Anterior Circulation Infarction Research Articles

Abstract TP158: Risk prediction for symptomatic Intracranial Hemorrhage (sICH) in Acute Ischemic Stroke (AIS) Patients Treated With Intravenous Thrombolysis (IVT): Does Infarct Location Matter?

Introduction: There are mounting data supporting a substantially lower risk of sICH in AIS patients with posterior circulation stroke (PCS) following treatment with IVT. However, stroke location is not included in any of the numerous risk prediction scores for sICH complicating IVT in AIS. We sought to compare the safety and efficacy of IVT for AIS with respect to the location of acute cerebral ischemia in a high-volume tertiary care stroke center. Methods: Consecutive AIS patients treated with IVT during a five-year period were evaluated. Baseline stroke severity and early hypodensity on baseline CT were assessed by NIHSS-score and ASPECTS by certified physicians. Stroke location was classified as posterior (PCS) vs. anterior circulation (ACS), and supratentorial (STN) vs. infraterorial (ITN) infarction. Safety of IVT was evaluated using the SITS-MOST sICH definition. Three-month functional status was assessed using modified Rankin Scale (mRS) scores. Results: Out of total 1008 IVT-treated AIS patients [52% men, mean age 64±15years, median baseline NIHSS-score: 8 pts (IQR: 4-4)], 181 (18%) had PC and 88 (9%) had STN location. The rates of sICH were lower in patients with PCS [2.8% vs. 6.9%; p=0.039 by Fisher’s exact test (FET)] and ITN infarction (0% vs. 6.7%; p=0.005 by FET). PCS and ITN strokes (OR computed using Firth’s penalized likelihood method for rare events: 0.11; 95%CI: 0.01-1.82) were not independently associated with lower likelihood of sICH on multivariable logistic regression models adjusting for multiple potential confounders including demographics, vascular risk factors, onset-to-treatment time, baseline stroke severity, serum glucose, BP parameters and ASPECTS, pretreatment with antiplatelets (single or dual), statins and oral anticoagulants. Conclusions: Our study indicates that infarct location appears not to be independently related to the risk of sICH in AIS patients treated with IVT.

Abstract TP162: Patterns of Pre-Stroke Atherosclerotic Stenosis and Pretreatment Collateral Status in Acute Ischemic Stroke

Background: To date, there is no consensus regarding the factors associated with collaterals in acute ischemic stroke. Our study attempts to examine variables associated with pretreatment collaterals. Methods: From our hospital stroke registry, we retrospectively recruited 115 patients with acute anterior circulation infarct considered for endovascular reperfusion therapy. Collateral score (0-3) was rated using pretreatment CT angiography. Score of 0 or 1 (≤50% filling of the occluded territory) was considered as poor collaterals. The patterns of steno-occlusion other than culprit occlusion for infarct were classified into intracranial or extracranial atherosclerotic stenosis based on the location of steno-occlusion (> 50% on CTA). Results: Forty five of the 115 patients had poor collaterals. Variables (with univariate P< 0.1) associated with collaterals were, as pretreatment variables, older age ( ≥65 years) (P=0.067), hypertension (P=0.034), diabetes (P=0.093), initial NIHSS (P=0.002), location of culprit occlusion for infarct (P=0.001), intracranial stenosis (P=0.003), and as treatment or post-treatment variables, use of intravenous tissue plasminogen activator (P=0.004), successful recanalization (TICI grade 2b or 3: P=0.009), symptomatic intracranial hemorrhage (P=0.004), final infarct size (P<0.001). When multivariable logistic regression for poor collaterals was performed using the pretreatment variables, internal carotid artery occlusion and intracranial stenosis were significantly associated with poor collaterals (Table). Conclusions: Coincidental intracranial atherosclerotic stenosis is associated with pretreatment poor collaterals during acute stage of stroke. It might be because collateral flow is assumed to be largely dependent on flow from non-occluded intracranial arteries neighboring to culprit vascular lesion for infarct.

Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: Risk factors, cerebral infarction area comparison.

