Independent Risk Factor For Stroke Research Articles

Assessing the Impact of Intensified Hypertension (HTN) Treatment Guidelines: A Single Center Experience.

Hypertension (HTN) is an independentrisk factor for heart disease, stroke, and premature death. In 2017 there was a shift in the definition of HTN by the American College of Cardiology (ACC), as well as the American Heart Association (ACC/AHA), resulting in lower blood pressure (BP) readings meeting criteria for diagnosis. Our study aimed to explore the impact the change had on a single cardiology practice's management of patients with HTN. We performed a retrospective chart review of a single cardiology practice. We separated the time into two categories: 12 months before and 12 months after the reclassification of HTN categories in November 2017. A paired t-test analysis was done comparing averaged blood pressures (BPs) in each of the two time periods, as well as the number of medications in each time period and several subgroup analyses. A total of 441 patients were included in the final analysis. Patients were prescribed an average of 2.61± 1.20 medications at baseline, and 2.74 ± 1.22 medications post-reclassification (p < 0.0001). There was an average of 0.82 ± 1.28 medication changes per patient. The overall average BP was 133.7 ± 14.1/76.4 ± 9.5 at baseline, and 131.3 ± 13.1/76.7 ± 7.7 after the recategorization [Δ -2.41 (95% CI 1.18-3.63)/0.269 (95% CI -0.29 to 0.459); p<0.0001 for systolic blood pressure (SBP), p=0.467 for diastolic blood pressure (DBP)]. The change in definition of HTN significantly impacted this single cardiology practice. There was astatistically significant increase in antihypertensive medications prescribed with an expected decrease in BP observed in this study.

Insulin resistance in ischemic stroke: Mechanisms and therapeutic approaches.

The pathological condition of insulin resistance prevents the neuroprotective effects of insulin. Numerous studies have demonstrated that insulin resistance, as an independent risk factor for ischemic stroke, accelerates the formation of thrombosis and promotes the development of atherosclerosis, both of which are major mechanisms of ischemic stroke. Additionally, insulin resistance negatively affects the prognosis of patients with ischemic stroke regardless of whether the patient has diabetes, but the mechanisms are not well studied. We explored the association between insulin resistance and the primary mechanisms of brain injury in ischemic stroke (inflammation, oxidative stress, and neuronal damage), looking for potential causes of poor prognosis in patients with ischemic stroke due to insulin resistance. Furthermore, we summarize insulin resistance therapeutic approaches to propose new therapeutic directions for clinically improving prognosis in patients with ischemic stroke.

Racial disparity in cardiovascular morbidity and mortality associated with obstructive sleep apnea: The sleep heart health study

BackgroundAfrican Americans (AA) have higher prevalence of cardiovascular diseases (CVD) and obstructive sleep apnea (OSA) compared to Whites. Previous research demonstrated increased risk of cardiovascular complications from OSA but there is paucity of data about any interaction of race on this effect. Sleep Heart Health Study (SHHS) is a multi-center cohort study that was done to determine the cardiovascular consequences of OSA. Using this data, we assessed the racial disparity of various CVD incidence and mortality between Whites and AA associated with OSA. MethodsWe analyzed data from 5692 participants. Logistic regressions were done to compare the incidence of all CVD and stroke between White and AA. Cumulative death risk from all causes over 13 years were assessed by Cox's proportional hazard model. All models were adjusted for age, BMI, gender, education, hypertension, diabetes, smoking, total sleep time and OSA. ResultsCompared to Whites, AA had higher adjusted odds of developing any CVD (OR = 1.6, 95% CI = 1.19–2.15) and stroke (OR = 1.71, 95 CI = 1.13–2.61). OSA remains an independent risk factor for CVD (OR = 1.15, 96% CI = 1.01–1.47) and stroke (OR = 1.36, 95% CI = 1.04–2.16) after adjusting for race and other covariates. The cumulative adjusted mortality risk was 1.24 times higher in AA than White (95% CI = 1.02–1.51) during this follow up period. Subjects with OSA in highest AHI quartile had 1.35 times (95% CI = 1.13–1.63) higher mortality compared to lowest quartile. ConclusionAA race and untreated OSA are independent predictors for new onset CVD, stroke and higher all-cause mortality, after adjusting for cardiovascular risk factors.

Inter-sleep stage variations in corrected QT interval differ between obstructive sleep apnea patients with and without stroke history.

