Cardioembolic Subtype Research Articles

Ischemic Stroke in Young Adults in India: Predictors of Recurrence and Functional Outcome.

Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18-50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0-2. Logistic regression was used to analyze the predictors of recurrence and outcome. The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07-5.50). We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome.

Short-Term Prognostic Risk Factors and Nomogram Predictive Model Construction for Acute Ischaemic Stroke after Endovascular Treatment.

To investigate the factors influencing the severity of acute ischaemic stroke (AIS) and short-term prognosis after endovascular treatment. Observational study. Place and Duration of the Study: Department of Cerebrovascular Diseases, The First People's Hospital of Qujing City, Yunnan Province, China, from June 2020 to December 2022. An analysis was conducted on 160 AIS patients undergoing endovascular treatment, classified into atherosclerosis subtype (AS) and cardioembolic subtype (CE) based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, each comprising 80 cases. The association among baseline and endovascular treatment parameters, clinical characteristics, postoperative complications, and short-term outcomes (risks of mortality and poor prognosis) was tested. Univariate analysis revealed significant positive correlations between increased fasting glucose, diastolic pressure, and the number of thrombectomy procedures with the frequency of cerebral haemorrhage in CE-type stroke. The time from femoral artery puncture to vessel opening was positively associated with the degree of brain oedema. In the AS subtype, univariate regression analysis demonstrated a significant association between heart rate, fasting glucose, cholesterol, time from femoral artery puncture to vessel opening, and degree of brain oedema with short-term prognosis. Fasting glucose and the number of thrombectomy procedures were significantly linked to short-term prognosis in CE-type AIS. A predictive model using line charts was developed for factors associated with postoperative complications and short-term prognosis, achieving predictive accuracies of 95.5% for the risk of death and 92.7% for poor prognosis (mRS >2), notably surpassing traditional prediction methods. Clinical characteristics and endovascular treatment-related factors are important for the short-term prognosis of AIS patients. Development of predictive models can efficiently identify high-risk patients at an early stage. Acute ischaemic stroke, Atherosclerosis, Cardioembolic, Severity, Prognosis.

Predictors of ischemic stroke in Chagas disease: Insights into mechanisms beyond cardiomyopathy severity

BackgroundChagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition. MethodsThe study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk. ResultsThe mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775. ConclusionsIn a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.

Prevalence and Angiographic Outcomes of Rescue Intracranial Stenting in Large Vessel Occlusion Following Stroke Thrombectomy – STRATIS

BACKGROUND Large vessel occlusion secondary to underlying intracranial atherosclerotic disease (ICAD‐LVO) has an estimated prevalence of 7% to30%. There is a large variation in the use of intracranial rescue stenting in interventional practice. We aimed to characterize the frequency and characteristics of intracranial rescue stenting in a large cohort of endovascular therapy for stroke. METHODS The Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) angiography core lab adjudicated the location of the occlusion, hyperdense vessel sign on initial imaging, the use of angioplasty and stenting, and imaging outcomes following endovascular therapy. Underlying cause of stroke was categorized into intracranial atherosclerosis, cardioembolic, and other subtypes. Statistical analyses examined the relationship between intracranial rescue stenting and imaging outcomes including intracranial hemorrhage, and arterial reperfusion using expanded Thrombolysis in Cerebral Infarction reperfusion score in patients with ICAD‐LVO. RESULTS Among 978 patients with LVO stroke undergoing endovascular therapy, 91 (9.3%) patients had ICAD‐LVO. Baseline hyperdense vessel sign was observed among 44 (62.7%) with ICAD versus 178 (68.2%) with cardioembolic LVO ( P = 0.4). Final successful reperfusion (expanded Thrombolysis in Cerebral Infarction 2b50 or more) was significantly lower among ICAD‐LVO as compared with cardioembolic‐LVO (74.2% versus 87.5%; P = 0.007). Intracranial rescue stenting was used among 14/665 (2.1%) of patients with LVO (5 ICA terminus, 7 M1 middle cerebral artery, 1 M2 middle cerebral artery, 1 proximal basilar artery). Among 14 intracranial rescue stenting cases, 5/70 (7.1%) belonged to the ICAD group, 3/261 (1.1%) cardioembolic group, and 6/334 (1.8%) in other or undetermined group. Successful reperfusion following rescue stenting was achieved in all cases with ICAD‐LVO. Among ICAD‐LVO, the rate of 24 hours symptomatic intracranial hemorrhage was 0% with acute intracranial stenting versus 7.7% in the nonstenting subgroup. CONCLUSION In STRATIS, nearly 1 of every 11 thrombectomies were performed in patients with underlying ICAD, among whom 7.1% underwent rescue intracranial stenting concomitant with thrombectomy. Acute intracranial stenting as rescue therapy in ICAD‐LVO was associated with favorable angiographic outcomes and low symptomatic hemorrhage rates.

