Higher Risk Of Stroke Research Articles

Current Therapy for Carotid Webs

IntroductionCarotid webs are a potential cause of ischemic stroke, particularly in younger patients with few traditional risk factors. Despite advances in imaging technology, the management of carotid webs remains poorly defined due to its rarity, absence of evidence-based guidelines, and the unique challenges presented by these lesions. This narrative review evaluates current knowledge on carotid web management, emphasizing diagnostic features, pathophysiological considerations, and treatment strategies. MethodsA literature search was conducted using PubMed and Google Scholar databases with search terms “carotid web management,” “carotid web treatment,” and “carotid web,” focusing on studies published between 2014 and 2024. ResultsCarotid webs are a variant of fibromuscular dysplasia and represent a potential source of embolic strokes. Despite the low overall prevalence, they account for a significant proportion of strokes in younger patients, with a high risk of recurrence when managed medically. Diagnosis often requires advanced imaging, such as CTA or MRA. Treatment options include medical management, carotid endarterectomy, and stenting, though no consensus guidelines exist. Medical management alone has a high recurrent stroke risk. ConclusionCarotid webs should be included in the differential diagnosis of patients with cryptogenic stroke, particularly in younger individuals. Given the high recurrence rates with medical management, both endarterectomy and stenting are recognized as safe and effective treatment options. Future prospective studies are needed to determine the optimal management strategy, including the role of preoperative anticoagulation and comparative outcomes of different treatment modalities.

Ten tips to manage oral anticoagulation in hemodialysis patients with atrial fibrillation

ABSTRACT Patients with chronic kidney disease (CKD) have a high incidence and prevalence of atrial fibrillation (AF). While general treatment strategies for AF may largely be transferred to patients with mild to moderate CKD, patients with advanced CKD—particularly hemodialysis (HD) patients—with AF pose substantial therapeutical challenges to cardiologists and nephrologists. The arguably greatest dilemma is the very limited evidence on appropriate strategies for prevention of stroke and systemic embolism in HD patients with AF, since the risk for both thromboembolic events without oral anticoagulation and severe bleeding events with oral anticoagulation are substantially increased in advanced CKD, compared with the general population. Thus, the benefit to risk ratio of either vitamin K antagonists or direct oral anticoagulants is less evident in HD than in non-CKD patients with AF. As a multidisciplinary panel of clinicians, we here propose 10 tips that may help our colleagues to navigate between the risk of undertreatment—exposing CKD patients with AF to a high stroke risk—and overtreatment—exposing the very same patients to a prohibitively high bleeding risk. These tips include ideas on alternative risk stratification strategies and novel treatment approaches that are currently in clinical studies—such as factor XI inhibitors or left atrial appendage closure—and may become game-changers for HD patients with AF.

Trajectory and predictors of post-stroke depression among patients with newly diagnosed stroke: A prospective longitudinal study

BackgroundPost-stroke depression (PSD) is the most prevalent neuropsychological disorder among stroke patients, affecting approximately one-third of stroke survivors at any one time after a stroke. We identified between-person associations between post-stroke depression trajectories across 3 timepoints and predictors affecting trajectory classification among stroke patients. MethodsThis is a prospective longitudinal study using a convenience sample of 119 participants from 2 tertiary hospitals from March 2022 to September 2022. Clinical assessments and data collection were performed at diagnosis (T1), 3 months (T2), and 6 months (T3) after diagnosis. The instruments were Demographic and Disease Information Sheet and PROMIS-Depression 8a. Data were analyzed using SPSS 27.0 for descriptive statistics, logistic regression, and the Mplus program for growth mixture model analysis. ResultsTwo stroke survivors depression trajectory classes (Class 1, moderate level decreasing- [37.8 %], and Class 2, high level increasing- [62.2%]) were delineated. Class 1 experienced moderate depression post-stroke, with a smooth diminishing pattern at T2 and T3, while Class 2 had a higher baseline depressive score and a significant increase at T2 and T3. The best growth mixture model was Class 2 model (LMR, p=0.010, BLRT, p≤0.01, AIC=2611.934, BIC=2650.842, aBIC=2606.583, Entropy= 0.944). The logistic regression results revealed that Class 2 of depression trajectory had a significant association with a lower score on cognitive function (B=-5.29, 95%CI: -8.80, -1.78, p <0.05) compared with Class 1. The stroke type, marital status, and monthly income were predictors of the Class 2 depression trajectory group among stroke patients. Precisely, ischemic stroke is associated with lower risk of class 2 trajectory. ConclusionThe trajectory of post-stroke depression changes over time. This research has the potential to serve as a foundation for the assessment of high-risk stroke patients, the development of precise management programs, the implementation of risk stratification, and the enhancement of prognosis.

