Cardioembolic stroke on unaffected side during thrombolysis for acute ischemic stroke

2010 ◽  
Vol 58 (1) ◽  
pp. 112 ◽  
Author(s):  
Arun Garg ◽  
Amitabh Yaduvanshi ◽  
KapilDev Mohindra
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cardioembolic Stroke ◽  
Unaffected Side

Abstract TP38: Core Growth Speed as a Marker of Collateral Circulation Status in Acute Ischemic Stroke with Known Onset Time

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laura Blanco-García ◽  
Elisa Cortijo ◽  
Mercedes De Lera ◽  
Ana Calleja ◽  
María Usero ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Cerebral Blood Volume ◽  
Onset Time ◽  
Growth Speed ◽  
Infarct Core ◽  
Anterior Circulation ◽  
Unaffected Side ◽  
Core Volume

Objective: We aimed to evaluate the parameter core growth speed (CGS) as a marker of collateral circulation status (CC) in acute ischemic stroke, and to compare it with other brain perfusion-derived markers of collateral capacity. Methods: We retrospectively studied acute ischemic stroke patients who were evaluated with urgent computed tomography perfusion (CTP) and CT angiography. Inclusion criteria comprised known time of onset and anterior circulation proximal occlusion. Collateral circulation was assessed on CTP-source images and rated as poor (0-1) vs. good (2-3) following a previously published scale. CTP maps were computed using Neuroscape 2.0 software by Olea Medical. Infarct core volume was calculated as the brain tissue with >70% reduction in cerebral blood flow (CBF) as compared to the unaffected side. CGS was obtained by dividing core volume by the time from stroke onset to CTP acquisition. Relative cerebral blood volume (rCBV), relative CBF, and hypoperfusion index ratio (HIR = Tmax>10s/Tmax>6s) were used as comparators. Results: We included 41 patients (mean age 71 years; median NIHSS 17; median onset-CTP time 150 minutes). We observed a positive correlation between CGS and HIR (ρ= 0.517 p< 0.001), and negative correlations between rCBV and CGS (ρ= -0.669 p<0.0001), and rCBF and CGS (ρ= -0.749 p<0.0001). Collateral circulation was categorized as poor or good in 15 and 26 patients respectively. A gradual descend in CGS was seen as CC improved (p=0.0005). A logistic regression model adjusted by rCBV, rCBF and HIR identified CGS as independently associated with CC. The association of CGS with good CC in a ROC curve was highly significant (p=0.002, area under the curve 0.8). Conclusion: Core growth speed is robustly associated with collateral circulation status. This parameter can be directly obtained from infarct core volume without the need to process other perfusion or angiographic images, if the time of onset is well known.

Abstract WP268: Von Willebrand Factor Expression in Various Subtypes of Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Oana M Mereuta ◽  
Sean Fitzgerald ◽  
Mehdi Abbasi ◽  
Daying Dai ◽  
Ramanathan Kadirvel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Von Willebrand Factor ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Unknown Etiology ◽  
Learning Software ◽  
Von Willebrand ◽  
The Relationship ◽  
Willebrand Factor

Introduction: Von Willebrand factor (VWF) is a key component of acute ischemic stroke (AIS) thrombi. The aim of our prospective study was to investigate the immunohistochemical expression of VWF in clots and to evaluate whether VWF is associated with certain subtypes of AIS. Methods: VWF immunostaining was performed on 79 thrombi collected as part of the multi-center Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) registry. The cases were classified according to TOAST criteria. The VWF expression was quantified using Orbit Image Analysis (www.Orbit.bio) machine learning software. IBM SPSS statistics 25 was used to assess the relationship between the VWF levels and different etiology subtypes. Results: A cardioembolic stroke was defined in 39 cases (49.4%) whereas an atherosclerotic origin was identified in 13 patients (16.5%). Other causes accounted for 12 cases (15.1%). Unknown etiology was reported in 15 cases (19%). The mean VWF content in the clots was 12.8%. According to the Mann-Whitney U-test, the level of VWF was significantly higher in the cases with unknown etiology compared to cardioembolic origin (p=0.044). We found also that patients with unknown etiology of stroke had higher VWF expression as compared to the other two subtypes, although this difference was not statistically significant. Conclusions: Among the patients with ischemic stroke included in this study, the VWF expression was significantly increased in those with unknown etiology compared to the group with cardioembolic stroke. Our finding provides new insights into clot composition in cryptogenic stroke and may influence the treatment and secondary prevention in these cases.

