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1,497 results for “Ischemic stroke”
Data from: Nanotransfection-based vasculogenic cell reprogramming drives functional recovery in a mouse model of ischemic stroke
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Low- versus standard-dose alteplase in acute lacunar ischemic stroke: the ENCHANTED trial - online supplemental
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Data from: Socioeconomic determinants of outcome after childhood arterial ischemic stroke
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Data from: Vegetarian diet and incidence of total, ischemic and hemorrhagic stroke in two cohorts in Taiwan
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Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke
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Data from: Automated CT perfusion imaging for acute ischemic stroke: pearls and pitfalls for real world use
Recent positive trials have thrust acute cerebral perfusion imaging into the routine evaluation of acute ischemic stroke. Updated guidelines state that in patients with anterior circulation large vessel occlusions presenting beyond 6 hours from time last known well, advanced imaging selection including perfusion based selection is necessary. Centers that receive acute stroke patients must now have the capability to perform and interpret CT or MR perfusion imaging, or provide rapid transfer to centers with the capability of selecting patients for a highly impactful endovascular therapy, particularly in delayed time windows. Many stroke centers are quickly incorporating the use of automated perfusion processing software to interpret perfusion raw data. As CT perfusion is being assimilated in real world clinical practice, it is essential to understand the basics of perfusion acquisition, quantification and interpretation. It is equally important to recognize the common technical and clinical diagnostic challenges of automated CTP including ischemic core and penumbral misclassifications that could result in underestimation or overestimation of the core and penumbra volumes. This review highlights the pitfalls of automated CT perfusion along with practical pearls to address the common challenges. This is particularly tailored to aid the acute stroke clinician who must interpret automated perfusion studies, in an emergency setting to make time-dependent treatment decisions for acute ischemic stroke patients.
Data from: Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke
<p><b>Objective: </b>To determine public health and cost consequences of time delays to EVT for patients, healthcare systems, and society, we estimated quality-adjusted life years (QALY) of EVT-treated patients and associated costs based on times to treatment.</p> <p><b>Methods: </b>The Markov model analysis was performed from United States healthcare and societal perspectives over a lifetime horizon. Contemporary data from seven trials within the HERMES collaboration served as data source. Aside from cumulative lifetime costs, we calculated the net monetary benefit (NMB) to determine the economic value of care. We used a contemporary willingness-to-pay threshold of $100,000 per QALY for NMB calculations.</p> <p><b>Results:</b><b> </b>Every 10 minutes of earlier treatment resulted in an average gain of 39 days (95% prediction interval: 23-53 days) of disability-free life. Overall, the cumulative lifetime costs for patients with earlier or later treatment were similar. Patients with later treatment had higher morbidity-related costs yet over a shorter time span due to their shorter life expectancy, resulting in similar lifetime costs as in patients with early treatment. Regarding the economic value of care, every 10 minutes of earlier treatment increased the NMB by $10,593 (95% prediction interval: $5,549-$14,847) and by $10,915 (95% prediction interval: $5,928-$15,356) taking healthcare and societal perspectives, respectively.</p> <p><b>Conclusions: </b>Any time delay to EVT reduces QALYs and decreases the economic value of care provided by this intervention. Healthcare policies to implement efficient pre-hospital triage and accelerate in-hospital workflow are urgently needed.</p>
Exploring the predictive value of lesion topology on motor function outcomes in a porcine ischemic stroke model
<p>Dataset to accompany manuscript currently in review at Scientific Reports (12/17/2020)</p>