Relationship between Lipid and Blood Glucose Levels with Stroke Risk in Dupak Surabaya

Background: Stroke is a syndrome characterized by rapidly developing symptoms and/or clinical signs in the form of focal or global brain functional disorders lasting more than 24 hours which are not caused by causes other than vascular. Stroke is the number one cause of disability and the main cause of death in Indonesia (19.42% of total deaths). Dyslipidemia and diabetes mellitus are two-fold risk factors for stroke.This research is to determine the relationship between lipids and blood glucose and a high risk of stroke. Methods: This research uses descriptive analytical methods with a cross sectional approach. The population is residents in Dupak Surabaya. The sampling method is random sampling technique. The total research sample was 53 participants. The statistical test used is Chi Square. Result: Statistical results show that there is no relationship between high cholesterol levels and the risk of stroke and there is a relationship between high triglyceride and blood sugar levels and the risk of stroke.Conclusion:This research concluded that there was a significant relationship between high levels of triglycerides and blood glucose and the risk of stroke and there was no significant relationship between high cholesterol levels and the risk of stroke. This lack of significant association could be due to the heterogeneous population and the presence of previous anti-cholesterol medication.

Risk of Stroke and Incident Atrial Fibrillation in Patients in Sinus Rhythm With Nonischemic Dilated Cardiomyopathy

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is associated with an increased risk of atrial fibrillation (AF) and stroke, especially in patients with high CHA2DS2-VASc. We aimed to identify variables associated with incident AF or stroke using left atrial (LA) deformation analysis and its prognostic value added to CHA2DS2-VASc score. Patients with NIDCM and LVEF <50% in sinus rhythm were included between January 2015 and December 2019. LA volume index (LAVI) and atrial strain were used in combination with the CHA2DS2-VAS score to predict ischemic stroke or incident AF. Proportional hazards Cox regression was used to provide hazard ratios (HR). There were 338 patients included. After a median follow-up of 3.6 years, the endpoint occurred in 41 (12.1%) patients. LAVI outperformed other echocardiographic parameters, with significant improvement in risk reclassification compared to CHA2DS2-VASc alone (net reclassification index 0.6, increase in Harrell's C from 0.63 to 0.73, P=0.003) and remained significant after multivariate adjustment. LAVI was associated with both components of the endpoint separately. The best cutoff for LAVI was 44 ml/m2. LAVI ≥44ml/m2 increased the risk of the endpoint among those with CHA2DS2-VASc ≥3 (HR=6.0, 95%CI 2.6-13.5), but not in those with CHA2DS2-VASc <3 (HR=1.2, 95%CI 0.3-4.5). Competing risk analysis did not alter the results. In conclusion, LAVI might be used to assess the risk of incident AF or stroke in NIDCM. Patients with LAVI ≥44 ml/m2 and CHA2DS2-VASc ≥3 could be at high risk of AF and stroke and may benefit from more intensive surveillance.

Left Atrial Appendage Occlusion vs Standard of Care After Ischemic Stroke Despite Anticoagulation