Stroke is the most common neurological disease that is associated with deglutition disorders. The aim of this study was to analyze dysphagia and aspiration pneumonia risk factors in post-stroke elderly inpatients. We consecutively enrolled 212 stroke patients over sixty years of age from July 2014 to June 2015. Seventeen patients were eliminated. Stroke patients' demographics, clinical symptoms and biochemistry data were collected. Modified water swallowing test was used for theassessment of deglutition difficulty. These inpatients were classified into two groups: territorial anterior circulation infarction (n= 114) and territorial posterior circulation infarction (n= 82). Finally, dysphagia and aspiration pneumonia risk factor were analyzed between these two groups. Number of previous cerebral infarction, National Institutes of Health Stroke Scale (NIHSS) score, masticatory muscle paralysis, abolition of gag reflex were correlated with the deglutition difficulty in these patients. In addition, NIHSS score (p= 0.017) and dysphagia (p= 0.02) were correlated with aspiration pneumonia. In stroke inpatients over sixty years of age, it is necessary to distinguish the patients with multiple previous cerebral infarctions, high NIHSS score, masticatory muscle paralysis, and abolition of gag reflex for early detection and rehabilitation of dysphagia.

Association Between Net Vertebral Artery Flow Volume and Non-AF Stroke: A Retrospective 2-Year Analysis.

Objectives: Association between net vertebral artery flow volume (NVAFV) and stroke types remains unclear. We hypothesize NVAFV is low in patients with posterior circulation infarction (PCI) and an ideal cut-off value for discriminating PCI from anterior circulation infarction (ACI) and controls may be present.Materials and Methods: As study candidates, we retrospectively enrolled hospitalized patients with first-time non-AF stroke within 2-years period. Consecutive non-AF, non-stroke subjects were enrolled as the control group. We compared NVAFV values among the PCI, ACI, and control groups.Results: Overall, 866 candidates—213, 418, and 235 candidates in the PCI, ACI, and control groups, respectively—were enrolled. NVAFV (mean ± SD) values were 134.8 ± 52.7, 152.3 ± 59.2, and 172.0 ± 54.7 mL/min in the PCI, ACI, and control groups, respectively. Statistics revealed significant difference (p < 0.001) among three groups. To use NVAFV as a diagnostic parameter, the AUC of any two groups should be between 0.58 and 0.69. Most (93.6%) of the controls had NVAFV above 100 mL/min. The odds ratio of any non-AF stroke is 3.48 if the NVAFV is below 100 mL/min.Conclusions: NVAFV is lowest in non-AF PCI group. Low NVAFV is associated with both non-AF ACI and PCI. No ideal cut-off value is available to discriminate PCI from other two conditions. We agree that an NVAFV of 100 mL/min is the lower limit of a normal value. Any value below 100 mL/min indicates high stroke risk and implies diffuse cerebral atherosclerosis and impaired cerebral perfusion.

Relationship between normalized distributional pattern and functional outcome in patients with acute cardiogenic cerebral embolism.

This study aimed to elucidate spatial characteristics for magnetic resonance imaging (MRI) of cardiogenic cerebral embolism, to determine imaging biomarkers predicting patient outcome and cerebral herniation in cardioembolic stroke. This retrospective study assessed 90 patients with cardiogenic cerebral embolism. All images from MRI were normalized using a voxel-based symptom lesion mapping technique. Patients were categorized into two subgroups based on the outcome and presence of cerebral herniation. Each subgroup was assessed individually. The distribution map of all analyzed patients revealed accumulated ischemic lesions in bilateral middle cerebral artery areas. Ischemic lesions for the poor outcome group accumulated at the corona radiata on the right side and throughout the entire left hemisphere. Receiver operating characteristic (ROC) analysis suggested that a normalized ischemic volume of 62.8 mL allowed optimal differentiation between good and poor outcomes (sensitivity, 0.923; specificity, 0.923; area under the curve (AUC), 0.91) for left-side-dominant infarction. The distribution map for the cerebral herniation group revealed large ischemic areas in the left hemisphere. The analysis of differential involvement map with random permutation analysis showed that left anterior circulation infarcts were associated with midline shift. Receiver operating characteristic analysis revealed that a normalized infarction volume of 192.9 mL was highly predictive of cerebral herniation (sensitivity, 0.929; specificity, 0.750; AUC, 0.895). The medial frontal and occipital lobes, caudate head and basal ganglia were significantly involved in those patients who developed cerebral herniation. Ischemic volume contributed to outcomes and cerebral herniation. Ischemic lesions of the anterior and posterior cerebral arteries and basal ganglia in addition to middle cerebral artery area were identified as differences on MRI images between with and without cerebral herniation patients.

