Ischemic Stroke
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2021 ◽  
Vol 2 (2) ◽  
pp. 46-53
Elisabeth Romana Tikalaka ◽  
Amin Husni ◽  
Retnaningsih - ◽  
Dodik Tugasworo ◽  
Jimmy Eko Budi Hartono ◽  

AbstractBackground : Periodontal diseases affect up to 80% of the global population. Periodontitis is a long-term inflammatory disease that affects the soft and hard tissues around the teeth. It may also play a role in the pathogenesis of atheroma formation and is associated with cerebrovascular disease. The Carotid Intima Media Thickness (CIMT) is a good marker for detecting early and progressive atherosclerosis. Several hypotheses link chronic infectious diseases, including periodontal tissue disease, to the atherosclerosis process and are risk factors for stroke.Objective : To determine the relationship between the severity of periodontitis and the degree of atherosclerosis in ischemic stroke.Methods : This is an analytic observational study with a case-control approach. Subjects were ischemic stroke patients with inclusion criteria. Analyzed the severity of periodontitis with Miller’s Mobility Index (MMI), the degree of progression of atherosclerosis assessed by measuring the CIMT using an ultrasound device or B mode to detect the presence and progression of atherosclerosis.Results : 54 subjects with a mean age were 63,43 ± 7,19 years, and the dominant sex was male. There was a significant relationship between severity of periodontitis  ( P : 0,011, OR : 3,425, CI 95% 1,332-8,807) and type of profile lipid triglyceride ( P : 0,027, OR : 6,840, CI 95% 1,242-37,676)  to Carotid intima media thickness.Conclusion :  There is an association between the severity of periodontitis and the degree of atherosclerosis. Severe periodontitis is related to the increases of CIMT, which is a marker of atherosclerosis, a risk factor for stroke.

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Qian Wang ◽  
Kai Wang ◽  
Yihong Ma ◽  
Simin Li ◽  
Yuzhen Xu

Objective. Galectin-3, an inflammatory mediator derived from microglia, participates in the pathophysiological process of various neurological diseases. However, the relationship between galectin-3 and poststroke cognitive impairment (PSCI) remains ambiguous. This research purposed to prove whether serum galectin-3 can predict PSCI. Methods. In the end, an aggregate of 416 patients with the first acute ischemic stroke (AIS) were continuously and prospectively enrolled in the study. Upon admission, the baseline data of AIS patients were collected, and their serum galectin-3 levels were measured. Three months after the stroke, the Montreal Cognitive Scale (MoCA) was utilized to measure the cognitive function of AIS patients, and PSCI was defined as a MoCA score less than 26 points. Results. Premised on the MoCA scores, patients were categorized into PSCI cohort and non-PSCI cohort. The two AIS patient cohorts did not exhibit any statistical difference in their baseline characteristics ( p > 0.05 ). However, the serum galectin-3 level of AIS patients in the PSCI cohort was considerably elevated ( p < 0.001 ). Pearson correlation analysis illustrated that serum galectin-3 level was negatively linked to MoCA score ( r = − 0.396 , p < 0.05 ). The findings from the receiver-operating curve (ROC) illustrated that the sensitivity of serum galectin-3 as a possible biomarker for diagnosing PSCI was 66%, and the specificity was 94%. The cut-off value of serum galectin-3 to diagnose PSCI is 6.3 ng/mL ( OR = 5.49 , p < 0.001 ). Upon controlling for different variables, serum galectin-3 level remained to be an independent predictor of PSCI ( p < 0.001 ). Conclusions. Elevated serum galectin-3 levels are linked to a higher risk of PSCI. Serum galectin-3 could be a prospective biomarker for predicting PSCI.

2021 ◽  
Vol 8 ◽  
Luis M. Beltrán Romero ◽  
Antonio J. Vallejo-Vaz ◽  
Ovidio Muñiz Grijalvo

Elevated low-density lipoprotein-cholesterol (LDL-C) is a causal factor for the development of atherosclerotic cardiovascular disease (ASCVD); accordingly, LDL-C lowering is associated with a decreased risk of progression of atherosclerotic plaques and development of complications. Currently, statins play a central role in any ASCVD management and prevention strategies, in relation to their lipid-lowering action and potentially to pleiotropic effects. After coronary artery disease, stroke is the most frequent cause of ASCVD mortality and the leading cause of acquired disability, a major public health problem. There is often a tendency to aggregate all types of stroke (atherothrombotic, cardioembolic, and haemorrhagic), which have, however, different causes and pathophysiology, what may lead to bias when interpreting the results of the studies. Survivors of a first atherothrombotic ischemic stroke are at high risk for coronary events, recurrent stroke, and vascular death. Although epidemiological studies show a weak relationship between cholesterol levels and cerebrovascular disease as a whole compared with other ASCVD types, statin intervention studies have demonstrated a decrease in the risk of stroke in patients with atherosclerosis of other territories and a decrease in all cardiovascular events in patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated the benefit of high doses of atorvastatin in the secondary prevention of ischemic stroke. In this review, we discuss the evidence, use and recommendations of statins in the primary and secondary prevention of stroke, and their role in other scenarios such as the acute phase of ischemic stroke, cerebral hemorrhage, cardioembolic stroke, small vessel disease, and cognitive impairment.

