scholarly journals Small vessel occlusion and syphilis in patients with first-ever ischemic stroke

2021 ◽  
Vol 79 (2) ◽  
pp. 103-106
Author(s):  
Matheus Gomes Ferreira ◽  
Valeria Cristina Scavasine ◽  
Giovanni Luís Breda ◽  
Bernardo Montesanti Machado de Almeida ◽  
Viviane de Hiroki Flumignan Zétola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Serological Test ◽  
Small Vessel ◽  
Vascular Involvement ◽  
Causal Mechanism ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Middle Income ◽  
Significant Difference

ABSTRACT Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD — when SVD was the potential causal mechanism (S1) — or non-SVD — when SVD was uncertain (S2), unlike (S3), or not detected (S0). Results: Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in patients with positive results: 9 (28%) vs. 22 (9%), p<0.01. Conclusion: The current study showed that the frequency of positive syphilis serological test was higher in patients with first-ever ischemic stroke and SVD as the potential causal mechanism. This finding could be related to the endothelial dysfunction occurring in syphilis.

scholarly journals Efficacy and Safety of Intravenous rtPA in Ischemic Strokes Due to Small-Vessel Occlusion: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Bartosz Karaszewski ◽  
Adam Wyszomirski ◽  
Bartosz Jabłoński ◽  
David J. Werring ◽  
Dominika Tomaka
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Vessel Occlusion ◽  
Excellent Outcome ◽  
Symptomatic Intracerebral Hemorrhage

AbstractIntravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.

scholarly journals Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Ping-Song Chou ◽  
Pi-Shan Sung ◽  
Chi-Hung Liu ◽  
Yueh-Feng Sung ◽  
Ray-Chang Tzeng ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Treatment Failure ◽  
Rating Scale ◽  
Small Vessel Disease ◽  
Demographic Data ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Stroke Patients ◽  
Vessel Disease

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

Abstract P549: Total Small Vessel Disease Burden Not Associated With Functional Independence After Endovascular Treatment in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lina Zheng ◽  
Xinyi Leng ◽  
Ximing Nie ◽  
Hongyi Yan ◽  
Thomas W Leung ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Primary Outcome ◽  
Small Vessel Disease ◽  
Functional Independence ◽  
Small Vessel ◽  
Perivascular Spaces ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Vessel Disease ◽  
Secondary Outcomes

Background: Individual small vessel disease (SVD) markers had been associated with outcomes of endovascular treatment (EVT) in acute stroke patients. We aimed to investigate the associations between total SVD burden and outcomes in such patients. Methods: In a nation-wide multicenter registration study, we enrolled stroke patients with anterior circulation large vessel occlusion (LVO) receiving EVT, who had undergone 3T MRI. Presence of lacunes, white matter hyperintensities, cerebral microbleeds and perivascular spaces in both hemispheres were assessed in MRI and each marker was assigned a score of 0 or 1 by presence. A total SVD burden score (0-4) was calculated by summing up the individual scores, which was dichotomized as none-to-mild (score 0-2) and moderate-to-severe (score 3-4). The primary outcome was 90-day functional independence, defined as modified Rankin Scale (mRS) of 0-2. Secondary outcomes included change in NIHSS from baseline to 7 days, early neurological deterioration (END), symptomatic intracranial hemorrhage and 90-day mortality. We investigated the associations of dichotomized total SVD burden score with the outcomes using binary logistic regression analyses. Results: Of the 202 patients (65.38% male; mean age 65.54 ± 11.93 years) enrolled, 176 patients had none-to-mild and 26 had moderate-to-severe total SVD burden. Those with moderate-to-severe SVD were older (mean age 69.8 versus 64.7; P=0.043) and more of them had a prior stroke (42.31% versus 23.3%; P=0.039), compared with otherwise. Dichotomized total SVD burden was not significantly associated with the primary outcome, 90-day functional independence (moderate-to-severe versus none-to-mild SVD burden: 53.85% versus 47.13%; OR 0.76, 95% CI 0.33-1.75; P=0.523). Although moderate-to-severe total SVD burden was associated with a higher rate of END (15.38% versus 3.43%; OR 5.12; 95% CI 1.34-19.58; P=0.017), no significant association was detected between the total SVD burden and other secondary outcomes. Conclusions: The total SVD burden as assessed in MRI was not significantly associated with the chance of obtaining functional independence at 90 days in LVO-stroke patients receiving EVT. A higher total SVD burden may not be an exclusion criteria for clinical decision for EVT.

Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients

2009 ◽  
Vol 111 (10) ◽  
pp. 852-857 ◽  
Author(s):  
Yangkun Chen ◽  
Xiangyan Chen ◽  
Weimin Xiao ◽  
Vincent C.T. Mok ◽  
Ka Sing Wong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Frontal Lobe ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Stroke Patients ◽  
Vessel Disease ◽  
Lobe Atrophy

Tissue Sodium Concentration within White Matter Correlates with the Extent of Small Vessel Disease

2021 ◽  
pp. 1-9
Author(s):  
Anne Adlung ◽  
Melina Samartzi ◽  
Lothar R. Schad ◽  
Eva Neumaier-Probst ◽  
Marc Fatar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Sodium Concentration ◽  
Small Vessel ◽  
Vessel Disease ◽  
Significant Difference ◽  
Tissue Sodium ◽  
23Na Mri

Introduction: Sodium MRI (23Na MRI) derived biomarkers such as tissue sodium concentration (TSC) provide valuable information on cell function and brain tissue viability and has become a reliable tool for the assessment of brain tumors and ischemic stroke beyond pathoanatomical morphology. Patients with major stroke often suffer from different degrees of underlying white matter lesions (WMLs) attributed to chronic small vessel disease. This study aimed to evaluate the WM TSC in patients with an acute ischemic stroke and to correlate the TSC with the extent of small vessel disease. Furthermore, the reliability of relative TSC (rTSC) compared to absolute TSC in these patients was analyzed. Methodology: We prospectively examined 62 patients with acute ischemic stroke (73 ± 13 years) between November 2016 and August 2019 from which 18 patients were excluded and thus 44 patients were evaluated. A 3D 23Na MRI was acquired in addition to a T2-TIRM and a diffusion-weighted image. Coregistration and segmentation were performed with SPM 12 based on the T2-TIRM image. The extension of WM T2 hyperintense lesions in each patient was classified using the Fazekas scale of WMLs. The absolute TSC in the WM region was correlated to the Fazekas grades. The stroke region was manually segmented on the coregistered absolute diffusion coefficient image and absolute, and rTSC was calculated in the stroke region and compared to nonischemic WM region. Statistical significance was evaluated using the Student t-test. Results: For patients with Fazekas grade I (n = 25, age: 68.5 ± 15.1 years), mean TSC in WM was 55.57 ± 7.43 mM, and it was not statistically significant different from patients with Fazekas grade II (n = 7, age: 77.9 ± 6.4 years) with a mean TSC in WM of 53.9 ± 6.4 mM, p = 0.58. For patients with Fazekas grade III (n = 9, age: 81.4 ± 7.9 years), mean TSC in WM was 68.7 ± 10.5 mM, which is statistically significantly higher than the TSC in patients with Fazekas grade I and II (p < 0.001 and p = 0.05, respectively). There was a positive correlation between the TSC in WM and the Fazekas grade with r = 0.48 p < 0.001. The rTSC in the stroke region was statistically significant difference between low (0 and I) and high (2 and 3) Fazekas grades (p = 0.0353) whereas there was no statistically significant difference in absolute TSC in the stroke region between low (0 and I) and high (2 and 3) Fazekas grades. Conclusion: The significant difference in absolute TSC in WM in patients with severe small vessel disease; Fazekas grade 3 can lead to inaccuracies using rTSC quantification for evaluation of acute ischemic stroke using 23 Na MRI. The study, therefore, emphasizes the importance of absolute tissue sodium quantification.

scholarly journals Association of the atherosclerosis, small vessel disease, cardioembolism, other causes with the executive function of the montreal cognitive assessment Indonesia in patients with post ischemic stroke

2019 ◽  
Vol 7 (5) ◽  
pp. 1707
Author(s):  
Dwi Retno Hastani ◽  
Aldy S. Rambe ◽  
Kiki M. Iqbal
Keyword(s):  
Ischemic Stroke ◽  
Executive Function ◽  
Cognitive Assessment ◽  
Small Vessel Disease ◽  
Montreal Cognitive Assessment ◽  
Small Vessel ◽  
Stroke Patients ◽  
Memory Decline ◽  
Vessel Disease ◽  
Phenotype Classification

Background: ASCO Phenotype classification is a new classification of stroke based on phenotypic system. ASCO classification can evaluate the etiology of ischemic stroke comprehensively to characterize patients using different grade of evidence for the subtype of ischemic stroke. ASCO classification can predict post ischemic stroke cognitive decline. This Study purpose to evaluate the association between ASCO classification with the executive function in post ischemic stroke patients.Methods: This cross sectional study followed by 28 post ischemic stroke patients (men 16, women 12) over 3 months. Mean age 52.82±8.66. Cognitive function was assessed by Montreal Cognitive Assessment Indonesia (MoCA INA).Results: There were 17 patients with grade 1 atherosclerosis (ASCO A1), ten patients with grade 1 small vessel disease (ASCO S1), one patient with grade 1 cardioembolism (ASCO C1) in post ischemic stroke. Grade 1 atherosclerosis (ASCO A1) was significantly associated with executive function decline (p=0.002), naming decline (p=0.05), abstraction decline (p=0.001), memory decline (p=0.002) and orientation decline (p=0.016)). Grade 1 small vessel disease (ASCO S1) was significantly associated with executive function decline (p=0.001) and memory decline (p = 0.001) and abstraction (p=0.001). Grade 1 cardioembolism 1 (ASCO C1) was not significantly associated with cognitive decline.Conclusions: There was significant association between ASCO classification with the executive function of Montreal Cognitive Assestment Indonesia (MoCA INA) in post ischemic stroke patients.

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