Perceptions of Perioperative Stroke Among Chinese Anesthesiologists: Starting a Long March to Eliminate This Underappreciated Complication.

Perceptions of Perioperative Stroke Among Chinese Anesthesiologists: Starting a Long March to Eliminate This Underappreciated Complication.

Predictive variables of mortality after acute ischaemic stroke in Tanta University Hospital

Background Acute ischaemic stroke (IS) is a major cause of mortality and long-term morbidity. Aim The aim of this study was to evaluate the predictors associated with increased mortality in acute IS. Patients and methods This prospective study was conducted on 251 patients with acute IS admitted to the Department of Neuropsychiatry, Tanta University, over 6 months, and these patients were followed-up for another 6 months. Patients were divided into group I, which included 66 patients who died after acute IS, and group II, which included 185 patients who survived after acute IS. All patients were subjected to full history taking and general and neurological examinations; stroke severity was assessed by National Institute of Health Stroke Scale; type of stroke was determined by Oxfordshire Community Stroke Project Classification and Trial of Org 10172 in Acute Stroke Treatment classifications, ECG, routine laboratory investigations and brain imaging. Patients were followed-up by Modified Rankin Scale. Results Patients in group I had a higher mean age (81.45±12.390). Diabetes mellitus and ischaemic heart disease were more prevalent in group I (68.2 and 90.9%, respectively). Coma was observed to be more in group I (37.88%). The mean of National Institute of Health Stroke Scale and Modified Rankin Scale was higher in group I (19.42±3.53 and ≥4, respectively). Total anterior circulation infarct and stroke of the large artery were more prevalent in group I (59 and 63.6%, respectively). Cerebral edema and leukoaraiosis were observed to be more in group I (87.9 and 80.3%, respectively). Conclusion Early mortality after acute IS is usually due to neurological complications. Septic conditions are considered one of the major causes of post-IS death after the first month.

Comparative study of the effects of Danhong injection with different doses on ischemic stroke: A substudy of hospital-based Danhong injection registry

OBJECTIVETo compare the effects of Danhong injection (DHI) with different doses on ischemic stroke. METHODSChinese hospital registered DHI study is a perspective observational study, in which a total of 1292 patients with ischemic stroke were treated with DHI. Two different doses of DHI were used in the present study. The patients were matched by acute phase of ischemic stroke (within 2 weeks after onset), partial anterior circulation infraction, sex, age, and National Institute of Health Stroke Scale (NIHSS) score. Finally 148 patients were grouped into the 20 or 40 mL DHI group with 74 in each. The primary endpoint was the improvement of NIHSS score at 14-day after treatment. RESULTSOf the 148 patients with ischemic stroke, the 74 in the 40 mL DHI group had clinically important improvements in the NIHSS score. The baseline and 14-day NIHSS score for the 40 mL DHI group were 6.6 ± 4.3 and 2.4 ± 2.5 respectively, versus 6.3 ± 5.7 and 3.6 ± 4.2, for the 20 mL DHI group (change from baseline in the 40 mL DHI group vs change from baseline in the 20 mL DHI group, −1.49 points; P = 0.029). Improvements were maintained after the baseline characteristics and other drugs were controlled (P = 0.012). No adverse events were observed. CONCLUSIONEffects of DHI on partial anterior circulation infarction in patients with acute phase of ischemic stroke is dose-dependent; however, further studies with larger sample sizes are needed to validate our findings (Chinese Clinical Trial Register, Number: ChiCTR-ONC-13003230).

