Acute Stroke Recurrence Research Articles

Abstract WP115: Atrial Fibrillation and Acute Stroke Recurrence in Minor Stroke Patients With Carotid Stenosis

Background & Purpose: Carotid stenosis (CS) and atrial fibrillation (AF) can be associated with a bad outcome even in minor stroke. We investigated acute stroke recurrence and short-term outcome in Japanese minor stroke patients with CS with or without AF. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 48 hurs after the onset, 429 patients with acute ischemic stroke with extracranial carotid stenosis (50% or more in diameter measured by using MR angiography or carotid ultrasonography), the initial NIH stroke scale (NIHSS) score of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. Patients who were planned for carotid endarterectomy within 3 weeks were excluded. We observed a stroke recurrence and outcome during 3 months. Stroke recurrence was defined as a neurological deterioration (NIHSS score worsening of ≥1 point) with a new ischemic lesion on diffusion weighted image. Good outcome was defined as a mRS score of 0 or 1 at 3 months. Results: AF was observed in 94 (22%) patients at hospital discharge. The acute stroke recurrence rate was not different between patients with (11%) and without AF (12%), however, good outcome was less frequent in patients with (39%) than without AF (66%). The Degree of carotid stenosis in NASCET method was more severe in patients with than without acute stroke recurrence (66% vs 59%). The initial diastolic blood pressure, pulse rate, NIHSS Score, WBC, TG, glucose, HbA1c, CRP, and D-dimer values were lower in patients with than without good outcome at 3 months. On the multivariate analysis, AF was negatively associated with good outcome (OR 0.36, 95%CI 0.20-0.0.64). The initial D-dimer value (OR 0.84, 95%CI 0.75-0.94) was also negatively associated with good outcome. Among 94 patients with both CS and AF, combined treatment with both antiplatelet and anticoagulant agents was more frequent in patients with than without good outcome. Conclusions: AF and the initial D-dimer value were significant negative predictors for good outcome in patients with CS. Optimal antithrombotic treatment in patients with both CS and AF should be investigated.

Abstract 163: Carotid Stenosis and Stroke Recurrence in Minor Stroke Patients With Atrial Fibrillation

Background & Purpose: Both atrial fibrillation (AF) and carotid stenosis (CS) can be associated with acute stroke recurrence and consequent bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or CS. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 634 patients with acute ischemic stroke with AF, the initial NIH stroke scale score of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. We observed an acute stroke recurrence during 3 weeks. Results: Acute stroke recurrence was observed in 27 (4.3%) patients. Major cerebral artery stenosis of 50% or more in diameter was observed in 159 (25.1%) patients, and among them 43 (6.8%) had carotid stenosis. Any major artery stenosis was more frequent in patients with than without stroke recurrence (55.6% vs 23.7%, p=0.0002). Carotid stenosis was more frequent in patients with than without stroke recurrence (25.9% vs 5.9%, p<0.0001). The initial NIHSS score was not different between patients with and without an acute stroke recurrence. Dyslipidemia, diabetes mellitus, and history of brain hemorrhage were more frequent, and HDL cholesterol and estimated GFR values were lower, and HbA1c, fasting glucose, BUN, and D-dimer values were higher, intima-media thickness 0f the common carotid artery was thicker in patients with than without an acute stroke recurrence. On the multivariate analysis, carotid stenosis (OR 4.93, 95%CI 1.60~15.2) and D-dimer value (OR 1.13, 95%CI 1.00~1.28) had a positive association with an acute stroke recurrence. Among 43 patients with both AF and CS, 7 had an acute stroke recurrence. With regard to the acute antithrombotic treatment, 5 patients were treated with only anticoagulant agents and other 2 patients were treated with both anticoagulant and antiplatelet agents. Conclusions: Carotid stenosis was a significant predictor for an acute stroke recurrence in patients with atrial fibrillation. Optimal antithrombotic treatment in the acute phase in stroke patients with both AF and CS should be investigated.

Intravenous heparin for acute stroke: what can we learn from the megatrials?

Recently published large clinical trials of heparin and aspirin in acute stroke-the International Stroke Trial, Chinese Acute Stroke Trial, and Trial of ORG 10172 in Acute Stroke Treatment--fail to show a net benefit from heparin. None of these trials used i.v., dose-adjusted, unfractionated heparin as generally employed in the United States. However, the control groups in these trials provide data on acute stroke recurrence in large numbers of patients, and these stroke recurrence rates can be used to establish an upper limit for the potential efficacy of antithrombotic therapy. The rates of recurrent ischemic stroke in the control groups of these trials were low, ranging from 0.6 to 2.2% per week. The low rates of recurrent stroke observed in these groups, coupled with the morbidity and mortality associated with i.v. heparin in this patient population, argue against routine use of i.v. heparin in the acute stroke period.