Patients with atrial fibrillation (AF) who have ischemic stroke despite taking oral anticoagulation therapy (OAT) have a very high risk of recurrence. Left atrial appendage occlusion (LAAO) is a mechanical stroke prevention strategy that may provide additional protection in patients with thromboembolic events under OAT. To compare percutaneous LAAO with continuing OAT alone regarding stroke prevention in patients with AF who had a thromboembolic event despite taking OAT. This cohort study was a propensity score-matched comparison of the STR-OAC LAAO cohort, an international collaboration of 21 sites combining patients from multiple prospective registries of patients who underwent LAAO between 2010 and 2022. STR-OAC LAAO cohort patients who had follow-up longer than 3 months were propensity score-matched to a previously published control cohort comprising patients from an established international collaboration of investigator-initiated prospective studies. This control cohort included patients with nonvalvular AF, recent ischemic stroke or transient ischemic attack, and follow-up longer than 3 months who were taking OAT before the index event. Analyses were adjusted for imbalances in gender, age, hypertension, diabetes, and CHA2 DS2-VASc score. Left atrial appendage occlusion vs continuation of oral anticoagulation therapy alone (control group). The primary outcome was time to first ischemic stroke. Four hundred thirty-three patients from the STR-OAC LAAO cohort (mean [SD] age, 72 [9] years; 171 [39%] females and 262 [61%] males; mean [SD] CHA2 DS2-VASc score, 5.0 [1.6]) were matched to 433 of 1140 patients (38%) from the control group. During 2-year follow-up, 50 patients experienced ischemic stroke: an annualized event rate of 2.8% per patient-year in the STR-OAC LAAO group vs 8.9% per patient-year in the control group. Left atrial appendage occlusion was associated with a lower risk of ischemic stroke (hazard ratio, 0.33; 95% CI, 0.19-0.58; P < .001) compared with the control group. After LAAO, OAT was discontinued in 290 patients (67%), and the remaining 143 patients (33%) continued OAT after LAAO as an adjunctive therapy. In patients with nonvalvular AF and a prior thromboembolic event despite taking OAT, LAAO was associated with a lower risk of ischemic stroke compared with continued OAT alone. Randomized clinical trial data are needed to confirm that LAAO may be a promising treatment option for this population with a very high risk of stroke.

Rates of strokes in Californians with sickle cell disease in the post-STOP era

AbstractNeurovascular complications, including strokes and transient ischemic attacks (TIAs), are common and cause significant morbidity in individuals with sickle cell disease (SCD). The Stroke Prevention Trial in Sickle Cell Anemia (STOP) (1998) established chronic transfusions as the standard of care for children with SCD at high risk for stroke. Using statewide emergency department and hospitalization data from the California Department of Health Care Access and Innovation (1991-2019), we determined the cumulative incidence and rates of primary and recurrent strokes and TIAs in people with SCD before and after the STOP trial. For the 7636 patients included in our SCD cohort, the cumulative incidence of the first ischemic stroke was 2.1% (95% confidence interval [CI], 1.8-2.4) by the age of 20 years and 13.5% (95% CI, 12.3-14.7) by the age of 60 years. The cumulative incidence of the first intracranial hemorrhage (ICH) was 0.5% (95% CI, 0.4-0.7) by the age of 20 years and 6.8% (95% CI, 5.9-7.7) by the age of 60 years. Ischemic stroke rates increased in children (age <18 years; 234.9 vs 165.1 per 100 000 PY; P = .012) and adults (age 31-50 years; 431.1 vs 303.2 per 100 000 PY; P = .031) in 2010 to 2019 when compared with the preceding decade. There was an increase in the rates of ICH in those aged 18 to 30 years and TIA in children <18 years from 2010 to 2019 when compared with the previous decade. Risk factors for stroke and TIA included increasing age, hypertension, and hyperlipidemia. These findings underscore the need for prevention of strokes in adults with SCD and suggest an emphasis on the management of modifiable cerebrovascular risk factors that have been demonstrated to be effective in the general population.

Six-year change in high-sensitivity cardiac troponin T with subsequent stroke risk in the general population

BackgroundThe association between change in high-sensitivity cardiac troponin T (hs-cTnT) and stroke risk in the general population remains unknown. We aimed to assess the association of a 6-year change in...

Adherence to cardiovascular medications and risk of cardiovascular disease in breast cancer patients: A causal inference approach in the Pathways Heart Study