Prediction of hemorrhagic transformation in patients with mild atrial fibrillation-associated stroke treated with early anticoagulation: post hoc analysis of the Triple AXEL Trial

ObjectivesTo investigate the predictors of hemorrhagic transformation (HT) in patients with mild atrial fibrillation-related stroke who were treated with early anticoagulation. We conducted a post-hoc subgroup analysis from Acute Cerebral Infarction Patients with Non-valvular Atrial Fibrillation (Triple AXEL) study. Patients and methodsThe Triple AXEL study was a randomized, multicenter, open-label, blinded end-point evaluation, comparative phase 2 trial. To identify the relationship between the type of HT and risk factors. We analyzed various factors using data from the Triple AXEL study, such as sex, history of hypertension, diabetes, microbleeds, concomitant antiplatelet use, initial infarction volume, initial infarction location, and new intracranial hemorrhage on follow-up gradient recalled echo or susceptibility-weighted imaging. ResultsWe analyzed various factors by dividing patients into a new HT group and a no HT group. No correlation was found between HT and risk factors that were significantly associated with HT, including age, sex, history of hypertension, diabetes, microbleeds, concomitant antiplatelet use, and initial infarction volume. When the initial infarction was classified into anterior circulation infarction (ACI) and posterior circulation infarction (PCI), the occurrence of new HT was significantly more associated with PCI than with ACI (57.6% vs 24.0%, P = 0.001). Multivariate logistic regression analysis was performed using HT as a response variable. Only the location of initial infarction according to the vascular territory contributed to the increased risk of HT (OR2.3, 95%CI1.33–3.91, P = 0.003). ConclusionPCI is a very important independent risk factor for HT in patients with mild AF-related stroke treated with early anticoagulation.

Association Between Unruptured Intracranial Aneurysms and Downstream Stroke.

Background and Purpose- Case reports suggest that unruptured intracranial aneurysms may serve as a nidus for thrombus formation and downstream embolic stroke. However, few data exist to support an association between unruptured aneurysms and ischemic stroke. Methods- We conducted a within-subjects case-control study of acute ischemic stroke patients prospectively enrolled in the Cornell Acute Stroke Academic Registry who had magnetic resonance imaging of the brain and arterial imaging of the head within 14 days of admission. Reviewers blinded to the study hypothesis ascertained the presence of aneurysms from the neuroradiologist's clinical report of the arterial imaging findings. McNemar test for paired data was used to compare the prevalence of unruptured aneurysms ipsilateral versus contralateral to the side of anterior circulation infarcts. Aneurysms of the anterior communicating artery or in the posterior circulation were not counted in the analysis. Results- Among 2116 patients registered in the Cornell Acute Stroke Academic Registry during 2011 to 2016, 1541 met our inclusion criteria, of whom 176 (11.4%; 95% CI, 9.8-13.0%) had an intracranial aneurysm. The prevalence of aneurysms did not differ on the side ipsilateral versus contralateral to the infarction (risk ratio [RR], 1.2; 95% CI, 0.9-1.5). There was no significant association between aneurysms and ipsilateral stroke in secondary analyses of the 1244 patients with stroke in a single anterior circulation territory (RR, 1.2; 95% CI, 0.8-1.9), the 619 patients with cryptogenic stroke (RR, 1.4; 95% CI, 0.9-2.0), or the 485 patients with cryptogenic stroke in a single anterior circulation territory (RR, 1.7; 95% CI, 0.8-3.3). Results were unchanged when counting only aneurysms >3 mm (RR, 1.2; 95% CI, 0.8-1.9) or 5 mm in diameter (RR, 1.2; 95% CI, 0.9-1.5). Conclusions- Contrary to our hypothesis, we found no significant association between unruptured intracranial aneurysms and ipsilateral ischemic stroke.

Watch your step! Who can recover stair climbing independence after stroke?

