Cardioembolic Ischemic Stroke Research Articles

Factor XI Inhibitors: perspectives in primary and secondary prevention of ischemic stroke.

Stroke is one of the most common causes of mortality and disability worldwide. Antithrombotic therapy represents the mainstay in primary and secondary prevention, both in cardioembolic and non-cardioembolic stroke. Particularly, direct oral anticoagulants play a crucial role in atrial fibrillation, the most common cause of cardioembolic stroke, whereas single or dual antiplatelet therapy is preferred in non-cardioembolic stroke. However, the limitations related to the residual risk of cardioembolic or cerebrovascular events, and the risk of major bleeding, still represent unmet medical needs. To overcome them, new drugs inhibiting Factor XI (FXI) and Factor XII have been proposed, with a selective inhibition of contact pathway of coagulation, delineating a new anticoagulant approach. This review provides a summary of the currently available evidence and future perspectives on FXI inhibitors, that can represent an additional therapeutic option in the primary and secondary prevention of cardioembolic and non-cardioembolic ischemic stroke, also in challenging therapeutic contexts.

Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation.

Stroke due to atrial fibrillation (AF) is more common in older adults. Frailty is associated with AF. As little is known about the impact of frailty on cardioembolic stroke, we examined its association with important healthcare outcomes including mortality and functional outcome in stroke with AF. Data were collected from patients presenting consecutively to a regional university hospital to assess pre-admission frailty using the Clinical Frailty Scale (CFS) and function with the Modified Rankin Scale (mRS). Stroke severity was assessed on the National Institute of Health Stroke Scale (NIHSS). In total, 113 patients presenting between August 2014 and July 2016 were identified with cardioembolic stroke, median age 80 years; 60% were male. Their median NIHSS score was 6. The median pre-admission CFS score was 3; 26.5% scored ≥5/9, indicating frailty. The median pre-admission mRS scores increased significantly from 1 to 3 at discharge (p < 0.001). Frailty was associated with worse mRS scores at discharge, odds ratio 1.5, (p = 0.03). While no patients with frailty were suitable to avail of early supported discharge, 10% of those without frailty were (p = 0.02). There was no significant difference in 30-day mortality. Frailty is prevalent among patients with cardioembolic stroke due to AF and was associated with poorer functional outcomes. Although the numbers were small, these data suggest that brief frailty assessments are useful to risk-stratify patients with acute cardioembolic stroke. Frailty status on admission with stroke due to AF can help identify those more likely to have poorer outcomes, to benefit from intervention, to require prolonged rehabilitation, and to avail of ESD.

Gender Predicts Differences in Acute Ischemic Cardioembolic Stroke Profile: Emphasis on Woman-Specific Clinical Data and Early Outcome-The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry.

Background and Objectives: Acute ischemic cardioembolic stroke (CS) is a clinical condition with a high risk of death, and can lead to dependence, recurrence, and dementia. Materials and Methods: In this study, we evaluated gender differences and female-specific clinical data and early outcomes in 602 women diagnosed with CS from a total of 4600 consecutive acute stroke patients in a single-center hospital stroke registry over 24 years. A comparative analysis was performed in women and men in terms of demographics, cerebrovascular risk factors, clinical data, and early outcomes. Results: In a multivariate analysis, age, hypertension, valvular heart disease, obesity, and internal capsule location were independent variables associated with CS in women. The overall in-hospital mortality rate was similar, but the group of women had a greater presence of neurological deficits and a higher percentage of severe limitation at hospital discharge. After the multivariate analysis, age, altered consciousness, limb weakness, and neurological, respiratory, gastrointestinal, renal, cardiac and peripheral vascular complications were independent predictors related to early mortality in women. Conclusions: Women with CS showed a differential demographic and clinical profile and worse early outcomes than men. Advanced age, impaired consciousness, and medical complications were predictors of stroke severity in women with CS.

