Acute ischemic stroke in adolescents

Neurology ◽  
2019 ◽  
Vol 94 (2) ◽  
pp. e158-e169 ◽  
Author(s):  
Thomas Rambaud ◽  
Nicolas Legris ◽  
Yannick Bejot ◽  
Céline Bellesme ◽  
Bertrand Lapergue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transition Period ◽  
Cryptogenic Stroke ◽  
Hemorrhagic Transformation ◽  
National Database ◽  
Limited Information ◽  
Treatment Rate ◽  
Anterior Circulation ◽  
Cerebrovascular Events ◽  
Male Patients

ObjectiveAdolescence represents a transition period between childhood and adulthood, and only limited information exists about stroke characteristics in this population. Our aim was to describe the clinical and neuroradiologic features, etiologies, initial management, and outcome of ischemic stroke in adolescents.MethodsThis retrospective cohort study evaluated all consecutive patients 10 to 18 years with a first-ever ischemic stroke hospitalized between 2007 and 2017 in 10 French academic centers representing a population of ≈10 million. Extracted data from the national database served as validation.ResultsA total of 60 patients were included (53% male, median age 15.2 years). Diagnosis at first medical contact was misevaluated in 36%, more frequently in posterior than anterior circulation strokes (55% vs 20% respectively, odds ratio 4.8, 95% confidence interval 1.41–16.40, p = 0.01). Recanalization treatment rate was high (n = 19, 32%): IV thrombolysis (17%), endovascular therapy (11.7%), or both IV and intra-arterial thrombolysis (3.3%); safety was good (only 1 asymptomatic hemorrhagic transformation). Despite thorough etiologic workup, 50% of strokes remained cryptogenic. The most common determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in female patients), and arterial dissections (10%, exclusively in male patients). Recurrent ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome was favorable (Rankin Scale score 0–2 at day 90) in 80% of cases.ConclusionsIschemic strokes in adolescents harbor both pediatric and adult features, emphasizing the need for multidisciplinary collaboration in their management. Recanalization treatments appear feasible and safe.

Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
James E Siegler ◽  
Pere Portela ◽  
Juan F Arenillas ◽  
Alba Chavarria-Miranda ◽  
Ana Guillen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Significant Risk ◽  
Stroke Severity ◽  
Cerebrovascular Event ◽  
Cerebrovascular Events ◽  
Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

scholarly journals Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction

2017 ◽  
Vol 23 (6) ◽  
pp. 594-600 ◽  
Author(s):  
FB Cabral ◽  
LH Castro-Afonso ◽  
GS Nakiri ◽  
LM Monsignore ◽  
SRC Fábio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Brain Infarction ◽  
Internal Capsule ◽  
Brain Regions ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Caudate Nuclei ◽  
Predictive Values ◽  
Cortical Regions

Purpose Hyper-attenuating lesions, or contrast staining, on a non-contrast brain computed tomography (NCCT) scan have been investigated as a predictor for hemorrhagic transformation after endovascular treatment of acute ischemic stroke (AIS). However, the association of hyper-attenuating lesions and final ischemic areas are poorly investigated in this setting. The aim of the present study was to assess correlations between hyper-attenuating lesions and final brain infarcted areas after thrombectomy for AIS. Methods Data from patients with AIS of the anterior circulation who underwent endovascular treatment were retrospectively assessed. Images of the brain NCCT scans were analyzed in the first hours and late after treatment. The hyper-attenuating areas were compared to the final ischemic areas using the Alberta Stroke Program Early CT Score (ASPECTS). Results Seventy-one of the 123 patients (65.13%) treated were included. The association between the hyper-attenuating region in the post-thrombectomy CT scan and final brain ischemic area were sensitivity (58.3% to 96.9%), specificity (42.9% to 95.6%), positive predictive values (71.4% to 97.7%), negative predictive values (53.8% to 79.5%), and accuracy values (68% to 91%). The highest sensitivity values were found for the lentiform (96.9%) and caudate nuclei (80.4%) and for the internal capsule (87.5%), and the lowest values were found for the M1 (58.3%) and M6 (66.7%) cortices. Conclusions Hyper-attenuating lesions on head NCCT scans performed after endovascular treatment of AIS may predict final brain infarcted areas. The prediction appears to be higher in the deep brain regions compared with the cortical regions.

Abstract P338: Cardiovascular And Cerebrovascular Events Associated With Cancer Surgery In The United States

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Anshul Saxena ◽  
Muni Rubens ◽  
Venkataraghavan Ramamoorthy ◽  
Sankalp Das ◽  
Chintan B Bhatt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perioperative Period ◽  
The United States ◽  
National Database ◽  
Perioperative Morbidity ◽  
Cerebrovascular Events ◽  
Colon And Rectum ◽  
National Trends ◽  
Over Time

