INFLUNCE OF EARLY NEUROLOGIGAL IMPROVEMENT ON LONG – TERM OUTCOME IN ISCHEMIC STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

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Fasting Normoglycemia after Intravenous Thrombolysis Predicts Favorable Long-Term Outcome in Non-Diabetic Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm10143005 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3005

Author(s):

Marcin Wnuk ◽

Justyna Derbisz ◽

Leszek Drabik ◽

Maciej Malecki ◽

Agnieszka Slowik

Keyword(s):

Ischemic Stroke ◽

Fasting Glucose ◽

Intravenous Thrombolysis ◽

Favorable Outcome ◽

Diabetic Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Glucose Levels

Background: Only a few studies evaluated the role of fasting glucose levels after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Importantly, formal analysis concerning the prognostic role of fasting glucose levels in these patients with and without diabetes mellitus (DM) was not performed. Therefore, we assessed whether fasting normoglycemia (FNG) next morning after AIS treated with IVT was associated with 90-day functional outcome in diabetic and non-diabetic patients. Methods: We retrospectively analyzed 362 AIS patients treated with IVT at The University Hospital in Krakow. FNG was defined as glucose below 5.5 mmol/L. A favorable outcome was defined as modified Rankin score (mRS) of 0–2 at day 90 after AIS onset. Results: At 3-month follow-up, FNG was associated with favorable outcome (87.5% vs. 60.8%, p < 0.001) and decreased risk of death (3.1% vs. 18.1%, p = 0.002). Independent predictors of a favorable outcome for the whole group were: younger age (HR 0.92, 95%CI 0.89–0.95), lower NIHSS score after IVT (HR 0.70, 95%CI 0.65–0.76), lower maximal systolic blood pressure within 24 h after IVT (HR 0.92, 95%CI 0.89–0.95) and FNG (HR 4.12, 95%CI 1.38–12.35). Association between FNG and mortality was found in univariable (HR 1.47, 95%CI 0.04–0.62) but not in multivariable analysis (HR 0.23, 95%CI 0.03–1.81). In subgroup analyses, FNG was an independent predictor of favorable outcome (HR 5.96, 95%CI 1.42–25.1) only in patients without DM. Conclusions: FNG next morning after IVT is an independent protective factor for a favorable long-term outcome in non-diabetic AIS patients.

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Abstract TP25: Early Major Neurologic Improvement after Endovascular Therapy in Acute Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.atp25 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Luzma Cardona ◽

Dolora Wisco ◽

Shu-Mei Man ◽

Pravin George ◽

Esteban Cheng-Ching ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Favorable Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Neurological Improvement ◽

Arterial Recanalization ◽

Pre Treatment

Background and Purpose: Intravenous thrombolysis is associated with early major neurologic improvement, which is reported to occur in about a quarter of patients after 24 hrs. The aim of the study is to evaluate the frequency and predictors of early major improvement in patient with ischemic stroke after undergoing acute intra-arterial therapy. Materials and methods: Prospective collected database of patients undergoing intra-arterial therapy for the acute ischemic stroke from January 2008 to December 2011 was reviewed. The NIHSS was used to assess severity of stroke in patients upon admission, 24 hrs after procedure and at hospital discharge. Major neurological improvement was defined as improvement of NIHSS by more or equal to 8 or absolute NIHSS of 0 or 1. Arterial recanalization was defined as thrombolysis in cerebral infarction grade 2b or 3. Favorable outcome was defined as modified Rankin scale of 0-2 at 1 month and 3 months. Demographic and radiographic data were collected. Results: MNI was seen in 28 out of 138 (20%) of patients at 24 hours but was not associated with a 30 day or 90 day favorable outcome. MNI at discharge was seen in 47 of 148 (31%) patients and was associated with a 30 day and 90 day favorable outcomes of 0-2 on mRankin (Odds Ratio (OR) : 9.1, 95% confidence interval (CI): 3.7-22.5). Recanalization was associated with MNI at 24 hours (OR 3.1, 95% CI: 1.2-7.9) and MNI at discharge (OR 2.8, 95% CI: 1.3-6.0). Among pre-treatment variables, MNI at discharge was associated with imaging by pre-treatment Alberta Stroke Program Early CT Score (median 9 with MNI, 8 without MNI, p=0.03) and time to treatment (median 5.2 hours with MNI v 7.2 hours without MNI, p<0.01). Age and baseline NIHSS were not associated with MNI. In a logistic regression model, favorable outcome at 90 days was independently associated with baseline NIHSS and MNI at discharge. Conclusions: MNI after intra-arterial therapy was seen in about a quarter of patients and was associated with higher CT ASPECT scores, time to therapy, and arterial recanalization. MNI at discharge was an independent predictor of long term outcome.

