Cardioembolic Ischemic Stroke Research Articles

Механічна тромбекстракція в пацієнтки з гострим ішемічним інсультом на тлі антикоагулянтної терапії

Thrombolytic therapy, which is a priority treatment strategy in patients with acute ischemic stroke in the first 3-4.5 hours after start of the disease, has significant limitations in case of background anticoagulant therapy. Mechanic thrombextraction is considered to be an alternative therapeutic strategy in case of inefficacy or contraindications to thrombolytic therapy. The article presents a clinical case of the 75-year old female patient with acute cardioembolic stroke on background of heart failure and atrial fibrillation. Long-term background usage of the direct oral anticoagulant due to atrial fibrillation is a limitation to use thrombolytic therapy, therefore mechanical thrombextraction was performed. The case presents possibilities of the successful interventional treatment of acute cardioembolic ischemic stroke. An example of a possible drug-drug interaction possibly leading to reduction of the effectiveness of anticoagulant therapy is shown. Key words: ischemic stroke, anticoagulants, mechanical trombextraction.

Cardioembolic stroke in syndrome of noncompaction cardiomyopathy

Stroke remains one of the most common diseases and causes of death. Reducing mortality from stroke is in great dependence on the effectiveness of its prevention, which, in turn, is impossible without an accurate understanding of its causes and mechanisms of development. The article represents the history of a patient with ischemic cardioembolic stroke that developed against noncompaction cardiomyopathy, a relatively rare disease that can be diagnosed with the use of available modern research methods. The algorithm for examining a patient with suspected cardioembolic stroke includes long-term Holter monitoring, echocardiography, CT and MRI of the heart, which makes it possible to identify rare causes of cardiac thromboembolism. Postexposure prophylaxis of stroke in such cases is likely to include the use of anticoagulants, but studies aimed to clarify most effective methods of recurrent strokes prevention in rare causes of cardiac thromboembolism are still being conducted.

Dynamics of platelet hemostasis indices in patients with cardioembolic stroke against the background of atrial fibrillation

To study the parameters of platelet hemostasis in patients with cardioembolic ischemic stroke on the background of atrial fibrillation and taking warfarin to assess the effectiveness of antiplatelet drugs in the prevention of recurrent ischemic strokes. 93 patients with ischemic stroke on the background of atrial fibrillation were examined, of which the main group consisted of 43 patients who took warfarin and 50 patients from the reference group without warfarin. The study of the platelet link of hemostasis using inductors (adrenaline, ristomycin, arachidonic acid, collagen, ADP) in patients of both groups was carried out. In the group of patients taking warfarin there was a significant increase in platelet aggregation for adrenaline up to 57.15 [29.51; 62.61] (p=0.0315), spontaneous aggregation 2.46 [1.39; 6.75] (p=0.047), reduction of platelet aggregation for collagen 14.45 [4.80; 43.63] (p=0.008). In 35 patients of the study group (n=93), laboratory resistance to aspirin was also revealed in terms of platelet aggregation to arachidonic acid, which is a criterion for evaluating the effectiveness of preventive measures for recurrent ischemic strokes with antiplatelet drugs. The obtained data are additional risk factors for recurrent strokes. It is also recommended to study platelet aggregation for arachidonic acid to assess the effectiveness of antiplatelet drugs prophylaxis of recurrent ischemic strokes.

Acceleration of opportunistic atrial fibrillation screening for elderly patients in routine primary care.