Obstructive sleep apnea (OSA) is related to the progression of cardiovascular diseases (CVD); it is an independent risk factor for stroke and is also prevalent post-stroke. Furthermore, heart rate corrected QT (QTc) is an important predictor of the risk of arrhythmia and CVD. Thus, we aimed to investigate QTc interval variations in different sleep stages in OSA patients and whether nocturnal QTc intervals differ between OSA patients with and without stroke history. 18 OSA patients (apnea-hypopnea index (AHI)≥15) with previously diagnosed stroke and 18 OSA patients (AHI≥15) without stroke history were studied. Subjects underwent full polysomnography including an electrocardiogram measured by modified lead II configuration. RR, QT, and QTc intervals were calculated in all sleep stages. Regression analysis was utilized to investigate possible confounding effects of sleep stages and stroke history on QTc intervals. Compared to patients without previous stroke history, QTc intervals were significantly higher (β = 34, p<0.01) in patients with stroke history independent of age, sex, body mass index, and OSA severity. N3 sleep (β = 5.8, p<0.01) and REM sleep (β = 2.8, p<0.01) increased QTc intervals in both patient groups. In addition, QTc intervals increased progressively (p<0.05) towards deeper sleep in both groups; however, the magnitude of changes compared to the wake stage was significantly higher (p<0.05) in patients with stroke history. The findings of this study indicate that especially in deeper sleep, OSA patients with a previous stroke have an elevated risk for QTc prolongation further increasing the risk for ventricular arrhythmogenicity and sudden cardiac death.

Acute Ischemic Stroke in Tubercular Meningitis Patients Without Conventional Vascular Risk Factors: A Retrospective Case Control Study.

Ischemic stroke is a common complication in patients with tubercular meningitis (TBM). However, the risk factors for Ischemic stroke in TBM patients are not fully understood, especially in those patients without conventional vascular risk factors. The aim of the present study was to explore the clinical features and independent risk factors for tubercular meningitis-related Ischemic stroke (TBMRIS). Tubercular meningitis patients with acute Ischemic stroke without conventional vascular risk factors were recruited between July 2010 and July 2020 as the TBMRIS group. Patients who solely had tubercular meningitis were recruited as the control group (TMB group). Demographic characteristics, clinical presentations, and cerebrospinal fluid (CSF) examinations were collected, and multiple logistic regression analysis was applied to analyse the independent risk factors for TBMRIS. A total of 70 TBMRIS patients and 70 TMB patients were enrolled. Most (82.86%) of the TBMRIS patients experienced Ischemic stroke events within 3 months after the diagnosis of tubercular meningitis. The multiple logistic regression analysis revealed that variation in red blood cell distribution width (RDW-CV), mean platelet volume (MVP), C-reactive protein (CRP), CSF glucose and Modified Research Council Grade II (MRC Grade II) were independent risk factors for TBRIS. The AUC of the identification model was 0.808, with a sensitivity of 68.60% and a specificity of 84.30%. This study revealed that RDW-CV, MVP, CRP, CSF glucose and MRC Grade II are potential independent risk factors for TBMRIS. The identification model established in this study may help monitor TBM patients who are at high risk of developing TBMRIS.

Left Atrial Diameter and the Risk of Thromboembolism in Patients with Left Ventricular Noncompaction.

Aims: Patients with left ventricular noncompaction (LVNC) are at risk of thromboembolism. The relationship between left atrial diameter (LAD), a robust predictor for thrombosis, and LVNC is unclear. The purpose of this study was to explore the effect of LAD on the thrombotic risk in LVNC. Methods: In this retrospective cohort study, 320 patients with imaging characteristics of LVNC were included for statistical analysis. The primary endpoint was a composite event of intracardiac thrombi and stroke or transient ischemic attack (TIA). The secondary endpoints were intracardiac thrombi and stroke/TIA. Results: The 320 included patients (211 [65.9%] men, median age: 45 years [interquartile range: 30−57]) were divided into LAD1 (<43 mm, n = 157) and LAD2 (≥43 mm, n = 163) groups based on the median LAD. Throughout the median follow-up of 34 months, the incidence of thromboembolism among them was 7.2%: 11 (3.4%) patients had stroke/TIA and 14 (4.4%) had intracardiac thrombi. The rate of thromboembolism in the LAD2 group was higher than that of patients in the LAD1 group (11.0% vs. 3.2%, p = 0.007). Kaplan−Meier survival curves suggested that a LAD ≥ 43 mm was associated with a higher risk of thromboembolism and intracardiac thrombi (log-rank test, all p < 0.05). After adjusting for potential risk factors, LAD ≥ 43 mm was found to be an independent risk factor for thromboembolism (p = 0.013) and stroke (p = 0.024). The area under the receiver operating characteristic curve of LAD for predicting thromboembolism reached 0.696 at 1 year, 0.635 at 2 years, and 0.660 at 3 years. Conclusions: A larger LAD was related to a higher risk of thromboembolism in patients with LVNC. The LAD may be a useful predictor for thrombotic risk stratification among such patients.