Clinical case of treatment of acute ischemic stroke (cardioembolic subtype) complicated by aspiration pneumonia and development of acute respiratory distress syndrome

Clinical case of treatment of acute ischemic stroke (cardioembolic subtype) complicated by aspiration pneumonia and development of acute respiratory distress syndrome

Effectiveness of statin treatment for recurrent stroke according to stroke subtypes

Understanding the effectiveness of statin treatment is essential for developing tailored stroke prevention strategies. We aimed to evaluate the efficacy of statin treatment in preventing recurrent stroke among patients with various ischemic stroke subtypes. Using data from the Clinical Research Collaboration for Stroke-Korea-National Institute for Health (CRCS-K-NIH) registry, we included patients with acute ischemic stroke admitted between January 2011 and July 2020. To evaluate the differential effects of statin treatment based on the ischemic stroke subtype, we analyzed patients with large artery atherosclerosis (LAA), cardio-embolism (CE), and small vessel occlusion (SVO). The primary outcomes were recurrent ischemic stroke and recurrent stroke events. The hazard ratio for outcomes between statin users and nonusers was compared using a Cox proportional hazards model adjusted for covariates. A total of 46,630 patients who met the inclusion criteria were analyzed. Statins were prescribed to 92%, 93%, and 78% of patients with LAA, SVO, and CE subtypes, respectively. The hazards of recurrent ischemic stroke and recurrent stroke in statin users were reduced to 0.79 (95% confidence interval [CI], 0.63-0.99) and 0.77 (95% CI, 0.62-0.95) in the LAA subtype and 0.63 (95% CI, 0.52-0.76) and 0.63 (95% CI, 0.53-0.75) in CE subtype compared to nonusers. However, the hazards of these outcomes did not significantly decrease in the SVO subtype. The effectiveness of statin treatment in reducing the risk of recurrent stroke in patients with LAA and CE subtypes has been suggested. Nonetheless, no significant effect was observed in the SVO subtype, suggesting a differential effect of statins on different stroke subtypes.

Seasonal variability of lesions distribution in acute ischemic stroke: A retrospective study

Seasonal variability could have an impact on the incidence and outcome of stroke. However, little is known about the correlation between seasonal variability and location of acute cerebral infarction. This study aimed to explore the relationship between onset season and the lesions distribution of acute ischemic stroke (AIS). We retrospectively analysis data from 1488 AIS patients admitted to the Second Hospital of Tianjin Medical University from 2018 to 2022. All subjects completed head magnetic resonance imaging examination (MRI) and were divided into four groups according to the onset seasons. The lesions distribution of AIS was evaluated for anterior/posterior/double circulation infarction (DCI), unilateral/bilateral infarctions, and single/multiple cerebral infarctions based on MRI. Logistic regression models were employed to assess the association of season with lesions distribution of AIS. Subgroup analysis was performed in different stroke subtypes. Of 1488 patients, 387 (26.0%) AIS occurred in spring, 425 (28.6%) in summer, 331 (22.2%) in autumn and 345 (23.2%) in winter. Multivariate logistic regression demonstrated that the winter group had 2.15 times (95% CI:1.44–3.21) risk of multiple infarctions, 2.69 times (95% CI:1.80–4.02) of bilateral infarctions and 1.54 times (95% CI:1.05–2.26) of DCI compared with summer group, respectively. Subgroup analysis showed an increased risk of multiple (p < 0.01) or bilateral infarctions (p < 0.01) in small-artery occlusion (SAO) subtype, and higher risk of bilateral infarctions (p < 0.01) or DCI (p < 0.05) in large artery atherosclerosis (LAA) subtype during winter. No significant associations of season with lesions distribution in cardioembolism subtype. Our study highlighted a prominent seasonal variability in the lesions distribution of AIS, particularly in LAA and SAO subtypes. The findings could help to formulating meteorological risk warning strategies for different subtypes.