OUTCOMES OF WARFARIN THERAPY FOR SECONDARY PREVENTION OF ISCHEMIC STROKE: A RETROSPECTIVE, FOLLOW-UP STUDY

Aim: Anticoagulant prophylaxis is recommended because cardioembolic ischemic stroke is associated with worse functional outcomes, increased recurrence rates, and higher mortality. This study aimed to investigate the rates of recurrent ischemic attacks and bleeding complications in patients receiving warfarin following ischemic stroke. Method: In this retrospective analysis, a total of 181 individuals who were initiated on warfarin therapy following an ischemic stroke were included in the study. These patients were subsequently monitored for a duration spanning from 1 month to as long as 16 years. The acute ischemic stroke diagnosis was established using the Trial of Org 10172 in Acute Stroke Treatment classification criteria. Patient follow-up periods, international normalized ratio (INR) levels, ischemic events, and bleeding were recorded and evaluated. Results: In the patient cohort, 97 (53.6%) were women and 84 (46.4%) were men. The recurrent ischemic stroke rate was 7.2%, major bleeding rate was 3.3%, and minor bleeding rate was 12.7%. While the average INR value during recurrent ischemic stroke was 1.69±0.31, the average INR value during bleeding complications was observed to be 3.15±1.38. The rate of minor bleeding was related to duration of warfarin use and non-valvular atrial fibrillation. Conclusion: Our results show that long-term warfarin use and non-valvular atrial fibrillation are risk factors for bleeding.

Clonal Hematopoiesis of Indeterminate Potential (CHIP) Related to the Etiology of Ischemic Stroke

Introduction: Clonal Hematopoiesis of Indeterminate Potential (CHIP) is associated with cardiovascular disease, including acute myocardial infarction and ischemic stroke, due to immune system dysregulation leading to increased atherosclerotic plaque formation and inflammation. Approximately 25-40% of ischemic strokes have an unknown cause even after a comprehensive etiological study and are eventually categorized as cryptogenic strokes. Our hypothesis is that the presence of CHIP could represent a biomarker for atherosclerotic or cardioembolic ischemic stroke and help to clarify the origin of cryptogenic strokes. Therefore, the objective of this study was to analyze the prevalence of CHIP in patients with different subtypes of ischemic stroke and its prognostic impact on cardiovascular risk. Methods: This prospective observational study included consecutive patients over 60 years of age with no prior history of neoplasia or cytotoxic treatment, who experienced embolic ischemic stroke between September 2021 and August 2022. Ischemic strokes were classified into cardioembolic (CE), atherothrombotic (AT) or cryptogenic (CRYP) etiologies after performing a systematic etiological study. During the stroke admission, peripheral blood samples were obtained in order to analyze the 13 genes most frequently associated with CHIP ( DNMT3A, TET2, ASXL1, JAK2, PPM1D, TP53, SF3B1, GNB1, SRSF2, CHEK2, CBL, GNAS, NRAS) through targeted next generation sequencing. Libraries were prepared using the KAPA HyperPlus capture chemistry (Roche) and were sequenced on a MiSeq platform (Illumina) following a 2x150bp paired-end read standard protocol, allowing the detection of variants with a variant allelic frequency (VAF) of ≥1%. The analysis was conducted using an in-house developed pipeline. Patients with one or more mutations in these genes with a VAF ≥2% were considered CHIP carriers. Cardiovascular risk factors including: hypertension, diabetes mellitus, dyslipidemia, smoking and obesity, were also analyzed. Results: Seventy-eight patients with stroke were included (50% female, median age 72 years (range: 59-90). Ischemic strokes were classified etiologically as: 36 CE (46.2%), 34 AT (43.6%) and 8 CRYP (10.3%) (Table 1). CHIP was detected in 21/78 (31.3%) patients, with the following gene mutation frequencies among CHIP carriers: DNMT3A (47.6%), TET2 (28.5%), SRSF2 (14.2%), PPM1D (9.5%), ASXL1 (4.8%), CBL (4.8%), CHEK2 (4.8%) and JAK2 (4.8%). The median VAF detected was 4.85% (range: 2.1%-43.7%), and 23.8% (5/21) of cases presented more than one mutation. The incidence of CHIP varied according to stroke etiology: CE etiology: 38.9% (14/36); AT etiology: 17.6% (6/34) and CRYP etiology: 12.5% (1/8) (p=0.046) (Figure 1). Moreover, only CE strokes showed mutations in TET2 (16.7% (6/36)) compared to AT (0/34) and CRYP (0/8) (p=0.015). No significant differences were observed in the blood counts (Hb, MCV, RDW, neutrophil count, monocytes, platelets or PCR) between stroke patients with CHIP and non-CHIP (Table 1). Finally, in the multivariate analysis, TET2 mutations were associated with CE stroke independently of age, coronary artery disease and classic cardiovascular risk factors (OR 8.1; Cl: 1.35-48.47; p=0.012). Conclusions: Our findings identify that CHIP is common in patients with ischemic strokes, especially in those of cardioembolic etiology, with TET2 being the most frequently mutated gene. The presence of CHIP TET2 could represent a novel cardiovascular risk factor, contributing to a more precise etiological distinction between the different etiologies of ischemic stroke. Funding source: this project is supported by health research fund of Carlos III health institute. FIS PI20/00881

