Diagnosis Of Acute Ischemic Stroke Research Articles

Building an Acute Ischemic Stroke Identification Model Using a Deep Learning Technique

Acute ischemic stroke (AIS) is a leading cause of mortality and disability. Over the past several decades, researchers proposed multiple techniques to enhance the effectiveness of AIS diagnosis. Magnetic resonance imaging (MRI) and computed tomography (CT) are widely used for assessing and treating AIS. In recent years, healthcare centers have applied the deep learning–based technique to support physicians in identifying diseases at earlier stages. Recently, researchers have employed convolutional neural network (CNN)-based image classifiers to detect diseases using complex images. However, the models demand high computation resources for generating a reasonable outcome. Thus, this study intends to build a fine-tuned CNN model for identifying AIS from MRI and CT images. The proposed framework contains three phases: image enhancement, feature extraction, and fine-tuned detection model. Initially, the researcher applies an image colorization technique using generative adversarial networks. You only look once V7 is used to extract the images’ features. In the second phase, the authors employed the Aquila optimization algorithm for tuning the hyperparameters of the Residual Network with Split attention (ResNest) model. To evaluate the performance of the ResNest model, the authors utilized two benchmark datasets of brain MRI and CT images. The MRI datasets contain 1021 healthy and 955 unhealthy images, whereas the CT datasets comprise 1551 healthy and 950 unhealthy images. The findings reveal that the ResNest model outperforms the recent approaches. The model achieves an average accuracy and F1 score of 98.25 and 97.275, and 98.65 and 98.25, for the MRI and CT datasets, respectively. In addition, the ResNest model obtained a confidence interval score of [97.84-98.13] and [97.91-98.52] for the MRI and CT datasets, respectively. The study uniquely develops a lightweight application through a compelling data preprocessing and feature extraction technique. In addition, the fine-tuned ResNest model achieves a superior outcome with limited resources. Healthcare centers can implement this lightweight model for diagnosing AIS patients.

Investigation of the relationship between inflammatory markers and grade of disease in patients with acute ischemic stroke with partial anterior circulation infarct

Objectives: The aim of this study was to investigate the relationship between National Institutes of Health Stroke Scale scores and Glasgow coma scores of patients with partial anterior ischemic stroke and laboratory results, particularly serum CRP, albumin, platelet and other complete blood count data, and prognosis. Methods: In this retrospective study 226 of patients with partial anterior circulation infarction who were admitted to the Bolu Abant İzzet Baysal University Neurology Clinic between January 2021 and 2022 with the diagnosis of acute ischemic stroke and hospitalized within the first 24 hours were investigated. The demographic data, stroke etiology and risk factors, National Institutes of Health Stroke Scale, Glasgow coma scores, complete blood count, certain inflammatory markers and biochemical parameters, length of hospital stay and mortality rates were examined. And the relationship between inflammatory markers and grade of disease was evaluated statistically. Results: The patients with moderate Glasgow coma score had a lower lymphocyte level, severe patients had higher PCT level and moderate patients had higher CRP level among others. Patients with moderate GCS had higher CRP/ALB val­ues than those with mild. Patients with moderate and moderate-severe National Institutes of Health Stroke Scale had higher RBC and HGB levels than the patients with mild. Moderate-severe patients had lower albumin lev­els. Conclusion: CRP-albumin ratio, serum platelet and serum albumin levels may have prognostic value in acute partial anterior ischemic stroke patients.

CORRELATION OF SERUM ALBUMIN LEVELS IN ACUTE ISCHEMIC STROKE PATIENTS.