Purpose Women with breast cancer (BC) are at high risk of developing cardiovascular disease (CVD). We examined adherence to CVD medications and their association with major CVD events over 14 years of follow-up in the Pathways Heart Study, a prospective study of 4,776 stage I-III BC patients diagnosed from 2005–2013. Methods Eligibility included being alive 6 months post-BC diagnosis, with dyslipidemia, hypertension, or diabetes at diagnosis along with ≥1 prior outpatient order or dispensing for a statin, anti-hypertensive, or diabetes medication, respectively, in the 30 months prior. Medication adherence was measured from pharmacy data to calculate cumulative average adherence (CAA). Incident heart failure (HF), ischemic heart disease (IHD), and stroke were determined via validated diagnosis and procedure codes. Working marginal structural models (MSM) fitted with inverse probability weighting evaluated the effect of adherence regimens on the hazards for each CVD event, while controlling for baseline and time-varying confounders. MSM parameterizations included: 1) CAA&lt;100% versus CAA = 100% (ref), 2) CAA&lt;80% versus CAA≥80% (ref) and 3) CAA&lt;80% versus 80%≤CAA&lt;100% versus CAA = 100%. Results Poor statin adherence (CAA&lt;80%) was associated with higher risk of composite CVD (HR = 2.54; 95% CI: 1.09, 5.94) versus CAA≥80%. Poor statin adherence was also associated with a higher risk of stroke (HR = 8.13; 95% CI: 2.03, 32.51) but not risk of IHD and HF. Further, compared with perfect adherence (CAA = 100%), good adherence (80%≤CAA&lt;100%) was associated with lower risk (HR = 0.35; 95% CI: 0.13, 0.92) while poor adherence (CAA&lt;80%) was associated with higher risk of composite CVD (HR = 2.45; 95% CI: 1.05, 5.70). Levels of adherence to anti-hypertensives and diabetes medications had mixed or null associations with risk of CVD. Conclusions Maintaining good adherence (≥80%) to statins after BC treatment is beneficial for cardiovascular health in patients with dyslipidemia. Future studies should determine factors associated with lower adherence to statins and ways to improve adherence.

A Comparison of Rural and Urban Differences in Geographic Proximity to Outpatient Stroke Rehabilitation Services in Tennessee

Purpose: Great travel distances and long travel times can be barriers to outpatient stroke rehabilitation services (OSR) receipt, but there is limited information on differences in proximity to specific OSR services between urban and potentially medically underserved rural areas. Accordingly, we compared travel distance and time to the nearest service for different OSR services between rural and urban counties in Tennessee. Methods: We conducted data scraping on Google Maps to locate Tennessee facilities offering any of the 13 American Heart Association recognized OSR services. We conducted manual validation by calling located facilities and visiting facility websites. We used the Wilcoxon rank sum test to examine if mean travel distance and time to a specific OSR service differed significantly between rural and urban counties. Results: All OSR services but audiology were available in Tennessee. In rural counties, social work had the highest median of mean travel distance (135.2 km), chaplaincy the highest median of mean travel time (113.5 min), and physical therapy the lowest distance (37.7 km) and time (36.3 min). Except for social work, rural counties had significantly higher travel distance and time than urban counties (P &lt; .01) for all OSR services. Conclusions: Rural Tennessee counties had significantly higher travel distance and time for almost all OSR services compared to urban areas. These findings from a largely rural state with high stroke risk factor prevalence suggest that additional focus on establishing maximum travel limits for OSR are warranted to overcome transportation barriers to enhance post-stroke services access in similar areas.

Association between intensive blood pressure lowering and stroke-free survival among patients with and without Diabetes

This study pooled data from SPRINT (Systolic Blood Pressure Intervention Trial) and ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) trial to estimate the treatment effect of intensive BP on stroke prevention, and investigate whether stroke risk score impacted treatment effect. Of all the potential manifestations of the hypertension, the most severe outcomes were stroke or death. A composite endpoint of time to death or stroke (stroke-free survival [SFS]), whichever occurred first, was defined as the outcome of interest. Participants without prevalent stroke were stratified into stroke risk tertiles based on the predicted revised Framingham Stroke Risk Score. The stratified Cox model was used to calculate the hazard ratio (HR) for the intensive BP treatment. 834 (5.92%) patients had SFS events over a median follow-up of 3.68 years. A reduction in the risk for SFS was observed among the intensive BP group as compared with the standard BP group (HR: 0.76, 95% CI: 0.65, 0.89; risk difference: 0.98([0.20, 1.76]). Further analyses demonstrated the significant benefit of intensive BP treatment on SFS only among participants having a high stroke risk (risk tertile 1: 0.76 [0.52, 1.11], number needed to treat [NNT] = 861; risk tertile 2: 0.87[0.65, 1.16], NNT = 91; risk tertile 3: 0.69[0.56, 0.86], NNT = 50). Intensive BP treatment lowered the risk of SFS, particularly for those at high risk of stroke.