Cardio-embolic ischemic stroke caused by atrial fibrillation is more severe compared with other types of stroke, such as lacunar infarction and atherothrombotic infarction in patients without atrial fibrillation. Therefore, it is important to prevent cardio-embolic ischemic stroke by detecting atrial fibrillation early in at-risk patients and administering appropriate anticoagulation therapy. This prospective observational study aimed to evaluate the effectiveness of opportunistic atrial fibrillation screening at 12 primary clinics in Japan. The study included a 12-month pre-campaign period and a 12-month campaign period. During the campaign period, an awareness campaign was conducted to encourage physicians to be mindful of screening patients aged ≥65 years for atrial fibrillation by checking their pulses and performing subsequent electrocardiography when an irregular pulse was detected. The primary outcome was the proportion of patients with newly diagnosed atrial fibrillation. A sub-analysis focusing on first-time outpatients was performed. There were 9921 and 10,282 patients with no history of atrial fibrillation in the pre-campaign and campaign periods, respectively. In the whole population, the proportion of patients with newly diagnosed atrial fibrillation was 0.9% throughout the pre-campaign and campaign periods. In the sub-analysis limited to first-time outpatients, the detection proportion increased from 1.6% to 1.9% during the campaign period. In terms of age stratification, a large increase in detection was observed, especially among patients aged 65–74 years (detection increased from 0.9% to 1.5%) and ≥85 years (detection increased from 2.9% to 3.3%) during the campaign period. Our findings suggest the feasibility of opportunistic atrial fibrillation screening in routine primary care practice in Japan. Of note, our findings suggest that opportunistic atrial fibrillation screening targeting first-time outpatients may be of clinical value.

IL6 trans-signalling associates with atherothrombotic but not with cardioembolic stroke

Abstract Background Pro-inflammatory processes underlie ischemic stroke, albeit it is largely unknown if they selectively associate with the risk of atherothrombotic and cardioembolic ischemic stroke. Here we analyse whether the pro-inflammatory interleukin (IL) 6 trans-signalling, associates with the risk of ischemic stroke and underlying atrial fibrillation (AF). Method During a 20-year follow-up, 203 incident ischemic strokes were recorded from national registers in the cohort of 60-year-old men and women from Stockholm (n=4232). For each study participant, we have estimated the activity of the IL6 trans-signalling through the calculation of the ratio between the circulating pro-inflammatory binary IL6:sIL6R complex and the circulating inactive ternary IL6:sIL6R:sgp130 complex, the so called B/T ratio. An excess of the binary complex, mirrored by a high B/T ratio, is associated with an increased risk of cardiovascular events. The B/T ratio has been dichotomized at the median. The risk of ischemic stroke associated with B/T ratio > median was estimated by Cox regression and expressed as hazard ratio (HR) with a 95% confidence interval (CI) in the presence and absence of AF. Risk estimates were adjusted for cardiovascular risk factors and anticoagulant treatment. In a secondary analysis, the association of IL6 trans-signalling with the risk of incident AF (n=279) was analysed. Results B/T ratio >median was associated with the risk of ischemic stroke only in study participants without AF diagnosis (adjusted HR 1.49; 95% CI 1.08–2.06). No association was observed with ischemic stroke in study participants also diagnosed with AF. Moreover, the B/T ratio was not associated with the risk of AF (HR 0.96; 95% CI 0.75–1.24). Conclusions IL6 trans-signalling, estimated by the B/T ratio, is associated with atherothrombotic but not cardioembolic stroke. Consistently, the B/T ratio did not associate with the risk of incident AF. Our results support the relevance of IL6 trans-signalling in atherosclerosis related ischemic stroke. Funding Acknowledgement Type of funding source: None

Current characteristics and early functional outcome of older stroke patients: a population-based study (Dijon Stroke Registry).

the ongoing growing and ageing population is associated with an increase in older patients suffering a stroke. We aimed to assess the current profile of these patients in a population-based setting. all patients with acute stroke were prospectively identified among residents of Dijon, France, between 2013 and 2017, using a population-based registry. Characteristics and early outcome of patients were compared according to age groups. 1,288 stroke cases were recorded (median age: 81.1years, interquartile range: 66.1-86.7, 54% women). Patients aged 75-85years and those >85years accounted for 27.6 and 33.9% of overall cases. Increasing age was associated with a greater prevalence of vascular risk factors, pre-existing cognitive impairment and handicap, higher initial severity, more frequent cardioembolic ischemic stroke, post-stroke pulmonary infection and delirium. Only 41% of patients aged 75-85years and 18% of those aged >85years had a good early recovery. Compared with patients aged <75years, patients aged 75-85years [adjusted odds ratio (OR) = 2.61; 95% confidence interval (CI): 1.74-3.93, P < 0.001] and those aged >85years (adjusted OR = 7.18; 95% CI: 4.58-11.3, P < 0.001) had an increased risk of poor post-stroke functional outcome. Among survivors, the proportion of patients discharged to home was 60% in age group <75years, compared with 49% in patients aged 75-85years and 29% in those aged >85years. Thirty per cent of patients >85years old required a long-term care institution. the increasing burden of stroke in older people has major implications for future treatment strategies and need for dedicated care facilities.