After discharge, most patients who have suffered a stroke remain with some limitations in their stair climbing ability. This is a critical factor in order to be independent in real-life mobility. Although there are several studies on prognostic factors for gait recovery, few of them have focused on the recovery of stair climbing. The aim of this study was to identify prognostic risk factors for the recovery of stair climbing ability in a large sample of subjects with subacute stroke. Observational study. Neurorehabilitation Inpatient Unit. Subjects within the first month after stroke that had been admitted to an inpatient rehabilitation unit and discharged after an intensive inpatient rehabilitation. Demographical and clinical data were collected. Barthel Index (BI), Trunk Control Test and Motricity Index (MI) scores were recorded at admission and at discharge. Patients received two daily 40-minute sessions of motor rehabilitation, six days per week, during approximately two months. Forward Binary Logistic regressions were used to identify the role of risk factors, using as dependent variables the recovery of stair climbing ability and walking ability at discharge. As independent variables we used age, gender, onset-to-admission interval, side of hemiparesis, trunk control, Motricity Index (MI), presence of obesity, presence of neglect, presence of depression, classification of cerebral infarction (total anterior circulation, partial anterior circulation, posterior circulation or lacunar infarcts), degree of independence in activities of daily living, and cognitive state, all assessed at admission. A total of 257 subjects were enrolled. BI-Score, MI-Score and presence of unilateral spatial neglect at admission were able to explain 83% of variance for the recovery of stair climbing ability. Subjects with a BI >40 at admission were about 17 times more likely to be able to climb stairs again than other patients, and those with MI ≥25 were about 9 times more likely than the rest. The presence of unilateral spatial neglect reduced this possibility of recovering stair climbing ability by about 5.5 times. Of these factors, only MI ≥25, together with a score at Trunk Control Test >12, significantly predicted also walking recovery. This study highlights the different prognostic factors for recovering stair climbing and walking abilities, with a major role of unilateral spatial neglect in the former. There is a need for specific rehabilitation of stair climbing, also for improving the independence in activities of daily living, especially in patients who the clinical staff already knows should manage stairs in their community after being discharged.

Association Between Stroke Severity and 5-Year Mortality in Ischemic Stroke Patients with High-Grade Stenosis of Internal Carotid Artery

BackgroundThe clinical presentations and outcomes of patients with high-grade stenosis of internal carotid artery (ICA) are highly variable. We investigate the influence of different stroke severity on outcomes of ischemic stroke patients with high-grade stenosis of ipsilateral ICA. Methods372 acute first-ever ischemic stroke patients with high-grade stenosis (70%-99%) or occlusion of ipsilateral ICA were enrolled and followed up for 5years. Stroke severities of the enrolled patients were grouped according to the Oxfordshire Community Stroke Project classification system as total anterior circulation infarcts (TACI) or non-TACI. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between the 2 groups. ResultsA total of 71 patients (19.1%) were presented with TACI. Of laboratory data, the values of white blood cell count and high-sensitivity C-reactive protein were significantly higher in patients with TACI (P = .008 and P = .003, respectively). Of clinical course, the occurrence of initial impaired conscious, stroke-in-evolution, pneumonia, gastrointestinal bleeding, and urinary tract infection were significantly higher in patients with TACI. The prevalence of dependent functional status was higher in patients with TACI. Multivariate Cox regression revealed that TACI is a significant predictor of 5-year all-cause mortality in first-ever ischemic stroke patients with high-grade stenosis of ipsilateral ICA (HR [hazard ratio] = 3.66, 95% confidence interval = 2.23-6.00, P < .001). ConclusionsTACI is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade stenosis of ipsilateral ICA. Intensive medical treatment for stroke prevention in patients with severe carotid artery stenosis is warranted.

Vertebral artery hypoplasia: an innocent lamb or a disguise?