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Abstract WP142: Low Risk Of Posterior Circulation Stroke In Ischemic Stroke Patients With Vertebral Artery Ositium Stenosis

Stroke ◽

10.1161/str.44.suppl_1.awp142 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Seung Hoon Song ◽

Joon Hwa Lee ◽

So Young Moon ◽

Hahn Young Kim

Keyword(s):

Ischemic Stroke ◽

Vertebral Artery ◽

Acute Ischemic Stroke ◽

Recurrent Stroke ◽

Posterior Circulation ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Angioplasty And Stenting

Backgrounds Atherosclerosis of vertebrobasilar artery is a major cause of the ischemic stroke in the posterior circulation. Vertebral artery ostium stenosis (VAOS) is occasionally observed in patients with acute ischemic stroke in anterior or posterior circulation. However, VAOS as a risk for stroke recurrence, especially for the posterior circulation stroke, has not been well studied. This study was performed to determine long-term outcome and clinical significance of VAOS in acute ischemic stroke patients. Methods As a prospective observational study of single stroke center registry, we studied risk of recurrent stroke and vascular outcome in acute ischemic stroke patients with VAOS, recruited consecutively from December 2007 to December 2010. VAOS was defined as more than 50% stenosis of either vertebral artery ostium on a contrast-enhanced MRA. Vascular risk factors and long-term outcome including recurrent stroke, cardiovascular event, vascular mortality, or all-cause mortality were investigated. Results Of 773 acute ischemic stroke patients, underwent contrast-enhanced MRA, 149 (19.2%) had more than 50% VAOS (age, 70±10 years). All patients had intensive medical treatment and 11 patients underwent angioplasty and stenting. During 327 patient-years of follow-up (mean, 2.2 years), there were 8 ischemic (3 in posterior circulation, 5 in anterior circulation), 5 hemorrhagic, and 2 unknown stroke. The annual rate of events were 1.36% for posterior circulation ischemic stroke, 3.64% for all ischemic stroke, 5.91% for all stroke, 1.36% for vascular death, and 9.55% for all cause mortality. Symptomatic VAOS, concomitant stenosis of other vertebrobasilar arteries or carotid arteries, or stroke subtype was not associated with long-term outcome. Conclusions Long-term outcome of acute ischemic stroke patients with more than 50% VAOS was favorable on intensive medical treatment and selective angioplasty and stenting. Vertebral artery ostium stenosis may not be a major risk factor for the recurrent ischemic stroke in the posterior circulation.

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Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Advances in Interventional Cardiology ◽

10.5114/aic.2020.101771 ◽

2020 ◽

Vol 16 (4) ◽

pp. 452-459

Author(s):

Klaudia Nowak ◽

Justyna Derbisz ◽

Jan Pęksa ◽

Bartłomiej Łasocha ◽

Paweł Brzegowy ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Post Stroke

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Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

European Stroke Journal ◽

10.1177/23969873211019586 ◽

2021 ◽

pp. 239698732110195

Author(s):

P Correia ◽

S Machado ◽

I Meyer ◽

M Amiguet ◽

A Eskandari ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Tobacco Use ◽

Migraine With Aura ◽

Hormonal Contraceptives ◽

Stroke Severity ◽

Term Outcome ◽

Long Term Outcome ◽

Female Patients

Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2021.10.157 ◽

2021 ◽

Author(s):

Sauson Soldozy ◽

Kaan Yağmurlu ◽

Pedro Norat ◽

Mazin Elsarrag ◽

John Costello ◽

...

Keyword(s):

Ischemic Stroke ◽

Meta Analysis ◽

Term Outcome ◽

Long Term Outcome

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Abstract TP448: High Residual Platelet Reactivity (hrpr) for Adenosine Diphosphate (adp) Stimuli is a Determinant Factor for Long-term Outcomes in Acute Ischemic Stroke With Anti-platelet Agents

Stroke ◽

10.1161/str.47.suppl_1.tp448 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Jae-Kwan Cha ◽

Eun-Kyu Kim

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Primary Endpoint ◽

Platelet Reactivity ◽

Large Artery ◽

Vascular Events ◽

Term Outcome ◽

Long Term Outcome ◽

Platelet Aggregometry

Background and Purpose: High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. Methods: We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70% or greater according to OPA after 10 μM ADP stimuli. Results: The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3% (109/968). Its rate was significantly higher in the patients with HRPR (16.7%) than in those without (9.7%). HPRP was independently associated with the primary endpoint (OR=1.97, CI 1.22 to 3.18, p<0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR=2.26, CI 1.15 to 4.45, P=0.02). Conclusions: In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.

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