Mechanical function of the left atrium within 28 days after restoration of sinus rhythm in patients with paroxysmal atrial fibrillation

Objective: Atrial fibrillation is a strong independent risk factor for cardioembolic stroke, with a significant impact on morbidity, mortality and healthcare costs. The aim of our study is to investigate left atrial mechanical function in healthy subjects and patients with atrial fibrillation paroxysms less than 48 hours with low risk of thromboembolic complications at 1 and 28 days after restoration of sinus rhythm. Methods: Thirty-six healthy controls and patients with paroxysms of non-valvular atrial fibrillation less than 48 hours (n=25) with low-risk CHA2DS2VASc score were included in the study. The mechanical function of the left atrium (LA) was investigated by the 2D speckle tracking program. Transthoracic echocardiography was performed on the 1st and 28th days after restoration of sinus rhythm by pharmacological cardioversion. Results: Despite the absence of differences in left ventricular systolic function and LA size between the groups, there was a significant decrease in LA deformation and strain rate on day 1 immediately after sinus rhythm recovery in the patients. In the pump phase, the decrease was about 3%, reservoir phase – 10%, and conduit phase – 7% compared to the control group. The strain rate also decreased in the patient group: -1.5 s-1 versus control: -2.14 s-1 (p&amp;lt;0.0001). On the 28th day after restoration of sinus rhythm, there were significant changes in reservoir and conduit functions in patients group in comparison with control group. Global longitudinal LA strain (reservoir phase) decreased to 7%, conduit phase decreased to 11% compared with the control group. In patients group we can see the dynamics during 28 days: pump phase and strain rate were significantly improved, however reservoir and conduit did not significantly change and were lower than in healthy. Conclusion: Mechanical function of the LA in patients with non-valvular atrial fibrillation and low risk of thromboembolic complications, studied with speckle tracking on the first day was significantly impaired compared with the control group (reservoir phase and strain rate). By day 28, mechanical function improved compared to day 1, but reservoir phase remained significantly lower than normal.

Analysis of Dyslipidemia as per Ayurveda and its Management

Dyslipidaemias refers to any abnormality in the level of circulating plasma lipids. It is an extremely significant condition, majorly because of its contribution to atherogenesis. It is an independent and modifiable risk factor for CAD and stroke. More than half of global cases of ischemic heart disease are associated with dyslipidemia. Quality of care for dyslipidemia is suboptimal in general and variable by cardiovascular disease risk group, ethnicity and gender. In modern medicine, there are effective dyslipidemic drugs which give rapid relief, but may cause some long term side effects. So there is a need for safe alternative treatment which may be effective in reducing lipid level, for prolonged use. In Ayurveda, dyslipidemia can be considered as a condition in which Kapha, Medas and Rasa are pathologically deranged due to Ama. There is defective Medo dhatu poshana due to Dhatwagnimandhya and formation of Ama at the level of Medo dhatu. It can be considered as presumable level of stage of Samprapti or a morbid state which may cause disease, but not attained a full status of disease. Nidanas include Beejadushti, Ahara – vihara –vikara and Manasika nidanas. Lipid profile can be brought back to normal by correcting Agni and ensuring proper Dhatuparinama. Treatment modalities include Nidana parivarjana, Sodhana, Samana, Rasayana and following Pathyapathya. Drug having Kaphamedohara, Deepana, Pachana, Ruksha and Lekhana property is useful to treat this clinical condition.