Tissue Oedema Following Pulsed Field Ablation Recognized during a Concomitant Left Atrial Appendage Closure Procedure. A Case Report

Abstract Background In patients with non-valvular atrial fibrillation (AF), at high stroke risk and who are ineligible for long-term oral anticoagulation the left atrial appendage closure (LAAC) could be an alternative to anticoagulation. Pulsed field ablation (PFA) is a new nonthermal method for cardiac ablation modality based on high-voltage electrical energy for irreversible electroporation. We first report a case of a concomitant PFA pulmonary vein isolation and LAAC. Case Summary A 74-year-old female patient was referred to our department for pulmonary vein isolation (PVI) for persistent AF (CHA2DS2-VASc Score 5). A concomitant percutaneous LAAC was proposed because of a history of previous cerebellar transient ischemic attack despite continuous oral anticoagulation therapy. PVI was achieved with a pentaspline PFA catheter, LAAC performed with a WATCHMAN FLXTM device (Boston Scientific, Plymouth, MN, USA). After PVI, a swelling of the left atrial ridge was observed, yet a 27 mm LAAC device was successfully implanted. The follow-up transesophageal echo (TEE) after 6 weeks showed complete resolution of the oedema, no device related thrombus but a slight proximal tilting of the LAAC device without leakage could be observed. The 6-month follow-up demonstrated a stable sinus rhythm, no stroke or bleeding events were recorded. Discussion In this case of synchronous PFA-PVI procedure in AF and Watchman FLXTM device implantation, the electroporation created an acute oedema at the ridge level which at the TEE follow-up after 6 weeks was resolved. This resulted in a slightly tilted Watchman device position which was nevertheless stable and showed no leakage.

The Evaluation of Content Relevance and Representativeness of the New Stroke Risk Screening Scales.

Stroke is a leading cause of death and disability worldwide. Early and comprehensive risk identification is essential for identifying individuals at high risk for stroke. This study aimed to evaluate each question in the new Stroke Risk Screening Scales (SRSS) and assess the domains for content relevance and representativeness. Initially, six stroke experts were invited to evaluate the SRSS questions. The content validity index (CVI), including the item-CVI (I-CVI) and the average-CVI (Ave-CVI), was then calculated. In our study, the acceptable standards for I-CVI and Ave-CVI were ≥0.78 and ≥0.9, respectively. The results showed that all invited experts accepted the invitation and evaluated the SRSS questions. The previous version of the SRSS consisted of 33 questions. Of these, 30 questions reached an I-CVI of ≥0.78, indicating good content validity. Three questions had an I-CVI of 0.67 and were considered invalid; thus, they were deleted. The overall instrument achieved an Ave-CVI of 0.95. Comprehensive SRSS are essential for effective stroke prevention planning. By facilitating the early identification of individuals at high risk for stroke, these scales help reduce the incidence and impact of stroke. The high content validity found in this study supports the reliability of the SRSS as a screening tool. In the future, implementing such validated scales in clinical practice can improve early intervention strategies, ultimately enhancing health outcomes and optimizing the use of healthcare resources.

Impact of adherence on the cost-effectiveness of apixaban and rivaroxaban in stroke prevention among patients with atrial fibrillation in the United States

ABSTRACT Objective Despite the beneficial effects of DOACs, suboptimal adherence is widely documented, and real-world adherence is lower than in clinical trials. The objective of this study is to compare the cost-effectiveness of apixaban versus rivaroxaban for stroke prevention by incorporating real-world adherence from the US payer’s perspective. Methods We developed a Markov model with three health states to evaluate the total costs and quality-adjusted life years (QALY) at a willingness to pay threshold of $100,000. The population was a hypothetical cohort of 65-year-old patients with moderate to high stroke risk. The transition probabilities of healthy adherent, nonadherent, and stroke were obtained from a Medicare Advantage Plan. The utilities and costs were obtained from prior clinical studies. Deterministic and probabilistic sensitivity analyses were conducted. Results Apixaban was cost-effective than rivaroxaban at a willingness to pay threshold of $100,000. Apixaban yielded an additional 0.12 QALYs at a cost of $1904.39, resulting in an incremental cost-effectiveness ratio (ICER) of $16,279.25 per QALY gained. The Monte Carlo simulations indicated that apixaban was cost-effective at 89.67% of simulations. The ICER results were impacted by the medical costs among nonadherent patients. Conclusion After incorporating adherence, apixaban 5 mg was a cost-effective alternative to rivaroxaban 20 mg for stroke prevention among elderly atrial fibrillation (AF) patients.

Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials.

The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. These pre-specified analyses of the NOAH-AFNET 6 (n=2534 patients) and ARTESiA (n=4012 patients) trials compared anticoagulation to no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. In patients with vascular disease (NOAH-AFNET 6 56%, ARTESiA 46.0%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6 2.7%/patient-year, ARTESiA 2.3%/patient-year in both randomised groups). Meta-analysis found consistent results across both trials (I2heterogeneity=6%) with a trend for interaction with randomised therapy (pinteraction=0.08). Stroke/SE behaved similarly. Anticoagulation increased major bleeding in vascular disease patients (edoxaban 2.1%/patient-year, no anticoagulation 1.3%/patient-year; apixaban 1.7%/patient-year; no anticoagulation 1.1%/patient-year; incidence rate ratio 1.55 [1.10-2.20]) and without vascular disease (edoxaban 2.2%/patient-year; no anticoagulation 0.6%/patient-year; apixaban 1.4%/patient-year; no anticoagulation 1.1%/patient-year, incidence rate ratio 1.93 [0.72-5.20]). Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.

Interaction Effect of Shift Work and Insomnia on Stroke Risk: A 19-Year Prospective Cohort Study in Korea.

Our study aimed to investigate the association between shift work and stroke and determine whether this association varies depending on the presence of insomnia. Utilizing the KoGES prospective cohort data, our primary exposure variables were shift work and insomnia. The occurrence of stroke was the main outcome of interest. Hazards ratios and 95% confidence intervals were estimated using Cox regression analysis. An interaction analysis was conducted to assess the interaction of shift work and insomnia on stroke incidence. In the interaction analysis, shift work was significantly associated with stroke incidence only in groups with insomnia and a hazards ratio of 2.49 (95% confidence interval, 1.02-6.11). Our study demonstrated that shift work was associated with a higher risk of stroke among the population with insomnia.

Hypertensive retinopathy can predict stroke: A systematic review and meta-analysis based on observational studies

ObjectiveThe aim of this study was to determine whether hypertensive retinopathy is specifically associated with stroke. MethodsThe relevant studies published until December 18, 2023 were identified as well as selected from PubMed, Embase, Web of science, WanFang, CNKI, VIP, and CBM databases. Hazard ratios (HRs), risk ratios (RRs), and 95% confidence intervals (CIs) were combined. ResultsSix cohort studies were included in this analysis. Patients with hypertensive retinopathy exhibited a significantly higher overall risk of stroke than those without hypertensive retinopathy (RR=1.46, 95%CI: 1.29-1.65). When subgroups were analyzed by region, patients with hypertensive retinopathy in Asia had the highest risk of stroke (RR=1.53, 95%CI: 1.33-1.77). In addition, among the different severity grades of hypertensive retinopathy, the risk of stroke in patients with grade 3/4 hypertensive retinopathy (RR=1.82, 95%CI: 1.41-2.34) was observed to be higher than that in patients with grade 1/2 hypertensive retinopathy (RR=1.43, 95%CI: 1.27-1.61). ConclusionsHypertensive retinopathy was found to be associated with an increased risk of stroke. Thus, it is necessary to include retinopathy in the routine screening of patients with hypertension.

Hybrid Surgery for symptomatic chronic internal carotid artery occlusion: a single-center experience.

Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO. This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes. The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100% for revascularization (n = 27), with a perioperative complication rate of 14.8% (n = 4). Following a median follow-up of 6.0months (IQR, 4-10), 21 patients underwent a DSA or CT angiography reexamination, confirming a vascular patency rate of 90.5% (n = 19). One patient required surgery for severe in-stent restenosis, and another experienced asymptomatic occlusion. Clinical follow-ups were conducted for all 26 patients; no new strokes were reported in the qualifying artery territory, with 13 patients scoring 0, 12 scoring 1, and 1 scoring 2 on the mRS. Although hybrid surgery represent a promising option for treating chronic ICAO, they are also associated with a relatively high incidence of treatment-related complications. The application of composite surgery should be based on standardized technical guidelines and the careful selection of patients who are genuinely at high risk for recurrent strokes.