Data from: Early sitting in ischemic stroke patients (SEVEL): a randomized controlled trial
Background: Extended immobility has been associated with medical complications during hospitalization. However no clear recommendations are available for mobilization of ischemic stroke patients. Objective: As early mobilization has been shown to be feasible and safe, we tested the hypothesis that early sitting could be beneficial to stroke patient outcome. Methods: This prospective multicenter study tested two sitting procedures at the acute phase of ischemic stroke, in a randomized controlled fashion (clinicaltrials.org registration number NCT01573299). Patients were eligible if they were above 18 years of age and showed no sign of massive infarction or any contra-indication for sitting. In the early-sitting group, patients were seated out of bed at the earliest possible time but no later than one calendar day after stroke onset, whereas the progressively-sitting group was first seated out of bed on the third calendar day after stroke onset. Primary outcome measure was the proportion of patients with a modified Rankin score [0–2] at 3 months post stroke. Secondary outcome measures were a.) prevalence of medical complications, b.) length of hospital stay, and c.) tolerance to the procedure. Results: One hundred sixty seven patients were included in the study, of which 29 were excluded after randomization. Data from 138 patients, 63 in the early-sitting group and 75 in the progressively-sitting group were analyzed. There was no difference regarding outcome of people with stroke, with a proportion of Rankin [0–2] score at 3 months of 76.2% and 77.3% of patients in the early- and progressive-sitting groups, respectively (p = 0.52). There was also no difference between groups for secondary outcome measures, and the procedure was well tolerated in both arms. Conclusion: Due to a slow enrollment, fewer patients than anticipated were available for analysis. As a result, we can only detect beneficial/detrimental effects of +/- 15% of the early sitting procedure on stroke outcome with a realized 37% power. However, enrollment was sufficient to rule out effect sizes greater than 25% with 80% power, indicating that early sitting is unlikely to have an extreme effect in either direction on stroke outcome. Additionally, we were not able to provide a blinded assessment of the primary outcome. Taking these limitations into account, our results may help guide the development of more effective acute stroke rehabilitation strategies, and the design of future acute stroke trials involving out of bed activities and other mobilization regimens.
Data from: Metabolic syndrome is a strong risk factor for minor ischemic stroke and subsequent vascular events
Background Minor ischemic stroke (MIS) represents a major global public health problem worldwide due to high incidence. The aim of this study was to investigate whether metabolic syndrome (MetS) is a strong risk for MIS and subsequent vascular events (SVE). Methods A retrospective cohort study was performed examining symptomatic MIS in a Chinese neurologic outpatient population aged over 25 years without history of stroke. MetS was defined using the International Diabetes Federation criteria. MIS was diagnosed by magnetic resonance imaging-diffusion weighted images or fluid-attenuated inversion recovery. Results Of 1361 outpatients, a total of 753 (55.3%) patients were diagnosed with MIS; of them, 80% had a score of 0 using the MIS had a 0 score on the National Institutes of Health Stroke Scale. Among these, 303 (40.2%) individuals with MIS were diagnosed with MetS. Diagnosed of MIS with MetS significantly correlated with abdominal obesity (30.7% v.s 18.0%), hypertension (91.1% v.s 81.6%), increased blood glucose (6.9±2.4 v.s 5.0±0.4), dyslipidemia (78.2% v.s 48.2%), and SVE (50.5% v.s 11.3%) when compared with the controls group. On adjusted analysis, the risk of SVE was also significantly associated with three additional MetS criterion (RR,9.0; 95% CI, 5.677–14.46). Using Cox proportional analysis, risk of SVE in patient with MIS was significantly associated with MetS (RR, 3.3; 95% CI, 1.799–6.210), older age (RR, 1.0; 95% CI, 1.001–1.048), and high blood glucose (RR,1.1; 95%CI, 1.007–1.187). Conclusions The MetS is a strong risk factor for MIS, and patients presenting with MIS and MetS are at a high risk of SVE. Further studies are required to determine the improvement of Mets prevention in the reduction of MIS and SVE.