Risk factors for ischemic cerebral stroke in patients with acute amaurosis fugax

ObjectifSelon la National Stroke Association et l'American Heart Association, l'ischémie rétinienne, comme celle qui se produit pendant une amaurose transitoire (AT), est une forme d'accident vasculaire cérébral (AVC). Notre étude visait à évaluer les facteurs de risque d'accident ischémique cérébral chez les patients hospitalisés en raison d'une AT aiguë. MéthodesOn a consulté la base de données NIS (National Inpatient Sample) pour recenser les patients d'au moins 21 ans qui avaient reçu un diagnostic primaire d'AT au moment de leur admission (code 362.34 de la neuvième édition de la classification internationale des maladies [ICD-9]) entre 2002 et 2014. Les mesures liées aux comorbidités et les incidents qui sont survenus pendant l'hospitalisation ont été recensés à l'aide des codes ICD-9 pertinents. On a eu recours au logiciel IBM SPSS 25 et au package R pour réaliser les analyses statistiques. RésultatsUn total pondéré de 12 142 patients a été identifié. Les troubles concomitants les plus fréquents au sein de cette cohorte présentant une AT comprenaient l'hypertension, la dyslipidémie, le tabagisme, la coronaropathie et le diabète de type 2. Selon l'analyse de régression multiple, certaines affections concomitantes – hypercoagulabilité, vascularite systémique, coronaropathie et athérosclérose – constituent des facteurs de risque indépendants d'accident ischémique cérébral en présence d'AT. En revanche, la dyslipidémie a été associée à une réduction du risque. Le risque était 5 fois plus élevé chez les Asiatiques et les personnes provenant des îles du Pacifique, comparativement aux Caucasiens. ConclusionOn a diagnostiqué un accident ischémique cérébral et un infarctus du myocarde chez 0,3 % à 0,9 % des patients hospitalisés en raison d'une AT aiguë. L'hypercoagulabilité, la vascularite systémique, la coronaropathie et l'athérosclérose étaient des facteurs de risque indépendants d'accident ischémique cérébral, chacun multipliant le risque par plus de 3. Les patients qui présentent ces facteurs de risque conjointement à une AT aiguë doivent faire l'objet d'une surveillance étroite en raison du risque de thrombose généralisée aiguë.

Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms.

The authors undertook an evaluation of periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms (IVADAs) and assessed the relevant risk factors. The authors included a series of 195 patients who had undergone endovascular treatment for 198 IVADAs. Clinical data, morphological characteristics, treatment details, and periprocedural cerebrovascular complications including intraprocedural rupture, intraprocedural thrombosis, intracranial hemorrhage (ICH), transient ischemic attack (TIA), and ischemic stroke (IS) were recorded. After evaluation of the 30-day modified Rankin Scale (mRS) scores, the authors applied univariate and multivariate logistic regression analyses to identify the risk factors for complications and 30-day unfavorable clinical outcomes. There were no intraprocedural ruptures, but the authors recorded intraprocedural thrombosis (n = 5), ICH (n = 3), TIA (n = 1), and IS (n = 13), comprising an 11.1% (22/198) complication rate. Multivariate logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.20-8.41, p = 0.020), IS history (OR 5.55, 95% CI 1.46-21.01, p = 0.012), and subarachnoid hemorrhage (SAH) (OR 4.48, 95% CI 1.52-13.20, p = 0.007) were risk factors for overall complications, whereas aneurysmal height (OR 0.77, 95% CI 0.61-0.98, p = 0.032) was a protective factor. SAH (OR 6.44, 95% CI 1.54-26.89, p = 0.011) and preprocedural mRS score > 2 (OR 5.07, 95% CI 1.01-25.59, p = 0.049) were independent risk factors for perforator occlusion stroke. Periprocedural cerebrovascular complications (OR 32.09, 95% CI 3.00-343.94, p = 0.004) and preprocedural mRS score > 2 (OR 319.92, 95% CI 30.28-3379.98, p < 0.001) were independent risk factors for 30-day unfavorable clinical outcomes. Hyperlipidemia, IS history, and SAH were independent predictors for overall periprocedural cerebrovascular complications of endovascular treatment for IVADAs, but aneurysmal height was an independent protective factor. SAH and preprocedural mRS score > 2 were independent risk factors for perforator occlusion stroke. Preprocedural mRS score > 2 and periprocedural complications were independent risk factors for 30-day unfavorable clinical outcomes.