Patients with atrial fibrillation and a low risk of thromboembolic events: prescription rate of anticoagulant therapy according to a retrospective analysis

Aim. To conduct a retrospective analysis of the prevalence of main risk factors for thromboembolic events (TEEs) and the prescription rate of anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and a low CHA2DS2-VASc score in certain Russian regions using artificial intelligence technologies.Material and methods. The information was obtained from the Webiomed predictive analytics platform. The sample included 87601 patients with AF aged 18-74 years (men, 49,5%, mean age, 59,3±12,3 years, mean CHA2DS2-VASc score, 2,3±1,5) who received care in medical organizations in 6 constituent entities of the Russian Federation in the period from 2016 to 2019. CHA2DS2VASc score of 1 and 2 in a man and a woman, respectively, was regarded as a moderate risk, while score of 0 and 1, respectively, as a low risk of TEEs.Results. There were 22337 (25,5%) patients with AF at moderate risk and 18366 (21,0%) patients at low risk of TEEs. With a moderate risk of TEEs, CHA2DS2-VASc score of 1 in 70,4% of cases was determined by hypertension, while in 15,7% — by age 65-74 years, in 9,0% — by heart failure, in 2,9% — by myocardial infarction and/or peripheral arterial disease, in 2,0% — by type 2 diabetes. In patients with AF and a moderate risk of TEEs, ACT was prescribed in 4927 (22,1%) patients, while with a low risk of TEEs — in 1833 (10,0%). Among patients with AF and a high risk of TEEs (n=46898, 53,5%), 1216 (24,6%) patients with ischemic stroke (IS) did not initially have a high CHA2DS2-VASc risk.Conclusion. In clinical practice, among patients with AF aged 18-74 years, there are quite often individuals with CHA2DS2-VASc score of 1 not associated with sex. These patients need an individualized approach in ACT, which is the basis for prospective studies in order to optimize the assessment of cardioembolic IS risk, as well as to analyze the efficacy and safety of long-term ACT.

The Effect of C60 Fullerenes on the Mechanokinetics of Skeletal Muscle Fatigue in Rats at the Administration of a Fraction of Peptides from the Blood Plasma of Patients with Cardioembolic Ischemic Stroke

The Effect of C60 Fullerenes on the Mechanokinetics of Skeletal Muscle Fatigue in Rats at the Administration of a Fraction of Peptides from the Blood Plasma of Patients with Cardioembolic Ischemic Stroke

Risk of Ischemic Stroke Associated with Calcium Supplements and Interaction with Oral Bisphosphonates: A Nested Case-Control Study.

Conflicting results about the association of calcium supplements (CS) with ischemic stroke (IS) have been reported. We tested this hypothesis by differentiating between CS alone (CaM) and CS with vitamin D (CaD) and between cardioembolic and non-cardioembolic IS. We examined the potential interaction with oral bisphosphonates (oBs). A nested case-control study was carried out. We identified incident IS cases aged 40-90 and randomly sampled five controls per case matched by age, sex, and index date. Current users were compared to non-users. An adjusted odds ratios (AOR) and 95% CI were computed through conditional logistic regression. Only new users were considered. We included 13,267 cases (4400 cardioembolic, 8867 non-cardioembolic) and 61,378 controls (20,147 and 41,231, respectively). CaM use was associated with an increased risk of cardioembolic IS (AOR = 1.88; 95% CI: 1.21-2.90) in a duration-dependent manner, while it showed no association with non-cardioembolic IS (AOR = 1.05; 95% CI: 0.74-1.50); its combination with oBs increased the risk of cardioembolic IS considerably (AOR = 2.54; 95% CI: 1.28-5.04), showing no effect on non-cardioembolic. CaD use was not associated with either cardioembolic (AOR = 1.08; 95% CI: 0.88-1.31) or non-cardioembolic IS (AOR = 0.98; 95% CI: 0.84-1.13) but showed a small association with cardioembolic IS when combined with oBs (AOR = 1.35; 95% CI: 1.03-1.76). The results support the hypothesis that CS increases the risk of cardioembolic IS, primarily when used concomitantly with oBs.