Data from: Hospital distance, socioeconomic status, and timely treatment of ischemic stroke
Objective: To determine whether lower socioeconomic status (SES) and longer home-hospital driving time are associated with reductions in tPA administration and timeliness of the treatment. Methods: We conducted a retrospective observational study using data from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) between January 2015 to March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by EMS to one of 1,489 US hospitals. We defined each patient's SES based on their zip code median household income. We calculated the driving time between each patient's home zip code and the hospital where they were treated, using the Google Maps Directions Application Programing Interface. The primary outcomes were tPA administration and onset-to-arrival time (OTA). Outcomes were analyzed using hierarchical multivariable logistic regression models. Results: SES was not associated with OTA (p=0.31) or tPA administration (p=0.47), but was associated with the secondary outcomes of onset-to-treatment time (p=0.0160) and in-hospital mortality (p=0.0037), with higher SES associated with shorter OTT and lower in-hospital mortality. Driving time was associated with tPA administration (p <0.001) and OTA (p <0.0001), with lower odds of tPA (0.83, 0.79-0.88) and longer OTA (1.30, 1.24-1.35) in patients with the longest versus shortest driving time quartiles. Lower SES quintiles were associated with slightly longer driving time quartiles (p=0.0029), but there was no interaction between the SES and driving time for either OTA (p=0.1145) or tPA (p=0.6103). Conclusions: Longer driving times were associated with lower odds of tPA administration and longer OTA, however SES did not modify these associations.
Data from: Acute ischemic stroke thrombi have an outer shell that impairs fibrinolysis
Objectives. Thrombi responsible for large vessel occlusion (LVO) in the setting of acute ischemic stroke (AIS) are characterized by a low recanalization rate after intravenous thrombolysis. To test whether AIS thrombi have inherent common features that limit their susceptibility to thrombolysis, we analyzed the composition and ultrastructural organization of AIS thrombi causing LVO. Methods. A total of 199 endovascular thrombectomy-retrieved thrombi were analyzed by immunohistology, scanning electron microscopy (SEM), and subjected to ex vivo thrombolysis assay. The relationship between thrombus organization and thrombolysis resistance was further investigated in vitro using thrombus produced by recalcification of citrated whole blood. Results. SEM and immunohistology analyses revealed that, although AIS thrombus composition and organization was highly heterogeneous. AIS thrombi shared a common remarkable structural feature in the form of an outer shell made of densely compacted thrombus components including fibrin, von Willebrand factor, and aggregated platelets. In vitro thrombosis experiments using human blood indicated that platelets were essential to the formation of the thrombus outer shell. Finally, in both AIS and in vitro thrombi, the thrombus outer shell showed a decreased susceptibility to t-PA-mediated thrombolysis as compared to the thrombus inner core. Interpretation. Irrespective of their etiology and despite their heterogeneity, intracranial thrombi causing LVO have a core-shell structure that influences their susceptibility to thrombolysis.
Supplemental data from: Global differences in risk factors, etiology and outcome of ischemic stroke in young adults
<p><b>Objective: </b>To study the global distribution of risk factors, causes and 3-month mortality of young ischemic stroke patients, by performing a patient data meta-analysis form different cohorts worldwide. </p> <p><b>Methods: </b>We did a pooled analysis of individual patient data from cohort studies which included consecutive ischemic stroke patients aged 18-50 years. We studied differences in prevalence of risk factors and causes between different ethnic groups, geographic regions and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.</p> <p><b>Results: </b>We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Blacks (hypertension, 52.1%; diabetes, 20.7%) and Asians (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often cause of stroke in high-income countries (HICs; both p<0.001), whereas ''other determined stroke'' and ''undetermined stroke'' were higher in low and middle-income countries (LMICs; both p<0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (OR 2.49; 95% CI 1.42-4.36).</p> <p><b>Conclusion: </b>The ethnic and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and regional differences in incidence of ischemic stroke. Our results also visualize the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as a call to action to improve healthcare facilities in LMICs.</p>
