Cases Of Acute Ischemic Stroke Research Articles

Multicenter Validation of lncRNA and Target mRNA Diagnostic and Prognostic Biomarkers of Acute Ischemic Stroke From Peripheral Blood Leukocytes.

Long noncoding RNA (lncRNA) and mRNA profiles in leukocytes have shown potential as biomarkers for acute ischemic stroke (AIS). This study aimed to identify altered lncRNA and target mRNA profiles in peripheral blood leukocytes as biomarkers and to assess the diagnostic value and association with AIS prognosis. Differentially expressed lncRNAs (DElncRNAs) and differentially expressed target mRNAs (DEmRNAs) were screened by RNA sequencing in the discovery set, which consisted of 10 patients with AIS and 20 controls. Validation sets consisted of a multicenter (311 AIS versus 303 controls) and a nested case-control study (351 AIS versus 352 controls). The discriminative value of DElncRNAs and DEmRNAs added to the traditional risk factors was estimated with the area under the curve. NAMPT-AS, FARP1-AS1, FTH1, and NAMPT were identified in the multicenter case-control study (P<0.05). LncRNA NAMPT-AS was associated with cis-target mRNA NAMPT and trans-target mRNA FTH1 in all validation sets (P<0.001). Similarly, AIS cases exhibited upregulated lncRNA FARP-AS1 and FTH1 expression (P<0.001) in the nested case-control study (P<0.001). Furthermore, lncRNA FARP1-AS1 expression was upregulated in AIS patients at discharge with an unfavorable outcome (P<0.001). Positive correlations were found between NAMPT expression level and NIHSS scores of AIS patients (P<0.05). Adding 2 lncRNAs and 2 target mRNAs to the traditional risk factor model improved area under the curve by 22.8% and 5.2% in the multicenter and the nested case-control studies, respectively. lncRNA NAMPT-AS and FARP1-AS1 have potential as diagnostic biomarkers for AIS and exhibit good performance when combined with target mRNA NAMPT and FTH1.

Hourly effect of atmospheric reactive nitrogen species on the onset of acute ischemic stroke: Insight from the Shanghai Stroke Service System Database

Acute ischemic stroke (AIS) is one of the most predominant causes of mortality and disability in China. Significant uncertainties in stroke diagnosis and time of onset have resulted in inconsistent evidence on the association between ambient air pollution and the risk of AIS. The present study aimed to evaluate the impact of air pollution on AIS onset based on high time-resolution air pollution data and a stroke-specific registry across the past five years. Hourly concentrations of PM2.5, PM10, O3, SO2, CO, NO2 and nitrous acid (HONO) were monitored from 2017 to 2021, with which a distributed lag non-linear model and conditional logistic regression models coupled with a time-stratified case-crossover design were applied to 106,623 AIS cases recorded in the Shanghai Stroke Service (4S) database during the study period. Results from the conditional logistic regression models indicate that acute exposure to PM2.5, PM10, SO2, NO2 and HONO was found to be associated with AIS onset, respectively. The corresponding cumulative excessive risks of AIS onset were 0.8 %, 1 %, 2.4 %, 2.1 % and 1.8 % for each interquartile range increase in the respective concentration. The longest lag-effect (up to 13 h) was observed for reactive nitrogen species (RNS), such as NO2 and HONO, which remained robust in two-pollutant models. Similar important role of RNS in AIS onset were confirmed by the distributed lag non-linear model. By demonstrating the transient effect of ambient air pollution on AIS, especially the relationships between RNS and AIS for the first time, our study provides stringent evidence for future mitigation strategies for pollution emission and public health.

Two cases of acute ischemic stroke associated with strut exposure in the cerebral artery lumen after stent-assisted coil embolization

Stent-assisted coil embolization (SAC) is used for complex wide-necked aneurysms but can expose stent struts to the arterial lumen, leading to thrombosis. Herein, we report two cases of delayed thromboembolic stroke post-SAC. Case 1: A 71-year-old woman had an acute ischemic stroke 2 months after Y-stent SAC for a basilar artery aneurysm, and aspirin was prescribed post-procedure. Diffusion-weighted imaging revealed multiple scattered infarcts of various sizes in the posterior circulation. Case 2: A 72-year-old woman experienced an acute ischemic stroke 3 years post-SAC for a right posterior communicating artery aneurysm. The stroke occurred after discontinuation of antiplatelet therapy. Diffusion-weighted imaging revealed scattered acute infarctions in the right middle and anterior cerebral artery territories. These two cases of delayed thromboembolic stroke after SAC might have been due to stent strut exposure in the arterial lumen and concurrent thrombosis.