August 2020 Highlights.

August 2020 Highlights.

Features of cognitive disorders in patients with cardioembolic stroke

In the structure of all ischemic strokes, cardioembolic stroke (CES) takes 2nd place in prevalence after atherothrombotic. A frequent complication (CES) is cognitive impairment of varying severity. The key point of the research was to evaluate the characteristics of cognitive impairment in patients who underwent (CES) at different periods of treatment. 33 patients were examined in different periods after a stroke (acute — 10—21 days after the occurrence of CES and early recovery 40— 60 days after the occurrence of CES). In the group of men and women, patients aged from 61 to 70 years were significantly more likely to meet. The functional state of patients was evaluated by the Barthel index, on the Rankine scale. The definition of cognitive functions was carried out using the MMSE scale. The level of forming correlates with the level of restoration of cognitive functions and the level of their social adaptation. With the localization of lesions focuses in the vertebrobasilar pool, better recovery of cognitive functions is noted. Positive dynamics of cognitive impairment is noted in the early recovery period of CES in the direction of increasing scores on the MMSE scale compared with the acute period. A higher level of social adaptation determined by the Barthel index and the Rankine index contributes to a better recovery of cognitive functions of patients with CES Key words: ischemic cardioembolicstroke, cognitive impairment, strokeperiods

Analysis of lethal cases in atherothrombotic and cardioembolic ischemic stroke taking into account the parameters of the fibrinolysis system

Analysis of lethal cases in atherothrombotic and cardioembolic ischemic stroke taking into account the parameters of the fibrinolysis system

Characteristics of aged ischemic stroke patients indicative of cardioembolism.

The treatment of ischemic stroke has recently witnessed dramatic developments. However, there are limited data on ischemic stroke characteristics in aged patients. As part of the South Tochigi Acute Ischemic Stroke Registry, we prospectively enrolled 636 consecutive acute ischemic stroke patients (within 7days after the onset) who were ≥ 60years of age and who were admitted to two independent institutes from April 1, 2016 to February 28, 2019. We analyzed three groups divided by age: early-aged (60-69years), middle-aged (70-79years), and oldest-aged (≥ 80years). From the 636 subjects, 194 were early-aged, 215 were middle-aged, and 227 were oldest-aged. There were significant differences in the ischemic stroke subtypes in each aging group (p < 0.01). The proportion of cardioembolism was 22.2% in early-aged, 27.4% in middle-aged, and 41.4% in the oldest-aged patients. The proportion of patients with a modified Rankin Scale of 0-2 at 1 year after onset decreased to 42.2% in middle-aged and 17.8% in oldest-aged with cardioembolic ischemic stroke. The proportion of patients receiving anticoagulation therapy before admission was 25.6% (36.7% of atrial fibrillation [AF]) in early-aged, 39.0% (52.3% of AF) in middle-aged, and 18.1% (21.0% of AF) in oldest-aged patients (p < 0.001). Our study reports characteristics of clinical ischemic stroke in an aging population. The assessment of cardiogenic embolism is important for an aging population.

Ischaemic stroke and SARS-CoV-2 infection: a causal or incidental association?

IntroductionIschaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. Materials and methodsWe describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. ResultsThe association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. ConclusionsSystemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.

Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease

Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design.