DNA methylation of the natriuretic peptides system genes and ischemic stroke: gene-based and gene-set analyses
<p><span><b>Background</b></span></p> <p><span>The natriuretic peptides (NP) system has been considered an important regulator for ischemic stroke (IS) with a limited clinical implication. A better understanding of the underlying molecular mechanisms is urgent. Here, we aimed to examine the role of NP system genes methylation in IS.</span></p> <p><span><b>Methods and Results</b></span></p> <p><span>DNA methylation at promoter regions of four core NP system genes, e.g., <i>CORIN</i>, <i>FURIN</i>, <i>NPPA</i>, and <i>NPPB</i>, was measured by targeted bisulfite sequencing in 853 IS patients and 918 healthy controls. We first examined the association between DNA methylation at each single CpG and IS, followed by gene-based and gene-set analyses to examine the joint associations of DNA methylation at multiple CpGs in a gene or all four genes as a pathway with IS. After control of covariates and multiple testing, DNA methylation at 19 of the 36 assayed CpGs were individually associated with IS at q<0.05. The average methylation levels at the targeted regions of <i>CORIN</i> (OR=0.64, 95%CI: 0.56-0.73), <i>FURIN</i> (OR=0.78, 95%CI: 0.69-0.88), and <i>NPPA</i> (OR=0.78, 95%CI: 0.69-0.88) were inversely associated with IS (all q<0.05). The truncated product method revealed the same gene-based associations (all q<0.05) and found that DNA methylation at all four NP system genes together was jointly associated with IS (<i>P</i>=0.0001).</span></p> <p><span><b>Conclusions</b></span></p> <p><span>DNA methylation at NP system genes was downregulated in IS patients. Our results may unravel a molecular mechanism underlying the regulating effect of the NP system on IS, and highlight the relevance of testing the joint effect of multiple CpGs in the epigenetic analysis.</span></p>
Intraprocedural angiographic signs observed during endovascular thrombectomy in patients with acute ischemic stroke: A systematic review
<p>There are three PDF files in this dataset. They are supplementary data of the paper "Intraprocedural angiographic signs observed during endovascular thrombectomy in patients with acute ischemic stroke: A systematic review". Tables e1-e3 provide detailed literature search strategy and study selection. Table e4 provides characteristics of included studies and quality assessment. Table e5-e7 provide summary of the main results with statistical significance levels of the included studies.</p> <p> </p>
Supplemental material: Time trends in incidence, comorbidity, and mortality of ischemic stroke in Denmark, 1996-2016
<p><i>Objective:</i> To examine whether the incidence, comorbidity, and mortality of first-time ischemic stroke changed in Denmark between 1996-2016 overall and according to age and sex using a nationwide cohort design.</p> <p><i>Methods: </i>In this cohort study, 224,617 individuals <u>></u>18 years admitted with first-time ischemic stroke between 1996-2016 were identified using Danish nationwide registries. We calculated annual age-standardized incidence rates and absolute 30-day and 1-year mortality risks. Further, we calculated annual incidence rate ratios using Poisson regression, odds ratios for 30-day mortality using logistic regression, and hazard ratios for 1-year mortality using Cox regression.</p> <p><i>Results</i><b>:</b> The overall age-standardized incidence rates of ischemic stroke per 1,000 person-years increased from 1996 (2.70 [95%CI,2.65-2.76]) to 2002 (3.25 [95%CI,3.20-3.31]) and then gradually decreased to below the initial level until 2016 (1.99 [95%CI,1.95-2.02]). Men had higher incidence rates than women in all age groups except 18-34 and <u>></u>85 years. Absolute mortality risk decreased between 1996-2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women between 55-64 and <u>></u>85 years had higher mortality than men. Similar trends were observed for all analyses after multivariable adjustment. The prevalence of atrial fibrillation, hypertension, diabetes mellitus, and use of lipid-lowering medication increased during the study period.</p> <p><i>Conclusions:</i> <a name="_Hlk36885003">The age-standardized incidence of first-time hospitalization for ischemic stroke increased from 1996-2002 and then gradually decreased to below the initial level until 2016. </a>Absolute 30-day and 1-year mortality risks decreased between 1996-2016. <a name="_Hlk36741776">These findings correspond to increased stroke prevention awareness and introduction of new treatments during the study period.</a></p>