Elevated sdLDL level and LDLR rs688 C>T mutation are independent risk factors for ischemic stroke

PurposeTo investigate the level of sdLDL and the frequency of LDLR rs688 polymorphisms, as well as the correspondence between them, and to analyze the risk factors for stroke. MethodsBetween March 2019 and November 2019, 232 patients diagnosed with stroke and 96 health volunteers were enrolled in Quanzhou First Hospital. Subjects were divided into control group, ischemic stroke group (n=120) and hemorrhagic stroke group (n=112). The level of sdLDL and the genotypes and allele frequencies of LDLR rs688 were compared between groups, the correspondence was analyzed with Spearman method. Risk factors were analyzed with Binary logistic regression. ResultsThe level of sdLDL was highest in ischemic group, followed by hemorrhagic stroke group and lowest control group. The differences of genotypes and allele frequencies of LDLR rs688 were significant in ischemic stroke group (p=0.0000 and 0.0000 respectively), while were not significant in hemorrhagic group (p=0.184 and .0137). There was no obvious correlation between the level of sdLDL and LDLR rs688 genotype by Spearman analysis (p=0.116). ConclusionElevated sdLDL level and the C>T mutation of LDLR rs688 are independent risk factors for ischemic stroke, while they are not correlative to hemorrhagic stroke. The surveillance and regulatory of sdLDL level, the detection of LDLR rs688 gene polymorphisms may contribute to the prevention of ischemic stroke.

Prevalence of stroke and associated risk factors: a population-based cross-sectional study from the Qinghai-Tibet Plateau of China

Background and objectivesThe epidemiology of stroke at high altitudes has not been extensively studied, especially at heights of 4000 m and above. Thus, stroke prevention and treatment at high altitudes...

PSAT026 A Treatable but Commonly Missed Etiology of Cerebrovascular Disease in Younger Adults; A Case of Primary Hyperaldosteronism Presented with Hemorrhagic Stroke.

Abstract Introduction Primary hyperaldosteronism is the leading cause of secondary hypertension. Although PH is an independent risk factor for acute stroke, it seems to be underdiagnosed as a cause of hypertensive emergencies. Here we discuss a case of a patient who presented with hypertensive emergency and stroke-like symptoms, eventually found to have hyperaldosteronism. Case Presentation A case of a 46-year-old male with a past medical history of uncontrolled hypertension and hypokalemia was admitted for acute onset of left-sided numbness and weakness associated with slurred speech. On admission, blood pressure was 292/156mmHg; physical exam revealed flaccid paralysis on the left upper and lower extremities, decreased sensation to light touch, and pinprick in the left side of the body. Initial potassium was 2.2mmol/L. CT scan of the brain revealed intracranial hematoma in the right basal ganglia, which brain MRI confirmed. The patient was first started on strict blood pressure control with IV medications and transitioned to oral antihypertensive and potassium supplementation. Given resistant hypokalemia, plasma renin activity and serum aldosterone levels were ordered and revealed to be 0.771ng/mL/hr. and 24.4ng/dL with a ratio &amp;gt;20 (31.26). The patient was started on spironolactone, and CT abdomen and pelvis with contrast revealed a 1.8cm nodule of the left adrenal. The patient's blood pressure and electrolyte abnormalities improved. Further evaluation with adrenal vein sampling to localize the functional adrenal tumor and possible surgery deferred until his neurological deficits improve. Discussion This case report emphasizes the consequences of primary hyperaldosteronism given that the aldosterone excess has detrimental cardiovascular and cerebrovascular effects that are in part independent of high blood pressure. Early detection of a disease that was previously believed to be rare has an essential impact on clinical outcomes and survival, especially in the younger population. Studies have shown that the overall risk of stroke was almost three times higher than that of patients with essential hypertension. Despite this elevated risk, the most significant problem in underdiagnosis is that the screening test is often not even performed. Screening guidelines for primary hyperaldosteronism consist of serum aldosterone/renin ratio; only done when there is suspicion of a secondary hypertension causes. The diagnosis of PH should not only rest on endocrinologists but also on primary care providers, who are initially the point of contact when hypertension is first detected. Conclusion PH is an identified risk factor for CVA; however, its diagnosis can be challenging if the CVA is the initial feature. This case sheds light on considering PH among the differential diagnosis when facing younger patients presenting with CVA in the setting of persistent hypertension and hypokalemia. Once diagnosed and adequately treated, it decreases the risk of CVA and avoids further complications. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT026 A Treatable but Commonly Missed Etiology of Cerebrovascular Disease in Younger Adults: A Case of Primary Hyperaldosteronism Presented with Hemorrhagic Stroke