In-hospital ischemic stroke in ophthalmic patients

Justifi cation. Due to the high prevalence of diseases of the visual organs (cataracts, glaucoma, etc.) and the large number of surgical interventions performed annually in elderly and senile people, the prevention of in-hospital ischemic stroke (IHS) is an urgent task.The purpose of the work. To study the risk factors of development, characteristics of care and outcomes of IHS in ophthalmic patients.Material and methods. The study was performed in the period from 01.01.2022 to 31.12.2022 on the basis of ophthalmological departments specializing in the performance of planned vitreoretinal surgical interventions, two large multidisciplinary hospitals in St. Petersburg.Results. It has been established that perioperative ischemic stroke (included in the structure of the IHS) is a rare complication of minimally invasive ophthalmic operations. Its share was 0.07% (n = 5) of the total number of patients who underwent elective ophthalmological intervention during the year; the total share of patients with IHS (taking into account 4 cases of ischemic stroke in the preoperative period) was 0.13%. Most strokes (n = 5; 55.6%) belonged to the cardioembolic subtype, the proportion of using reperfusion techniques was high and amounted to 33.3% (2 endovascular interventions, 1 systemic thrombolysis); the proportion of adverse outcomes was 22.2% (n = 2). A distinctive characteristic of patients with IHS was a combination of high comorbidity with insuffi cient antithrombotic prophylaxis, which consisted in the cancellation of antiplatelet agents and anticoagulants in the preoperative period.Conclusion. Current recommendations on perioperative management of patients indicate the need to continue taking antiplatelet and anticoagulant drugs for most ophthalmic operations, due to the predominance of threats of thromboembolic complications over the risk of retrobulbar bleeding.

Arterial transit artifact as a short-term prognostic indicator in acute ischemic stroke

BackgroundArterial transit artifact (ATA) observed on arterial spin labeling (ASL) was recently suggested to be associated with improved functional outcomes following acute ischemic stroke (AIS). AIS is a heterogeneous disease with diverse pathogenic mechanisms depending on the stroke subtype. This study aimed to investigate the association between ATA and 3-month functional outcomes in AIS patients according to etiology subtypes.MethodsConsecutive patients with AIS were included. All patients underwent ASL MRI with postlabeling delay (PLD) of 1.5 and 2.5 s. ATA was assessed from the ASL images of both PLDs. Stroke etiologic subtypes were determined according to the modified TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Short-term functional outcomes were evaluated using the 3-month modified Rankin scale (mRS). Log-binomial regression was applied to analyze the association between ATA and functional outcomes at 3 months after stroke.ResultsNinety-eight AIS patients (62.73 ± 13.05 years; 68 men) were finally included. ATA was detected in forty-six patients and most frequently seen in the large-artery atherosclerosis (LAA) subtype (35/46). The ATA group exhibited a lower percentage of patients with mRS > 2 compared to the group without ATA (36.5% vs. 19.6%; P < 0.001). ATA was independently associated with better 3-month clinical outcomes (adjusted risk ratio, 0.35[95% CI, 0.16—0.74]) in the multivariate log-binomial regression model. After stratification by TOAST subtypes, a significant association was found between ATA and better outcomes in the LAA subtype (adjusted risk ratio, 0.20[ 95% CI, 0.05—0.72]) but not in cardioembolism and small artery occlusion (SVO) subtype.ConclusionATA is associated with better outcomes at 3 months in patients with AIS, especially in the LAA subtype, but this association attenuated in the cardioembolism and SVO subtypes.