The role of vertebral artery hypoplasia (VAH) in stroke pathophysiology is still debated. In this study, we correlated extra- and intra-cranial vertebral artery ultrasound findings with brain CT/MRI and clinical outcome. We recruited all consecutive first-ever stroke patients with a documented acute ischemic brain lesion and a complete extra-intracranial ultrasound evaluation. Those with previous stroke, or with anterior and posterior strokes were excluded. The prevalence of VAH diagnosed by ultrasound was recorded both in anterior circulation and posterior circulation infarctions. In the latter group, we compared the risk profile, topographic and neuroradiological lesion features, etiology and clinical outcome based on the presence of VAH. The study included 750 patients [436 males (58%); mean age 65years; age range 18-90] with first-ever acute ischemic stroke: 193 (25.7%) with a posterior circulation infarction, 557 (74.3%) with an anterior circulation infarction. VAH was more often detected in the former group (33.7 vs. 14.1%; p < 0.0001). Patients with posterior circulation stroke and VAH had a significantly higher frequency of basilar artery stenosis [OR 2.07 (1.00-4.26); p < 0.05], stenosis of the contralateral vertebral artery [64 vs. 36%; OR 3.22 (1.24-8.37); p < 0.05], and fetal-type variant of the posterior cerebral artery [25 vs. 13%; OR 2.17 (1.00-4.68); p < 0.05]. According to our study, VAH identifies patients at higher risk of posterior circulation stroke, and higher frequency of contralateral vertebral artery stenosis and basilar artery stenosis.

Impact of clinical severity of stroke on the severity and recovery of visuospatial neglect.

Background and purposeThere is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may also affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.MethodsThis is a secondary data analysis with merged data from two prospective cohort studies. Resulting in 90 patients and 8 longitudinal measurements at 1, 2, 3, 4, 5, 8, 12, and 26 weeks post-stroke onset. A letter cancellation test (LCT) was used as the primary outcome measure to demonstrate presence and severity of VSN. The clinical severity of stroke was classified using the Bamford Classification.ResultsNo significant association between clinical severity and the number of ipsilesional, as well as contralesional, omissions on the LCT was observed. Recovery of VSN at the contralesional hemiplegic, as well as ipsilesional non-hemiplegic side, was only dependent on ‘time’ as a reflection of spontaneous neurobiological recovery post-stroke. The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group.ConclusionsLarger strokes have a significant negative impact on recovery of visual attention at the non-hemiplegic side. No clinical determinants that regulate spontaneous time-dependent recovery of VSN were found. While early ‘stroke severity’ has been regarded as a strong predictor of functional outcome at a group level, other prognostic factors (demographic, stroke related) need to be determined.Clinical trial registrationEXPLICIT-stroke Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1424Stroke Intensity Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1665

Dyslipidaemia was correlated to the posterior circulation infarction in non-diabetic populations

BackgroundDiabetes mellitus (DM) was prone to happening in posterior circulation infarction (POCI) and DM also has the impact on the lipids, our study was to investigate the correlation between lipid compositions and POCI.MethodsData was collected from the patients with acute ischemic stroke (AIS) hospitalization in Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2008 to May 2012. Lipids and other risk factors in the different populations were investigated in relation to occurrence of POCI based on the infarction location.ResultsSix hundred ten patients with AIS were included in this study, which had 428 with anterior circulation infarction (ACI) and 182 with POCI. Elevated Triglyceride (TG) and decreased High density lipoprotein cholesterol (HDL-C) were seen in the POCI of total populations and AIS without DM compared to the ACI, but not in the populations of AIS with DM, so did the elevated TG/HDL-C ratios. Also, the percent of low HDL-C level and high TG level were higher in POCI group than that in ACI group. Furthermore, single factors logistic regression demonstrated that TG, HDL-C and TG/HDL-C ratio were correlated to the POCI whatever in the total populations or AIS without DM, but this kind of trend just maintained in the populations of AIS without DM after adjusting by relative interference factors.ConclusionDyslipidaemia was prone to happening in POCI compared to ACI in the non-diabetic populations, which was correlated to the pathogenesis of POCI.

Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment.

