scholarly journals Association between Circulatory and Plaque Resistin Levels with Carotid Plaque Instability and Ischemic Stroke Events

2018 ◽  
Vol 21 (6) ◽  
pp. E448-E463
Author(s):  
Ivana Jurin ◽  
Frane Paić ◽  
Stela Bulimbašić ◽  
Igor Rudež ◽  
Lovorka Đerek ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
High Grade ◽  
Plaque Vulnerability ◽  
Histological Features ◽  
Plaque Instability

ses of ischemic stroke. The risk of ischemic stroke increases with the degree of carotid stenosis and plaque vulnerability. The aim of this study was to investigate the association of circulating and plaque resistin levels with plaque vulnerability and ischemic stroke events in patients with moderate- to high-grade carotid artery stenosis. Methods: 40 patients with ischemic stroke events and 38 neurologically asymptomatic patients scheduled for carotid endarterectomy were recruited for this study. Fasting blood samples for laboratory analysis were collected preoperatively and serum resistin levels were measured by enzyme-linked immunosorbent assays. Carotid endarterectomy specimens were analyzed according to the gold-standard procedure of histological classification. Plaque resistin expression was determined by standard immunohistochemical procedure. Results: Serum resistin levels and resistin plaque expression were found to be significantly higher in subjects with unstable carotid plaque (P < .001) while significantly higher serum resistin levels were also present in patients with ischemic stroke events (P < .001). In univariate stepwise logistic regression analysis, higher serum resistin levels were significantly associated with plaque instability (OR 2.223, 95% CI 1.488-3.320, P < .0001) and ischemic stroke events (OR 1.237, 95% CI 1.079-1.420, P = .002). There was also a significant association between higher serum and plaque resistin expression (OR 1.663, 95% CI1.332-2.077, P < .0001). These associations remained significant in all models of multivariate logistic regression analysis. High serum and plaque resistin levels were also significantly associated with specific histological features of plaque instability. Conclusion: The results suggests that serum resistin levels may be used as a potential biomarker of plaque vulnerability and ischemic stroke events in patients with moderate- to high-grade carotid artery stenosis and highlight the possible relationship that plaque resistin expression has with histological features of plaque vulnerability.

scholarly journals Association between low levels of serum miR-638 and atherosclerotic plaque vulnerability in patients with high-grade carotid stenosis

2019 ◽  
Vol 131 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Ana Luque ◽  
Abduljalil Farwati ◽  
Jerzy Krupinski ◽  
Josep M. Aran
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Control Group ◽  
High Grade ◽  
Plaque Vulnerability ◽  
Historical Group

OBJECTIVECarotid artery atherosclerosis is a major cause of ischemic stroke. However, reliable criteria to identify patients with high-risk carotid plaques beyond the severity of stenosis are still lacking. Circulating microRNAs (miRNAs) are being postulated as biomarkers for a variety of vascular immune-inflammatory diseases. The authors investigated whether cell-free circulating miR-638, highly expressed in vascular smooth muscle cells and implicated in proliferative vascular diseases, is associated with vulnerable atherosclerotic plaques in high-risk patients with advanced carotid artery stenosis undergoing carotid endarterectomy (CEA).METHODSThe authors conducted a prospective study in 22 consecutive symptomatic patients with high-grade carotid stenosis undergoing CEA and 36 age- and sex-matched patients without ischemic stroke history or carotid atherosclerosis (control group). In addition, they reviewed data from a historical group of 9 CEA patients who underwent long-term follow-up after revascularization. Total RNA was isolated from all serum samples, and relative miR-638 expression levels were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and compared among groups. A correlation analysis of serum miR-638 levels with vascular risk factors and treatments, and with plaque features, was performed. The ability of serum miR-638 to discriminate between the non-CEA control group and the different CEA groups was assessed by receiver operating characteristic evaluation. A logistic regression model was employed to examine the association between stratified CEA patients and serum miR-638 levels.RESULTSSerum levels of miR-638 were significantly lower in symptomatic CEA patients (p = 0.009) and particularly in the subgroup of CEA patients who had experienced stroke (p = 0.0006) than in non-CEA controls. Discrimination of high-risk plaques was accurate (area under the curve [AUC] 0.66 for symptomatic CEA patients in general and 0.76 for those who had experienced stroke). When only patients with high cardiovascular risk were considered, the diagnostic value of serum miR-638 from symptomatic CEA patients and CEA patients who had experienced stroke improved (AUC 0.79 and 0.85). Moreover, serum miR-638 was negatively correlated with the occurrence of stroke, smoker status, presence of bilateral pathology, coronary artery disease, and cholesterol treatment; and with the high-risk fibroatheroma plaques extracted from CEA patients. Multivariate logistic regression analysis demonstrated that serum miR-638 was an independent predictor of plaque instability. Furthermore, serum miR-638 appeared to attain good discrimination for atherosclerotic stenosis in CEA patients based on analysis of blood samples obtained in the historical group before and 5 years after intervention (p = 0.04) (AUC = 0.79).CONCLUSIONSAccording to this preliminary proof-of-concept study, serum miR-638 might constitute a promising noninvasive biomarker associated with plaque vulnerability and ischemic stroke, particularly in individuals with elevated cardiovascular risk.