Abstract Introduction Primary hyperaldosteronism is the leading cause of secondary hypertension. Although PH is an independent risk factor for acute stroke, it seems to be underdiagnosed as a cause of hypertensive emergencies. Here we discuss a case of a patient who presented with hypertensive emergency and stroke-like symptoms, eventually found to have hyperaldosteronism. Case Presentation A case of a 46-year-old male with a past medical history of uncontrolled hypertension and hypokalemia was admitted for acute onset of left-sided numbness and weakness associated with slurred speech. On admission, blood pressure was 292/156mmHg; physical exam revealed flaccid paralysis on the left upper and lower extremities, decreased sensation to light touch, and pinprick in the left side of the body. Initial potassium was 2.2mmol/L. CT scan of the brain revealed intracranial hematoma in the right basal ganglia, which brain MRI confirmed. The patient was first started on strict blood pressure control with IV medications and transitioned to oral antihypertensive and potassium supplementation. Given resistant hypokalemia, plasma renin activity and serum aldosterone levels were ordered and revealed to be 0.771ng/mL/hr. and 24.4ng/dL with a ratio &amp;gt;20 (31.26). The patient was started on spironolactone, and CT abdomen and pelvis with contrast revealed a 1.8cm nodule of the left adrenal. The patient's blood pressure and electrolyte abnormalities improved. Further evaluation with adrenal vein sampling to localize the functional adrenal tumor and possible surgery deferred until his neurological deficits improve. Discussion This case report emphasizes the consequences of primary hyperaldosteronism given that the aldosterone excess has detrimental cardiovascular and cerebrovascular effects that are in part independent of high blood pressure. Early detection of a disease that was previously believed to be rare has an essential impact on clinical outcomes and survival, especially in the younger population. Studies have shown that the overall risk of stroke was almost three times higher than that of patients with essential hypertension. Despite this elevated risk, the most significant problem in underdiagnosis is that the screening test is often not even performed. Screening guidelines for primary hyperaldosteronism consist of serum aldosterone/renin ratio; only done when there is suspicion of a secondary hypertension causes. The diagnosis of PH should not only rest on endocrinologists but also on primary care providers, who are initially the point of contact when hypertension is first detected. Conclusion PH is an identified risk factor for CVA; however, its diagnosis can be challenging if the CVA is the initial feature. This case sheds light on considering PH among the differential diagnosis when facing younger patients presenting with CVA in the setting of persistent hypertension and hypokalemia. Once diagnosed and adequately treated, it decreases the risk of CVA and avoids further complications. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Outcomes and role of shunting during carotid endarterectomy for symptomatic patients.

Shunt placement during carotid endarterectomy (CEA) has often been advocated to protect the ischemic penumbra in patients with symptomatic carotid stenosis. In the present study, we assessed the effect of shunt placement during CEA on postoperative stroke risk in symptomatic patients. We queried the American College of Surgeons National Surgical Quality Improvement Program database (2016-2019) for CEA cases with complete CEA procedure-targeted data available. Symptomatic patients were identified as those with a preoperative diagnosis of stroke on presentation (DS), transient ischemic attack, amaurosis fugax, or temporary monocular blindness. The DS patients were further analyzed according to the severity of their stroke using the modified Rankin scale scores. To better assess the effect of shunt placement on the stroke rate, we compared cases of CEA with the patch angioplasty technique stratified by the use of an intraoperative shunt. Patients who had undergone carotid eversion or primary closure were excluded. The baseline demographics and perioperative outcomes were compared using the χ2 and Mann-Whitney U tests. Multivariate analysis was performed to identify the independent risk factors for postoperative stroke and cranial nerve injury. We identified 4652 cases of CEA with patch angioplasty in symptomatic patients, including 1889 with (40.6%) and 2763 without (59.4%) shunt placement. The distribution of age, race, and sex was similar for both procedures. Compared with patients without a shunt, those with a shunt had significantly higher rates of emergency surgery (9.1% vs 7.0%; P= .010), nonelective surgery (40.3% vs 37.2%; P= .035), general anesthesia (97.0% vs 86.3%; P< .001), and bleeding disorders (27.2% vs 22.7%; P< .001). The 30-day incidence of postoperative stroke was similar between the patients with (3.2%) and without (2.6%) shunt placement (P= .219). Additionally, a subgroup analysis failed to show any benefit from shunt placement on the incidence of postoperative stroke, regardless of the preoperative symptoms or neurologic disability. In contrast, shunt placement was associated with an increased rate of cranial nerve injury (4.1% vs 2.4%; P= .001). Multivariate analysis revealed that nonelective surgery (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.36-2.91; P< .001) and DS (vs transient ischemic attack, amaurosis fugax, or temporary monocular blindness; OR, 1.64; 95% CI, 1.12-2.41; P= .012) were predictive of 30-day postoperative stroke. After adjusting for confounders, shunt placement had no effect on stroke risk at 30days but remained an independent risk factor for cranial nerve injury (adjusted OR, 1.87; 95% CI, 1.32-2.64; P< .001). For symptomatic patients undergoing CEA with patch angioplasty, shunt placement was associated with an increased risk of cranial nerve injury without a reduction in postoperative stroke risk.

