November 2022 Stroke Highlights

Abstract

HomeStrokeVol. 53, No. 11November 2022 Stroke Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBNovember 2022 Stroke Highlights José Rafael Romero José Rafael RomeroJosé Rafael Romero https://orcid.org/0000-0002-1101-2950 Search for more papers by this author Originally published24 Oct 2022https://doi.org/10.1161/STROKEAHA.122.041383Stroke. 2022;53:3249is related toPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesIs It About the Destination or About the Journey?Importance of Delayed Reperfusions in Patients With Incomplete ThrombectomyPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesFood insecurity (FI) may interfere with adequate secondary stroke prevention. Kim-Tenser and colleagues assessed FI prevalence and trends using data from the US National Health and Nutrition Examination Survey survey (1999–2015). Food security was categorized as full, marginal, low, or very low, with the last 2 categories constituting FI. Stroke data were based on self-report. Among 48 242 participants, 1877 reported a stroke. FI was reported in 17% of participants with stroke and 12% of those without stroke. Predictors of FI included Black race, Hispanic ethnicity, low education, low income, non-married status, diabetes, smoking, and obesity. In age-adjusted analysis, FI increased over the study period from 7.8% to 42.1% in stroke survivors, and 8% to 17% in stroke-free participants. This study highlights FI as a growing adverse social determinant of health and modifiable social factor for stroke prevention targeting vulnerable groups. See p 3369.Yield of Dual Therapy with Statin and Ezetimibe in the Treat Stroke to Target TrialAmarenco and colleagues conducted a post-hoc analysis of the Treat Stroke to Target trial which randomized patients to dual therapy (statin and ezetimibe) versus statin monotherapy to achieve target LDL (low-density lipoprotein) <100 or LDL <70 mg/dl and assessed recurrent major cardiovascular events. Patients had ischemic stroke or transient ischemic attack and established atherosclerotic disease (aortic, intra or extracranial large artery or coronary arteries). There were differences in statin intensity between the LDL target groups, and other lipid-lowering treatments were allowed in the monotherapy group. Target LDL levels were achieved in the groups, but there was higher compliance in the dual therapy group. Overall, the dual therapy group targeting LDL <70 mg/dL had lower event rates across all major adverse cardiovascular outcomes, including intracerebral hemorrhage. Although this study suggests a benefit of dual therapy over monotherapy and target of lower LDL levels, confirmatory randomized clinical trials are needed. See p 3260.Importance of Delayed Reperfusions in Patients with Incomplete ThrombectomyIncomplete revascularization after mechanical thrombectomy in acute large vessel occlusion ischemic strokes occurs in a substantial proportion of patients. Mujanovic and colleagues conducted a single-center study to assess the relation of delayed reperfusion (DR) with tissue and functional outcomes after incomplete recanalization with mechanical thrombectomy for the treatment of acute ischemic stroke due to large vessel occlusion. Incomplete recanalization was defined as extended Thrombolysis in Cerebral Infarction (eTICI) score 2a or lower. Patients included also had a follow-up cerebral perfusion study at 24 hours. DR was defined as absence of a focal perfusion delay with values of Tmax≥4 seconds on contrast-enhanced follow-up perfusion imaging within the territory of the initially occluded vessel. Among 566 patients studied, DR occurred in 40.3% patients with incomplete recanalization and in none of the patients with complete recanalization (eTICI 3). DR and persistent perfusion deficits were related to eTICI score with higher DR rates associated with higher eTICI score. DR was related to preserved tissue (ie, no new infarction) while persistent perfusion deficit was related to new infarct on follow-up imaging. In multivariable analysis adjusted for relevant confounders, patients with DR had better functional outcomes regardless of eTICI score achieved (adjusted odds ratio, 2.37 [95% CI, 1.34–4.23]) and lower mortality (adjusted hazard ratio, 0.60 [95% CI, 0.39–0.91]). This study needs replication but suggests that DR is an important measure of tissue fate and correlated with functional outcome. DR may be a relevant marker for patient selection, and potential target for randomized clinical trials in patients with acute ischemic stroke undergoing mechanical thrombectomy. See p 3350. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesAmytis Towfighi, et al. Stroke. 2022;53:3369-3374Is It About the Destination or About the Journey?Dylan Blacquiere, et al. Stroke. 2022;53:3268-3269Importance of Delayed Reperfusions in Patients With Incomplete ThrombectomyAdnan Mujanovic, et al. Stroke. 2022;53:3350-3358 November 2022Vol 53, Issue 11 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.041383 Originally publishedOctober 24, 2022 PDF download Advertisement SubjectsCerebrovascular Disease/StrokeRevascularization