Background Westernization of lifestyle and the resulting demographic transition might increase the burden of stroke even in the developing countries. Stroke or cerebrovascular accident is a life threatening neurological disorder. It constitutes more than 50% of admissions in a hospital. Albumin is a multifunctional protein which has been proven to have neuroprotective effects in animal studies. Albumin is also an indicator of the nutritional status. Methods Total 75 patients admitted with the diagnosis of acute ischemic stroke and meeting the inclusion and exclusion criteria. A prospective, observational study is conducted under the Department of Medicine, MGM Medical College and Hospital, Navi Mumbai. A written signed informed consent was taken from all the patients prior to their enrolment in the study. Results It was observed that the mean age of the study population was 52.96 ± 13.11 years. Almost 58.66% of the cases belonged to the age group of 51 to 70 years. There was a male preponderance in the study population (86.67%). The age distribution was similar in both the genders; P value: 0.486. the results also showed that the mean serum albumin levels at the time of admission was 3.86 ± 0.49 g/dL and the mean serum albumin levels at discharge were 3.95 ± 0.47 g/dL. When assessed with age, there was no signicant variation in the serum albumin levels at admission and discharge; P value: more than 0.50. Conclusion From the present study, it can be effectively concluded that acute ischemic stroke is prevalent in the older age groups with signicant male preponderance. When the severity of the stroke was assessed by the NIHSS score, it was observed that moderate type of stroke was the most common. When assessed with the mean serum albumin levels, there was a signicant strong negative correlation with NIHSS score. This indicates that low serum albumin levels are associated with increased severity of the stroke.

Non-Hodgkin's Lymphoma Is Associated with Increased in-Hospital Morbidity and Mortality in Patients with Acute Ischemic Stroke

Background Stroke in cancer patients is common due to multiple mechanisms including direct tumor related, coagulation disorders, infections and therapy related. There have been few studies associating risk of stroke with different types of cancers including non-Hodgkin's lymphoma (NHL). However, literature on association of mortality in patients with stroke and non-Hodgkin's lymphoma is sparce. Aim of our study was to examine the morbidity and mortality in NHL patients admitted with acute ischemic stroke. Methodology All adult hospitalized patients from January 2016 to December 2019 in the nationwide inpatient sample were captured. The study population included all patients with a primary diagnosis of Acute Ischemic stroke. The population was divided into patients with underlying NHL (Study) and those without it (Control). We used Wilcoxon rank sum test for comparing continuous variables and Chi-square tests for categorical variables. For univariate and multivariate analysis, we performed univariate and multivariate logistic regression models respectively. The primary outcome was mortality rates and secondary outcomes were morbidity rates and healthcare utilization. Results The sample size included 2,534,589 adult patients with acute ischemic stroke, of which 2,526,824 (99.7%) had no documented non-Hodgkin's lymphoma while 7765 (0.3%) did. The mean age of patients in both the groups was 70 years. Sex-distribution was approximately equal with no significant difference between the two groups. Patients with NHL had increased In-hospital mortality (Adjusted OR: 2.02, p<0.001). They also had increased risk of hospital acquired pneumonia (Adjusted OR (aOR): 2, p<0.001), C.diff infection (aOR: 4.03, p<0.001), Sepsis (aOR: 1.59, p<0.001), septic shock (aOR:1.46, p<0.001). The risk of developing UTIs however was insignificantly different between the two groups. Underlying NHL also increased the risk of Venous thromboembolism (aOR: 3.63, p<0.001) and requirement of Total Parental Nutrition (aOR 3.82, p<0.001) in patients admitted with acute ischemic stroke. Mean total hospitalization charge was insignificant but the mean length of stay was 0.61 days (p<0.001) higher in patients with underlying NHL. Conclusion Patients admitted with acute ischemic stroke and underlying NHL have 2-fold higher mortality risk compared to patients without NHL. It also increases morbidity in acute ischemic stroke patients that ultimately increases the health-care utilization and burden on the patient and their families. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 10073: Acute Ischemic Stroke in Medicare Patients Following Admission for Acute Myocardial Infarction: Analysis From 2019 National Inpatient Sample

