INVESTIGATION OF THE INTERNAL RISK FACTORS INFLUENCE ON THE TIME OF THE ISCHEMIC STROKE ONSET

2019 ◽  
Vol 15 (67) ◽  
pp. 021
Author(s):  
A. O. Volosovets ◽  
I. S. Zozulya
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Onset

scholarly journals Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients

Stroke ◽  
2021 ◽  
Author(s):  
Lindsay S. McAlpine ◽  
Adeel S. Zubair ◽  
Ilavarasy Maran ◽  
Pola Chojecka ◽  
Paul Lleva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Endothelial Activation ◽  
Vascular Risk Factors ◽  
Interquartile Range ◽  
Stroke Onset ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Markers Of Inflammation ◽  
Von Willebrand

Background and Purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor. Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause. Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13–375] versus 8 [4–11], P <0.01) and sIL (soluble IL)-2 receptor (1972 [1525–4720] versus 767 [563–1408.5], P =0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%–382%] versus 150% [128%–183%], P =0.034; von Willebrand antigen 330.0% [265%–650%] versus 152% [130%–277%], P =0.007, and factor VIII 301% [289%–402%] versus 49% [26%–94%], P <0.001). Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.

Abstract T P19: “Futile” Interhospital Transfer for Endovascular Recanalization Treatment in Acute Ischemic Stroke. The Madrid Stroke Network

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Blanca Fuentes ◽  
Maria Alonso de Leciñana ◽  
Alvaro Ximenez-Carrillo ◽  
Patricia Martínez-Sánchez ◽  
Antonio Cruz-Culebras ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Vascular Risk Factors ◽  
Stroke Onset ◽  
Vascular Risk ◽  
Interhospital Transfer ◽  
Hospital Transfer ◽  
Arterial Recanalization

Objectives: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke (IS) and the small number of patients eligible for that treatment justifies the development of Stroke Center networks with interhospital transfer of eligible patients. But it is possible that this approach generate “futile“ transfers (i.e. shift of patients who finally do not receive ET) generating unnecessary costs. Our aim is to analyze the frequency of “futile” transfers, the reasons for rejection for ERT and to identify the possible associated factors. Methods: We analyzed a prospective registry of ERT from a Stroke Network integrated by three hospitals with facilities for ERT for acute stroke patients. These hospitals share a common stroke protocol and have established a weekly rotatory shift with inter-hospital transference to the on-call center for ERT in those patients in whom this therapy is indicated, both primarily, after completing IV thrombolysis or in patients attended in outside hospitals (drip and shift). We analyzed: demographic data, vascular risk factors, stroke severity, frequency of prior intravenous thrombolysis, time from stroke onset and reasons for rejection. Study period: 1/02/2012 to 07/05/2013. Results: ERT protocol was activated in 199 patients, receiving ERT 129 (64.8%). 120 (60.3%) patients required inter-hospital transfer, among them 50 (41%) were not finally treated (futile transfer). These were more often male (74.1% vs. 25.9%, P = 0.04), with no differences in age, vascular risk factors, time-lapse from stroke onset or delay of inter-hospital transfer, baseline NIHSS, baseline ASPECTS or rate of prior intravenous thrombolysis between transferred patients treated with ERT and those non-treated. Reasons for rejection were: clinical improvement (16%), arterial recanalization (24%), clinical deterioration (8%); ASPECTS <7 in the 2nd TC (20%), absence of mismatch (20%); delay in shipment (2%), revocation of consent (1%). Conclusions: 40% of shipments for ERT are “futile”. None of the baseline patient characteristics predict this fact, being arterial recanalization and findings in a second imaging test done in the receiving hospital the main reasons for ERT rejection.

scholarly journals Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Qianqian Wu ◽  
Jingjing Cui ◽  
Yuanli Xie ◽  
Min Wang ◽  
Huifang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Protective Factor ◽  
Density Lipoprotein ◽  
The Elderly ◽  
Outcome Data ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Large Artery

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P &lt; 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P &lt; 0.001) at 3 months, 4.95 (2.70–9.10, P &lt; 0.001) at 12 months, and 4.82 (2.25–10.32, P &lt; 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P &lt; 0.001) at 3 months, 11.08 (5.26–23.34, P &lt; 0.001) at 12 months, and 14.30 (4.85–42.11, P &lt; 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P &lt; 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

scholarly journals Risk Factors of Hypoperfusion on MRI of Ischemic Stroke Patients Within 7 Days of Onset

2021 ◽  
Vol 12 ◽  
Author(s):  
Jingjing Xiao ◽  
Huazheng Liang ◽  
Yue Wang ◽  
Shaoshi Wang ◽  
Yi Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Onset Time ◽  
Residue Function ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Metabolic Characteristics ◽  
Vascular Stenosis ◽  
Prior Stroke