2021 ◽  
Vol 12 ◽  
Junzhao Cui ◽  
Jingyi Yang ◽  
Kun Zhang ◽  
Guodong Xu ◽  
Ruijie Zhao ◽  

Objectives: Patients with anterior circulation large vessel occlusion are at high risk of acute ischemic stroke, which could be disabling or fatal. In this study, we applied machine learning to develop and validate two prediction models for acute ischemic stroke (Model 1) and severity of neurological impairment (Model 2), both caused by anterior circulation large vessel occlusion (AC-LVO), based on medical history and neuroimaging data of patients on admission.Methods: A total of 1,100 patients with AC- LVO from the Second Hospital of Hebei Medical University in North China were enrolled, of which 713 patients presented with acute ischemic stroke (AIS) related to AC- LVO and 387 presented with the non-acute ischemic cerebrovascular event. Among patients with the non-acute ischemic cerebrovascular events, 173 with prior stroke or TIA were excluded. Finally, 927 patients with AC-LVO were entered into the derivation cohort. In the external validation cohort, 150 patients with AC-LVO from the Hebei Province People's Hospital, including 99 patients with AIS related to AC- LVO and 51 asymptomatic AC-LVO patients, were retrospectively reviewed. We developed four machine learning models [logistic regression (LR), regularized LR (RLR), support vector machine (SVM), and random forest (RF)], whose performance was internally validated using 5-fold cross-validation. The performance of each machine learning model for the area under the receiver operating characteristic curve (ROC-AUC) was compared and the variables of each algorithm were ranked.Results: In model 1, among the included patients with AC-LVO, 713 (76.9%) and 99 (66%) suffered an acute ischemic stroke in the derivation and external validation cohorts, respectively. The ROC-AUC of LR, RLR and SVM were significantly higher than that of the RF in the external validation cohorts [0.66 (95% CI 0.57–0.74) for LR, 0.66 (95% CI 0.57–0.74) for RLR, 0.55 (95% CI 0.45–0.64) for RF and 0.67 (95% CI 0.58–0.76) for SVM]. In model 2, 254 (53.9%) and 31 (37.8%) patients suffered disabling ischemic stroke in the derivation and external validation cohorts, respectively. There was no difference in AUC among the four machine learning algorithms in the external validation cohorts.Conclusions: Machine learning methods with multiple clinical variables have the ability to predict acute ischemic stroke and the severity of neurological impairment in patients with AC-LVO.

2021 ◽  
pp. 1-9
Anxin Wang ◽  
Shuang Cao ◽  
Xue Tian ◽  
Yingting Zuo ◽  
Xia Meng ◽  

<b><i>Introduction:</i></b> Serum potassium abnormality is a risk factor of incident stroke, but whether it is associated with recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. This study aimed to investigate the association of serum potassium with the risk of recurrent stroke in patients with AIS or TIA. <b><i>Methods:</i></b> We included 12,425 patients from the China National Stroke Registry III. Patients were classified into 3 groups according to tertiles of potassium. The outcomes were recurrence of stroke and combined vascular events at 1 year. Cox proportional hazards regression was adopted to explore the associations by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs). <b><i>Results:</i></b> Among 12,425 enrolled patients, the median (interquartile range) of potassium was 3.92 (3.68–4.19) mmol/L. Compared with the highest tertile, after adjusted for confounding factors, the lowest tertile potassium was associated with increased risk of recurrent stroke at 1 year. The adjusted HR with 95% CI was 1.21 (1.04–1.41). There was an independent, linear association between serum potassium and stroke recurrence. Per 1 mmol/L decrease of potassium was associated with 19% higher risk of recurrent stroke (HR, 1.19; 95% CI, 1.04–1.37). Similar trends were found in ischemic stroke and combined vascular events. <b><i>Conclusions:</i></b> Lower serum potassium level was independently associated with elevated risk of recurrent stroke in patients with AIS or TIA. The finding suggested that monitoring serum potassium may help physicians to identify patients at high risk of recurrent stroke and to stratify risk for optimal management.