Ictus isquémico e infección por SARS-CoV-2, ¿asociación casual o causal?

IntroductionIschaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. MethodsWe describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. ResultsThe association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. ConclusionsSystemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.

Abstract TMP110: Antithrombotic Therapy and Risk of Stroke Recurrence in Children With Congenital and Acquired Cardiac Disease

Background: Antithrombotic therapy (ATT) is currently recommended for stroke prevention in pediatric cardioembolic arterial ischemic stroke (CE-AIS) where the risk of recurrence is high. Methods: We conducted a retrospective study of a prospectively enrolled cohort of neonates and children with radiologically-confirmed cardioembolic arterial ischemic stroke (CE-AIS) from January 2003 - December 2017. We evaluated the clinical and radiographic predictors of hemorrhagic transformation (HT) and stroke recurrence to assess the safety and efficacy of ATT. Results: Eighty-two children met inclusion criteria [53.7% males and 28% neonates; median age 0.43 (IQR: 0.08 - 4.23) years]. Stroke recurred in 11 children at a median of 32 days (IQR: 5.5 - 93) from the index event. Most recurrent infarcts were silent (n=6; 54.5%) and found on follow-up neuroimaging with an average follow-up interval of 4.1 ±3 .5 years. Procedure-related recurrence took place in 1 (9.1%) child. Ten (90.9%) children were receiving antithrombotic therapy at the time of recurrence: 8 (72.7%) were on anticoagulant therapy (ACT) and 2 (18.2%) were on a combination of antiplatelet (ATP) and ACT. HT occurred in 20 of 82 children (24.4%), all of whom were receiving ACT, 5 (6.1%) of whom were symptomatic. Four (4.9%) had systemic hemorrhage. There was no difference in the frequency of stroke recurrence between those with and without HT [3 (15.0%) vs. 8 (12.9%); p=1.00]. Children with univentricular physiology were less likely to have HT [15% vs. 43.5%; p=0.03] and had higher rates of recurrent stroke, prior to definitive cardiac repair, despite receiving ATT. Stroke recurrence was highest in those with cyanotic congenital heart disease (CHD) pre-surgery (3/11), cyanotic CHD post-palliative surgery with residual right-to-left-shunt (3/11) and in those with cardiomyopathy (4/11). HT was not associated with ATP vs. ACT use nor combination therapy. Conclusion: ATT appears to be relatively safe in children with CE-AIS. However, ATT warrants further optimization to prevent stroke recurrence, particularly in those with single ventricle physiology and reduced left ventricular function.

Abstract WP227: Risk Factors for Pathophysiologic Subtypes of Ischemic Stroke Among West Africans: Findings From the SIREN Study

Background: The risk factors associated with the occurrence of the distinct pathophysiologic subtypes of ischemic stroke are unknown among indigenous Africans. Objective: To identify and quantify the contributions of risk factors for occurrence of ischemic stroke and its etiologic subtypes among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged &gt;18 years with CT/MRI confirmed stroke and ischemic strokes were etiologically subtyped using the TOAST protocol. Controls were age-and-gender matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive evaluation for vascular, lifestyle and psychosocial factors was performed using standard instruments. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: There were 1,721 ischemic stroke cases with a mean age of 62.19 ± 14.03 vs 60.86 ± 13.71 for controls. Using the TOAST etiologic scheme, 867 (50.3%) were small vessel occlusions, 425(24.7%) were large-artery atherosclerotic, 181(10.5%) were cardio-embolic, 204(11.9%) were undetermined and 44(2.6%) were of other determined etiology. The 7 dominant risk factors for ischemic strokes aOR (95%CI) were hypertension 10.76(7.15-16.20), dyslipidemia 5.30(3.86-7.29), diabetes 3.61(2.72-4.80), psychosocial stress 1.68(1.20-2.35), cardiac disease 1.94 (1.25-3.02), meat consumption 2.02(1.54-2.65), green vegetable consumption 0.44(0.33-0.59). Hypertension, dyslipidemia, diabetes, meat consumption and green vegetable intake were confluent factors shared by small-vessel, large-vessel and cardio-embolic ischemic stroke subtypes. Conclusion: We provide empiric evidence of risk factors to be targeted for stroke prevention. Our findings open a vista into future studies aimed at elucidating the genetic factors linked with pathophysiologic subtypes of stroke among Africans.