Analysis of Clinical Characteristics and Influencing Factors of Early Neurological Deterioration in Patients With Mild Stroke by Intravenous Alteplase Therapy.

Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate the clinical characteristics and influencing factors of early neurological deterioration (END) in this group of patients. A retrospective analysis was performed on ischemic stroke patients with intravenous thrombolysis (IVT) in Wenzhou Central Hospital. Subgroup analyses were performed for the mild stroke group and nonmild stroke group, END group, and non-early neurological deterioration group in mild stroke patients, respectively. A total of 498 patients were included in this study. Compared with the control group, the mild stroke group was younger age, less atrial fibrillation, previous history of stroke and less use of antithrombotic drugs, more dyslipidemia, smoking, and drinking. Small artery occlusion type was more common in mild stroke, cardioembolism and stroke of undetermined etiology type were less. In the mild stroke group, the symptomatic intracerebral hemorrhage (sICH) rate was 2.54%, and the END rate was 16.1%. Predictors of END included systolic blood pressure, blood glucose, cardioembolism subtype, sICH, and large vessel occlusion. In END patients, the sICH rate was 10.53%, and 84.21% of cases started to worsen within 12 hours after IVT. There was no statistically significant difference in the time to exacerbation among different subtypes. The occurrence of mild stroke in young patients was largely related to unhealthy lifestyles. The incidence of END in mild stroke IVT patients was low, with most occurring within 12 hours of IVT. There were many risk factors for END: large vessel occlusion and hyperglycemia were independent risk factors for END after IVT. sICH was an important but rare risk factor for END.

Ischemic stroke in men 18-50 years of age

To evaluate the main modifiable risk factors for ischemic stroke (IS) and features of the course in atherothrombotic, cardioembolic, and lacunar subtypes of IS in men aged 18-50 years. The study included 125 men (the mean age was 42.6±5.3 years) who were admitted to the Vascular department before the COVID-19 pandemic and survived for the first 30 days after IS. Information on patients' baseline characteristics, traditional vascular risk factors, and lifestyle risk factors was systematically collected. Neuroimaging, ultrasound and laboratory tests were performed. Atherothrombotic subtype was identified in 60 patients, lacunar subtype in 46 patients and cardioembolic subtype in 19 patients. In the group as a whole, major risk factors included arterial hypertension (83.2%), dyslipidemia (50.4%), smoking (67.2%), alcohol consumption (29.6%), obesity (16.8%), heart rhythm disorders (12%), and diabetes mellitus (8%). The study revealed the main risk factors, the frequency of which differed depending on the stroke subtype and the age of the patients.

Place of oligopeptide H-Met-Glu-His-Phe-Pro-Gly-Pro-OH in the therapy and rehabilitation of patients with ischemic stroke

Cerebrovascular diseases (CVDs) are one of the leading causes of death and disability In Russia: they rank second in the structure of mortality from diseases of the circulatory system and in the overall mortality of the population. Successful treatment of CVD involves an integrated approach to the problem, taking into account the compensation of cardiovascular disorders, the elimination of neurological and psychopathological syndromes, the improvement of cerebral circulation and the use of neuroprotective agents that increase the resistance of brain tissue to hypoxia and ischemia. Insufficient clinical efficacy of neuroprotectors is due to a number of objective reasons, of which only two are universal. The first of these reasons is the timing of the start of therapy in the clinic, as a rule, is outside the «therapeutic window»; the second reason is the fact that disturbance of the patency of the cerebral vessels in the affected area makes it difficult or impossible to deliver the drug to the penumbra area. The way out of this situation is the intranasal route of drug administration, which is characteristic for the analogs of regulatory peptides such as for H-Met-Glu-His-Phe-Pro-Gly-Pro-OH (MGHPPGP). The review of clinical studies indicates that MGHPPGP is clinically effective in the treatment of ischemic stroke both in the acute period of stroke and in the recovery period. The clinical efficacy of MGHPPGP was shown both in atherothrombotic and cardioembolic subtypes of stroke, against the background of blood flow disturbances in both the carotid and vertebrobasilar systems.