Association of oral bisphosphonates with cardioembolic ischemic stroke: a nested case-control study.

Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and non-cardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants. Methods: We performed a case-control study nested in a cohort of patients aged 40-99years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randomly selected, matched for age, sex, and index date (first recording of IS) using an incidence-density sampling. The association of IS (overall and by subtype) with the use of oral bisphosphonates within the last year before index date was assessed by computing the adjusted odds ratios (AOR) and their 95% CI using a conditional logistic regression. Only initiators of oral bisphosphonates were considered. Results: A total of 13,781 incident cases of IS and 65,909 controls were included. The mean age was 74.5 (SD ± 12.4) years and 51.6% were male. Among cases, 3.15% were current users of oral bisphosphonates, while among controls they were 2.62%, yielding an AOR of 1.15 (95% CI:1.01-1.30). Of all cases, 4,568 (33.1%) were classified as cardioembolic IS (matched with 21,697 controls) and 9,213 (66.9%) as non-cardioembolic IS (matched with 44,212 controls) yielding an AOR of 1.35 (95% CI:1.10-1.66) and 1.03 (95% CI: 0.88-1.21), respectively. The association with cardioembolic IS was clearly duration-dependent (AOR≤1year = 1.10; 95% CI:0.82-1.49; AOR>1-3years = 1.41; 95% CI:1.01-1.97; AOR>3years = 1.81; 95% CI:1.25-2.62; p for trend = 0.001) and completely blunted by anticoagulants, even in long-term users (AOR>1year = 0.59; 0.30-1.16). An interaction between oral bisphosphonates and calcium supplements was suggested. Conclusion: The use of oral bisphosphonates increases specifically the odds of cardioembolic IS, in a duration-dependent manner, while leaves materially unaffected the odds of non-cardioembolic IS.

Cognitive impairment in the acute period of cardioembolic stroke

Background. Acute disorders of cerebral circulation are one of the most urgent problems of modern clinical neurology. Its significance is due to both the high frequency of occurrence and a large number of unsatisfactory outcomes, as well as the significant impact on the quality of life. Cognitive disorders are one of the main syndromes that manifest in post-stroke period and are associated with the rehabilitation potential, as well as opportunities for social and household adaptation. Our objective was to study the profile of cognitive impairment in a continuous sample of patients with cardioembolic stroke in the acute period of stroke, as well as to determine the correlations between their occurrence and the factors determining the course of the disease. Design and methods. The study involved 46 patients of both sexes in the acute stage of ischemic stroke (average age was 69 ± 11 years). The selection of patients was carried out in accordance with the diagnostic criteria of the International Association of Vascular Behavioral and Cognitive Disorders VASCOG. The results of the Hachinski scale were also considered. All patients underwent interview for history, complaints, as well as the assessment of the neurological status. Risk factors for stroke were evaluated. We also assessed the results of computer and magnetic resonance imaging, standard “stroke” scales and performed a neuropsychological examination aimed at a comprehensive study of cognitive functions. All studies were conducted at the end of 10-14 days from the development of focal neurological symptoms. Results. Cognitive disorders in patients with cardioembolic ischemic stroke turned out to be quite heterogeneous. Their severity in the majority of our patients was considered as mild cognitive impairment. Changes at dementia level were much less common and were characteristic of patients with extensive lesions or in the case of disorders in the field of cognitively significant “strategic” foci. Neurodynamic disorders predominated in the profile of disorders of higher cortical functions. Memory impairment was expressed slightly and was of a secondary nature. With the aggravation of cognitive disorders, mnestic disorders progressed. In addition, regulatory disorders began to be detected. The most significant correlations were found between the results of neurocognitive tests on the one hand and the assessment on the Bartel scales, the assessment of changes in white matter, as well as the volume of the necrosis focus, the presence of heart failure and dyscirculatory encephalopathy in the anamnesis. Conclusions. Cognitive impairment is a significant component of the clinical picture of cardioembolic stroke. Their severity is largely determined by the volume and topical localization of the ischemic focus, as well as the presence and severity of previous chronic cerebrovascular pathology. This determines the need to develop methods to assess the state of cognitive functions before the development of stroke.