Safety of Non-Vitamin K Oral Anticoagulants in Elderly Patients with Atrial Fibrillation

Aim. To study the safety of non-vitamin K oral anticoagulants (NOAC) in patients with atrial fibrillation (AF) over 75 years old. Material and methods. The observation study included patients ≥75 years of age with confirmed AF, receiving dabigatran in a reduced dosage, apixaban or rivaroxaban in full or reduced dosage. Previous experience of NOAC treatment from the very beginning of therapy, if a patient was ≥75 years old, or from the point a patient reached 75 years was considered; episodes of NOAK change, as well as hemorrhagic and ischemic events associated with taking an anticoagulant, were recorded. Patient groups were comparable in risk score by CHA2DS2-VASc and HAS-BLED scales. Results. Patients with AF (n=102; 39 men and 63 women; an average age 79.4Ѓ}4.1 years) were included: 32 patients were in dabigatran group, 34 patients – in apixaban group and 36 patients – in rivaroxaban group. 19 clinically significant bleedings were recorded, 10 occurred in patients taking dabigatran and 9 in those taking rivaroxaban. No hemorrhagic events in patients treated with apixaban were observed. Hematuria (31.6%), large subcutaneous hematomas (26.3%) and intensive nasal bleedings (26.3%) were the most frequent events. No ischemic cardioembolic stroke was recorded. Conclusions. In elderly patients, all NOAC (dabigatran, rivaroxaban and apixaban) demonstrated good safety profile without major bleeding within a 1.5-year follow-up period.

Этнические особенности носительства сочетаний генотипов CYP2C9 и VKORC1 среди пациентов с кардиоэмболическим ишемическим инсультом

Этнические особенности носительства сочетаний генотипов CYP2C9 и VKORC1 среди пациентов с кардиоэмболическим ишемическим инсультом

Influence of metabolic syndrome on the result of ischemic cardioembolic stroke due to atrial fibrillation

Metabolic syndrome is a complex of metabolic, hormonal, and clinical disorders, which are based on insulin resistance and compensatory hyperinsulinemia, abdominal obesity, disorders of lipid, purine metabolism, and arterial hypertension, is a combination of factors, each of which, both individually and in combination with others, has a significant effect on the risk of occurrence and the characteristics of the course of cardiovascular diseases, in particular ischemic strokes. The clinical feature of metabolic syndrome is the frequent development of paroxysms of atrial fibrillation, as a manifestation of the late stages of "hypertensive heart", which is illustrated in a number of large-scale population studies on the relationship between metabolic syndrome and the risk of atrial fibrillation. Our work raises the question of the features of the relations between metabolic syndrome and ischemic stroke caused by atrial fibrillation. Information concerning the qualitative and quantitative characteristics of the components of the metabolic syndrome with a breakdown of the clinical features of ischemic cardioembolic stroke in persons with the pathology under discussion, their natural course, the prognosis of the outcome, and sensitivity to treatment is very low. The article presents the results of the analysis of factors that make it possible to predict the course and outcome of acute ischemic stroke caused by atrial fibrillation against the background of metabolic syndrome. In order to determine the prognostic criteria for the outcome of cardioembolic stroke, 86 patients were examined, 41 patients were diagnosed with a cardioembolic stroke on the background of metabolic syndrome, 45 patients with cardioembolic stroke without metabolic syndrome. The analysis was based on the construction of correlation pleiades. A similar factor structure of indicators in both studied groups of patients with cardioembolic stroke indicates the same nature of changes in the state against the background of acute vascular catastrophe. A more severe course of the disease, based on the data of correlation analysis and data obtained by comparing indicators, is noted in the presence of the metabolic syndrome. Prognostically significant factors that allow predicting the course and outcome of cardioembolic stroke are the degree of a motor deficit on a five-point scale, total cholesterol, high-density lipoproteins, blood glucose, persistent atrial fibrillation, degree of stenosis of the internal carotid arteries, CHA2DS2-VASc scale indices.