Introduction: With the increasing burden of Acute Myocardial Infarction(AMI) on Medicare, there is a paucity of information on the incidence of Acute Ischemic Stroke(AIS) in those patients and their risk factors. Methods: Patients with a principal diagnosis of AMI covered by Medicare from the 2019 National Inpatient Sample were extracted. Multiple variable regression allowed us to estimate the adjusted odds ratio (aOR) of AIS among patients while acknowledging various possible factors. Results: A total of 378,390 cases of AMI covered by Medicare were found, amongst which 6110 patients,1.6%, also experienced AIS. The mean age of AIS cases was 75.34 years, while it was 74.31 years in non-AIS patients. Patients with AMI are more likely to have a diagnosis of AIS during their hospitalization if they are females (aOR 1.195, 95% CI 1.134-1.260, p&lt;0.01), had a history of alcohol abuse (aOR 1.564, 95% CI 1.346-1.818, p&lt;0.01), peripheral vascular disease (aOR 1.651, 95% CI 1.546-1.764, p&lt;0.01), diabetes (aOR 1.158, 95% CI 1.097-1.222, p&lt;0.01). However, AIS chances are decreased in patients with chronic pulmonary disease (aOR 0.855, 95% CI 0.802-0.912, p&lt;0.01), obese (aOR 0.829, 95% CI 0.770-0.893, p&lt;0.01), smokers (aOR 0.699, 95% CI 0.660-0.739, p&lt;0.01), hyperlipidemia (aOR 0.743, 95% CI 0.703-0.785, p&lt;0.01), ages 60 or less (aOR 0.740, 95% CI 0.662-0.828, p&lt;0.01), and hypertensive (aOR 0.824, 95% CI 0.765-0.889, p&lt;0.01). Blacks (aOR: 1.091, 95% CI 1.002- 1.189, p=0.046) and races other than White, Black, or Hispanic (aOR: 1.353, 95% CI 1.224- 1.495, p&lt;0.01) also showed a higher risk of AIS compared to Whites. AIS also led to an increased risk of mortality (aOR 2.599, 95% CI 2.413-2.801, p&lt;0.01). Conclusions: Several factors influenced the risk of AIS in AMI patients covered by Medicare. More studies are recommended to understand the impact of other possible factors not covered by the NIS, such as medication history.

Abstract 9746: Atrial Fibrillation Among the Elderly With Amyloidosis Admitted for Acute Ischemic Stroke in the United States

Introduction: Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied. Methods: Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies. Results: Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p&lt;0.01), use of intravenous tissue plasminogen activator (aOR 2.062, p&lt;0.01), old CABG (aOR 3.350, p&lt;0.01), current anticoagulation therapy (aOR 13.426, p&lt;0.01), supraventricular tachycardia (aOR 3.970, p&lt;0.01). Smoking (aOR 0.680, p&lt;0.01), diabetes (aOR 0.597, p&lt;0.01), and ventricular tachycardia (aOR 0.504, p= 0.033) showed lower risks. While a higher mortality rate was seen among patients with Atrial Fibrillation (30 deaths, 6.1% in Atrial Fibrillation vs. 4.6% in others), the result was not statistically significant (p=0.213). Patients with Atrial Fibrillation were also older (80.35 vs. 76.11 years) but had a shorter stay (6.22 vs. 6.81 days) with a lower mean hospital charge ($77,977.01 vs. $78,940.89). Conclusions: While various factors can influence the odds of Atrial Fibrillation in the elderly with amyloidosis admitted for acute ischemic stroke, it did not increase mortality risk.

Abstract 9761: Risk Factors for Cardiopulmonary Resuscitation Among Acute Ischemic Stroke Admissions in the United States; An Overview From the National Inpatient Sample

Introduction: Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain. Methods: Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation. Results: Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%). Conclusions: We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.

A retrospective study of immunoglobulin E as a biomarker for the diagnosis of acute ischemic stroke with carotid atherosclerotic plaques.