A Unique Case of Vestibular Symptoms in Parietal Stroke (P3-5.030)

<h3>Objective:</h3> We present a case of a 65-year-old female patient with acute cardioembolic ischemic stroke affecting the right parietal lobe presenting with dizziness and vertigo. Transesophageal echocardiogram revealed a patent foramen ovale (PFO) and MRI of the brain revealed an acute to subacute infarction involving the cortical region of the right parietal lobe. The patient was initiated on Aspirin, Plavix, and Atorvastatin while in the hospital, and her symptoms resolved prior to discharge. Patient was referred to structural cardiology for consideration of PFO closure. <h3>Background:</h3> Vestibular symptoms in acute stroke most likely originate from the brainstem. Recent prospective study focusing on acute vestibular syndrome showed parietal strokes to present with acute vertigo. It was demonstrated that these lesions most commonly occurred in the right hemisphere within the territory of the vestibular cortical network. In all of these patients, the vestibular symptoms resolved within two days. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> N/A <h3>Conclusions:</h3> This case stresses the importance of considering supratentorial cortical stroke, particularly in the right parietal region, when evaluating vestibular symptoms. <b>Disclosure:</b> Dr. Albadareen has nothing to disclose. Dr. Stephens has nothing to disclose.

Plasma Proteomic Associations With Incident Ischemic Stroke in Older Adults: The Cardiovascular Health Study.

Plasma proteomics may elucidate novel insights into the pathophysiology of ischemic stroke (IS), identify biomarkers of IS risk, and guide development of nascent prevention strategies. We evaluated the relationship between the plasma proteome and IS risk in the population-based Cardiovascular Health Study (CHS). Eligible CHS participants were free of prevalent stroke and underwent quantification of 1298 plasma proteins using the aptamer-based SOMAScan assay platform from the 1992-1993 study visit. Multivariable Cox proportional hazards regression was used to evaluate associations between a 1-standard deviation increase in the log-2 transformed estimated plasma protein concentrations and incident IS, adjusting for demographics, IS risk factors, and estimated glomerular filtration rate. For proteins independently associated with incident IS, a secondary stratified analysis evaluated associations in subgroups defined by sex and race. Exploratory analyses evaluated plasma proteomic associations with cardioembolic and non-cardioembolic IS as well as proteins associated with IS risk in participants with left atrial dysfunction but without atrial fibrillation. Of 2983 eligible participants, the mean age was 74.3 (± 4.8) years, 61.2% were women, and 15.4% were Black. Over a median follow-up of 12.6 years, 450 participants experienced an incident IS. N-terminal pro-brain natriuretic peptide (NTproBNP, adjusted HR 1.37, 95% CI 1.23-1.53, P=2.08x10-08) and macrophage metalloelastase (MMP12, adjusted HR 1.30, 95% CI 1.16-1.45, P=4.55x10-06) were independently associated with IS risk. These two associations were similar in men and women and in Black and non-Black participants. In exploratory analyses, NTproBNP was independently associated with incident cardioembolic IS, E-selectin with incident non-cardioembolic IS, and secreted frizzled-related protein 1 with IS risk in participants with left atrial dysfunction. In a cohort of older adults, NTproBNP and MMP12 were independently associated with IS risk. We identified plasma proteomic determinants of incident cardioembolic and non-cardioembolic IS and found a novel protein associated with IS risk in those with left atrial dysfunction.

Factors that pre-determine the main subtypes of ischemic stroke in middle-aged and senior women

Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies.&#x0D; Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 4574 years.&#x0D; Materials and methods. The study included 348 female patients aged 4574 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test.&#x0D; Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.10232.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.82728.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673491.998; р 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.3318.476; р 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.2102673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312484.159; р 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945644.535; р 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.0697.566; р 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.92336.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.77245.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.49114.599; р 0.001).&#x0D; Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.

Twenty-three medication-taking traits and stroke: A comprehensive Mendelian randomization study.