P.026 Success with incrementally faster times to endovascular therapy (SWIFT-EVT): a systematic review and meta-analysis

Background: Previous research demonstrates that for acute ischemic stroke (AIS) cases, rapid endovascular therapy (EVT) performance improves outcomes. This study provides updated metrics summarizing estimates for modified Rankin Scale (mRS) gains accrued by streamlining time to EVT. Methods: A systematic review and meta-analysis (MA) was conducted using electronic databases. Eligible studies reported time-benefit slope with times from AIS onset (or time last-seen-normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively. Results: The five included studies showed increased chance of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270’ (OR 1.25, 95% CI 1.16-1.35, I2 40%) and 271-360’ time frame (1.22, 95% CI 1.12-1.33, I2 58%). For studies assessing mRS 0-1, pooled effect estimates were appropriate for the 0-270’ time frame (OR 1.34, 95% CI 1.19-1.51, I2 27%) and the 271-360’ time frame (OR 1.20, 95% CI 1.03-1.38, I2 60%). Conclusions: Each hour saved from AIS onset to EVT start is associated with a 22-25% increased odds of functional independence, a useful metric to inform patient-specific and systems planning decisions.

The pEGASUS-HPC stent system for intracranial arterial stenosis: a single-center case series

BackgroundIntracranial arterial stenting is a technique for the treatment of symptomatic stenosis. In this single-center retrospective case series we evaluated a novel low profile laser-cut stent with an antithrombogenic hydrophilic...

Factors Affecting Management of Acute Ischaemic Stroke with Reference to Intravenous Thrombolysis and Its Impact on Short-term Outcome

Background: Stroke is a major global health concern, ranking second in terms of fatality worldwide, following ischaemic heart disease. However, few stroke patients arrive at the hospital within the optimal time for thrombolysis, and even among those who do, not all receive this therapy. Therefore, the objective of the study was to examine the factors that influence the treatment of acute ischaemic stroke (AIS), particularly with intravenous thrombolysis and to evaluate the short-term outcomes. Methods: This prospective observational study was carried out between August 2019 and August 2021 in the emergency department of a tertiary care hospital. Patients with AIS who were eligible for intravenous thrombolysis within 4.5 hours of the beginning of symptoms were included in the study. Comprehensive assessments, including history, examinations and blood investigations, were conducted. Thrombolytic treatment was administered within the specified time frame, while antiplatelets were given in other cases. Follow-up evaluations were conducted at discharge and 90 days. Results: The age distribution, comorbidities and CT-MRI findings were similar between individuals who received thrombolysis and those who did not. Among the thrombolysis group, 84% had no complications, while 8% experienced intracerebral haemorrhage and 8% had an extension of the infarction. The overall mortality rate was 13.33% for non-thrombolysis patients and 12% for thrombolysis recipients, with no statistically significant difference between the two groups. Conclusion: The results highlight the need for careful consideration when deciding to use thrombolysis for AIS cases. Additionally, they emphasise the importance of actively monitoring and effectively managing any potential treatment complications.

Persistent intracranial steno-occlusion from calcified embolism: a treatment challenge.

