Cytokines, Selectins and Adhesion Molecules Plasma Levels in Acute Ischaemic Stroke: Relationship with Stroke Subtype, Ischaemic Lesion Site and Clinical Outcome

2007 ◽  
Vol 14 (3) ◽  
pp. 145-196
Author(s):  
A Tuttolomondo ◽  
A Pinto ◽  
D Di Raimondo ◽  
S Corrao ◽  
R Di Sciacca ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Adhesion Molecules ◽  
Acute Ischaemic Stroke ◽  
Plasma Levels ◽  
Lesion Site ◽  
Stroke Subtype ◽  
Ischaemic Lesion

Symmetric dimethylarginine is a marker of detrimental outcome in the acute phase after ischaemic stroke: role of renal function

2011 ◽  
Vol 122 (3) ◽  
pp. 105-111 ◽  
Author(s):  
Nicole Lüneburg ◽  
Rouven-Alexander von Holten ◽  
Rudolf F. Töpper ◽  
Edzard Schwedhelm ◽  
Renke Maas ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Plasma Levels ◽  
Recurrent Stroke ◽  
Composite Endpoint ◽  
Adverse Clinical Outcome ◽  
Symmetric Dimethylarginine ◽  
Stroke Event

Methylarginines have been shown to interfere with NO (nitric oxide) formation by inhibiting NOS (NO synthase)–ADMA (asymmetric dimethylarginine) and cellular L-arginine uptake into the cell [ADMA and SDMA (symmetric dimethylarginine)]. In a recent study, elevation of SDMA was related to long-term mortality in patients recruited 30 days after a stroke event. In the present study, we aimed at investigating the association of SDMA and adverse clinical outcome in the early phase (first 30 days) after acute ischaemic stroke. A total of 137 patients were recruited immediately upon admission to the emergency unit with an acute ischaemic stroke. Plasma levels of methylarginines were determined by a validated LC–MS/MS (liquid chromatography–tandem MS) method. Patients were prospectively followed for 30 days. A total of 25 patients (18.2%) experienced the primary composite endpoint [death, recurrent stroke, MI (myocardial infarction) and rehospitalization]. SDMA plasma levels were significantly higher in stroke patients compared with patients without event (0.89±0.80 compared with 0.51±0.24 μmol/l; P<0.001). SDMA levels were significantly correlated with markers of renal function. Kaplan–Meier survival analysis demonstrated that cumulative survival decreased significantly with ascending tertiles of SDMA (P<0.001). Our study provides the first data indicating that SDMA is strongly associated with adverse clinical outcome during the first 30 days after ischaemic stroke. Our results strengthen the prognostic value of renal function in patients with stroke and confirm the hypothesis that SDMA is a promising marker for renal function.

scholarly journals Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

2021 ◽  
pp. 197140092110091
Author(s):  
Hanna Styczen ◽  
Matthias Gawlitza ◽  
Nuran Abdullayev ◽  
Alex Brehm ◽  
Carmen Serna-Candel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

scholarly journals Cerebral Haemodynamics following Acute Ischaemic Stroke: Effects of Stroke Severity and Stroke Subtype

2018 ◽  
Vol 8 (2) ◽  
pp. 80-89 ◽  
Author(s):  
Osian Llwyd ◽  
Angela S.M. Salinet ◽  
Ronney B. Panerai ◽  
Man Y. Lam ◽  
Nazia P. Saeed ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Arteries ◽  
Correlation Coefficients ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Cerebral Haemodynamics ◽  
Anterior Circulation ◽  
Mean Values