ObjectiveIn this study, serum markers of acute ischemic stroke (AICS) with carotid artery plaque were retrospectively evaluated to establish a basis for discovering serological indicators for early warning of acute ischemic stroke (AICS).MethodsA total of 248 patients with AICS were enrolled in Lanzhou University Second Hospital from January 2019 to December 2020. The study population included 136 males and 112 females, 64 ± 11 years of age. Of these, there were 90 patients with a transient ischemic attack (TIA), including 60 males and 30 females, aged 64 ± 8 years old. Patients with AICS were stratified by carotid ultrasound into a plaque group (n = 154) and a non-plaque group (n = 94). A total of 160 healthy subjects were selected as the control group. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2), amyloid A (SAA), immunoglobulin E (IgE), D-dimer (D-D), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were collected from all subjects. Multivariate logistic regression was used to analyze the risk factors of AICS with carotid plaque. ROC curve was used to analyze the diagnostic efficacy of AICS with carotid plaque.ResultsThe IgE, Lp-PLA2, SAA, LDL-C, TC, TG, and D-D levels in the AICS group were higher than those in the TIA group and healthy control group (P < 0.05). The IgE level was significantly higher than that in the healthy control group and TIA group. The IgE level in the AICS plaque group was significantly higher than that in the AICS non-plaque group (P < 0.01), and the Lp-PLA2 level was also different (P < 0.05). The incidence of AICS was positively correlated with Lp-PLA2, TC, IgE, TG, D-D, SAA and LDL-C (r = 0.611, 0.499, 0.478, 0.431, 0.386, 0.332, 0.280, all P < 0.05). The incidence of AICS with plaque was only positively correlated with IgE and Lp-PLA2 (r = 0.588, 0.246, P < 0.05). Logistic regression analysis showed that IgE and Lp-PLA2 were independent risk factors for predicting the occurrence of AICS with carotid plaque (P < 0.05). ROC curve analysis showed that the AUC of IgE (0.849) was significantly higher than other indicators; its sensitivity and specificity were also the highest, indicating that IgE can improve the diagnostic efficiency of AICS with carotid plaque.ConclusionIgE is a serum laboratory indicator used to diagnose AICS disease with carotid plaque, which lays a foundation for further research on potential early warning indicators of AICS disease.

152 EXPLORATORY ANALYSIS OF TROPONIN AS BIOMARKER OF ACUTE ISCHAEMIC STROKE SUBTYPES IN A GROUP OF PATIENTS RECRUITED TO THE MIND STUDY

Abstract Background Stroke is a major common cause of acquired disability and death worldwide. Atrial dysfunction or cardiomyopathy, defined by the presence of specific serum biomarkers, ECG findings, or echocardiographic findings, increases the risk of atrial fibrillation, which has been implicated as a key risk factor for ischaemic stroke. There is now growing body of evidence which suggests that early positive troponin after ischaemic stroke may be independently associated with a cardiac embolic source. miRNA as Novel Diagnostic biomarker (MiND) is a current Irish-led research study whose aim is to discover a unique highly diagnostic and prognostic biomarker expressed in acute ischaemic stroke. Methods Data were retrospectively extracted from patients recruited to the MiND study with confirmed diagnosis of acute ischaemic stroke within 12 hours of symptoms onset having also undergone high-sensitivity troponin testing from July 2019 to November 2021. Stroke subtypes were classified as per ESUS criteria. Statistical analysis was carried out using STATA/SE, version 16.0. Results We identified 52 patients who had troponin performed within 12 hours of symptoms onset. Twenty-two patients were identified as having cardioembolic stroke (CE), 17 as non-cardioembolic stroke (NCE) and 13 as Embolic stroke of unknown source (ESUS). The mean age for each group was 77.5 (±9.8), 65.5 (±12.8) and 66.3 (±11.7) years, respectively. The rate of troponin positivity for each group was 55% (12/22), 29% (5/17) and 15% (2/13), respectively. The unadjusted logistic analysis revealed a positive association between CE stroke subtype and elevated troponin (OR 3.94, 95% 1.20-12.98, p = 0.024) and an inverse association between ESUS stroke subtype and elevated troponin (OR 0.24, 95% CI 0.05-1.21, p = 0.083). Conclusion Our analysis reveals that early positive troponin after ischaemic stroke is a strong predictor of CE stroke subtype but not of ESUS stroke subtype.