Blood pressure (BP) control in the early phase of stroke is controversial to reduce the risk of poststroke cognitive impairment (PSCI). This study was to investigate the impact of BP levels in the early phase of ischemic stroke and stroke subtype on PSCI. Seven hundred and ninety-six patients with acute ischemic stroke were included. Cognitive function was assessed after stroke onset using the Montreal Cognitive Assessment. Patients were divided into quintiles according to systolic BP and diastolic BP levels in the early phase. Subtype analyses were according to Trial of ORG 10172 in Acute Stroke Treatment classification (infarct cause) and Oxfordshire Community Stroke Project classification (infarct location). After adjusting for multiple variables, the quintiles with the lowest systolic BP (Q1, 102-127 mm Hg) and with the highest systolic BP (Q5, 171-215 mm Hg) were associated with increased PSCI risk (odds ratio, 1.83; 95% confidence interval, 1.64-2.28; P=0.007 in Q1; odds ratio, 2.32; 95% confidence interval, 1.74-2.90; P<0.001 in Q5) at 3 months as compared with the middle quintile (Q3, 143-158 mm Hg). Similar association was found in diastolic BP quintiles. The analysis of cerebral infarction subtype demonstrated that both large artery atherosclerosis and total anterior circulation infarct were associated with increased risk of PSCI at 3 months after adjusting for multiple variables (large artery atherosclerosis: odds ratio, 1.42; 95% confidence interval, 1.06-1.90; P=0.031; total anterior circulation infarct: odds ratio, 1.68; 95% confidence interval, 1.32-2.15; P=0.001). Lower or higher BP in the early phase of ischemic stroke was correlated with increased PSCI risk at 3 months. Maintaining systolic/diastolic BP in the levels of 143 to 158/93 to 102 mm Hg might be beneficial to reduce the occurrence of PSCI. Moreover, large artery atherosclerosis subtype and total anterior circulation infarct subtype were correlated with increased PSCI risk at 3 months. URL: https://www.chictr.org. Unique identifier: ChiCTR-TRC-14004804.

The association of different types of cerebral infarction with post-stroke depression and cognitive impairment.

The aim of this study was to investigate post-stroke depression (PSD) and cognitive impairments in patients with different types of cerebral infarction.A total of 110 patients with cerebral infarction treated in our hospital from January 2015 to February 2016 were included in present study. Forty-seven patients were PSD patients and 63 patients were non-PSD patients. The Hamilton Depression Rating Scale (HAMD) and Mini-Mental State Examination (MMSE) were employed to assess depression and cognition of patientsAmong PSD patients, the proportion of patients with partial anterior circulation infarction (PACI, 68.75%) was significantly higher than patients with lacunar circulation infarction (LACI, 29.17%) and posterior circulation infarction (POCI, 26.67%) (P < .05). No significant difference was found in PSD patients with LACI and POCI (P > .05). The MMSE score of patients with PACI (18.05 ± 2.61) was lower than patients with POCI and LACI (P < .05), however, no significant difference was found in patients with LACI and POCI (P > 0.05). The incidences of cognitive impairment in patients with PACI, LACI, and POCI were 12.50%, 14.58%, and 13.33%, respectively. The MMSE score of PSD patients (21.23 ± 2.12) was significantly lower than non-PSD patients (P < .05).Compared with LACI and POCI patients, PACI patients had a higher incidence of PSD and impaired cognitive functions. In addition, affective disorders such as depression may be correlated with cognitive impairment in patients with cerebral infarction.

Blood microRNA-15a Correlates with IL-6, IGF-1 and Acute Cerebral Ischemia.

This study aims to explore the function of blood microRNA-15a (miR-15a) in the pathogenesis of acute cerebral ischemia (AIS). Blood samples were collected from healthy control and AIS patients within 72 h after onset. A model of ischemia in human umbilical vein endothelial cells (HUVECs) was established through oxygen and glucose deprivation (OGD). MiR-15a in patients and in cells was measured using real-time quantitative polymerase chain reaction (qPCR). The predicted target of miR-15a such as interleukin-6 (IL-6) and insulin-like growth factors-1 (IGF-1) in plasma was detected by enzyme-linked immunosorbent assay (ELISA). The relations between blood miR-15a and stroke severity, stroke etiology, infarct location, stroke prognosis, predicted targets were analyzed by Statistical Product and Service Solutions (SPSS) software respectively. Higher miR-15a levels were found in AIS patients and ischemic cells within 72 h, compared to control (p < 0.05). Receiver Operating Characteristic (ROC) analysis showed that blood miR-15a predicted stroke onset with 98.67% specificity. Blood miR-15a had a negative correlation with National Institutes of Health Stroke Scale (NIHSS) scores (r = -0.3695, p < 0.01). The AIS patients with increased miR-15a levels had a better prognosis. MiR-15a was up-regulated in anterior circulation infarction and small-artery atherosclerosis stroke. Plasma levels of IL-6 and IGF-1 were associated with blood miR-15a (r = -0.6051, 0.3231, p < 0.05, respectively). Blood miR-15a associates with IL-6, IGF-1 and acute cerebral ischemia. It could serve as a potential diagnostic biomarker and therapeutic target for stroke.