scholarly journals Relationship of Neutrophil-to-Lymphocyte Ratio with Carotid Plaque Vulnerability and Occurrence of Vulnerable Carotid Plaque in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xin Li ◽  
Jing Li ◽  
Guode Wu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Vulnerable Plaque ◽  
Carotid Plaque ◽  
Multivariate Logistic Regression Analysis ◽  
Plaque Vulnerability ◽  
Multivariate Logistic Regression ◽  
Carotid Ultrasonography ◽  
Stable Plaque

Background. Carotid plaque is an undefined risk factor in ischemic stroke and is driven by inflammation. Mounting evidence suggests that neutrophil-to-lymphocyte ratio (NLR) is crucial not only for cerebrovascular events but also in atherosclerosis progression. Here, we aimed to explore the association between the admission NLR and carotid plaque vulnerability as well as the occurrence of vulnerable carotid plaque detected by carotid ultrasonography in patients with acute ischemic stroke (AIS) among Chinese. Methods. We conducted a retrospective study composed of 588 patients with AIS and 309 healthy controls free of carotid plaque in the Department of Neurology in The Second Hospital of Lanzhou University from March 2014 to February 2015. All patients were classified as nonplaque, stable plaque, and vulnerable plaque groups on the basis of carotid ultrasonography results. The baseline information was collected and compared among the four different groups. The correlation between variables and carotid plaque vulnerability was tested by Spearman linear correlation analysis. To identify the independent predictors for vulnerable carotid plaque, univariate and multivariate logistic regression analysis was performed. Results. The comparisons of age, sex proportion, history of hypertension, diabetes, and smoking, the levels of HDL-C, Lp(a), BMI, SBP, DBP, Fib, CRP, leukocyte, and NLR among the four groups showed a statistically significant difference ( P < 0.05 ); in particular, the NLR was significantly higher in the vulnerable plaque group as compared to the control ( P = 0.043 ), nonplaque ( P = 0.022 ), and stable plaque groups ( P = 0.015 ). The Spearman correlation analysis presented a positive correlation between carotid plaque vulnerability and age ( r = 0.302 ; P < 0.001 ), SBP ( r = 0.163 ; P < 0.001 ), and NLR ( r = 0.087 ; P = 0.034 ), while the lymphocyte was negatively related to the carotid plaque vulnerability ( r = − 0.089 ; P = 0.030 ). The multivariate logistic regression analysis adjusted for confounding factors revealed that age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.025-1.060; P < 0.001 ), male gender (OR, 2.005; 95% CI, 1.394-2.884; P < 0.001 ), diabetes (OR, 1.481; 95% CI, 1.021-2.149; P = 0.039 ), SBP (OR, 1.012; 95% CI, 1.003-1.021; P = 0.010 ), and NLR (OR, 1.098; 95% CI, 1.018-1.184; P = 0.015 ) are independent predictors of vulnerable carotid plaque in patients with AIS. Conclusion. The admission NLR is a novel and meaningful biomarker that can be used in predicting carotid plaque vulnerability and the presence of vulnerable carotid plaque assessed by carotid ultrasonography in patients with AIS among Chinese.