Clinical-evolutive particularities and a multimodal therapeutic-rehabilitative approach, as well as through connected care approach, in the case of hemiplegia after ischemic cardio-embolic stroke within a polypathological context – A case report

Introduction: Cardiac embolism is one of the most common causes of embolic CVA. The recovery of patients with cardio-embolic stroke is a complex process which requires taking into account all associated pathologies (e.g. diabetes mellitus) that can play a decisive role in the evolution of the patient. A multidisciplinary team is required for such a purpose. Material and methods: The paper presents the case of a 63-year old patient with hemiplegia after an ischemic cardio-embolic stroke within a poly-pathological context. In January 2019, the patient suffered from an ischemic stroke in the carotid region with an ataxic spastic hemiparesis and left facial paresis with cerebrasthenia and bradylalia and he was admitted to “St. Ioan” Clinical Emergency Hospital in Bucharest. After the patient was stabilized and received specialized treatment, following the investigations and the interdisciplinary consultations, he received indication of neuromuscular recovery and for this reason he was admitted to our clinic. The patient was clinically and functionally evaluated, according the standardized protocols implemented in our clinic, through the assessment scales (MMSE, GOS-E and Rankin, MoCA, FIM, FAC, QoL, Asworh and Penn) and also para-clinically, in order to evaluate his biological reserve and his bearing availability of the recovery program. Results: After a complex neuro-recovery program undertaken by a multidisciplinary team formed by doctors, kinesiotherapists, medium healthcare and paramedical personnel, the patient displayed a slowly favorable evolution (hardened by his multiple associated diseases due to the above-mentioned co-morbidities) from a functional point of view with the improvement of the walking program and the increase in the muscle force and self-autonomy. Conclusion: The recovery of patients with cardio-embolic stroke is a complex process, which requires taking into account all associated pathologies that can play a decisive role in the evolution of the patient. A multidisciplinary team is required for such purposes. Key words: stroke, hemiplegia, poly-pathologic, ischemic

Ischemic Stroke and Genetic Variants: In Search of Association with Severity and Recurrence in a Brazilian Population

ObjectiveThe aim of this study was to investigate the relationship between genetic variants in candidate genes and clinical severity and prognosis (recurrence) of ischemic stroke (IS) in a Brazilian population. MethodsThis was a retrospective study based on clinical and demographic data retrieved from the JOINVASC cohort—Epidemiological Study on Cerebrovascular Diseases in Joinville and on respective DNA samples available at the Joinville Stroke Biobank, over the period 2010-2015. Four hundred and thirty-five subjects were included. Patients were divided into large artery atherosclerosis (195 cases) and cardioembolic IS (240 cases) subgroups according to Trial of Org 10172 in the Acute Stroke Treatment standards. The severity of the event was established from the score obtained using the National Institutes of Health Stroke Scale. The genotypic and allelic frequencies of each variant were acquired by Real-Time Polymerase Chain Reaction. The codominance model was considered for the analysis of the genotypes’ influence. ResultsThere was no association between clinical severity and recurrence with variants rs2383207 (CDKN2B-AS1) for atherothrombotic IS and variants rs879324 (ZFHX3), rs966221 (PDE4D), and rs152312 (PDE4D) for cardioembolic IS. The variants rs1396476, rs2910829, rs6843082, and rs2107595 were not in Hardy-Weinberg equilibrium in the evaluated population. ConclusionsAlthough this study failed to identify an association between genetic variants and clinical response variability, the need to carry out related studies with larger number of cases covering other populations and genetic variants remains, which would allow the uncovering of hypothetical genetic factors governing stroke outcomes and recurrence.