317 Implementation of a Stroke Response Team at a Pediatric Emergency Department

Acute ischemic stroke (AIS) is an important cause of morbidity and mortality in children. Timely usage of hyperacute therapies, such as intravenous tissue plasminogen activator (IV-tPA) and mechanical thrombectomy, appear to be safe and effective in children. Despite this, early recognition and diagnosis of pediatric AIS within the therapeutic window for hyperacute therapies remains a challenge. Our objective is to improve timely diagnosis of AIS at our pediatric tertiary hospital emergency department (ED) through the implementation of an interdisciplinary stroke alert team and improved coordination of care.

Advances in cerebral perfusion imaging techniques in acute ischemic stroke.

The application of cerebral perfusion imaging has demonstrated significant assessment benefits and an ability to establish an appropriate triage of patients with acute ischemic stroke (AIS) and large artery occlusion (LAO) in the extended time window. Computed tomography perfusion (CTP) and magnetic resonance imaging (MRI) are routinely used to determine the ischemic core, as well as the tissue at risk, to aid in therapeutic decision-making. However, the time required to transport patients to imaging extends the door-to-reperfusion time. C-arm cone-beam CT (CBCT) is a novel tomography technology that combines 2D radiography and 3D CT imaging based on the digital subtraction angiography platform. In comparison with CT or MRI perfusion techniques, CBCT combined with catheterized angiogram or therapy can serve as a "one-stop-shop" for the diagnosis and treatment of AIS, and greatly reduce the door to reperfusion time. Here, we review the current evidence on the efficacy and theoretical basis of CBCT, as well as other perfusion techniques, with the purpose to assist clinicians to establish an effective and repaid workflow for patients with AIS and LAO in clinical practice.

Revascularization in the treatment of acute ischemic stroke

Objective ‒ to analyze the experience of providing care to patients with acute stroke in the conditions of the multidisciplinary neurosurgical department of Poltava Regional Clinical Hospital named after M.V. Sklifosovsky.Materials and methods. In the neurosurgical department in 2020 treated 1,148 patients aged 18 to 83, among whom 49 % were patients with acute stroke. Ischemic stroke was observed in 54.7 % of people, and hemorrhagic stroke in 45.3 %. A total of 173 patients with a diagnosis of acute ischemic stroke were hospitalized in 2020, of which 54 patients were delivered within 4.5 hours from the onset of the disease and received thrombolytic therapy and 20 patients within 6 hours who underwent mechanical thrombectomy, with of them, bridging was used in 5 patients. To determine the presence of signs of a stroke and pre-notification, the following scales were used: FAST and «МОЗОК-ЧАС». Neuroimaging was performed as an emergency using native SCT and SCT-angiography or MRT and MRT-angiography in 100 % of cases. To evaluate the results of neuroimaging, the ASPECTS scale was used for stroke in the anterior hemisphere and pc-ASPECTS – in the vertebrobasilar basin. The NIHSS scale was used to determine the severity of the patient; the following scales were used to determine the presence of occlusion of a large vessel: RACE, BRAIN2. A modified Rankin scale was used to assess the patient’s functional status. In the treatment of ischemic stroke, we divided all patients into 2 groups: the first – 41 % patients, who are subject to revascularization treatment, the second – 59 % patients, who are shown only optimal drug therapy. Revascularization had 2 treatment options. The first option provided for thrombolytic therapy in case of detection of small vessel occlusion, the second – mechanical thrombectomy in case of detection of large vessel occlusion. In cases where the patient was admitted within the therapeutic window, bridging therapy was performed, i.e. intravenous administration of plasminogen activator and simultaneous endovascular thrombectomy. In case of simultaneous detection of a stroke and a heart attack in a patient, the Canadian Stroke Best Practice Recommendations for Acute Stroke Management (2018) were used as a basis, according to which the specifics of the management of patients undergoing revascularization treatment are defined. The following EVT techniques were used in our study: ADAPT – in 5 % of patients, Solumbra – in 10 % of patients and SAVE – in 85 % of patients during endovascular thrombectomy.Results. Thrombolytic therapy was carried out – 31 % of the total number of treated patients with ischemic stroke, mechanical thrombectomy – 10 % of the total number of treated patients. Decompressive craniectomies were performed in 6 % of patients with ischemic stroke.Conclusions. Analysis of the results of treatment of patients with ischemic stroke using the above methods indicates a good result at discharge from the medical institution and later, namely on the 90th day after the treatment.