A Novel Neuroimaging Model to Predict Early Neurological Deterioration After Acute Ischemic Stroke.

Objective: In acute ischemic stroke, early neurological deterioration (END) may occur in up to one-third of patients. However, there is still no satisfying or comprehensive predictive model for all the stroke subtypes. We propose a practical model to predict END using magnetic resonance imaging (MRI).Method: Patients with anterior circulation infarct were recruited and they underwent an MRI within 24 hours of stroke onset. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 72 hours of stroke onset. We examined the relationships of END to individual END models, including: A, infarct swelling; B, small subcortical infarct; C, mis-match; and D, recurrence.Results: There were 163 patients recruited and 43 (26.4%) of them had END. The END models A, B and C significantly predicted END respectively after adjusting for confounding factors (p=0.022, p=0.007 and p<0.001 respectively). In END model D, we examined all imaging predictors of Recur-rence Risk Estimator (RRE) individually and only the “multiple acute infarcts” pattern was signifi-cantly associated with END (p=0.032). When applying END models A, B, C and D, they success-fully predicted END (p<0.001; odds ratio: 17.5[95% confidence interval: 5.1–60.8]), with 93.0% sensitivity, 60.0% specificity, 45.5% positive predictive value and 96.0% negative predictive value.Conclusion: The results demonstrate that the proposed model could predict END in all stroke sub-types of anterior circulation infarction. It provides a practical model for clinical physicians to select high-risk patients for more aggressive treatment to prevent END.

Analysis of clinical characteristics of non-valve atrial fibrillation and acute ischemic stroke in the very elderly patients

Objective To compare the clinical characteristics of patients with non-valve atrial fibrillation(NAVF)and acute ischemic stroke(AIS)between two groups: aged ≥80 years versus 60-79 years. Methods One hundred and five inpatients with NVAF and AIS, treated in Neurological Department Beijing Hospital from November 2009 to November 2014, were divided into two groups of the very elderly patients(≥80 years, n=44)and old patients(60-79 years, n=61). Baseline data and clinical characteristics of patients with NAVF and AIS were retrospectively compared between the two groups to explore their risk factors, subtypes of AIS, the complications and prognosis. Results Age was the risk factor for stroke in the very elderly patients with NAVF.Compared with old patients group, the very elderly patients were associated with significantly higher baseline NIHSS(National Institutes of Health Stroke Scale)(11.59±7.76 vs. 6.03±7.12, t=3.80, P=0.000). The rates of mRS(modified Rankin Scale)≥3(poorer clinical turnover)1 or more month after AIS was 21.3% in the old patients versus 56.8% in the very elderly patients(χ2=13.96, P<0.01). Moreover, anterior circulation infarction was the main subtypes of AIS in the very elderly patients versus old patients(χ2=12.28, P=0.020). Meanwhile, the very elderly patients versus the old patients had markedly higher rates of complications of AIS, such as pneumonia(65.9% vs. 27.9%; χ2=14.53, P<0.05), gastrointestinal bleeding(36.4% vs. 13.1%; χ2=7.84, P<0.05), acute coronary syndrome or heart failure(34.1% vs.11.5%; χ2=7.89, P<0.05). Conclusions The very elderly patients versus the old patients show that risk factors for NVAF with AIS are more often the ageing and smoking, and that anterior cerebral circulation is more often affected.The degrees of NVAF and AIS severity are higher, the more complications are found, and the prognosis is worse. Key words: Atrial fibrillation; Stroke