scholarly journals Characteristics and Outcomes of Intravenous Thrombolysis in Mild Ischemic Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Huan Tang ◽  
Shenqiang Yan ◽  
Chenglong Wu ◽  
Yanxing Zhang
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Unfavorable Outcome ◽  
Cardioembolic Stroke ◽  
Stroke Patients ◽  
Early Neurological Deterioration ◽  
Baseline Systolic Blood Pressure ◽  
History Of

Objective: This study assessed the characteristics of intravenous thrombolysis (IVT) with respect to early neurological deterioration (END) and functional outcome in mild ischemic stroke patients.Methods: Data were obtained from acute mild ischemic stroke patients (defined as having a National Institute of Health Stroke Score (NIHSS) ≤ 5) treated with IVT in our hospital from July 2017 to December 2020. END was defined as the NIHSS increased ≥1 over the baseline at 24 h after IVT. A modified Rankin scale (mRS) ≤ 1 at 3 months was considered as a favorable outcome, and an mRS ≥2 at 3 months was an unfavorable outcome.Results: Two hundred thirty-three acute mild ischemic stroke patients (all patients underwent MRI and DWI restriction) with IVT were included in this study. Thirty-one patients experienced END, and 57 patients experienced an unfavorable outcome at 3 months. With multivariate analysis, END was associated with an elevated baseline systolic blood pressure (SBP) (OR = 1.324, 95% CI, 1.053–1.664, p = 0.016) and coronary heart disease (OR = 4.933, 95% CI, 1.249–19.482, p = 0.023). An unfavorable outcome at 3 months after IVT was independently associated with a baseline elevated SBP (OR = 1.213, 95% CI, 1.005–1.465, p = 0.045), baseline NIHSS (OR = 1.515, 95% CI, 1.186–1.935, p = 0.001), prior hyperlipemia (OR = 3.065, 95% CI, 1.107–8.482, p = 0.031), cardioembolic stroke (OR = 0.323, 95% CI, 0.120–0.871, p = 0.025), and END at 24 h (OR = 4.531, 95% CI, 1.950–10.533, p < 0.001) in mild ischemic stroke patients.Conclusion: In mild ischemic stroke patients with IVT, an elevated baseline SBP and coronary heart disease were associated with END. The elevated baseline SBP, baseline NIHSS, a history of prior hyperlipemia, cardioembolic stroke, and END at 24 h after IVT were useful in predicting an unfavorable outcome at 3 months.

scholarly journals Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

2015 ◽  
Vol 39 (5-6) ◽  
pp. 262-268 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Ahmed A. Malik ◽  
Omar Saeed ◽  
Malik M. Adil ◽  
Gustavo J. Rodriguez ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Annual Rate ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Incident Cancer ◽  
Race Ethnicity ◽  
Age Adjusted Rates

Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.

Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

2019 ◽  
Vol 14 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Ying Zhou ◽  
Wansi Zhong ◽  
Anli Wang ◽  
Wanyun Huang ◽  
Shenqiang Yan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Terminal Branch ◽  
Stroke Patients ◽  
Lenticulostriate Arteries ◽  
Early Neurological Deterioration

Background Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ≥ 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p = 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

2019 ◽  
Vol 47 (1-2) ◽  
pp. 80-87 ◽  
Author(s):  
BaiLi Song ◽  
YuKai Liu ◽  
Linda Nyame ◽  
XiangLiang Chen ◽  
Teng Jiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Valvular Heart Disease ◽  
Cerebral Hemorrhage ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Lemeshow Test

Background: Accurate prognostication of unfavorable outcome made at the early onset of stroke is important to both the clinician and the patient management. This study was aimed to develop a nomogram based on the integration of parameters to predict the probability of 3-month unfavorable functional outcome in Chinese acute ischemic stroke patients. Methods: We retrospectively collected patients who underwent acute ischemic stroke at Stroke Center of the Nanjing First Hospital (China) between May 2013 and May 2018. After exclusion, the study population includes 1,025 patients for nomogram development. The main outcome measure was 3-month unfavorable outcome (modified Rankin Scale > 2). Multivariable logistic regression analysis was used to develop the predicting model, and stepwise logistic regression with the Akaike information criterion was utilized to find best-fit nomogram model. We incorporated the creatinine, fast blood glucose, age, previous cerebral hemorrhage, previous valvular heart disease, and NHISS score (COACHS), and these factors were presented with a nomogram. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Results: Multivariate analysis of the 1,025 patients for logistic regression helped identify the independent factors as National Institutes of Health Stroke Scale score on admission, age, previous valvular heart disease, fasting blood glucose, creatinine, and previous cerebral hemorrhage, which were included in the COACHS nomogram. The AUC-ROC of nomogram was 0.799. Calibration was good (p = 0.1376 for the Hosmer-Lemeshow test). Conclusions: The COACHS nomogram may be used to predict unfavorable outcome at 3 months after acute ischemic stroke in Chinese population. It may be also a reliable tool that is effective in its clinical utilization to risk-stratify acute stroke patients.

