Predicting the development of ischemic stroke in patients with cerebral atherosclerosis and diabetes mellitus

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients. The aim of our study is to predict the development of IS based on indicators of the structural and functional state of the heart and cerebral vessels and heart rate variability in patients with cerebral atherosclerosis (CA) and DM2. Materials and methods. The complex clinical and instrumental study involved 229 patients with CA 1–3 degrees. Study design: simple, prospective, non-randomized, sequential enrollment. All patients underwent instrumental examinations: transthoracic echocardiography, electrocardiography ECG, ultrasound Doppler of the vessels of the head and neck, MRI of the brain. All patients took antihypertensive and antidiabetic drugs, antiplatelet agents, statins. Results: Patients were divided into 2 groups: I - with CA 1–2 degrees, II - with CA 3 degrees (after ischemic atherothrombotic stroke (IS)). Average age = 65.1 ± 10.5 and 65.4 ± 9.1 years, respectively. The share of men was 21.2% in the 1st and 52% in the 2nd groups. The number of patients with type 2 diabetes, mean fasting glucose and glycosylated hemoglobin levels were comparable in both groups. At the time of examination, all patients achieved the target BP and T2DM compensation. In our study, for patients with CA, a negative relationship between ischemic stroke and end-diastolic size index and a positive relationship with the thickness of the interventricular septum and male sex was established, which logically explains the important role of LV geometry in the development of ischemic stroke. For patients with T2DM, a negative relationship was found between ischemic stroke and LV diastolic function and positive - with fasting glucose and IM thickness. Conclusion: Based on multivariate regression analysis, in patients with cerebral atherosclerosis with the development of ischemic stroke, the presence of a relationship between the thickness of the interventricular septum, end-systolic size index, end-diastolic size index and the male sex was revealed (AUC = 0.94 (CI 0.91 - 0.97), but in patients with DM2 and CA - fasting glucose level, interventricular septum thickness, intima-media complex thickness and E/A AUC = 0.99 (95% CI 0.94 - 1.00).

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Effects of Stress Hyperglycemia Ratio on 1-Year Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke

10.21203/rs.3.rs-104474/v1 ◽

2020 ◽

Author(s):

Dehao Yang ◽

Junli Ren ◽

Honghao Huang ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Glucose Concentration ◽

Fasting Glucose ◽

Glycosylated Hemoglobin ◽

Operating Characteristics ◽

Stress Hyperglycemia ◽

Poor Outcome

Abstract BackgroundStress hyperglycemia manifests as transient hyperglycemia in the context of illness with or without known diabetes, which may cause poor clinical outcome in acute ischemic stroke (AIS) patients. The present study intended to evaluate the association between stress hyperglycemia ratio (SHR) and 1-year clinical outcome after treatment with recombinant tissue plasminogen activator (r-tPA) for AIS patients and compare the predictive effect of fasting glucose concentration, glycosylated hemoglobin (HbA1c) and SHR. MethodsData from 205 AIS patients following thrombolytic therapy with r-tPA in the Third Affiliated Hospital of Wenzhou Medical University from Apr. 2016 to Apr. 2019 were retrospectively reviewed. We grouped AIS patients according to SHR tertiles to contrast the 1-year clinical outcome. Multivariate regression analysis was carried to further analyze the association between SHR and AIS prognosis. Moreover, the receiver operating characteristics (ROC) curve analysis was used for the purpose of comparing the prognostic effects of fasting glucose concentration, HbA1c and SHR on AIS patients. ResultsSHR was an independent predictor for 1-year poor outcome (OR 1.447; 95% CI, 1.124-1.864, p = 0.004) but not the mortality of AIS patients. Restricted cubic spline regression showed a linear relationship between SHR and the odds of poor outcome. Furthermore, SHR is a fair predictor to predict 1-year poor outcome. The cut-off value of SHR levels was 0.79 with 71.0% sensitivity and 72.0 % specificity. ConclusionsThe increased SHR was strongly associated with 1-year poor outcome following thrombolytic therapy with r-tPA. Meanwhile, SHR had higher predictive value for prognosis of AIS patients than fasting glucose concentration and HbA1c. Trial registrationRetrospectively registered

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Abstract 3313: Outcomes of “Drip-and-Ship” Paradigm Among Patients with Acute Ischemic Stroke. Results of a State Wide Study

Stroke ◽

10.1161/str.43.suppl_1.a3313 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Gustavo J Rodriguez ◽

M. Fareed K Suri ◽

Adnan I Qureshi

Keyword(s):