Calcified arterial cerebral embolism is a rare occurrence among large and medium vessel occlusions causing ischemic stroke and its diagnosis and treatment is a challenge. The sources of calcified embolism might be a calcific atheroma from the aortic arch and carotid artery, but also heart valve disease has been reported in the literature. Calcified embolism is frequently simultaneous on multiple vascular territories. The prognosis of patients is usually poor, including patients treated by using endovascular thrombectomy (EVT) and this diagnosis could be easily missed in the acute phase. In addition, the optimal secondary prevention has not been yet fully stated. We are presenting two cases of acute stroke due to calcified embolism in the middle cerebral artery (MCA) coming from a complicated carotid atheroma, non-stenosing in the first case (a 49years old man) and stenosing in the second case (a 71years old man) without clinical indications to intravenous thrombolysis and/or EVT, extensively investigated in the acute phase and followed-up for over 12months with a favorable clinical course and the persisting steno-occlusion in the involved MCA. In both cases, antiplatelet treatment and targeting of vascular risk factors were done without recurrences in the follow-up period. Cerebral calcified embolism has been reported in 5.9% of cases of acute ischemic stroke in a single center series and only in 1.2% of a large retrospective cohort of EVT-treated patients. In both series the prognosis was poor and only one third of EVT-treated patients had functional independence at 3-months follow-up. The natural history of these subtype of ischemic stroke is relatively poorly understood and both etiological diagnosis and treatment have not yet defined. It is possible that some cases might be underdiagnosed and underreported. Calcified cerebral embolism is a rare cause of stroke, but it is largely underreported and both acute phase and secondary preventive treatment have to be defined.

Optimizing catheter centering enhances mechanical thrombectomy success: Performance difference in cases using novel macrowires versus traditional microwires.

The aim of this study is to determine how guidewire selection impacts procedure time and success and analyze if the trend toward the adoption of larger diameter guidewires provides a quantifiable advantage over traditional 0.014″ guidewires. A review of 494 consecutively performed acute ischemic stroke cases performed between 2018 and 2022 were reviewed and grouped into cases using a single 0.014″ outer diameter (OD) guidewire (195 cases) and cases using a single 0.018″ or 0.024″ OD guidewire (128 cases). These groups were compared for differences in average time to recanalization, average number of passes to achieve recanalization, and first pass success. Cases were compared overall, and further analyzed by region of occlusion to look at specific guidewire related differences for cases with M1, M2, and ICA occlusions. Procedures using a larger OD guidewire have an average 5 min and 30 s reduction in time from puncture to recanalization (p = 0.0201). ICA occlusion cases using a larger macrowire show a 20 min reduction in recanalization time (p = 0.0005), a reduction in average number of passes from 2.6 to 1.7 (p = 0.0058), and an increase in first pass success from 18.8% to 58.3% when compared to traditional guidewires. Large 0.018″ or 0.024″ OD guidewires better fill the lumen of the catheter and help to center the thrombectomy system in the vessel and navigate to the clot face. This leads to a reduction in procedure time and number of passes, and an increase in first pass success, especially when treating occlusions in the ICA.

A Case of Varicella Zoster Virus Acute Retinal Necrosis, Vasculopathy, and Acute Ischemic Stroke in a Patient Newly Diagnosed with Systemic Sarcoidosis (P1-13.008)

A Case of Varicella Zoster Virus Acute Retinal Necrosis, Vasculopathy, and Acute Ischemic Stroke in a Patient Newly Diagnosed with Systemic Sarcoidosis (P1-13.008)

Association of Internal Cerebral Vein Asymmetry and Collateral Status with Outcome of Anterior Circulation Acute Ischemic Stroke Cases (P3-5.028)

Association of Internal Cerebral Vein Asymmetry and Collateral Status with Outcome of Anterior Circulation Acute Ischemic Stroke Cases (P3-5.028)

Trends in admissions for COVID-19 in the United States between April 2020 and December 2021 and cardiovascular events

IntroductionCoronavirus disease 2019 (COVID-19) can lead to cardiovascular complications. We aimed to understand the trends in admission for COVID-19 and the incidence of various cardiovascular events.Material and methodsThe 2020 and 2021 National Inpatient Sample (NIS) was studied for cases of COVID-19 between April 2020 and December 2021 in the United States. Linear-by-linear association helped us understand the trends of various events.ResultsThe number of cases of COVID-19 was highest in January 2021 (261,469 patients). The incidence of acute pulmonary embolism rose from 2.08% in April 2020 to 4.82% in November 2021, while deep vein thrombosis cases rose from 1.74% in April 2020 to 2.63% in December 2021. The incidence of cardiac arrest varied, with a maximum of 3.00% in August 2021. Similarly, acute ischemic stroke cases experienced their highest incidence in January 2021 (0.91%). The incidence of myocarditis was highest in April and May 2020 (0.42% each). Peak takotsubo cases were seen between October and December 2021. The highest overall all-cause mortality among COVID-19 cases was seen in April 2020 (16.74%).ConclusionsThroughout the 21 months of our analysis, various trends in COVID-19 cases and incidence of cardiac events were noticed. This could relate to the different variants of COVID-19, their direct and indirect impact on coagulation pathways and the myocardial tissues, and the protective roles of the vaccines.