Abstract TMP44: Contrast Enhanced Ultrasound Can Detect Small Disruption of Carotid Plaques Related to Symptomatic Internal Carotid Artery Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Soichiro Abe ◽  
Kozue Saito ◽  
Hatsue Ishibashi-Ueda ◽  
Shuichi Tonomura ◽  
Kota Mori ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Internal Carotid ◽  
Color Doppler ◽  
Internal Carotid Artery Stenosis ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

Background: The ulcerated atheroma of the carotid artery is a risk factor of ipsilateral ischemic stroke. Contrast-enhanced ultrasound (CEUS) is a novel noninvasive technique useful for evaluating the morphology of carotid plaques, and can detect small disruptions on plaque surface. However, it remains unclear whether the disrupted carotid plaque detected by CEUS is related to the symptomatic internal carotid artery stenosis (ICS). Methods: A total of 79 ICS patients who underwent carotid endarterectomy (CEA) were enrolled from July 2010 to July 2015. Before operation, ICA lesions were examined by color Doppler ultrasound (CDUS) and CEUS using perflubutane. The ulceration was diagnosed when both of the color Doppler signal on CDUS and the pooling of microbubbles on CEUS were observed within the plaque. The disruption was diagnosed only by CEUS when microbubbles pooled through the fissured surface, unlike the linear delineation of neovessels. We validated findings on ultrasound compared with the histopathological findings of ulceration and present/recent plaque rupture. The associations between ulceration/disruption on ultrasound and symptomatic ICS (with a history of ipsilateral transient ischemic attack and/or ischemic stroke) were investigated. Results: Of 79 subjects (mean age 71.2±6.8 years old, 78 men), 55 had symptomatic ICS. The ulceration by CEUS and CDUS was recognized in 20 patients (25%), and the disruption on plaque surface was seen by CEUS solitary in 26 patients (33%). The sensitivity and specificity of detecting plaque ulceration or disruption using CEUS compared with histopathological findings were 0.57 (45/66) and 1.00 (13/13), respectively. The detection rate of ulceration or disruption using CEUS was higher in symptomatic ICS than in asymptomatic ICS (66% vs 42%, P=0.049). Compared to plaques without ulceration/disruption on ultrasound, prevalence of symptomatic ICS was higher in plaques with the disruption (88% vs 58%, P=0.01), whereas it was similar in plaques with the ulceration (65% vs 58%, P=0.77) Conclusion: Small disruptions on carotid plaque surface detected by CEUS were significantly related to symptomatic ICS and this results may help the detailed assessment of plaque vulnerability.

Abstract WP122: Asymptomatic Moderate Carotid Artery Stenosis With Intraplaque Hemorrhage ∼ Progression of Degree of Stenosis and New Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shinichi Yoshimura ◽  
Shigehiro Nakahara ◽  
Yoshikazu Sato
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Intraplaque Hemorrhage ◽  
Progression Rate ◽  
Negative Group ◽  
Positive Group ◽  
Carotid Plaques

Background: Carotid artery stenosis is one of the major causes of ischemic stroke. Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. Previous studies showed that IPH was associated with high intensity signal (HIS) on maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. Materials and Methods: We included 45 carotid plaques with moderate stenosis (50% to 69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS in carotid plaque on MIP image from routine 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS in the plaques and new ischemic strokes and annual progression rate of carotid stenosis. Results: HIS in carotid plaque was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred ipsilateral to the index carotid artery. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (6 of 21, 29%) than HIS negative group (0 of 24, 0%) (p=0.017). Annual progression rate of carotid stenosis is significantly higher in HIS positive group (+3.35%/year) than HIS negative group (-0.02%/year) (p= 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p=0.003). Conclusions: HIS in carotid plaques on 3DTOF-MRA MIP images are associated with new ischemic stroke and higher annual progression rate of stenosis. Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.

scholarly journals Association between Estimated Glomerular Filtration Rate and Clinical Outcomes in Ischemic Stroke Patients with High-Grade Carotid Artery Stenosis

2020 ◽  
Author(s):  
Chung-Hao Chao ◽  
Chia-Lun Wu ◽  
Wen-Yi Huang
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Glomerular Filtration Rate ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
High Grade ◽  
All Cause Mortality ◽  
Lower Egfr