Ischemic Stroke ◽

Recombinant Tissue Plasminogen Activator ◽

Population Based ◽

Primary Diagnosis ◽

Hospital Charges ◽

Stroke Patients ◽

Frequency Distributions ◽

Number Of Patients ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: “Drip-and-ship” denotes patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 hours to a comprehensive stroke center. Although drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population based level. Methods: State-wide estimates of thrombolysis, associated in-hospital outcomes and mortality were obtained from 2008-2009 Minnesota Hospital Association (MHA) data. Patient numbers and frequency distributions were calculated for state-wide sample of patients hospitalized with a primary diagnosis of ischemic stroke. Patients outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n=473) or drip-and-ship paradigm (n=129). The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with drip-and-ship paradigm (8.5% versus 3.1, p=0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or drip-and-ship paradigm (5.9% versus 7.0%). The mean hospital charges were $65,669 for primary ED arrival and $47,850 for drip-and-ship treated patients (p<0.001). Conclusions: The results of drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this state-wide study.

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Abstract 392: Warfarin Versus Aspirin in Patients with Systolic Heart Failure and Normal Sinus Rhythm: Insights From a Meta-Analysis

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.392 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Rachit Shah ◽

George Mueller ◽

Dhavalkumar Patel ◽

Janos Molnar ◽

Kalpesh Patel ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Stroke ◽

Relative Risk ◽

Sinus Rhythm ◽

Systolic Heart Failure ◽

Aspirin Therapy ◽

Major Hemorrhage ◽

Risk Of Death ◽

Number Of Patients ◽

Aspirin Group

Background: It is unknown whether warfarin or aspirin therapy is superior for the treatment of patients with systolic heart failure who are in sinus rhythm. Methods: We performed a systematic literature search for randomized trials comparing warfarin and aspirin in patients with systolic heart failure which provided the event rates for ischemic stroke, major hemorrhage and death in the two groups. Heterogeneity of the studies was analyzed by Q statistics. The studies were homogeneous for each outcome; therefore the fixed-effect model was used to compute the relative risk based on the number of events and total number of patients in each group. A two-sided alpha error of <0.05 was considered to be statistically significant (p<0.05). Results: We found 4 randomized clinical trials comparing warfarin and aspirin therapy in patients with systolic heart failure with a mean duration of follow up of 2.3 years enrolling a total of 3663 patients. The relative risk for ischemic stroke in patients treated with warfarin was 0.50 with 95% confidence interval (CI) of 0.33 - 0.75 (P= 0.001) while the relative risk for major hemorrhage was 1.94 with 95% CI of 1.40- 2.71 (P= 0.000) in comparison to the aspirin group. The relative risk of death was 1.01 with 95% CI of 0.89- 1.14 (P= 0.871) in the warfarin group compared to the aspirin group. Conclusion: Although warfarin therapy appears to reduce the risk of ischemic stroke in patients with systolic heart failure who are in sinus rhythm, the reduction comes at the cost of higher risk of bleeding and there is no evidence of an overall benefit on mortality.

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Abstract W P224: Higher Pre-Hospital Blood Pressure Prolongs Door to Needle Thrombolysis Times

Stroke ◽

10.1161/str.46.suppl_1.wp224 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Digvijaya Navalkele ◽

Chunyan Cai ◽

Mohammad Rahbar ◽

Renganayaki Pandurengan ◽

Tzu-Ching Wu ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Small Sample Size ◽