Background: Major adverse cardiovascular and cerebrovascular events (MACCE) are significant causes of perioperative morbidity and mortality but, the incidence and effects following cancer surgeries are unknown. The aims of this study were to evaluate national trends in MACCE after major cancer surgeries and to identify cancer types associated with cardiovascular events using a large national database. Methods: Patients who had major cancer surgeries from 2005 to 2014 were identified from the National Inpatient Sample database. Hospitalizations for surgeries for cancer of prostate, bladder, esophagus, pancreas, lung, liver, breast, colon and rectum were identified by ICD9 diagnosis and procedure codes. The main outcome was perioperative MACCE, defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, and was evaluated over time. Results: Among 2,854,810 hospitalizations for major cancer surgeries, perioperative MACCE occurred in 67,316 hospitalizations (2.4%). Mean (SE) age of patients was 65.4 (0.07) years and 54.2% were male patients. MACCE occurred most frequently in patients undergoing surgeries for lung (6.8%), pancreatic (4.5%), and colorectal (3.3%) cancers. Between 2005 and 2014, the frequency of MACCE declined from 2.7% to 2.2% ( P <0.001) and was driven by a decline in the frequency of perioperative death ( P <0.001) and AMI ( P = 0.002). However, no significant changes were observed for acute ischemic stroke ( P = 0.6) during the study period. Conclusion: Perioperative MACCE occurs in 1 out of every 42 hospitalizations for major cancer surgeries. Despite reductions in the rate of death and AMI among patients undergoing major cardiac surgeries, perioperative ischemic stroke remained constant over time. The lack of improvements in perioperative ischemic stroke rate is concerning and requires additional interventions. Significant efforts should be directed towards improving cardiovascular care during the perioperative period of cancer surgeries.

scholarly journals Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 49-55
Author(s):  
Huong Bich Thi Nguyen ◽  
Thang Huy Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Limited Information ◽  
Anterior Circulation ◽  
Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

scholarly journals Five Year Follow-Up of Cryptogenic Stroke Patients Following Patent Foramen Ovale Closure

2021 ◽  
Vol 6 (1) ◽  
pp. 2
Author(s):  
Agnete Teivāne ◽  
Kristaps Jurjāns ◽  
Ainārs Rudzītis ◽  
Krista Lazdovska ◽  
Artūrs Balodis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Amplatzer Occluder ◽  
Cerebrovascular Events ◽  
Ischemic Attack ◽  
Pfo Closure

Background and Objectives: According to guidelines, patent foramen ovale (PFO) closure is recommended for secondary stroke prevention in patients with cryptogenic stroke. Paradoxial embolism from PFO-mediated right to left shunt has been described as the mechanism of stroke in these cases. The aim of the study was to determine whether PFO closure can be associated with improvement of complaints (headaches, fatigue, heart palpitations, dizziness, and visual impairment) and determine its long-term effectiveness on recurrent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 year, and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: Male patients accounted for 43.7% (n = 45). The mean age was—44.4 ± 13 (18–75). The most probable cause for cryptogenic stroke for 53.4% (n = 55) of patients with possible cardio-aortic embolism was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder—87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patients presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints.

Abstract 1173: Risk of Recurrent Cerebrovascular Events in Patients with Cryptogenic Cerebral Ischemia and Patent Foramen Ovale: A Meta-Analysis of Observational Studies

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Stephen B Wilton ◽  
Mohammed A Almekhlafi ◽  
Doreen M Rabi ◽  
William A Ghali ◽  
Diane L Lorenzetti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Recurrent Events ◽  
Comparison Group ◽  
Meta Analysis ◽  
Cryptogenic Stroke ◽  
Absolute Rate ◽  
Foramen Ovale ◽  
Cerebrovascular Events ◽  
Increased Risk

In patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or transient ischemic attack (TIA), the risk of recurrent events is unclear. To conduct a systematic review and meta-analysis of studies assessing the risk of recurrent cerebrovascular events in patients with cryptogenic cerebral ischemia and PFO. MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) databases were searched to identify studies in any language. Searches were supplemented by scanning bibliographies of key articles. Studies reporting original data on recurrent cerebrovascular events in patients with prior cryptogenic stroke or TIA and PFO, with or without a non-PFO comparison group, were included. Uncontrolled case series evaluating device or surgical closure of PFO were excluded. Two authors independently extracted the data from included studies and evaluated study quality. For studies with a non-PFO comparison group, relative risks were pooled using a fixed effects model after confirming homogeneity of results. For all studies, the pooled absolute rate of recurrent events was calculated using a random effects model due to heterogeneity of results. Fifteen studies published between 1994 and 2007, following 2377 patients over a mean of 37 months were included. In the four studies with a non-PFO comparison group, the pooled relative risk of recurrent stroke or TIA associated with the presence of a PFO was 1.1 (95% CI 0.8 to 1.5), while for recurrent ischemic stroke the pooled relative risk associated with the presence of a PFO was 0.8 (95% CI 0.5 to 1.3). The pooled absolute rate of recurrent ischemic stroke or TIA in patients with PFO was 4.0 events per 100 person-years (95% CI 3.0 to 5.1) while the rate of recurrent ischemic stroke was 1.6 events per 100 person years (95% CI 1.1 to 2.1). No clinical or imaging features are reliably associated with increased risk of recurrent events. In medically treated patients with prior cryptogenic stroke, available evidence does not support an increased risk of recurrent ischemic events in those with vs. without a PFO. Routine PFO closure in these patients may not be warranted, outside of ongoing clinical trials.