Unveiling the negative association of Faecalibacterium prausnitzii with ischemic stroke severity, impaired prognosis and pro-inflammatory markers

BackgroundThe correlation between acute ischemic stroke (AIS) and gut microbiota has opened a promising avenue for improving stroke prognosis through the utilization of specific gut bacterial species. This study aimed to identify gut bacterial species in AIS patients and their correlation with stroke severity, 3-month prognosis, and inflammatory markers. Methods: We enrolled 59 AIS patients (from June 2021 to July 2022) and 31 age-matched controls with similar cerebrovascular risk profiles but no stroke history. Fecal samples were analyzed using 16 S rDNA V3–V4 sequencing to assess α and β diversity and identify significant microbiota differences. AIS cases were categorized based on the National Institute of Health Stroke Scale (NIHSS) scores and 3-month modified Rankin Scale (mRS) scores. Subgroup analyses were performed, and correlation analysis was used to examine associations between flora abundance, inflammatory markers and stroke outcome. ResultsSignificant differences in β-diversity were observed between case and control groups (P < 0.01). Bacteroides dominated AIS samples, while Clostridia, Lachnospirales, Lachnospiraceae, Ruminococcaceae, Faecalibacterium, and Faecalibacterium prausnitzii were prominent in controls. Faecalibacterium and Faecalibacterium prausnitzii were significantly reduced in non-minor stroke and 3-month poor prognosis groups compared to controls, while this difference was less pronounced in patients with minor stroke and 3-month good prognosis. Both Faecalibacterium and Faecalibacterium prausnitzii were negatively correlated with the NIHSS score on admission (r = −0.48, −0.48, P < 0.01) and 3-month mRS score (r = −0.48, −0.44, P < 0.01). Additionally, they showed negative correlations with pro-inflammatory factors and positive correlations with anti-inflammatory factors (both P < 0.01). ConclusionsFaecalibacterium prausnitzii is negatively associated with stroke severity, impaired prognosis, and pro-inflammatory markers, highlighting its potential application in AIS treatments.

Abstract TMP56: Accuracy of Dual-Energy Computed Tomography for Differentiation Between Cerebral Hemorrhage and Contrast Extravasation Following Mechanical Revascularization in Acute Ischemic Stroke: A Diagnostic Accuracy Meta-Analysis

Background: Mechanical revascularization has become an essential treatment for acute ischemic stroke patients. Post-treatment imaging frequently displays hyperdense regions, prompting concerns regarding possible cerebral hemorrhage. Dual-energy computed tomography (DECT), as an advanced imaging modality, offers the potential to discern between hemorrhage and harmless contrast leakage. Aim: This study aims to assess the diagnostic precision of DECT in distinguishing cerebral hemorrhage from contrast extravasation post-mechanical revascularization in acute ischemic stroke cases. Methods: A comprehensive search was performed for PubMed, EMBASE, and the Cochrane Library until January 2023. We focused on studies that focused on the diagnostic efficacy of DECT for this specific application. R software (version 4.0.3) coupled with mada package facilitated the analyses pooling metrics such as sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios. These metrics were reported with a 95% Confidence Interval (CI). Results: Our analysis included 5 studies involving 241 patients. DECT demonstrated a pooled sensitivity of 94.5% (95% CI: 25.9% to 99.9%, I 2 =0%) and a specificity of 99% (95% CI: 77.3% to 100%, I 2 =0%). The false-positive rate was minimal at 1% (95% CI: 0% to 22.7%). The positive likelihood ratio was calculated as 98.94 (95% CI: 3.34 to 2929.22), while the negative likelihood ratio was 0.05 (95% CI: 0.001 to 2.21). The diagnostic odds ratio was substantial at 1795.17 (95% CI: 10.04 to 321055.24), signifying a robust performance of DECT in making the differentiation. Conclusion: While DECT manifests impressive accuracy in differentiating cerebral hemorrhage from contrast extravasation after mechanical revascularization in acute ischemic stroke cases, the wide confidence intervals signify a degree of uncertainty in these estimates. Nevertheless, given its high diagnostic metrics, DECT can substantially influence post-intervention evaluations, paving the way for more informed clinical decisions and potentially reducing patient adverse outcomes. However, further studies with larger sample sizes might help refine these diagnostic estimates.