Heart Association ◽

Small Sample ◽

Categorical Variables ◽

Continuous Variables ◽

Intravenous Tissue Plasminogen Activator ◽

Number Of Patients

Background: Per American Heart Association guidelines, blood pressure (BP) should be < 185/110 to be eligible for intravenous tissue plasminogen activator (tPA). It is shown that door to needle (DTN) time is prolonged in patients who require anti-hypertensive medications prior to thrombolysis in the emergency department (ED). To our knowledge, no studies have focused on pre-hospital BP and its impact on DTN times. We hypothesize that DTN times are longer for patients with higher pre-hospital BP. Methods: We conducted a retrospective review of acute ischemic stroke patients who presented between 1/2010 and 12/2010 to our ED through Emergency Medical Services (EMS) within 3-hrs of symptom onset. Patients were identified from our registry and categorized into two groups: Pre-hospital BP ≥ 185/110 (Pre-hsp HBP) and < 185/110 (Pre-hsp LBP). BP records were abstracted from EMS sheets. Two groups were compared using two-sample t-test or Wilcoxon rank sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. Results: A total of 107 consecutive patients were identified. Out of these, 75 patients (70%) were treated with tPA. Among the patients who received thrombolysis, 35% had pre-hospital BP ≥ 185/110 (n= 26/75). Greater number of patients required anti-hypertensive medications in ED in high BP group compared to low BP group (Pre-hsp HBP n= 14/26, 54%; Pre-hsp LBP n= 13/49, 27%, p < 0.02). Mean door to needle times were significantly higher in Pre-hsp HBP group. (mean ± SD 87.5± 34.2 Vs. 59.7±18.3, p<0.0001). Analysis of patients only within the Pre-hsp HBP group (n= 26) revealed that DTN times were shorter if patients received pre-hsp BP medications compared to patients in the same group who did not receive pre-hsp BP medication (n= 10 vs 16; mean ± SD 76.5 ± 25.7 Vs. 94.3 ± 37.7, p = 0.20) Conclusion: Higher pre-hospital BP is associated with prolonged DTN times and it stays prolonged if pre-hospital high BP remains untreated. Although the later finding was not statistical significant due to small sample size, pre-hospital blood pressure control could be a potential area for improvement to reduce door to needle times in acute ischemic stroke.

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Abstract TMP8: The New Alteplase Package Insert: What is the Potential Impact?

Stroke ◽

10.1161/str.47.suppl_1.tmp8 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Harn Shiue ◽

Karen Albright ◽

Kara Sands ◽

April Sisson ◽

Michael Lyerly ◽

...

Keyword(s):

Health Care ◽

Ischemic Stroke ◽

Health Care Costs ◽

Lifetime Cost ◽

Package Insert ◽

Cost Savings ◽

Number Of Patients ◽

History Of ◽

Potential Impact ◽

Care Costs

Background: Alteplase (tPA) contraindications for acute ischemic stroke (AIS) were originally derived from the 1995 NINDS trial. Recently, a history of intracranial hemorrhage (ICH) and recent stroke (within 3 months) were removed as contraindications from the drug package insert, which could increase the number of patients eligible for IV thrombolysis. We sought to define the potential impact on outcomes and health care costs in this newly eligible population. Methods: Consecutive patients (March 2014 - April 2015) who presented with AIS to our Comprehensive Stroke Center (CSC) were retrospectively analyzed. Demographics and tPA exclusions were recorded. The annual number of discharges with primary diagnosis of ischemic stroke in the U.S. was estimated from the National Inpatient Sample (2006 - 2011). A previously reported value of $25,000/patient was utilized to calculate lifetime cost savings in patients receiving tPA. Results: During the study period, 776 AIS were admitted to our CSC (median age 64; 55,74, 51% men, 62% white). Seventy-six percent of our patients (n=590) had ≥1 tPA exclusions according to the NINDS trial. Among these patients, 11 excluded had history of ICH, 15 with recent strokes, and 1 both. Following the new package insert, the proportion of patients with ≥1 tPA exclusion fell to 73% (n=563). Given the 432,000 ischemic stroke discharges annually, a 3% increase in patients eligible for tPA could translate to treatment of 12,960 more patients annually and a lifetime cost savings of $324,000,000. Furthermore, we estimate that 1,685 of these newly eligible patients will experience a favorable functional outcome based on the results of the NINDS trial (13% shift analysis for mRS 0-1). Conclusions: Our results suggest that the new tPA package insert has the potential to increase national tPA treatment rates, decrease U.S. health care costs, and improve functional outcomes in eligible AIS patients. National guidelines need to be updated to reflect these changes.

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The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0509 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Emre Sarıkaya ◽

Dilek Çiçek ◽

Ebru Gök ◽

Leyla Kara ◽

Uğur Berber ◽

...

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Glycosylated Hemoglobin ◽

Emergency Admissions ◽

Single Center Experience ◽

Number Of Patients ◽

Significant Difference ◽

Before And After ◽

One Year

Abstract Objectives Coronavirus disease 2019 has caused a major epidemic worldwide, and lockdowns became necessary in all countries to prevent its spread. This study aimed to evaluate the effects of staying-at-home practices on the metabolic control of children and adolescents with type 1 diabetes during the pandemic period. Materials and Methods Eighty-nine patients younger than 18 years old who were diagnosed with type 1 diabetes at least one year before the declaration of the pandemic were included in the study. The last visit data of the patients before and after the declaration of the pandemic, and the frequency of presentation of diabetes-related emergencies from one year after diagnosis of type 1 diabetes to the declaration of the pandemic, and from the declaration of the pandemic to the last visit after the pandemic declaration were compared. Results The total number of patients was 89, and 48 (53.9%) were boys. The mean (± standard deviation [SD]) age at diagnosis was 8.4 ± 3.7 years (boys 7.9 ± 3.6 years; girls 8.9 ± 3.9 years). There was no statistically significant difference when the SD values of the anthropometric measurements, and the glycosylated hemoglobin (HbA1c) and lipid profile tests were compared. However, the frequency of admission to the emergency service related to diabetes was significantly different. Conclusions Although the pandemic did not significantly affect the metabolic and glycemic controls of the children with type 1 diabetes included in this study, an increase in the frequency of diabetes-related emergency admissions was noted.