2021 ◽  
Jialei Yang ◽  
Xiaoxiao Song ◽  
Yibing Yang ◽  
Yan Yan ◽  
Baoyun Liang ◽  

Abstract Previous studies reported that the SRC protein was involved in a variety of pathological mechanisms related to ischemic stroke (IS). In this study, we conducted a genetic association study between rs6017916 within the 5’UTR region of SRC gene and IS susceptibility. A total of 533 IS patients and 531 healthy controls were recruited to participate in the current study. The sequenom MassARRAY technology platform was used for genotyping. The quantitative polymerase chain reaction (qPCR) was conducted to detect SRC mRNA expression. The dual luciferase reporter system was used to verify the regulation of rs6017916 on SRC mRNA expression. Results showed that SRC mRNA expression was significantly increased in IS patients than that in controls (P<0.001). Receiver operating characteristic curve (ROC) analysis demonstrated that the signature of SRC mRNA expression differentiated between controls and IS patients with an area under the curve (AUC) of 0.935 corresponding to a specificity of 0.820 and sensitivity of 0.920. Genetic association analysis showed that rs6017916 was significantly associated with IS susceptibility under multiple genetic models, including additive [OR (95% CI)=0.76 (0.60,0.96), Padj=0.019] and dominant [OR (95% CI)=0.75(0.58,0.98), Padj=0.031]. In addition, the dual luciferase reporter system showed that the minor allele C of rs6017916 inhibited luciferase activity compared with the major allele A. In summary, we report that SRC mRNA expression was significantly increased in IS patients and was a potential diagnostic biomarker. Moreover, the 5’UTR variant rs6017916 of SRC was significantly associated with IS susceptibility. And rs6017916 might affect the pathological process of IS by regulating SRC expression.

2021 ◽  
pp. neurintsurg-2021-018117
Tengfei Zhou ◽  
Tianxiao Li ◽  
Liangfu Zhu ◽  
Zhaoshuo Li ◽  
Qiang Li ◽  

BackgroundMechanical thrombectomy is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation. This trial aimed to indicate whether Skyflow, a new thrombectomy device, could achieve the same safety and efficacy as Solitaire FR in the treatment of AIS.MethodsThis study was a prospective, multicenter, randomized, single blind, parallel, positive controlled, non-inferiority clinical trial. Patients with intracranial anterior circulation LVO within 8 hours from onset were included to receive thrombectomy treatment with either the Skyflow or Solitaire FR stent retriever. The primary endpoint was the rate of successful reperfusion (modified Treatment In Cerebral Infarction (mTICI) ≥2b) after the operation. The safety endpoints were the rate of symptomatic intracranial hemorrhage (sICH) and subarachnoid hemorrhage (SAH) at 24 hours after operation.ResultsA total of 95 and 97 patients were involved in the Skyflow group and Solitaire FR group, respectively. A successful reperfusion (mTICI ≥2b) was finally achieved in 84 (88.4%) patients in the Skyflow group and 80 (82.5%) patients in the Solitaire FR group. Skyflow was non-inferior to Solitaire FR in regard to the primary outcome, with the criterion of a non-inferiority margin of 12.5% (p=0.0002) after being adjusted for the combined center effect and the National Institutes of Health Stroke Scale (NIHSS) score. The rate of periprocedural sICH and SAH did not differ significantly between the two groups.ConclusionEndovascular thrombectomy with the Skyflow stent retriever was non-inferior to Solitaire FR with regard to successful reperfusion in AIS due to LVO (with a pre-specified non-inferiority margin of 12.5%).

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Rizky Sarengat ◽  
Mohammad S. Islam ◽  
Mohammad S. Ardhi

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

2021 ◽  
Vol 21 (1) ◽  
Qiao Yu Shao ◽  
Zhi Jian Wang ◽  
Xiao Teng Ma ◽  
Xu Ze Lin ◽  
Liu Pan ◽  

Abstract Background We performed a meta-analysis sought to investigate the risk of stroke with antiplatelet and anticoagulant therapies among patients with coronary artery disease (CAD). Methods We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials from January 1995 to March 2020. Studies were retrieved if they reported data of stroke for patients with CAD and were randomized to receive intensive versus conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC). Analyses were pooled by random-effects modeling. A total of 42 studies with 301,547subjects were enrolled in this analysis. Results Intensive antithrombotic therapy significantly reduced risk of all stroke (RR 0.86, 95% CI 0.80–0.94) and ischemic stroke (RR 0.80, 95% CI 0.71–0.91), but increased risk of hemorrhagic stroke (RR 1.36, 95% CI 1.00–1.86) and intracranial hemorrhage (RR 1.46, 95% CI 1.17–1.81). Subgroup analyses indicated that OAC yields more benefit to all stroke than antiplatelet therapy (OAC: RR 0.73, 95% CI 0.58–0.92; Antiplatelet: RR 0.90, 95% CI 0.83–0.97; Between-group heterogeneity P value = 0.030). The benefit of antiplatelet therapy on all stroke and ischemic stroke were mainly driven by the studies comparing longer versus shorter duration of dual antiplatelet therapy (All stroke: RR 0.86, 95% CI 0.78–0.95; ischemic stroke: RR 0.84, 95% CI 0.75–0.94). Conclusions Among CAD patients who have already received antiplatelet therapy, either strengthening antiplatelet or anticoagulant treatments significantly reduced all stroke, mainly due to the reduction of ischemic stroke, although it increased the risk of hemorrhagic stroke and intracranial hemorrhage. OAC yields more benefit to all stroke than antiplatelet therapy.

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