Sex Differences in the Risk of Stroke Associated With Traditional and Non-Traditional Factors in a US Cohort of People With HIV Infection.

Although stroke risk associated with HIV may be greater for women than men, little is known about whether the impact of different factors on cerebrovascular risk varies by sex in people with HIV (PWH) and contributes to stroke risk disparities in this population. The primary objective of this study was to examine whether sex modifies the effect of demographics, cardiometabolic factors, health-related behaviors, and HIV-specific variables on stroke risk in PWH from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. In this observational cohort study, we analyzed data from clinical encounters for PWH followed at 5 CNICS sites from approximately 2005 to 2020. All potential stroke events were adjudicated by neurologists. Patient-reported outcomes collected at clinic visits, including substance use and depression, were also available. We used Cox proportional hazards models to determine whether sex modified the association of predictors of interest with incident stroke. Among 13,573 PWH (19% female sex at birth, mean age 44 years, mean follow-up 5.6 years), female sex was associated with a higher risk of stroke only among individuals aged 50 years or younger (hazard ratio [HR] 2.01 at age 40 [1.25-3.21] vs HR 0.60 at age 60 [0.34-1.06]; p = 0.001 for the interaction). Younger female participants who developed a stroke were more likely to have treated hypertension, a higher cardiovascular risk score, and detectable HIV than younger male participants whereas these factors were comparable by sex among older participants who developed a stroke. Sex modified the effect of detectable HIV (HR 4.66 for female participants [2.48-8.74] vs HR 1.30 for male participants [0.83-2.03]; p = 0.001 for the interaction), methamphetamine use (HR 4.78 for female participants [1.47-15.56] vs HR 1.19 for male participants [0.62-2.29]; p = 0.04 for the interaction), and treated hypertension (HR 3.44 for female participants [1.74-6.81] vs HR 1.66 for male participants [1.14-2.41]; p = 0.06 for the interaction) on stroke risk. Younger female participants with HIV were at elevated cerebrovascular risk compared with younger male participants. Several risk factors had a greater adverse effect on stroke risk in female participants than in male participants, including HIV viremia, methamphetamine use, and treated hypertension. These findings underscore the importance of a personalized approach to predict and prevent cerebrovascular risk among PWH.

Do interaction and joint effects between physical activity and dietary inflammatory index modify stroke risk?

ObjectiveStroke is a major public health threat, and both physical activity (PA) and diet are modifiable risk factors for stroke. This study assessed the interaction and joint effects of PA and the dietary inflammatory index (DII) on stroke. MethodsWe included 18,676 participants from the 2007–2020 National Health and Nutrition Examination Survey. The independent associations, interactions, and joint effects of PA and the DII on stroke were assessed by weighted multivariable logistic regression. ResultsThe weighted mean age of the participants was 48.24 years, and comprised 703 individuals who had experienced a stroke. After adjusting for confounders, increased stroke risk was independently associated with a higher DII (Q4, odds ratio [OR]: 1.72, 95 % confidence interval [CI]: 1.27–2.34) and insufficient PA (inactive, OR: 1.37, 95 % CI: 1.05–1.78). No significant multiplicative (OR: 1.11, 95 % CI: 0.34–1.93) or additive (relative excess risk due to interaction: 0.45, 95 % CI: 0.35–1.25) interactions were found between DII and PA. The results of joint associations indicated that individuals who consumed the most pro-inflammatory diet (DII, Q4) and were physically inactive (OR: 2.39, 95 % CI: 1.61–3.56) had the highest stroke risk than those who consumed the most anti-inflammatory diet (DII, Q1) and were physically active. ConclusionActive PA and low DII scores are independent protective factors against stroke. Although the multiplicative and additive effects of the DII and PA on stroke risk are not statistically significant, the analysis of their joint effects suggest that individuals who consume anti-inflammatory diets and exhibit active PA consistently have the lowest risk of stroke.