Abstract 036: Failure To Achieve Optimal Blood Pressure Control Among Stroke Patients In The Outpatient Setting

Introduction: Despite being an AHA Class 1 recommendation to achieve a blood pressure (BP) &lt; 130/80 for secondary stroke prevention, only an estimated 20% of the general population can achieve this benchmark. Furthermore, it has been suggested that stroke patients may be at higher risk for an inability to achieve this goal. We aimed to examine real world clinic data to evaluate BP control among stroke patients. Methods: We conducted a population-based retrospective study using electronic health records collected during routine care at our institution for all adult patients 18 years or older with a diagnosis for stroke between January 2019 to November 2021. BP measurements were taken in an outpatient setting between 90 and 180 days from the index stroke. Descriptive statistics using R (R Core Team, 2022, r-project.org) were reported as the mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Results: Our review identified a total of 1,583 patients with a new diagnosis of acute ischemic stroke (AIS: 1,252; 79.1%) or intracerebral hemorrhage (ICH: 331; 20.9%). AIS patients were 45.7% female with a mean age of 68 years old, compared to 47.7% female and 59 years old for ICH patients. AIS patients had a higher proportion of secondary medical issues, including 34.7% with diabetes, 33.0% congestive heart failure, 19.2% cardiac disease, and 33.9% renal disease (compared to 22.2%, 16.1%, 8.8%, 19.2% respectively for ICH patients). In follow-up, only 11.7% of AIS patients were at goal (defined as a BP &lt; 130/80) at 3 months, 17.3% at 6 months, 11.6% at 9 months, and 8.9% at 12 month follow-up. Conversely, ICH patients were slightly better controlled with 21.6%, 32.8%, 15.8%, and 12.2% controlled at 3, 6, 9, and 12 month follow-up respectively. Patients with stroke after March 2020 (post-COVID19 pandemic) had lower rates of blood pressure control compared to those diagnosed one year prior to the pandemic. Conclusion: Patients with AIS have lower rates of BP control compared to the general population, which was further amplified by the COVID19 pandemic. These results may suggest that stroke patients face unique barriers in BP management and highlight the need to perform targeted treatment for this especially vulnerable group.

Serum Uric Acid and Lipid Levels in Patients With Acute Ischemic Stroke: A Cross-Sectional Study.

Background and objectiveGiven the enormous public health burden posed by acute ischemic stroke (AIS), it becomes imperative to identify associated risk factors such as serum uric acid (SUA) and lipid profile that can be tangibly assessed. This could potentially provide useful markers for disease risk or progression, facilitating timely diagnosis and management of AIS. This study aimed to evaluate the SUA and lipid levels in patients with AIS.MethodThis cross-sectional study enrolled 66 AIS patients aged >18 years, from both genders. After a thorough medical history and clinical examination, each patient was subjected to SUA analysis and lipid profiling using an auto-analyzer with dedicated reagents. Results were statistically analyzed using Chi square test, and p-value ≤0.05 indicated statistical significance.Results and interpretationThe study cohort showed a mean age of 61.17 ± 14.01 years and male to female (M:F) ratio of 1.7:1, with mean blood levels of SUA, triglyceride, and high-density lipoprotein (HDL) reaching 5.68 ± 1.71 g/dL, 205.42 ± 105.08 g/dL, and 29.80 ± 8.45 g/dL, respectively. Most patients suffered from hypertension (81.82%), diabetes (77.27%), and alcoholism (24.24%). Cerebrovascular Doppler findings revealed the combined presence of plaque and stenosis (24.24%). Male AIS patients showed a significantly greater association with alcohol and smoking/nicotine use (p<0.001). Gender showed no significant association with SUA, lipid profile, hypertension, and diabetes (p>0.05).ConclusionAIS is associated with hyperuricemia and dyslipidemia, with no significant gender differences.