Comparison study of clinical presentation and risk factors for cerebrovascular stroke in diabetic versus nondiabetic patients

BackgroundDiabetes and stroke prevalence rates are increasing worldwide, and both are major human health threats causing disability and death. Diabetes is a well-known independent risk factor for stroke. In addition, diabetes increases the prevalence of other stroke risk factors; however, few studies evaluate whether diabetes may influence stroke presentation.Aim of the workThis study was conducted to assess the risk factors and clinical presentation of stroke in patients with and without diabetes.Patients and methodsThis cross-sectional study was conducted on 200 patients with radiologically confirmed acute cerebrovascular stroke, selected from tertiary care hospitals in Alexandria, Egypt. They were divided into 2 groups: group 1: 100 patients with diabetes for more than 5 years and group 2: 100 nondiabetic patients. All patients were evaluated for risk factors, stroke types, and clinical presentation.ResultsCompared with nondiabetic patients, diabetic patients with stroke had a significantly higher prevalence of hypertension (p = 0.031) and dyslipidemia (p = 0.016) and higher incidence of ischemic stroke (p = 0.030), and they were more likely to present with motor deficit (p = 0.045) and dysarthria (p = 0.048). There was a modest difference between diabetic and nondiabetic group regarding OCSP ischemic stroke subtypes, but it was non-significant.ConclusionThere was a significant difference in stroke risk factors, pathological types, and presentation between diabetic and nondiabetic patients, but not in ischemic stroke anatomical subtypes.

Correlation between Endophthalmitis and Stroke Development in Ankylosing Spondylitis Patients: A Population-Based Cohort Study.

Background: This cohort study aimed to research the correlation between endophthalmitis and stroke development in ankylosing spondylitis (AS) patients by reviewing National Health Insurance Research Database (NHIRD) data. Methods: This study obtained data from the NHIRD over a sixteen-year period. The primary outcome was stroke development. We used Fisher’s exact test and Pearson’s chi-squared test to analyze the variables. We investigated the risk factors for disease development using Cox regression analyses. We compared the cumulative incidence of stroke using Kaplan–Meier analysis. Results: The study cohort included 549 patients with AS and endophthalmitis, while the comparison cohort included 2196 patients with AS but without endophthalmitis. The stroke development was increased in the study cohort (adjusted hazard ratio, 1.873; p ≤ 0.001). The total stroke development in the study cohort and the comparison cohort was 1724.44 per 100,000 person-years and 1085.11 per 100,000 person-years, respectively (adjusted hazard ratio, 1.873; 95% confidence interval, 1.776–2.022; p < 0.001). Our study cohort showed an increased stroke rate. Conclusions: Our studies showed that endophthalmitis increases the risk of stroke in AS patients and endophthalmitis is an independent risk factor for stroke in AS patients. Nonetheless, advanced studies that thoroughly investigate the correlation between endophthalmitis and stroke in AS patients are needed to validate our findings.

Inflammation and endothelial toxicity: pathogenetic aspects of central nervous system damage due to novel coronavirus disease