Abstract WMP98: Elevated Troponin With and Without Myocardial Infarction in Acute Ischemic Stroke

Introduction: Elevated cardiac troponin (cTn) in acute ischemic stroke (AIS) is common, and associated with increased risk of death. Whether this association depends on the cause of the cTn elevation is unclear. We examined whether etiology of elevated cTN after AIS modulates the risk of death using a large population-based study in the Greater Cincinnati Northern Kentucky (GCNK) region. Methods: Using well-validated methods, all hospitalized AIS cases in the GCNK region were collected and adjudicated in 2015. Cases with a positive cTN underwent retrospective review by cardiologists using the Fourth Universal Definition of Myocardial Infarction (MI). Date/cause of death were obtained from the National Death Index. Kaplan Meier estimates of 3-year cardiac and all-cause death were generated, stratified into the following three categories: Acute MI (Type I/Type II), elevated troponin without acute MI, and nonelevated troponin. Estimates were then compared with a Log Rank test. Results: There were 2096 AIS patients during the study period in which a cTN was obtained; cTN was elevated in 464 (22.1%). Among AIS patients with elevated cTN, 107 (23%) had an acute MI, and the remaining 357 (77%) had elevated cTN without MI. At 3 years, cardiac/all cause deaths were more common in patients with elevated cTN when compared with patients without elevated cTN regardless of cause (P&lt;0.01, Figure). Among patients with elevated cTN, death rates were not significantly higher in patients with acute MI (P=0.44 all cause, p=0.67 cardiac). Discussion: Elevated cTN after AIS is associated with a higher risk of death at 3 years, regardless of whether an MI occurred. Interventions targeting patients with elevated cTN could improve long-term outcome after AIS.

Abstract TP44: Door In-Door Out Times: A Comprehensive Stroke Center Review

Expeditious transfer of patients with acute ischemic stroke (AIS) and LVO presenting to a primary stroke center (PSC) and within the window for mechanical thrombectomy (MT) is vital to optimize their functional outcome. Door-in-door-out (DIDO) represents the time of patient arrival to the PSC to the time of discharge from the PSC for transfer to a comprehensive stroke center (CSC). The goal for this metric is 90 minutes. At a large urban academic and CSC with a high volume of patient transfers, we examined our DIDO metrics to identify trends and opportunities for improvement. Methods: The CSC MT database was queried to analyze DIDO times. Inclusion criteria included AIS cases with LVO transferred to the CSC for MT from fiscal year 2022-2023. Hospitals transferring less than 5 cases during that timeframe, inpatient cases, and unavailable times were excluded. Hospital DIDO times and their components (i.e. each step in the process) were grouped into quartiles and analyzed. A survey to PSC stakeholders was sent to identify themes for possible barriers. Results: Among 8 hospitals, the top quartile with the fastest DIDO times had a mean of 132 minutes and median of 122 (N = 22 patients). The hospitals with the longest DIDO had a mean of 205 and a median of 193 (N=17). The components of DIDO times that separated the fastest from the slowest were PSC arrival to 1 st call to CSC and 1 st call of PSC to acceptance at CSC . The PSCs with the highest DIDOs took double the time in these components (40 vs 81, 22 vs 53 minutes). Distance from the CSC does not appear to be a factor in DIDO times, with the fastest being 13 to 68 miles away vs. 11 to 30 miles for the slowest. In the survey results, 81% of participants had CSC bed availability as the top barrier, whereas 69% reported delays in transport time to PSC. Conclusion: DIDO times from PSCs continues to be an opportunity for process improvement. Only 5% in our sample met the DIDO metric goal of 90 minutes. Two areas of potential improvement include decreasing PSC time to 1 st call and improving time of CSC acceptance. PSCs believe that a “ready” bed at the CSC would decrease DIDO times, but there are additional opportunities among the components.