Plasma D-dimer as a biomarker for the early classification of common acute ischemic stroke subtypes in Indonesia

BackgroundD-dimer is a well-known marker for abnormal hemostasis in acute ischemic stroke (AIS), indicating the presence of fibrin degradation due to thrombus formation and lysis. The diagnostic performance of D-dimer for different AIS types in the Indonesian population has not been established. The aim of this study is to compare the plasma D-dimer levels in three of the most common AIS subtypes in Indonesia; the cardioembolic, large artery atherosclerosis (LAA), and small-vessel occlusion (SVO), and to determine its most optimal diagnostic performance.ResultsIn this cross-sectional study, 64 subjects with confirmed AIS diagnosis at the Wahidin Sudirohusodo General Hospital Makassar between June and October 2019 were recruited. Plasma D-dimer levels were measured and grouped according to the subtype of acute ischemic stroke based on the TOAST classification. A significant difference was observed between the D-dimer levels across the three AIS subtypes, with an average D-dimer of 2.93 ± 1.7, 1.27 ± 0.81, and 0.56 ± 0.46 µg/ml in the cardioembolic, LAA, and SVO subtypes, respectively. As a marker of cardioembolic stroke, an optimal cut-off was determined to be 1.52 µg/ml, yielding a sensitivity of 84.44% (CI 71.22–92.25% and specificity of 84.21% (CI 62.43–94.48%).ConclusionPlasma D-dimer levels varied significantly between the cardioembolic, LAA, and SVO subtypes of AIS, with the highest D-dimer level in the cardioembolic subtypes. As a marker of cardioembolic stroke, an optimal cut-off was determined to be 1.52 µg/mL, yielding a sensitivity and specificity of 84.44% and 84.21%, respectively.

Prediction of restoration of swallowing function in patients with ischemic stroke and neurogenic dysphagia

Objective: to determine prognostic characteristics of the restoration of swallowing function in patients with ischemic stroke (IS) of various pathogenetic subtypes.Material and methods. The study included 110 patients (64 men and 46 women aged 44–89 years) with dysphagia in the acute period of IS. The SSS-TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding depending on the severity of dysphagia, a non-linear regression method was used using the least squares method.Results. Patients with cardioembolic stroke subtype were initially characterized by a greater degree of dysphagia in comparison with patients with atherothrombotic stroke subtype in groups comparable in severity (p&lt;0.05). In the cardioembolic subtype of IS, the probability of switching patients to self-feeding on the 21st day in groups with dysphagia severity from 105 to 135 points on the MASA scale was lower than in the atherothrombotic subtype of IS (p&lt;0.05).Conclusion. Patients with cardioembolic strokes are characterized by more severe initial dysphagia and a worse prognosis for recovery of swallowing function compared to patients with atherothrombotic strokes.

Plasma lncRNA LIPCAR Expression Levels Associated with Neurological Impairment and Stroke Subtypes in Patients with Acute Cerebral Infarction: A Prospective Observational Study with a Control Group.

