LONG-TERM OUTCOME OF ENDOVASCULAR STROKE TREATMENT.

Genetic determinants play important role in the complex processes of inflammation and immune response in stroke and could be studied in different ways. Inflammation and immunomodulation are associated with repair processes in ischemic stroke, and together with the concept of preconditioning are promising modes of stroke treatment. One of the important aspects to be considered in the recovery of patients after the stroke is a genetic predisposition, which has been studied extensively. Polymorphisms in a number of candidate genes, such as IL-6, BDNF, COX2, CYPC19, and GPIIIa could be associated with stroke outcome and recovery. Recent GWAS studies pointed to the variant in genesPATJ and LOC as new genetic markers of long term outcome. Epigenetic regulation of immune response in stroke is also important, with mechanisms of histone modifications, DNA methylation, and activity of non-coding RNAs. These complex processes are changing from acute phase over the repair to establishing homeostasis or to provoke exaggerated reaction and death. Pharmacogenetics and pharmacogenomics of stroke cures might also be evaluated in the context of immuno-inflammation and brain plasticity. Potential novel genetic treatment modalities are challenged but still in the early phase of the investigation.

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Predicting Long-Term Outcome after Endovascular Stroke Treatment: The Totaled Health Risks in Vascular Events Score

American Journal of Neuroradiology ◽

10.3174/ajnr.a2050 ◽

2010 ◽

Vol 31 (7) ◽

pp. 1192-1196 ◽

Cited By ~ 64

Author(s):

A.C. Flint ◽

S.P. Cullen ◽

B.S. Faigeles ◽

V.A. Rao

Keyword(s):

Health Risks ◽

Vascular Events ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Treatment

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Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

Italian Journal of Medicine ◽

10.4081/itjm.2009.239 ◽

2013 ◽

pp. 239-243

Author(s):

Michele Stornello ◽

Filomena Pietrantonio

Keyword(s):

Early Stage ◽

Integrated Approach ◽

Stroke Care ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Treatment ◽

Care Approach ◽

Long Term Follow Up ◽

Set Up

Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours) and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

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Long-term neurological, vascular, and mortality outcomes after stroke

International Journal of Stroke ◽

10.1177/1747493018798526 ◽

2018 ◽

Vol 13 (8) ◽

pp. 787-796 ◽

Cited By ~ 11

Author(s):

Ravinder-Jeet Singh ◽

Shuo Chen ◽

Aravind Ganesh ◽

Michael D Hill

Keyword(s):

Acute Stroke ◽

Recurrent Stroke ◽

Intravenous Thrombolysis ◽

Stroke Recurrence ◽

Stroke Survivors ◽

Acute Stroke Care ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Treatment

Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.

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