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Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014239 ◽

2018 ◽

Vol 11 (3) ◽

pp. 241-245 ◽

Cited By ~ 22

Author(s):

Nikita Lakomkin ◽

Mandip Dhamoon ◽

Kirsten Carroll ◽

Inder Paul Singh ◽

Stanley Tuhrim ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Review Of The Literature ◽

Qualitative Synthesis ◽

Vessel Occlusion ◽

Number Of Patients ◽

Meta Analyses

BackgroundAccurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.ObjectiveTo perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.MethodsA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.ResultsSixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.ConclusionsDespite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.

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Etiology of ischemic stroke among young adults of Serbia

Vojnosanitetski pregled ◽

10.2298/vsp0811803j ◽

2008 ◽

Vol 65 (11) ◽

pp. 803-809 ◽

Cited By ~ 8

Author(s):

Dejana Jovanovic ◽

Ljiljana Beslac-Bumbasirevic ◽

Ranko Raicevic ◽

Jasna Zidverc-Trajkovic ◽

Marko Ercegovac

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Heart Diseases ◽

Developed Countries ◽

Large Artery ◽

Stroke Treatment ◽

Prosthetic Valves ◽

Number Of Patients ◽

Coagulation Inhibitors

Background/Aim. Etiology of ischemic stroke (IS) among young adults varies among countries. The aim of the study was to investigate the causes and risk factors of IS in the young adults of Serbia. Methods. A total of 865 patients with IS, aged 15 to 45 years, were treated throughout the period 1989-2005. Etiologic diagnostic tests were performed on the patient by the patient basis and according to their availability at the time of investigation. The most likely cause of stroke was categorized according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Results. There were 486 men and 379 women, with 19% of the patients ? 30 years old. Large artery arteriosclerosis and small artery disease were confirmed in 14% of the patients, and embolism and other determined causes in 20%. Undetermined causes made up 32% of the patients, mostly those (26%) with incomplete investigations. Smoking (37%), hypertension (35%) and hyperlipidemia (35%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were the most common causes of IS. Arterial dissections and coagulation inhibitors deficiency were detected in a small number of patients. Conclusion. Etiology of IS among Serbian young adults shares characteristics of those in both western and less developed countries.

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Disbalance of testosterone is a risk factor of the beginning of ischemic stroke of middle age men

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2008-0-23-28 ◽

2008 ◽

Vol 7 ◽

pp. 23-28

Author(s):

B. M. Doronin ◽

Ye. A. Vas’kina ◽

O. A. Denisova

Keyword(s):

Body Mass Index ◽

Risk Factor ◽

Ischemic Stroke ◽

Body Mass ◽

Sex Hormones ◽

Critical Period ◽

Middle Age ◽

Hormone Concentration ◽

Hormonal Dysfunction ◽

Male Sex

The aim of work is to exposure how disbalance of male sex hormones in the period of the age-specific reorganization affects development of atherosclerosis and vascular disorders by the example of ischemic stroke, establishment of correlation between hormonal dysfunction by the example testosterone and lipid metabolism according to the somatic type in the critical period of ischemic stroke. The pilot analysis of level of sex hormones by the example testosterone, lipids and body mass index confirms that there is correlation between these indices. Rising of body mass index is accompanied by reduction of sex hormone concentration, but for all that levels of cholesterol and atherogenic fraction are increased.

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Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1067 ◽

2019 ◽

Vol 74 (4) ◽

pp. 283-288

Author(s):

Petr A. Gerasimchuk ◽

Alexander V. Shidlovskyi ◽

Dmitriy B. Fira ◽

Andrey V. Pavlyshyn

Keyword(s):

Diabetes Mellitus ◽

Negative Pressure ◽

Diabetic Foot ◽

Chronic Wound ◽

Lower Limbs ◽

Diabetic Foot Syndrome ◽

Vacuum Therapy ◽

Social Significance ◽

Number Of Patients ◽

Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

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