This prospective observational study with a control group aimed to compare the plasma levels of long non-coding RNA (lncRNA) LIPCAR between patients with acute cerebral infarction (ACI) and healthy controls, and to assess the prognostic abilities of LIPCAR for adverse outcomes of patients with ACI at 1-year follow-up. Eighty patients with ACI, of whom 40 had large artery atherosclerosis (LAA) and 40 had cardioembolism (CE) and who were hospitalized at Xi'an No. 1 Hospital from July 2019 to June 2020, were selected as the case group. Age- and sex-matched non-stroke patients from the same hospital throughout the same time period were chosen as the control group. Real-time quantitative reverse transcription polymerase chain reaction was used to measure the levels of plasma lncRNA LIPCAR. The correlations of LIPCAR expression among the LAA, CE, and control groups were assessed using Spearman's correlation analysis. Curve fitting and multivariate logistic regression were used to analyze the LIPCAR levels and 1-year adverse outcomes of patients with ACI and its subtypes. The expression of plasma LIPCAR in the case group was noticeably higher than that of the control group (2.42±1.49 vs. 1.00±0.47, p<0.001). Patients with CE had considerably higher levels of LIPCAR expression than those with LAA. The National Institute of Health Stroke Scale score and modified Rankin scale score on admission were significantly positively correlated with LIPCAR expression in patients with CE and LAA. Furthermore, the correlation was stronger in patients with CE than in those with LAA, with correlation coefficients of 0.69 and 0.64, respectively. Curve fitting revealed a non-linear correlation between LIPCAR expression levels, 1-year recurrent stroke, all-cause mortalities, and poor prognoses, with a cut-off value of 2.2. The expression level of lncRNA LIPCAR may play a potential role in the identification of neurological impairment and CE subtype in patients with ACI. Increased 1-year risk of adverse outcomes may be associated with high levels of LIPCAR expression.

Obesity paradox and stroke outcomes according to stroke subtype: a propensity score-matched analysis.

Obesity has traditionally been considered a risk factor for ischemic stroke. However, some clinical observations have reported a complex relationship between patients who are overweight or obese with paradoxically better stroke outcomes. Stroke subtypes have differing distributions of risk factors, so this study aimed to explain the relationship between body mass index (BMI) and functional prognosis according to stroke subtype. A prospective institutional database on stroke was accessed between March 2014 and December 2021, and consecutive patients with ischemic stroke were retrospectively selected. BMI was categorized into five groups (underweight, normal weight, overweight, obese, and morbid obesity). The outcome of interest in this study was the modified Rankin Scale (mRS) at 90 d, which was divided into favorable (mRS = 0-2) and unfavorable (mRS ≥ 3) groups. The relationship between functional outcome and BMI was analyzed according to stroke subtype. Among 2779 patients with stroke, 913 (32.9%) had unfavorable outcomes. After a propensity score-matched analysis, obesity was inversely associated with unfavorable outcomes (adjusted odds ratio [aOR] = 0.61, 95% confidence interval [95% CI]: 0.46-0.80) in all patients with stroke. Among the stroke subtypes, overweight (aOR = 0.38, 95% CI: 0.20-0.74) and obese (aOR = 0.40, 95% CI: 0.21-0.76) groups were inversely associated with unfavorable outcomes in the cardioembolism subtype. Obesity (aOR = 0.55, 95% CI: 0.32-0.95) was inversely associated with unfavorable outcomes in the small vessel disease subtype. There was no significant relationship between stroke outcome and BMI classification in the large artery disease subtype. These findings suggest that the obesity paradox in ischemic stroke outcomes might differ according to the stroke subtype.

Determining ischemic stroke subtype: an improved algorithm and its use in a comprehensive stroke unit

Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU).Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed.Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.

Mathematical modeling of severe ischemic stroke with multiple organ failure: a retrospective observational study

INTRODUCTION: The development of organ dysfunctions and multiple organ failure (MOF) in patients with severe ischemic stroke (IS) is a factor in aggravating the clinical course and outcome. OBJECTIVE: To study the prognostic aspects of the clinical course and outcomes of severe IS with the development of MOF. MATERIALS AND METHODS: The study included 110 patients with severe IS (National Institutes of Health Stroke Scale ≥ 16 points). To assess the severity of MOF on days 1 and 5 of hospitalization, standard scales SAPS II, SOFA were used. The predictor significance of the indicators was determined by a comparative regression analysis using the least squares method. RESULTS: In patients with a fatal outcome compared to survivors, a higher severity of MOF on the SAPS II was observed both on the first (31 (25; 39) and 24 (21; 29) respectively, p &lt; 0.0001) and fifth days of the disease (40 (33; 49.5) and 29 (25; 35) respectively, p &lt; 0.0001). In the development of severe IS with MOF, an unfavorable outcome is significantly more often observed in the cardioembolic subtype compared to the atherothrombotic subtype of IS (50.75 and 29.85 % respectively, p = 0.0469). The probable mortality according to comparative regression analysis was significantly higher in cardioembolic stroke for patients with MOF severity from 29 to 49 points on the SAPS II (p = 0.0021). CONCLUSIONS: MOF is the most important predictor of death in severe IS. At the same time, the cardioembolic subtype of IS differ by a higher probable mortality in comparison with the atherothrombotic subtype with the MOF severity in the range of 29–49 points according to the SAPS II scale.