Abstract TP126: Diffusion Weighted Image Lesion Dynamics in Acute Ischemic Stroke and Functional Recovery: Application of an Automated Software to 7000 Cases

Introduction: The change in DWI lesion volume in acute ischemic stroke has not been investigated in detail. We aimed to investigate the effect of DWI lesion growth or regression within seven days of onset on functional recovery after ischemic stroke. Methods: From a prospective stroke registry, we retrieved acute ischemic stroke cases who had more than two DWIs during in-hospital care between 2005 and 2022. The DWI lesion volume was automatically measured using JBS-01K (JLK Inc., South Korea), a fully automated and validated deep learning algorithm using 3D U-net. The association between categorized DWI lesion volume change (10, 25, 50, and 75 percentiles corresponding to -45%, 0%, 57%, and 220% of volume change) and functional recovery was assessed using multivariable ordinal logistic regression analysis taking lower modified Rankin scale (mRS) as a dependent variable, adjusting for relevant covariates. Results: A total of 7308 patients with ischemic stroke who underwent follow-up DWIs were included. A male was 62%, mean age of 67.5±13.5, and a median of initial NIHSS 4 [IQR 1-7]. The median of interval between the initial and follow-up DWI was 90 hours [IQR 68.25 - 112.20]. The median of the initial DW lesion volume was 1.00 ml [IQR 0.27-5.98], and the median of the follow-up DW lesion volume was 2.05 ml [IQR 0.27-5.98]. DWI lesion volume was regressed in 1844 cases (25%); 136 cases (13%) of EVT and 1708 cases (27%) of non-EVT cases. Compared with patients with 25-50 percentile strata, the adjusted odds ratios (OR) of having favorable functional recovery for &lt; 10th, 10-25th, 50-75th, and ≥75th percentile were 1.25 [95% CI 1.05 - 1.48], 0.96 [0.83 - 1.11], 0.67 [0.59 - 0.76], and 0.63 [0.55 - 0.72], respectively (Figure). Conclusions: We found that approximately a quarter of patients with ischemic stroke had an interval regression of infarct volume on DWI, which is independently associated with favorable functional recovery.

Multicenter exploration of tenecteplase transition factors: A quantitative analysis

BackgroundTenecteplase (TNK) is gaining recognition as a novel therapy for acute ischemic stroke (AIS). Despite TNK offering a longer half-life, time and cost saving benefits and comparable treatment and safety profiles to Alteplase (ALT), the adoption of TNK as a treatment for AIS presents challenges for hospital systems. ObjectiveIdentify barriers and facilitators of TNK implementation at acute care hospitals in Texas. MethodsThis prospective survey used open-ended questions and Likert statements generated from content experts and informed by qualitative research. Stroke clinicians and nurses working at 40 different hospitals in Texas were surveyed using a virtual platform. ResultsThe 40 hospitals had a median of 34 (IQR 24.5–49) emergency department beds and 42.5 (IQR 23.5–64.5) inpatient stroke beds with 506.5 (IQR 350–797.5) annual stroke admissions. Fifty percent of the hospitals were Comprehensive Stroke Centers, and 18 (45 %) were solely using ALT for treatment of eligible AIS patients. Primary facilitators to TNK transition were team buy-in and a willingness of stroke physicians, nurses, and pharmacists to adopt TNK. Leading barriers were lack of clinical evidence supporting TNK safety profile inadequate evidence supporting TNK use and a lack of American Heart Association guidelines support for TNK administration in all AIS cases. ConclusionUnderstanding common barriers and facilitators to TNK adoption can assist acute care hospitals deciding to implement TNK as a treatment for AIS. These findings will be used to design a TNK adoption Toolkit, utilizing implementation science techniques, to address identified obstacles and to leverage facilitators.

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke.