Supplementary references from: Thrombus composition, imaging, and outcome prediction in acute ischemic stroke
<p><strong>Purpose of the Review</strong>: <span>This article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in acute stroke patients based on thrombus characteristics.</span><br> <br> <span><strong>Recent Findings:</strong> New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real-time, An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombi has spurred interest in new acute therapies for acute stroke.</span></p> <p><strong><span>Summary</span></strong><span><strong>: </strong>Thrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.</span></p>
Risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease: A synthesis of the literature
<span><span><span><span><span><span><span><span><span><span>Objective </span></span></span></span></span></span></span></span></span></span> <p><span><span><span><span><span><span><span><span><span><span>To assess the risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease (AD) compared to non-AD subjects with similar risk profiles.</span></span></span></span></span></span></span></span></span></span></p> <span><span><span><span><span><span><span><span><span><span>Methods </span></span></span></span></span></span></span></span></span></span> <p><span><span><span><span><span><span><span><span><span><span>A search was conducted on Embase and Medline for reports published up to September 26, 2018. Studies were included if they: 1) assessed incidence of stroke in patients diagnosed with </span></span></span></span></span></span></span></span></span></span><span><span><span><span><span><span><span><span><span><span>AD; 2) included patients with no history of stroke; and 3) reported outcomes by stroke subtype. The main outcome was relative risk of ischemic or hemorrhagic stroke. Further, the rate of stroke occurrence per 1000 person-years was assessed. A random effects meta-analysis was undertaken. The risk of bias in included studies was assessed in terms of selection, comparability and outcome.</span></span></span></span></span></span></span></span></span></span></p> <span><span><span><span><span><span><span><span><span><span>Results </span></span></span></span></span></span></span></span></span></span> <p><span><span><span><span><span><span><span><span><span><span>3,605 studies were screened in the title and abstract phase after removing duplicates, and 88 eligible studies were screened for full text. Eight studies met the inclusion criteria representing 121,719 subjects (AD=73,044; non-AD=48,675). Five studies were included in the relative risk analysis, among which four studies applied formal matching criteria of 44,544 AD and 44,660 non-AD subjects. The included studies were based on nation-wide registries from Finland, Sweden, Taiwan (2), UK (2), one clinic-based study from the Netherlands and one US population-based cohort.</span></span></span></span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><span><span><span>Among AD patients, the incidence rate of hemorrhagic stroke was 3.41/1000-person years (95% </span></span></span></span></span></span></span></span></span></span><span><span><span><span><span><span><span><span><span><span>CI 2.70, 4.32) and 2.23 (95% CI 1.72, 2.88) among AD-cases and non-AD controls respectively. </span></span></span></span></span></span></span></span></span></span><span><span><span><span><span><span><span><span><span><span>This is in contrast to 13.98 (95% CI 9.86, 19.81) and 12.12 (95% CI 7.55, 19.46) for ischemic stroke among AD-cases and non-AD controls respectively. Compared to non-AD subjects with similar risk profiles, AD patients had a relative risk of 1.42 (95% CI 1.23, 1.64) for hemorrhagic stroke and 1.15 (95% CI 0.89, 1.48) for ischemic stroke. </span></span></span></span></span></span></span></span></span></span></p> <span><span><span><span><span><span><span><span><span><span> Conclusion </span></span></span></span></span></span></span></span></span></span> <p><span><span><span><span><span><span><span><span><span><span>Compared to non-AD subjects with similar risk profiles, AD patients are likely at higher risk of hemorrhagic, but not ischemic stroke. </span></span></span></span></span></span></span></span></span></span></p>
Statins Role in Acute Ischemic Stroke
ClinicalTrials.gov study NCT06371495. IPD Sharing: Not stated. Countries: 0. Publications: 1.
Safety and Efficacy of Selective Intra-Arterial Cooling Infusion Combined With EVT in Acute Ischemic Stroke
ClinicalTrials.gov study NCT06485427. IPD Sharing: NO. Countries: 1. Publications: 0.
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OpenNeuro
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