Abstract Background: Chronic kidney disease has been identified as a risk factor affecting stroke prognosis. High-grade carotid artery stenosis (CAS) is associated with distal hemodynamic compromise. The association between the estimated glomerular filtration rate (eGFR) and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between eGFR and outcomes of acute IS patients with high-grade CAS.Methods: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. The eGFR on admission was assessed using the Modification of Diet in Renal Disease Study equation. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between different eGFR levels. Results: Among 372 individuals, 76 (20.4%) had eGFR≺45, 65 (17.5%) had eGFR between 45 to 59, and 231 (62.1%) had eGFR≧60 mL/min/1.73 m2. The prevalence rates of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, valvular heart disease, and gout in patients with lower eGFR were significantly higher than in those with higher eGFR (P = 0.013, P = 0.030, P = 0.001, P < 0.001, P = 0.043, and P < 0.001, respectively). Patients with lower eGFR demonstrated lower hemoglobin and total cholesterol levels compared with those with higher eGFR (P < 0.001 and P = 0.048). The blood potassium and uric acid levels were significantly higher in patients with lower eGFR (P < 0.001 and P < 0.001). The multivariate Cox proportional hazards model indicated that eGFR≺45 mL/min/1.73 m2 as a significant risk factor for the 5-year all-cause mortality in IS patients with high-grade CAS after adjusting for these variables (HR = 2.05; 95% CI = 1.31-3.21; P = 0.002).Conclusions: eGFR≺45 mL/min/1.73 m2 was associated with an increased risk of 5-year all-cause mortality in acute IS patients with high-grade CAS. Therefore, the prevention of eGFR decline in patients with high-grade CAS may improve long-term stroke outcome.

Does Carotid Artery Tortuosity Play a Role in Stroke?

2021 ◽  
pp. 084653712199105
Author(s):  
Luca Saba ◽  
Roberto Sanfilippo ◽  
Jasjit S. Suri ◽  
Filippo Cademartiri ◽  
Giuseppe Corrias ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Logistic Regression Analysis ◽  
Carotid Arteries ◽  
Final Analysis ◽  
P Value ◽  
Anterior Circulation ◽  
Age Range

Purpose: To explore the association between carotid artery length and tortuosity, and the occurrence of stroke. Material and Methods: In this retrospective study, IRB approved, 411 consecutive patients (males: 245; median age: 56 ± 12 years, age range: 21-93 years) with anterior circulation ischemic stroke were included. Only patients that underwent CTA within 7 days were considered and stroke caused by cardiac embolism and thoracic aorta embolism were excluded. For each patient, both carotid arteries were considered, and the ICA, CCA-ICA length and tortuosity were calculated. Inter-observer analysis was quantified with the Bland-Altman test. Mann-Whitney test and logistic regression analysis were also calculated to test the association between length and tortuosity with the occurrence of stroke. Results: In the final analysis, 166 patients (males: 72; median age: 54 ± 12 years, age range: 24-89 years) with anterior circulation ischemic stroke that were admitted to our hospital between February 2008 and December 2013 were included. The results showed a good concordance for the length of the vessels with a mean variation of 0.7% and 0.5% for CCA-ICA and ICA length respectively an for the tortuosity with a mean variation of 0.2% and -0.4% for CCA-ICA and ICA respectively. The analysis shows a statistically significant association between the tortuosity index of the ICA and CCA-ICA sides with stroke ( P value = 0.0001 in both cases) and these findings were confirmed also with the logistic regression analysis. Conclusion: Results of this study suggest that tortuosity index is associated with the presence of stroke whereas the length of the carotid arteries does not play a significant role.

scholarly journals Leucocyte count indicates carotid plaque instability in stroke patients

2016 ◽  
Vol 73 (6) ◽  
pp. 515-525 ◽  
Author(s):  
Gordana Arandjelovic-Minic
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Carotid Plaque ◽  
Biochemical Parameters ◽  
Stroke Risk ◽  
Control Group ◽  
Plaque Instability ◽  
Symptomatic Group ◽  
Inflammatory Parameters