We investigated the seasonal variations in stroke in 4040 retrospectively enrolled patients with acute ischemic stroke (AIS) admitted between January 2011 and December 2022, particularly those with cardioembolic (CE) stroke, and compared predictors of unfavorable outcomes between AIS patients and CE stroke patients. The classification of stroke subtypes was based on the Trial of ORG 10172 in Acute Stroke Treatment. Stroke occurrence was stratified by seasons and weekdays or holidays. Of all AIS cases, 18% were of CE stroke. Of all five ischemic stroke subtypes, CE stroke patients were the oldest; received the most thrombolysis and thrombectomy; had the highest initial National Institutes of Stroke Scale (NIHSS) and discharge modified Rankin Scale (mRS) scores; and had the highest rate of in-hospital complications, unfavorable outcomes (mRS > 2), and mortality. The highest CE stroke prevalence was noted in patients aged ≥ 85 years (30.9%); moreover, CE stroke prevalence increased from 14.9% in summer to 23.0% in winter. The main predictors of death in patients with CE stroke were age > 86 years, heart rate > 79 beats/min, initial NIHSS score > 16, neutrophil-to-lymphocyte ratio (NLR) > 6.4, glucose > 159 mg/dL, cancer history, in-hospital complications, and neurological deterioration (ND). The three most dominant factors influencing death, noted in not only patients with AIS but also those with CE stroke, are high initial NIHSS score, ND, and high NLR. We selected the most significant factors to establish nomograms for predicting fatal outcomes. Effective heart rhythm monitoring, particularly in older patients and during winter, may help develop stroke prevention strategies and facilitate early AF detection.

A task-driven cerebral angiographic imaging based on CT perfusion.

Current clinical computed tomography arteriography (cCTA) and clinical computed tomography venography (cCTV) images often display restricted cerebrovascular profiles, incomplete brain tissue segmentation, and incomplete artery-vein segmentation. Especially for vessels associated with diseases, capturing their complete profiles proves challenging. In this work, we developed a Task-driven Cerebral Angiographic Imaging (TDCAI) technique using computed tomography perfusion (CTP) images of stroke patients. A evaluation on intracranial hemorrhagic stroke (IHS) and acute ischemic stroke (AIS) cases was performed with CT perfusion imaging. The TDCAI technique processed the CTP images, resulting in supplementary diagnostic images, including CTA, CTV, centerline images of the vessels-of-interest [internal carotid artery (ICA) for AIS patients, Labbé vein for IHS patients], and straightened images of the vessels-of-interest. We conducted a comparison between the obtained CTA/CTV images and the cCTA/cCTV images in terms of overall image quality and visibility of the vessels-of-interest. By constructing a virtual vascular phantom, we extracted its centerline and compared it with the actual centerline to calculate maximum and average deviations. This allowed us to evaluate both the accuracy of the centerline extraction algorithm and its capability to resist the influence of side branches. We assessed whether vascular stenosis and dilatation could be expressed in straightened vessel images, conducting statistical analyses to establish the superiority of TDCAI technique. This study proposes a TDCAI technique to eliminate bone and soft tissue interference, effectively segregate the comprehensive cerebral venous and arterial systems, and extract centerlines and straighten the vessels-of-interest, which would aid doctors in assessing the outflow profiles of vessels after a stroke and seeking imaging biomarkers correlated with clinical outcomes.

Association between the blood urea nitrogen-to-creatinine ratio and 3-month outcomes in patients with acute ischemic stroke: a secondary analysis based on a prospective cohort study.

This study aimed to assess the correlation between the blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio and adverse outcomes (AOs) at 3 months in patients with acute ischemic stroke (AIS) in the Korean population. This cohort study encompassed 1906 cases of AIS at a South Korean hospital from January 2010 to December 2016. To determine the linear correlation between the BUN/Cr ratio and AOs in AIS, a binary logistic regression model (BLRM) was employed. Additionally, generalized additive models and techniques for smooth curve fitting were utilized to reveal the nonlinear dynamics between the BUN/Cr ratio and AOs in patients with AIS. The prevalence of AOs was 28.65%, with a median BUN/Cr ratio of 18.96. Following adjustments for covariates, the BLRM disclosed that the association between the BUN/Cr ratio and the risk of AOs in patients with AIS did not attain statistical significance. Nevertheless, a nonlinear relationship surfaced, pinpointing an inflection point at 21.591. To the left of this inflection point, a 31.42% reduction in the risk of AOs was noted for every 1-unit surge in the Z score of the BUN/Cr ratio [odds ratio (OR) = 0.686, 95% confidence interval (CI): 0.519, 0.906, p = 0.008]. On the right side of the inflection point, the effect size (OR = 1.405, 95% CI: 1.018, 1.902, p = 0.039) was determined. The findings of this study underscore the intricate nature of the relationship between the BUN/Cr ratio and 3-month outcomes in patients with AIS, establishing a robust groundwork for future investigations.