Admission hyperglycemia, stroke subtypes, outcomes in acute ischemic stroke

AimsWhether admission hyperglycemia is differentially associated with early vascular outcomes in acute ischemic stroke (AIS) depending on stroke subtype has been incompletely delineated. MethodsIn a multicenter, prospective stroke registry, patients with AIS were categorized based on admission glucose levels into normoglycemia, moderate hyperglycemia, and severe hyperglycemia (<140mg/dl, 140–179mg/dl, and ≥180mg/dl, respectively) groups. Multivariate analysis assessed the interaction between the hyperglycemia and ischemic stroke subtypes of large artery atherothrombosis (LAA), cardioembolism (CE), and small vessel occlusion (SVO) and early vascular outcomes (3-month stroke, all-cause mortality, and composite of stroke, MI, and all-cause mortality). ResultsAmong the 32,772 patients (age:69.0±12.6yrs, male:58.4%) meeting eligibility criteria, 61.9% were in the normoglycemia group, 19.5% were in the moderate hyperglycemia group, and 18.7% were in the severe hyperglycemia group. Substantial interactions between hyperglycemia groups and stroke subtypes were observed for 3-month stroke (Pinteraction = 0.003) and composite of stroke, MI, and all-cause mortality (Pinteraction = 0.001), with differential recurrence strongest among CE, intermediate among LAA, and least among SVO. ConclusionsHyperglycemia was differently associated with the risk of 3-month stroke by ischemic stroke subtype. The associations of hyperglycemia with 3-month stroke were greatest in CE subtype but not in SVO subtype. These results suggest that the effect of glucose-lowering treatment after AIS may differ according to stroke subtype.

Features of pathogenesis and risk factors of in-hospital ischemic stroke

In-hospital ischemic stroke (IHIS) is one of the most critical competing diseases that can develop in patients during inpatient treatment. Causes associated with diagnostic and therapeutic measures may play an additional role in the pathogenesis of IHIS, in addition to traditional risk factors. Objective : to study the pathogenesis features and assess risk factors for IHIS. Patients and methods . The comorbidity, main and additional risk factors of IHIS in patients of therapeutic (n=112; 44.3%), surgical (n=125; 49.4%) and neurological (n=16; 6.3%) profiles were studied. Results and discussion . The proportion of perioperative stroke in the study was 37.2%. The frequency of atherothrombotic, cardioembolic, and lacunar subtypes of IHIS did not differ in groups of patients of different profiles. In the group of surgical patients, the proportion of strokes of another established etiology was 24.8% and was higher than in therapeutic (9.8%; p&lt;0.05) and neurological (6.25%; p&lt;0.005) patients. The proportion of strokes of unknown etiology in the group of surgical patients, on the contrary, was lower (15.2%) than in patients with therapeutic (35.7%; p&lt;0.05) and neurological (50.0%; p&lt;0.05) profile. An additional risk factor for IHIS for non-surgical patients was insufficient antithrombotic prophylaxis, for surgical patients – surgery. Conclusion . Compared with out-of-hospital ischemic stroke, the causes of in-hospital ischemic stroke are more diverse and cannot always be explained solely by the higher comorbidity of hospitalized patients. The TOAST classification of ischemic stroke subtypes does not fully reflect the pathogenesis of IHIS, as it does not take into account the possibility of external influences, especially in cases where it is not possible to establish the exact cause of stroke, and the most likely trigger is medical intervention.