Background/Aim. Increasing evidence points to the inflammatory character of atherosclerosis and several parameters of inflammation have been proposed as cerebrovascular risk markers. The objective of the research was to examine the connection of serum inflammatory parameters and ultrasound (US) characteristics of the structure and size of carotid plaque. We assumed that the number of leukocytes (Le) was an indicator of carotid plaque instability and an in-creased risk of stroke. Methods. Serum inflammatory parameters: erythrocyte sedimentation rate in the first (ESR I) and second hour (ESR II), the number of Le, high sensitivity C-reactive protein (hsCRP) and fibrinogen were measured by standard methods. All the subjects (n = 75) were divided into 3 groups (symptomatic, asymptomatic and control). US evaluation of extracranial carotid arteries was performed in a duplex system. Plaques were classified into categories according to stenosis percentage (? 50%, < 50%) and pursuant to echomorphological characteristics (Gray-Weale classification). In the subjects with stroke an ischemic lesion was confirmed by computed tomography. Results. The average values of biochemical parameters in the symptomatic group were: ESR I 29.57 ? 29.87 cm, ESR II 51.60 ? 36.87 cm, the number of Le 10.10 ? 3.20 x 10-9 U/L, hs-CRP 8.15 ? 5.50 mg/L and fibrinogen 4.03 ? 0.70 g/L. The average values of all testing biochemical parameters in symptomatic patients were significantly higher than in the asymptomatic ones and the control group: for ESR I (p < 0.05) and ESR II (p < 0.05); for the number of Le (p < 0.001); for hsCRP (p < 0.001) and fibrinogen (p < 0.001). Category I of echomorphological characteristics in the symptomatic group was present in 66.7% cases and it was significantly higher than in the asymptomatic (40.0%; p < 0.05) and the control group (20.0%; p < 0.01). Univariate logistic regression analysis confirmed that all testing bio-chemical parameters are indicators of stroke risk. Multivariate logistic regression analysis confirmed a statistically significant correlation of the number of Le and stroke risk, while the increase in the value by a unit of measurement was associated with the growth of risk by 3.22 times (from 1.67 to 6.22). Conclusion. The number of Le is associated with the phenomenon of carotid plaque instability and may be a useful additional marker of increased risk for developing acute cerebral infarction.

High-Intensity Signal in Carotid Plaque on Routine 3D-TOF-MRA Is a Risk Factor of Ischemic Stroke

2015 ◽  
Vol 41 (1-2) ◽  
pp. 13-18 ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shinichi Yoshimura ◽  
Manabu Shirakawa ◽  
Kazutaka Uchida ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Artery Stenosis ◽  
Carotid Plaques ◽  
Tof Mra ◽  
The Relationship ◽  
Ischemic Events

Background: Carotid atherosclerotic disease is recognized as an important risk factor for brain ischemic events. However, high-grade stenosis does not always cause ischemic strokes, whereas moderate-grade stenosis may often cause ischemic strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new cerebral ischemic events. The purpose of this study was to elucidate the relationship between high-intensity signals (HIS) on maximum intensity projection (MIP) images from routine 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and prior ischemic strokes in the patients with moderate carotid stenosis. Materials and Methods: Sixty-one patients with moderate carotid artery stenosis (50-69% stenosis based on North American Symptomatic Carotid Endarterectomy Trial criteria) were included. Carotid IPH was defined as the presence of HIS in carotid plaques on MIP images detected by 3D-TOF-MRA using criteria we previously reported. We analyzed the relationship between the presence of HIS in plaques and prior ischemic strokes defined as ischemic lesions on diffusion-weighted brain images. Results: HIS in carotid plaques were present in 27 (44%) of 61 patients. Prior ipsilateral ischemic strokes occurred more frequently in the HIS-positive group than the HIS-negative group (67 vs. 9%, p < 0.001). Furthermore, there were more smokers in the group with ischemic stroke than without it (62 vs. 25%, p = 0.005). In multivariate logistic regression analysis, HIS in carotid plaque (OR 23.4, 95% CI 4.62-118.3, p < 0.001) and smoking (OR 5.44, 95% CI 1.20-24.6, p = 0.028) were independent determinants of prior ischemic strokes after adjustment for age. Conclusions: HIS in carotid plaques on 3D-TOF-MRA MIP images are independent determinants of prior ischemic strokes in patients with moderate carotid artery stenosis, and they can potentially provide a reliable risk stratification of patients with moderate carotid artery stenosis.

Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

2020 ◽  
Vol 25 (45) ◽  
pp. 4827-4834 ◽  
Author(s):  
Limin Zhang ◽  
Xingang Li ◽  
Dongzhi Wang ◽  
Hong Lv ◽  
Xuezhong Si ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Operating Characteristic ◽  
Control Group ◽  
Case Group ◽  
Stroke Patients ◽  
Clopidogrel Therapy ◽  
Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

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