Background: Acute ischaemic stroke (AIS) patients often show impaired cerebral autoregulation (CA). We tested the hypothesis that CA impairment and other alterations in cerebral haemodynamics are associated with stroke subtype and severity. Methods: AIS patients (n = 143) were amalgamated from similar studies. Data from baseline (< 48 h stroke onset) physiological recordings (beat-to-beat blood pressure [BP], cerebral blood flow velocity (CBFV) from bilateral insonation of the middle cerebral arteries) were calculated for mean values and autoregulation index (ARI). Differences were assessed between stroke subtype (Oxfordshire Community Stroke Project [OCSP] classification) and severity (National Institutes of Health Stroke Scale [NIHSS] score < 5 and 5–25). Correlation coefficients assessed associations between NIHSS and physiological measurements. Results: Thirty-two percent of AIS patients had impaired CA (ARI < 4) in affected hemisphere (AH) that was similar between stroke subtypes and severity. CBFV in AH was comparable between stroke subtype and severity. In unaffected hemisphere (UH), differences existed in mean CBFV between lacunar and total anterior circulation OCSP subtypes (42 vs. 56 cm•s–1, p < 0.01), and mild and moderate-to-severe stroke severity (45 vs. 51 cm•s–1, p = 0.04). NIHSS was associated with peripheral (diastolic and mean arterial BP) and cerebral haemodynamic parameters (CBFV and ARI) in the UH. Conclusions: AIS patients with different OCSP subtypes and severity have homogeneity in CA capability. Cerebral haemodynamic measurements in the UH were distinguishable between stroke subtype and severity, including the association between deteriorating ARI in UH with stroke severity. More studies are needed to determine their clinical significance and to understand the determinants of CA impairment in AIS patients.

scholarly journals Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial

2014 ◽  
Vol 13 (6) ◽  
pp. 567-574 ◽  
Author(s):  
Pooja Khatri ◽  
Sharon D Yeatts ◽  
Mikael Mazighi ◽  
Joseph P Broderick ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Phase 3 ◽  
Interventional Management

scholarly journals Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Si Zhao Tang ◽  
Jon Sen
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Qualitative Synthesis ◽  
Poor Clinical Outcome ◽  
Significant Difference ◽  
Quantitative Synthesis

AbstractT2*-weighted MRI using GRE and SWI sequences can potentially prognosticate the recanalization rate and clinical outcomes in patients with acute ischaemic stroke, using susceptibility vessel sign (SVS) and prominent hypointense vessel sign (PHVS).A literature search on PubMed, EMBASE databases and other sources from inception up to 01 February 2020 was conducted. 15 studies which reported SVS and PHVS were included in qualitative synthesis. 9 studies on SVS were included in quantitative synthesis i.e. meta-analysis.Meta-analysis did not show any significant difference in the recanalization rate between SVS (+) group and SVS (-) group (RR = 0.95, 95% CI = 0.87–1.05, p = 0.33). Treatment subgroup analysis (intravenous thrombolysis, IVT- or mechanical thrombectomy, MT-only) does not show significant association between the SVS and IVT-only (RR = 0.73, 95% CI = 0.51-1.05, P=0.09); or MT-only groups (RR = 0.99, 95% CI = 0.90-1.09, P=0.90). No significant association between poor clinical outcome at 3 months and presence of SVS (RR = 1.42, 95% CI = 0.79–2.57, p = 0.24). Treatment subgroup analysis revealed significant association of the SVS and poor clinical outcome at 3 months in the MT-only (RR = 0.67, 95% CI = 0.55–0.82, p = 0.0001) or no thrombolytic treatment (RR = 2.83, 95% CI = 1.69-4.75, p < 0.0001).In conclusion, there is a significant association between the presence of SVS and poor clinical outcome in patients who underwent MT or without treatment, and no definitive association between the presence of SVS and recanalization rate for acute ischemic stroke.

Blood pressure course in acute ischaemic stroke in relation to stroke subtype

2004 ◽  
Vol 9 (3) ◽  
pp. 107-114 ◽  
Author(s):  
Konstantinos N. Vemmos ◽  
Georgios Tsivgoulis ◽  
Konstantinos Spengos ◽  
Andreas Synetos ◽  
Efstathios Manios ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Subtype

scholarly journals Secondary prevention by stroke subtype: a nationwide follow-up study in 46 108 patients after acute ischaemic stroke

2013 ◽  
Vol 34 (35) ◽  
pp. 2760-2767 ◽  
Author(s):  
Dohoung Kim ◽  
Seung-Hoon Lee ◽  
Beom Joon Kim ◽  
Keun-Hwa Jung ◽  
Kyung-Ho Yu ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Subtype ◽  
Follow Up Study ◽  
Subtype A

scholarly journals Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

2014 ◽  
Vol 20 (6) ◽  
pp. 704-714 ◽  
Author(s):  
Salvatore Mangiafico ◽  
Valentina Saia ◽  
Patrizia Nencini ◽  
Ilaria Romani ◽  
Vanessa Palumbo ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Collateral Circulation ◽  
Clinical Results ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Clinical Role

Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11–22.31) or death (OR 4.66, 95% CI 1.48–14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.

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