Introduction. There are inconsistent data on the incidence of stroke in patients with COVID-19, including acute cerebrovascular accidents in younger people without obligate risk factors, as well as the risk of SARS-CoV-2 infection in patients with acute stroke.&#x0D; The aim of the study was to evaluate the features of concomitant stroke and COVID-19, and the role of inflammation and endothelial toxicity in cerebral damage.&#x0D; Materials and methods. The study included 1,524 patients admitted to vascular clinics across St. Petersburg in 20202021, including 1,068 people with confirmed COVID-19 infection and 551 death cases. The patients were divided into four groups depending on disease severity, for clinical and laboratory data analysis.&#x0D; Results. There were marked changes in the laboratory markers of inflammation, haemostasis, fibrinolysis, cytolysis, iron metabolism, cerebral ischaemia, proteolysis, immunodeficiency (lymphocytopenia, monocytopenia, elevated white blood cell count, elevated levels of C-reactive protein, fibrinogen, D-dimer, creatine kinase, ferritin and neutrophil elastase), with statistically significant differences when compared with patients without COVID-19. Changes in inflammatory markers in the first 2472 hours provided the most information. A multifold increase (escalation) in the marker values was always correlated with an imminent adverse outcome and was usually accompanied by subsequent laboratory confirmation of COVID-19 infection or specific signs of viral pneumonia.&#x0D; Conclusion. COVID-19 should be considered an independent risk factor for acute stroke, while the virus-induced thrombosis, manifesting in an escalation in inflammatory factors and products of endothelial damage, should be considered a pathogenetic link leading to cerebral tissue damage.

The association between total body bone mineral density and stroke: a Mendelian randomization analyses.

The recent prospective cohort study by Zhu et al.1 suggested that total bone mineral density (BMD) may be an independent risk factor for stroke, especially in men. But a report2 that includes a prospective study and meta-analysis reached the opposite conclusion. Additionally, although we all know that BMD reduction and stroke are major age-related, the above two studies lack the analysis of the relationship between BMD and stroke in different age groups. Moreover, it is difficult to infer causal effects only from observational studies because of the possibility that any identified associations may be attributable to confounding. Nowadays, Mendelian randomization (MR) is widely used to explore putative causal relationships between exposures and outcomes. Compared with observational studies, MR is less likely to be affected by confounding or reverse causation. Therefore, we used MR analysis to verify the previous researchers’ findings and assess the potential associations of BMD in different age groups with the risk of stroke.

Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation

Abstract Background Ischemic stroke is a common complication in patients with hypertrophic cardiomyopathy (HCM) (1). Although atrial fibrillation (AF) is a well-established risk factor for ischemic stroke in HCM, the risk of ischemic stroke in patients with HCM without documented AF is less recognized (1, 2). This study aimed to determine the risk of ischemic stroke and identify its risk factors in patients with HCM without documented AF. Methods This nationwide population-based cohort study used the Korean National Health Insurance database. After excluding patients with a prior history of AF, thromboembolic events, cancer, or the use of anticoagulants, we identified 8,328 HCM patients without documented AF and 1:2 propensity score-matched 16,656 non-HCM controls. The clinical outcome was an incident ischemic stroke. Results During a mean follow-up of approximately 6 years, ischemic stroke occurred in 328/8,328 (3.9%) patients with HCM and 443/16,656 (2.7%) controls. Among individuals who developed ischemic stroke, the proportion of AF concomitantly detected accounted for 26.5% (87/328) and 5.8% (26/443) in the HCM and control groups, respectively. The overall incidence of ischemic stroke was 0.716/100 person-years in the HCM group, which was significantly higher than that in the control group (0.44/100 person-years) (HR 1.643; 95% CI, 1.424–1.895; P&amp;lt;0.001, Figure 1). The subgroup analysis according to age, sex, and comorbidities (chronic heart failure, hypertension, dyslipidemia, and vascular disease) consistently demonstrated a higher risk of ischemic stroke in the HCM group (P for interaction &amp;gt;0.05). In the HCM group, age ≥65 years (adjusted hazard ratio [HR] 2.741; 95% confidence interval [CI], 2.156–3.486; P&amp;lt;0.001) and chronic heart failure (adjusted HR 1.748; 95% CI, 1.101–2.745; P=0.018) were independent risk factors for ischemic stroke. Overall incidence was 1.360/100 in patients with HCM aged ≥65 and 2.315/100 person-years years in those with chronic heart failure, respectively. Also, compared to controls aged &amp;lt;65 years and without CHF, adjusted HR for ischemic stroke was 4.756 (95% CI 3.807–5.867) in patients with HCM aged ≥65 years and 2.539 (95% CI 1.638–3.936) in those with CHF, respectively (Figure 2). Conclusions Patients with HCM without documented AF are at a higher risk of ischemic stroke than the propensity score-matched general population. Age ≥65 years and chronic heart failure are two strong independent risk factors for ischemic stroke in this population. Funding Acknowledgement Type of funding sources: None.