Certain medication categories may increase the risk of stroke. Nonetheless, the evidence regarding the causal relationship of medication-taking in promoting stroke and subtypes is deficient. We evaluated the causal effect of a genetic predisposition for certain medication categories on stroke and subtypes (ischemic and hemorrhagic categories) by a two-sample Mendelian randomization (MR) analysis. Data for 23 medication categories were gathered from a genome-wide association study (GWAS) involving 318,177 patients. The Medical Research Council Integrative Epidemiology Unit Open GWAS database and the FinnGen consortium were used to gather GWAS data for stroke and subtypes. Inverse variance weighted, MR-Egger, and weighted median were used for the estimation of causal effects. Cochran's Q test, MR-Egger intercept test, and leave-one-out analysis were used for sensitivity analyses. Ten medication categories were linked to a high stroke risk. Nine categories were linked to a high-risk ischemic stroke. Five categories were associated with small vessel ischemic stroke. Nine categories were positively associated with large artery atherosclerotic ischemic stroke. Three categories causally increased the possibility of cardioembolic ischemic stroke. Four categories were associated with intracerebral hemorrhage. Four categories were associated with nontraumatic intracranial hemorrhage. Three categories were causally associated with subarachnoid hemorrhage (SAH). Four categories were associated with the combination of SAH, unruptured cerebral aneurysm, and aneurysm operations SAH. This study confirms that some medication categories lead to a greater risk of strokes. Meanwhile, it has an implication for stroke screening as well as direct clinical significance in the design of conduction of future randomized controlled trials.

The Effect of Atrial Fibrillation on Recanalization and Prognosis in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy and/or Intravenous Thrombolysis

ABSTRACT Background: Atrial fibrillation (AF) is the most common cause of cardioembolic ischemic strokes. It causes large-vessel occlusions and a poor prognosis. Regardless of ischemic stroke etiology, hyperacute therapy strategies are effective treatment modalities. Methods: Patients who were diagnosed as having AF were classified as AF (+) and others without AF were classified as AF (-). It is not clear which treatment should be preferred in patients with stroke who are AF (+). We studied demographic characteristics, recanalization rates, and clinical outcomes in acute patients with ischemic stroke with or without nonvalvular AF who underwent hyperacute treatments. Results: We detected that clinical findings were more severe and the NIHSS scores were significantly higher at admission inpatients who were AF (+). In our study, mechanical thrombectomy rates were high in patients who were AF (+), whereas intravenous tissue plasminogen activator treatment rates were higher in patients who were AF (-). Thrombolysis in cerebral infarction scores were similar in our patient groups. We found high rates of both symptomatic (PH 2) and asymptomatic hemorrhagic transformation in patients who were AF (+) in 24th-h cranial computed tomography. A positive correlation was found between symptom-admission, symptom-needle, and symptom-groin times and discharge-modified Rankin Scale scores regardless of the hyperacute treatments in all patient groups. Conclusion: As a result, physicians should focus on the diagnosis of AF, and appropriate anticoagulant treatment is important for primary prevention.

A clinical case report: stroke in a young patient with systemic lupus erythematosus on the background of secondary antiphospholipid syndrome

The article describes a clinical case report of a young patient with ischemic stroke on the background of antiphospholipid syndrome (APLS). The uniqueness of this case lies in the complex diagnostic search that we performed. On admission, the patient had general cerebral, general infectious and focal syndromes. We suspected encephalitis due to the peculiarities of the onset of the disease and the results of computed tomography. However, after the results of lumbar puncture, the diagnosis of encephalitis required careful differential diagnosis. We performed an extensive diagnostic search. Based on clinical-laboratory, instrumental and immunological data the patient had the following final diagnosis: “Ischemic cardioembolic stroke in the right middle cerebral artery pool (15.10.17) (ICD 11: 8B11.5). Acute period with left pyramidal reflex insufficiency and changes in magnetic resonance imaging. Systemic lupus erythematous (ICD 11: 4A40.0), subacute course, activity II, with the lesion of skin (transient erythematous rash), kidneys (proteinuria, transient impaired renal function), lungs (bilateral pleurisy with immunological disorders). Secondary APLS (ICD 11: 4A45) (Acute iliofemoral thrombosis, May 2017; chronic thrombosis of the inferior vena cava, iliac veins, positive IgG to cardiolipin, beta 2 glycoproteins). Thus, we have to link thrombotic complications in young patients with APLS and to examine the patients for antiphospholipid antibody presence.

