window, 107 (58,2%) received acute treatment in early window. Baseline characteristics were similar between groups, except for longer onset to groin puncture time (median, 300 vs 705 min; P<0,0001), higher admission NIHSS (median, 13 vs 16; P<0,0001), lower in ASPECTS (median, 9 vs 8; P<0,0001), and large artery atherosclerosis etiology (61,7 vs 72,7%, P=0,002) in the late window group. No significant differences in successful reperfusion rate and rates of parenchymal hematoma type 2 (81,3 vs 83,1%, P=0,75; 4/107 vs 4/77, P=0,63, respectively). Functional independence (mRS 0-2) and mortality at 90 days did not differ significantly (65,4 vs 57,1%, P=0,25; 10,3 vs 6,5%, P=0,43; respectively). Conclusions: This real-world observational study suggests that EVT may be safe and effective in patients presenting within 6-24 hours selected using clinical-core mismatch and collateral blood blow.

Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2178-e2191
Author(s):  
Tai Hwan Park ◽  
Jeong-Kon Lee ◽  
Moo-Seok Park ◽  
Sang-Soon Park ◽  
Keun-Sik Hong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Stroke Onset ◽  
Large Artery ◽  
Stroke Subtype ◽  
Relative Risks ◽  
Neurologic Deterioration ◽  
Early Arrival ◽  
Ischemic Attack

ObjectiveTo improve epidemiologic knowledge of neurologic deterioration (ND) in patients with acute ischemic stroke (AIS).MethodsIn this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.ResultsND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24–48 hours, and 0.66 within 72–96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3–6) at 3 months and 1 year were 1.75 (1.70–1.80) and 1.70 (1.65–1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45–1.74).ConclusionsND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.

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