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology

:Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

Diagnosis and prognostic value of circDLGAP4 in acute ischemic stroke and its correlation with outcomes

Rationale and aimsCircular RNAs are a subclass of noncoding RNAs in mammalian cells and highly expressed in the central nervous system. Although their physiological functions are not yet completely defined, they are thought to promise as stroke biomarkers because of their stability in peripheral blood.Sample Size Estimate: 222 participants.Methods and designThe plasma of patients with acute ischemic stroke (AIS) (n = 111) and non-stroke controls (n = 111) from November 2017 to February 2019 were enrolled in our research. The expression of circDLGAP4 in plasma was evaluated using real-time PCR.Study outcomesIn patients with AIS, circDLGAP4 was significantly decreased in comparison with non-stroke controls. The CircDLGAP4 level had a significant AUC of 0.7896 with 91.72% sensitivity and 64.83% specificity in diagnosing AIS. Furthermore, the circDLGAP4 level was related to smoking history and previous transient ischemic attack/stroke/myocardial infarction in all samples. The change rate in circDLGAP4 within the first 7 days showed an AUC curve of 0.960 in predicting an stroke outcome.ConclusioncircDLGAP4 could serve as biomarker for AIS diagnosis and prediction of stroke outcomes.

High Neutrophil-Lymphocyte Ratio and Low Lymphocyte-Monocyte Ratio Combination after Thrombolysis Is a Potential Predictor of Poor Functional Outcome of Acute Ischemic Stroke.

(1) Background: Ischemic stroke is one of the leading causes of death and disability. An inflammatory response is observed in multiple stages of cerebral ischemia, particularly in the acute phase. Recent publications revealed that the neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR) may be used to predict long-term prognosis in acute ischemic stroke (AIS) after thrombolysis. To test whether there is a relationship between the combination of these parameters and long-term prognosis, we analyzed the NLR–LMR combination in AIS patients treated with intravenous recombinant tissue plasminogen activator (rtPA); (2) Methods: The study included 285 adults with a diagnosis of AIS and rtPA treatment within a 4.5 h time window. Blood samples were obtained at admission and 24 h after thrombolysis to calculate pre- and post-thrombolysis NLR and LMR. Clinical data, including NIHSS was registered on admission and day 1. The long-term outcome was defined 90 days post-event by the modified Rankin Scale (mRS). Therapy-associated intracranial hemorrhage (ICH) was classified according to ECASS II. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs of NLR and LMR as predictors of therapy outcomes; (3) Results: Patients were stratified by cutoffs of 5.73 for NLR and 2.08 for LMR. The multivariate logistic regression model, including all possible confounders, displayed no significant association between NLR or LMR with 3-months functional prognosis. The combination of high NLR–low LMR vs. low NRL–high LMR as obtained 24 h after thrombolysis was found to be an independent predictor of poor 3-months functional outcome (mRS ≥ 2; OR 3.407, 95% CI 1.449 to 8.011, p = 0.005). The proportion of patients between low NLR–high LMR and high NLR–low LMR groups from admission to day 1 showed no significant change in the good outcome group. On the other hand, in the poor outcome group (mRS ≥ 2), low NLR–high LMR and high NLR–low LMR groups displayed a significant shift in patient proportions from 67% and 21% at admission (p = 0.001) to 36% and 49% at 24 h after thrombolysis (p < 0.001), respectively; (4) Conclusions: Our study demonstrated for the first time that a high NLR–low LMR combination as observed at 24 h after thrombolysis can serve as an independent predictor of 3-months poor outcome in AIS patients. This simple and readily available data may help clinicians to improve the prognostic estimation of patients and may provide guidance in selecting patients for personalized and intensified care post-thrombolysis.

Pre-Hospital Delay in Acute Ischemic Stroke Care: Current Findings and Future Perspectives in a Tertiary Stroke Center from Romania-A Cross-Sectional Study.