Abstract TP222: Prevalence of Carotid Web in Patients With Cryptogenic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anusha Boyanpally ◽  
Sleiman El Jamal ◽  
Michael Reznik ◽  
Tina Burton ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
A Priori ◽  
Cryptogenic Stroke ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Anterior Circulation ◽  
Web Based ◽  
Calcified Tissue ◽  
History Of ◽  
Stroke Mechanism

Introduction: Carotid web is a putative mechanism of cryptogenic ischemic stroke. We aimed to determine the prevalence of carotid web based on assigned stroke mechanism, and hypothesized that carotid webs would be found more frequently in younger cryptogenic stroke patients. Methods: We performed a single-center retrospective cohort study using institutional registry data from consecutive patients with confirmed anterior circulation ischemic stroke between July 2015-September 2017. We reviewed all available computed tomography angiogram (CTA) studies of the neck, and excluded patients who did not have a high-quality CTA of the neck performed. Carotid web was defined as a thin shelf of non-calcified tissue protruding into the lumen of the internal carotid artery immediately distal to the bifurcation, best visualized on sagittal oblique imaging and evident as a small septum on axial imaging. Stroke subtype was adjudicated a priori using validated methods, and we compared relevant risk factors in patients with cryptogenic stroke with and without carotid web. Results: We identified 882 patients with anterior circulation stroke who had a CTA neck available for review (49.3% male, 30% cryptogenic). A total of 7 patients (0.8%) were found to have carotid webs, of which 4 were ipsilateral to a patient’s stroke; all patients with ipsilateral carotid webs were adjudicated to have cryptogenic stroke. Patients with carotid web were younger than other patients in our cohort (age 49.0±14.6 vs. 72.2±14.9 years, p=0.003), and none of them had a history of hypertension (0% vs. 72%, p=0.04). In patients with cryptogenic stroke, overall prevalence of carotid webs was 1.5%, but the prevalence was significantly higher in younger cryptogenic stroke patients (age <60: 4.8%; age ≥60: 0.5%; p=0.01). Imaging findings that mimicked carotid webs, including non-calcified atherosclerosis and small protruding lesions, were prevalent in 8.3% of all patients. Discussion: Carotid web may represent an under-recognized occult mechanism of cryptogenic stroke, particularly amongst younger patients.

scholarly journals Prospective, Multicenter, Single-Arm Study of Mechanical Thrombectomy Using Solitaire Flow Restoration in Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2802-2807 ◽  
Author(s):  
Vitor M. Pereira ◽  
Jan Gralla ◽  
Antoni Davalos ◽  
Alain Bonafé ◽  
Carlos Castaño ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Unique Identifier ◽  
Vessel Occlusion ◽  
Clinical Trial Registration ◽  
End Point ◽  
Flow Restoration

Background and Purpose— Mechanical thrombectomy using stent retriever devices have been advocated to increase revascularization in intracranial vessel occlusion. We present the results of a large prospective study on the use of the Solitaire Flow Restoration in patients with acute ischemic stroke. Methods— Solitaire Flow Restoration Thrombectomy for Acute Revascularization was an international, multicenter, prospective, single-arm study of Solitaire Flow Restoration thrombectomy in patients with large vessel anterior circulation strokes treated within 8 hours of symptom onset. Strict criteria for site selection were applied. The primary end point was the revascularization rate (thrombolysis in cerebral infarction ≥2b) of the occluded vessel as determined by an independent core laboratory. The secondary end point was the rate of good functional outcome (defined as 90-day modified Rankin scale, 0–2). Results— A total of 202 patients were enrolled across 14 comprehensive stroke centers in Europe, Canada, and Australia. The median age was 72 years, 60% were female patients. The median National Institute of Health Stroke Scale was 17. Most proximal intracranial occlusion was the internal carotid artery in 18%, and the middle cerebral artery in 82%. Successful revascularization was achieved in 79.2% of patients. Device and procedure-related severe adverse events were found in 7.4%. Favorable neurological outcome was found in 57.9%. The mortality rate was 6.9%. Any intracranial hemorrhagic transformation was found in 18.8% of patients, 1.5% were symptomatic. Conclusions— In this single-arm study, treatment with the Solitaire Flow Restoration device in intracranial anterior circulation occlusions results in high rates of revascularization, low risk of clinically relevant procedural complications, and good clinical outcomes in combination with low mortality at 90 days. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01327989.

scholarly journals Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

2020 ◽  
pp. 174749302095921 ◽  
Author(s):  
James E Siegler ◽  
Pere Cardona ◽  
Juan F Arenillas ◽  
Blanca Talavera ◽  
Ana N Guillen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Significant Risk ◽  
Stroke Severity ◽  
Cerebrovascular Event ◽  
Cerebrovascular Events ◽  
Observational Cohort

Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020–16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970–1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920–1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130–280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4–60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63–15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07–2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34–0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

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