Abstract 183: Effect of Statin in Acute Cardioembolic Stroke Patients Who Are not Indicated According to Current Guidelines

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hong-Kyun Park ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Jong-Moo Park ◽  
Kyusik Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cardioembolic Stroke ◽  
Secondary Outcome ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Specific Recommendation ◽  
Stroke Patients ◽  
Vascular Events

Background: There is no specific recommendation on statin therapy for cardioembolic stroke (CES) patients in current stroke guidelines. We evaluated the effect of statin on major vascular events following acute ischemic stroke in patients with CES and no other indications for statin. Methods: Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients who were hospitalized between 2008 and 2015 and were categorized into CES according to the Trial of Org 10172 in Acute Stroke Treatment classification. Patients who had established indications for statin in accordance with the recent stroke guidelines were excluded. Primary outcome measure was a major vascular event, a composite of stroke recurrence, myocardial infarction and vascular death; and secondary outcome measures were stroke recurrence and all-cause death. We performed frailty model analysis to estimate hazard ratios (HRs) of statin therapy on outcomes accounting for variation in quality of care among centers. Stabilized inverse probability of treatment weighting method with propensity scores was used to remove baseline imbalances between statin users and non-users. Results: Of the 6124 CES patients, 2987 patients (male, 52%; mean age, 73±12 years) met the eligibility criteria; and 2125 (71%) of 2987 patients were on statin at discharge. Compared to the non-users, the statin users were more likely to arrive at hospitals later, have milder neurologic deficits at presentation, be on stain prior to index stroke and have hyperlipidemia and were less likely to have atrial fibrillation and occlusion of relevant cerebral arteries. During the median follow-up of 364 days, major vascular events were observed in 118 patients (5.6%) among the statin users and 177 patients (20.5%) among the non-users, respectively (p<0.001 on log rank test); the adjusted HR of statin therapy was 0.35 (95% confidence interval, 0.27-0.46). The adjusted HRs of statin therapy were 0.71 (0.49-1.04) for stroke recurrence and 0.55 (0.46-0.66) for all-cause death, respectively. Conclusion: This study suggests that statin therapy may reduce major vascular events and all-cause death in cardioembolic stroke patients without definite indications for statin.

scholarly journals CARDIAC CHANGES IN ACUTE ISCHEMIC STROKE

2017 ◽  
Vol 16 (1) ◽  
pp. 15-20
Author(s):  
Maria Mirabela Manea ◽  
◽  
Dorin Dragos ◽  
Vladimir Moldoveanu ◽  
Constantin Popa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Troponin T ◽  
Holter Monitoring ◽  
Cardioembolic Stroke ◽  
Function Parameter ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Long Term Outcome

Purpose: the analysis of the paraclinical features of heart changes in the acute ischemic stroke, especially electrocardiographic (ECG) abnormalities. Material and methods. We performed a prospective study on 23 patients admitted in our stroke unit with large lesions induced by acute ischemic strokes and no history of cardiovascular disease. Results. The average age of patients was 72,87 +/- 11,55 years. On admission NIHSS score was higher in the cardioembolic stroke patients compared to atherothrombotic stroke patients, the difference persisting after the first seven days. Echocardiography demonstrated a larger left atrium area in cardioembolic compared to atherothrombotic stroke patients. The E-wave deceleration time (a diastolic function parameter) was longer in atherothrombotic compared to cardioembolic stroke. The ECG monitoring and repeated 24h Holter monitoring detected atrial fibrillation (AF) in 52, 17% of the patients and it was associated with a higher in-hospital mortality and stroke severity. No significant correlation was found between the increase in troponin T levels and AF, or in-hospital mortality. Discusions. In our study atherothrombotic stroke is associated with a more pronounced tendency to diastolic dysfunction compared to cardioembolic stroke. The percentage of detected AF is higher than expected because of: 1) the higher average age of patients, 2) the inclusion of patients with large strokes, and 3) continuous ECG and Holter monitoring for longer periods of time compared to the usual procedure in stroke patients. Conclusion. The cardiologic monitoring has strong implications for stroke mechanisms and short and long term outcome and prognosis of the patients.

scholarly journals A new algorithm for suspected stroke patient management with NT-proBNP POCT platform in the emergency department: A new algorithm for suspected stroke patient

2018 ◽  
Vol 25 (1) ◽  
pp. 12-19
Author(s):  
Ming-feng He ◽  
Wei-dong Cai ◽  
Ming-ming Zhao ◽  
Chong-hui Jiang ◽  
Feng-zhou Qin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Brain Natriuretic Peptide ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Stroke Patient ◽  
Cardioembolic Stroke ◽  
Stroke Treatment ◽  
Suspected Stroke ◽  
Sensitivity Specificity