Взаимосвязь факторов риска микроэмболии с возрастом в восстановительном периоде ишемического инсульта

Identification of the age-related features of interaction between the risk factors of microembolism can improve understanding of the mechanisms underlying the development of ischemic stroke (IS). The study was aimed to assess the effects of age and other risk factors of stroke on the biophysical characteristics of microembolic signals (MES) recorded during the ischemic stroke recovery period. Transcranial Doppler ultrasound (TCD) involving microembolus detection (MED) was performed in 515 people, the data of 28 patients having a history of ischemic stroke, among them 9 women (32%) and 19 men (68%) aged 33–78 (average age 58 ± 13 years), were included in the study. Using the mixed-effects linear model it was found that age and interaction between age and atrial fibrillation affected the power of MES. The increase in the power of the recorded MES with age is observed, that is especially evident in patients with atrial fibrillation (р &lt; 0.0005). As for cardioembolic IS variant, the power and duration of MES turn out to be significantly higher in elderly patients (p &lt; 0.0005). The power of MES gradually increases with age in patients with no atherosclerosis and gradually decreases in patients with atherosclerosis, while MES power in patients with atherosclerosis in general (all age groups) is significantly higher (р &lt; 0.0005) than that observed in patients with no atherosclerosis.

Ischemic stroke as the first manifestation of anthracycline cardiomyopathy

This article is devoted to the discussion of cardioembolic complications of anthracycline cardiomyopathy. The article describes a clinical case of cardiotoxicity caused by aggressive neoadjuvant chemotherapy in a patient with breast cancer and complicated by the development of cardioembolic ischemic stroke.

ODP451 A Case of Papillary Thyroid Cancer Presenting with Marantic Endocarditis and Recurrent Stroke

Abstract Marantic endocarditis or non-bacterial thrombotic endocarditis (NBTE) is characterized by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and are devoid of inflammation or bacteria. The hypercoagulable state associated with malignancy is well known to be associated with NBTE. Here we report a rare case of Papillary Thyroid Cancer presenting with Marantic Endocarditis and Recurrent Stroke. A 52-year-old lady, with medical background of hypertension, presented to the Emergency Department with history of sudden onset of difficulty in speaking for 3 days. On examination she had slurred speech and tongue deviation to the right side. Neurological examination was otherwise normal. Imaging revealed left frontal, right frontal and left cerebellar infarcts. Transthoracic Echocardiogram showed a large, highly mobile vegetation 18 mm in size, attached to the posterior mitral valve leaflet as well as severe Mitral Regurgitation. She was diagnosed as a case of Cardioembolic ischemic stroke due to endocarditis. She completed a course of empiric antibiotic therapy. However, her blood cultures and fungal culture revealed no growth. After 5 years, she again presented to the hospital with acute stroke. Trans esophageal Echocardiography now revealed multiple filamentous vegetations on the atrial surface of mitral valve, largest measuring 20 mm×4 mm. Her inflammatory markers were negative and 3 sets of blood cultures were again negative. A question was raised, as to whether the filamentous masses represent prolapsing ruptured chordae tendinae rather than vegetations. FDG PET-CT scan was thus performed and revealed: Left thyroid lobe focal uptake seen with an FDG-avid left parajugular lymph node. Ultrasound neck was then performed, which showed bilateral thyroid nodules with high suspicion ultrasound pattern per American Thyroid Association: ill-defined nodule seen in the lower pole measuring 8×8×7 mm with multiple foci of macrocalcification. Thyroid function tests were normal. Ultrasound guided thyroid fine needle aspiration (FNA) biopsy of the left thyroid nodule was performed. The cytology report was consistent with papillary thyroid carcinoma. She is planned for total thyroidectomy, after undergoing mitral valve replacement surgery. This case illustrates one of the paraneoplastic syndromes associated with thyroid cancer. A hypercoagulable state has been observed in several types of thyroid cancer, although the pathogenesis has not been well studied. The etiology of cancer-associated coagulopathy is complex, related to an imbalance in the hemostatic system and abnormal levels of coagulation factors. Further studies on the occurrence of thrombosis in different types of thyroid cancer would help to inform clinical practice in the management of thyroid cancer, including the need for anticoagulation in certain situations. Presentation: No date and time listed

Evaluation of hemostasis clinical and laboratory indicators of patients with stroke and coronavirus infection (COVID-19) on the basis of a multidisciplinary hospital in the period of its conversion to an infectious diseases hospital

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.