scholarly journals HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

2019 ◽  
Vol 37 (1) ◽  
Author(s):  
Ignatius Ivan ◽  
Budi Riyanto Wreksoatmodjo ◽  
Octavianus Darmawan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Severe Stroke ◽  
History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial  fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are  >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic  of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords:  Atrial  fibrillation,  heart  failure,  ischemic  stroke,  myocardial  infarction,  National  Institutes  of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

scholarly journals Proteinuria Independently Predicts Unfavorable Outcome of Ischemic Stroke Patients Receiving Intravenous Thrombolysis

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80527 ◽  
Author(s):  
Chih-Hao Chen ◽  
Sung-Chun Tang ◽  
Li-Kai Tsai ◽  
Shin-Joe Yeh ◽  
Kai-Hsiang Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Unfavorable Outcome ◽  
Stroke Patients

Abstract 210: The Risk Of A Diagnosis Of Cancer After Ischemic Stroke: Two Year Follow-up Study Of 3247 Cancer Free Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Ahmed A Malik ◽  
Omar Saeed ◽  
Malik M Adil ◽  
Fareed K Suri
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Composite Endpoint ◽  
Annual Rate ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Incident Cancer ◽  
Age Adjusted Rates

Background: Subclinical cancer can manifest as a thrombo-embolic event and may be detected at a later interval in ischemic stroke survivors. Objective: To determine the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3680 adults with non-disabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. We calculated age adjusted rates of incidence of cancer among ischemic stroke survivors and calculated the standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3247 patients (mean age (±SD) of 66 (±11); 2013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 month, 1 year, and 2 years, respectively. The age adjusted annual rate of cancer in patients with ischemic stroke over 1 year after recruitment was 581.8/100,000 persons which was higher than the age adjusted cancer rate of 486.5/100,000 persons in the general population (SIR 1.2, 95% CI 1.16-1.24). The age adjusted annual rate continued to be higher in patients with ischemic stroke over 2 years after recruitment (1301.7/100,000 versus 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6). There was a higher risk for death (OR 3.1, 95% CI, 1.8-5.4), fatal/disabling stroke or death (OR 2.3, 95% CI 1.4-3.7), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age adjusted cancer incidence was higher among ischemic stroke patients compared with general population. The risk of mortality was three folds greater among stroke survivors who developed incident cancer.

scholarly journals Initial in-hospital heart rate is associated with three-month functional outcomes after acute ischemic stroke

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ya-Wen Kuo ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Jiann-Der Lee
Keyword(s):  
Heart Rate ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Reference Group ◽  
Unfavorable Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
History Of

Abstract Background Increased heart rate (HR) has been associated with stroke risk and outcomes. Material and methods We analyzed 1,420 patients from a hospital-based stroke registry with acute ischemic stroke (AIS). Mean initial in-hospital HR and the coefficient of variation of HR (HR-CV) were derived from the values recorded during the first 3 days of hospitalization. The study outcome was the 3-month functional outcome. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. Results A higher mean HR level was significantly and continuously associated with a higher probability of unfavorable functional outcomes. Compared with the reference group (mean HR < 70 beats per minute), the multivariate-adjusted OR for an unfavorable outcome was 1.81 (95% CI, 1.25–2.61) for a mean HR ≥ 70 and < 80 beats per minute, 2.52 (95% CI, 1.66 − 3.52) for a mean HR ≥ 80 and < 90 beats per minute, and 3.88 (95% CI, 2.20–6.85) for mean HR ≥ 90 beats per minute. For stroke patients with a history of hypertension, the multivariate-adjusted OR for patients with a HR-CV ≥ 0.12 (versus patients with a HR-CV < 0.08 as a reference) was 1.73 (95% CI, 1.11–2.70) for an unfavorable outcome. Conclusions Our results indicated that a high initial in-hospital HR was significantly associated with unfavorable 3-month functional outcomes in patients with AIS. In addition, stroke patients with a HR-CV ≥ 0.12 also had unfavorable outcomes compared with those with a HR-CV < 0.08 if they had a history of hypertension.

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