Introduction: Stroke is a leading cause of mortality and morbidity in China. Of the different subtypes of ischemic stroke, cardioembolic stroke is of particular importance because it is potentially preventable. This study aimed to evaluate the usefulness of measuring N-terminal pro-brain natriuretic peptide in the emergency department in early recognition of patients with cardioembolic stroke. Methods: This was a multicenter prospective cohort study conducted from 1 June 2015 to 30 June 2016 in four emergency departments. Adult patients with acute ischemic stroke were recruited. Plasma N-terminal pro-brain natriuretic peptide was measured in the emergency department. Discharge diagnosis was determined by neurologists according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The diagnostic performance of N-terminal pro-brain natriuretic peptide was assessed by measuring the sensitivity, specificity, receiver operating characteristic curve, and the area under curve. Results: In all, 258 patients were analyzed. Of them, 17.9% were diagnosed with cardioembolic stroke. The optimal cut-off concentration, sensitivity, specificity, and the area under the curve of the plasma N-terminal pro-brain natriuretic peptide concentration suitable to distinguish cardioembolic stroke from other subtypes of stroke were 501.2 pg/mL, 82.6%, 80.2%, and 0.87 (95% confidence interval: 0.83–0.92), respectively. Conclusion: Emergency physicians should strongly consider cardioembolic stroke in patients presented with acute ischemic stroke with an N-terminal pro-brain natriuretic peptide level over 501.2 pg/mL. However, it must be considered in context with clinical assessment and judgment before making treatment decisions.

scholarly journals Independent Prognostic Value of MRproANP (Midregional Proatrial Natriuretic Peptide) Levels in Patients With Stroke Is Unaltered Over Time

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1873-1875
Author(s):  
Markus Arnold ◽  
Christos Nakas ◽  
Andreas Luft ◽  
Mirjam Christ-Crain ◽  
Alexander Leichtle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Cardioembolic Stroke ◽  
Multiple Time ◽  
Change Over Time ◽  
Time Points ◽  
Over Time

Background and Purpose— MRproANP (midregional proatrial natriuretic peptide) is known to be independently associated with cardioembolic stroke cause and to improve risk stratification for 90-day mortality when measured within 24 to 72 hours after symptom onset in patients with acute ischemic stroke. However, the optimal time point for assessment remains unclear. This study aimed to evaluate prognostic utility of MRproANP at different time points during the first 5 days of hospitalization in patients with acute ischemic stroke. Methods— Samples of MRproANP were collected on admission (<72 hours after onset) and at multiple time points during the first 5 days of hospitalization in 348 consecutively enrolled patients with acute ischemic stroke. The prognostic value for 90-day mortality, 90-day functional outcome, and the association with cardioembolic stroke cause was assessed regarding the time of measurement, and change over time was modeled using generalized estimating equations. Results— MRproANP levels modestly decease over the initial 5 days but remain highly predictive for cardioembolic stroke cause (odds ratio, 9.75 [95% CI, 3.2–29]; 10.62 [95% CI, 3.4–33.3]; 10.8 [95% CI, 3.1–37.1]; 19.4 [95% CI, 5.49–68.7] on admission, day 1, 3 and 5) and 90-day mortality (odds ratio, 59.4 [95% CI, 7.4–480.7]; 78.3 [95% CI, 7.9–772.6]; 14.5 [95% CI, 1.4–145]; 19.81 [95% CI, 2.7–143.4] on admission, day 1, 3, and 5). Change over time does not significantly modify the prognostic value of MRproANP ( P =0.65 and P =0.56 for the interaction term in the multivariate model). Conclusions— Independent prognostic value of MRproANP remains unaltered in the acute phase of stroke at least up to 5 days; repeated measurements do not improve the prognostic value.

scholarly journals The follow-up of patients of sixty-five years of age and younger with acute ischemic stroke and transient ischemic attacks, and elevated D-dimer levels in plasma

2009 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Magnus Vrethem ◽  
Tomas Lindahl
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Cardioembolic Stroke ◽  
Transient Ischemic Attacks ◽  
Stroke Patients ◽  
Follow Up Study ◽  
Cerebrovascular Events ◽  
D Dimer

D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA) admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead). Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardio- or cerebrovascular events. Advanced age was found to be an independent risk factor.

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