Background and objectives: The time interval between stroke onset and hospital arrival is a major barrier for reperfusion therapies in acute ischemic stroke and usually accounts for most of the onset-to-treatment delay. The present study aimed to analyze the pre-hospital delays for patients with acute ischemic stroke admitted to a tertiary stroke center in Romania and to identify the factors associated with a late hospital arrival. Material and methods: The study population consisted of 770 patients hospitalized with the diagnosis of acute ischemic stroke in the University Emergency Hospital Bucharest during a 6-month period, between 1 January and 30 June 2018. Data regarding pre-hospital delays were prospectively collected and analyzed together with the demographic and clinical characteristics of the patients. Results: In total, 31.6% of patients arrived at the hospital within 4.5 h from stroke onset and 4.4% in time intervals between 4.5 and 6 h from the onset, and 28.7% of the patients reached the hospital more than 24 h after onset of symptoms. Transport to hospital by own means was the only factor positively associated with arrival to hospital > 4.5 h from stroke onset and more than doubled the odds of late arrival. Factors negatively associated with hospital arrival > 4.5 h after stroke onset were prior diagnosis of atrial fibrillation, initial National Institute of Health Stroke Scale (NIHSS) score ≥ 16 points, presence of hemianopsia, facial palsy and sensory disturbance. Factors increasing the odds of hospital arrival after 24 h from stroke onset were living alone and living in rural areas. Conclusions: Almost one in three ischemic stroke patients presenting to our center reaches hospital more than 24 h after onset of symptoms. These findings highlight the need for urgent measures to improve not only stroke awareness but also pre-hospital protocols in order to provide timely and appropriate care for our stroke patients.

Baseline Characteristics Associated with Good Collateral Status Using Hypoperfusion Index as an Outcome.

Up to 30% of ischemic stroke cases are due to large vessel occlusion (LVO), causing significant morbidity. Studies have shown that the collateral circulation of patients with acute ischemic stroke (AIS) secondary to LVO can predict their clinical and radiological outcomes. The aim of this study is to identify baseline patient characteristics that can help predict the collateral status of these patients for improved triage. In this IRB approved retrospective study, consecutive patients presenting with AIS secondary to anterior circulation LVO were identified between September 2019 and August 2021. The baseline patient characteristics, laboratory values, imaging features and outcomes were collected using a manual chart review. From the 181 consecutive patients initially reviewed, 54 were confirmed with a clinical diagnosis of AIS and anterior circulation LVO. In patients with poor collateral status, the body mass index (BMI) was found to be significantly lower compared to those with good collateral status (26.4 ± 5.6 vs. 31.7 ± 12.3; p = 0.045). BMI of >35 kg/m2 was found to predict the presence of good collateral status. Age was found to be significantly higher (70.5 ± 9.6 vs. 58.9 ± 15.6; p = 0.034) in patients with poor collateral status and M1 strokes associated with older age and BMI.

Incidence of Poststroke Depression in Patients With Poststroke Dysphagia.

Poststroke dysphagia and poststroke depression (PSD) can have devastating effects on stroke survivors, including increased burden of care, higher health care costs, poor quality of life, and greater mortality; however, there is a dearth of research examining depression in patients diagnosed with dysphagia after stroke. Thus, we aimed to study the incidence of PSD in patients with poststroke dysphagia to provide foundational knowledge about this patient population. We conducted a retrospective, cross-sectional study of individuals with a primary diagnosis of acute ischemic stroke (AIS) and secondary diagnoses of dysphagia and/or depression using administrative claims data from the 2017 Medicare 5% Limited Data Set. The proportion of depression diagnosis in patients with poststroke dysphagia was significantly higher than the proportion of depression diagnosis in those without poststroke dysphagia during acute hospitalization: 12.01% versus 9.52%, respectively (p = .003). Our results demonstrated that persons with poststroke dysphagia were as, or slightly more, likely to have PSD compared to the general stroke population, and to our knowledge, they establish the first reported incidence of PSD in Medicare patients with dysphagia after AIS. Future research is warranted to further explore the effects of PSD on poststroke dysphagia.