Objective: Hypoperfusion is an important factor determining the prognosis of ischemic stroke patients. The present study aimed to investigate possible predictors of hypoperfusion on MRI of ischemic stroke patients within 7 days of stroke onset.Methods: Ischemic stroke patients, admitted to the comprehensive Stroke Center of Shanghai Fourth People's Hospital affiliated to Tongji University within 7 days of onset between January 2016 and June 2017, were recruited to the present study. Magnetic resonance imaging (MRI), including both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), was performed within 7 days of the symptom onset. Time to maximum of the residue function (Tmax) maps were automatically evaluated using the RAPID software. The volume of hypoperfusion was measured outside the infarct area based on ADC &lt; 620 × 10−6 mm2/s. The 90 d mRS score was assessed through either clinic visits or telephone calls. Multivariate step-wise analysis was used to assess the correlation between MR findings and clinical variables, including the demographic information, cardio-metabolic characteristics, and functional outcomes.Results: Among 635 patients admitted due to acute ischemic stroke within 7 days of onset, 241 met the inclusion criteria. Hypoperfusion volume of 38 ml was the best cut-off value for predicting poor prognosis of patients with cerebral infarction (90 d-mRS score ≥ 2). The incidences of MR perfusion Tmax &gt; 4–6 s maps with a volume of 0–38 mL or &gt;38 mL were 51.9% (125/241) and 48.1% (116/241), respectively. Prior stroke and vascular stenosis (≥70%) were associated with MR hypoperfusion. Multivariate step-wise analysis showed that prior stroke and vascular stenosis (≥70%) were risk factors of Tmax &gt; 4–6 s maps, and the odds ratios (OR) were 3.418 (adjusted OR 95% CI: 1.537–7.600), and 2.265 (adjusted OR, 95% CI: 1.199–4.278), respectively.Conclusion: Our results suggest that prior stroke and vascular stenosis (≥70%) are strong predictors of hypoperfusion in patients with acute ischemic stroke within 7 days of stroke onset.

scholarly journals Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

2020 ◽  
Vol 5 (3) ◽  
pp. 252-261
Author(s):  
Jan H Schaefer ◽  
Christoph Stephan ◽  
Christian Foerch ◽  
Waltraud Pfeilschifter
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Onset ◽  
Large Vessel ◽  
Control Group ◽  
Vessel Disease ◽  
Immunodeficiency Virus ◽  
Large Vessel Disease

Introduction The global incidence of ischemic stroke among patients with human immunodeficiency virus is increasing. The aim of this controlled case analysis was to study patient characteristics, stroke etiologies, and risk factors in human immunodeficiency virus-positive patients in a medical system with easy access to antiretroviral therapies. Patients and methods We conducted a retrospective, observational study of human immunodeficiency virus-positive patients treated in our stroke unit and outpatient clinic in Germany between 2012 and 2018. A control group of all patients treated for acute ischemic stroke in 2018 was used to elicit possible differences in stroke localization, etiology, and distribution of risk factors. Results Out of 3615 patients with an acute ischemic stroke, 24 (0.7%) were newly or previously diagnosed as human immunodeficiency virus-positive. Strokes in this cohort were caused by large-vessel disease (37.5%), small-vessel disease (20.8%), cryptogenic-embolism (20.8%), vasculitis (16.7%), and cardio-embolism (4.2%). Large-vessel disease-related strokes were more often located in the posterior circulation (77.8%). Compared to the control group, cardio-embolic strokes were less and vasculitis and large-vessel disease more frequent. Human immunodeficiency virus-positive patients were younger at stroke onset (53.7 ± 12.8 vs. 70.2 ± 14.6 years, p = 0.05). Discussion Although the prevalence of human immunodeficiency virus-infection among patients treated for acute ischemic strokes appears low, this collective merits special attention due to a high burden of potentially modifiable risk factors and vasculitis. Conclusion Compared to previous studies, age at stroke onset was one of the highest, supporting the hypothesis that as antiretroviral therapy increases the life expectancy of people living with HIV/AIDS, they will be increasingly affected by cardiovascular disease. Human immunodeficiency virus-related cerebral vasculitis was associated with high mortality (75%).

The relation between hyperhomocysteinemia and the intima-media complex thickness in common carotid artery, as risk factors for ischemic stroke

2018 ◽  
Vol 31 (06) ◽  
Author(s):  
Monika Chorazy ◽  
Dominika Jakubowicz-Lachowska ◽  
Michal Szczepanski ◽  
Katarzyna Krystyna Snarska ◽  
Agata Krajewska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Common Carotid Artery

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.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

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