Ischemic Stroke Syndrome Research Articles

Risk Factors and Outcome of Cerebrovascular Complications in Transplant Recipients (P14-5.013)

<h3>Objective:</h3> To determine the incidence of cerebrovascular complications, risk factors, and outcomes in transplant patients. <h3>Background:</h3> Post-Transplant patients experience a myriad of cerebrovascular (CV) complications including ischemic stroke (IS), TIA, SAH, ICH, and posterior reversible encephalopathy syndrome (PRES). These increase mortality and morbidity in an already susceptible population. <h3>Design/Methods:</h3> Retrospective observational study. Population: Patients ≥18 years of age who underwent solid organ transplantation since 2012 at a tertiary care center. Patients were divided into 2 groups, with CV complications and without. Outcomes of interest were the proportion of CV complications, length of stay (LOS), discharge disposition, functional outcomes (defined by a mRS), and survival time post-transplant. <h3>Results:</h3> A total of 94 patients met the inclusion criteria (31% with CV complications vs 69% patients without). The median age was 57.5 years (51.41 vs 45.75). IS was the most prevalent CV complication (n=13, 44%, most common etiology was cryptogenic 76.9% (n=11)) followed by ICH (n=6, 20%), and most of the complications occurred within 1 year post-transplant (n=17, 58.6%). A previous TIA or stroke predisposed to more CV complication post-transplant (OR 0.66 vs 4.89, p=0.05) but no difference was found for other risk factors when compared to recipients without complications. Patients with complications were more likely to have lung transplants (24.1% vs 1.5%, p&lt;0.05) and to be discharged to hospice (6.9% vs 0%, p&lt;0.05) or dead (27.6% vs 0%, p&lt;0.05) than those without complications, who were more likely to have kidney transplants (20.4% vs 79.6%, p&lt;0.05) and to be discharged home (17% vs 66%, p&lt;0.001). There was no difference for the other outcomes. <h3>Conclusions:</h3> Post-transplant patients, especially lung recipients, have a high incidence of CV complications and high mortality. A history of TIA or IS predisposes this population to subsequent CV events. LOS, demographic characteristics, use of antithrombotics, or survival time post-transplant was no different between groups. <b>Disclosure:</b> Dr. Cadena Tejada has nothing to disclose. Dr. Ozark has nothing to disclose. Dr. Gregoski has nothing to disclose. Dr. Grewal has nothing to disclose.

Abstract TP195: Risk Factors And Outcome Of Cerebrovascular Complications In Transplant Recipients

Introduction: Post Transplant patients experience a great variety of cerebrovascular (CV) complications including ischemic stroke (IS), TIA, SAH, ICH, and posterior reversible encephalopathy syndrome (PRES). These increase mortality &amp; morbidity in an already susceptible population but the incidence of these complications, risk factors, and outcomes in transplant recipients have not been examined in detail. Methods: Design: A retrospective observational study. Population: Patients &gt;18 years of age who underwent solid organ transplantation since 2012 at a tertiary care center. Patients were divided into 2 groups, with CV complications and without. Outcomes of interest were the proportion of CV complications, length of stay (LOS), discharge disposition, functional outcomes (defined by a mRS), and survival time post-transplant. Results: A total of 94 patients met the inclusion criteria (31% (n=29) with CV complications vs 69% (n=65) patients without). The median age was 57.5 years (51.41 vs 45.75 p&gt;0.05). IS was the most prevalent CV complication (n=13, 44%, most common etiology was cryptogenic 76.9% (n=11)) followed but ICH (n=6, 20%), and most of CV complications occurred within 1 year post-transplant (n=17, 58.6%). Patients with past history of TIA or stroke were more likely to have a CV complication post-transplant (OR 0.66 vs 4.89, p=0.05) but there was no significance for the other cardiovascular risk factors when compared to transplant recipients with no complications. Patients with complications were more likely to have lung transplants (p&lt;0.05) and to be discharged to hospice or dead than those without complications, who were more likely to have kidney transplants (p&lt;0.05) and to be discharged home (p&lt;0.001). There was no difference for the other outcomes of interest (p&gt;0.05). Conclusions: Post-transplant patients, especially lung transplants, have a high incidence of CV complications including stroke and higher case fatality. There was an association between a history of TIA or IS and subsequent CV events in our patient population. We did not demonstrate any difference in LOS, demographical characteristics, use of antithrombotic, or length of survival post-transplant in both the groups.

Uncovering the characteristics of the gut microbiota in patients with acute ischemic stroke and phlegm-heat syndrome.

Growing evidence has indicated that the characteristics of gut microbiota are associated with acute ischemic stroke (AIS). Phlegm-heat syndrome (PHS), a specific pathological state of the AIS, is one of the common traditional Chinese syndromes of stroke. The long duration of PHS in patients with AIS could lead to poor clinical outcomes. Gut microbiota characteristics in patients with both AIS and PHS, and their relationship remains unknown. This study was designed to investigate the alterations in gut microbiota in patients with AIS and PHS through a cross-sectional study. Fecal samples were collected from 10 patients with AIS and non-PHS (ntAIS), 7 patients with AIS and PHS (tAIS), and 10 healthy controls (HC). Samples were profiled via Illumina sequencing of the 16S rRNA V3-V4. Stroke severity was assessed at admission by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS); their correlation with gut microbiota was investigated. The alpha-diversity of the bacterial communities was significantly higher in the fecal samples of patients with tAIS than in patients with ntAIS (Shannon index, P = 0.037). In addition, the combined tAIS and ntAIS group (tntAIS) exhibited higher microbiotic diversity when compared with HC (chao1, P = 0.019). The structure of intestinal microbiota was effectively distinguished between the tAIS and ntAIS group (ANOSIM, r = 0.337, P = 0.007). Additionally, the gut microbiota structure was significantly different between the tntAIS and HC groups (ANOSIM, r = 0.217, P = 0.005). The genera, Ruminococcaceae_ UCG_002 and Christensenellaceae_R-7_group, were implicated in the discrimination of PHS from non-PHS. The order Lactobacillales and family Lachnospiraceae were significantly negatively correlated with NIHSS and mRS at admission (P < 0.05). By contrast, the order Desulfovibrionales, families Christensenellaceae and Desulfovibrionaceae, and genera Ruminococcaceae UCG-014 and Ruminococcaceae UCG-002 were significantly positively correlated with NIHSS and mRS at admission (P < 0.05). This study is the first to profile the characteristics of gut microbiota in patients with AIS and PHS, compared with those with non-PHS. The genera, Ruminococcaceae_ UCG_002 and Christensenellaceae_R-7_group, may be objective indicators of this traditional Chinese medicine (TCM) syndrome in AIS. Furthermore, it provides a microbe-inspired biological basis for TCM syndrome differentiation.

Persistent brain damage in reversible cerebral vasoconstriction syndrome on 99mTc-ethyl cysteinate dimer single-photon emission computed tomography: A long-term observational study

BackgroundBlood-brain barrier (BBB) breakdown is considered a key step in the pathophysiology of reversible cerebral vasoconstriction syndrome (RCVS); however, its temporal course remains unclear. Based on the characteristics and dynamics of 99mTc-ethyl cysteinate dimer (99mTc-ECD) as a tracer, 99mTc-ECD single-photon emission computed tomography (SPECT) can detect not only hypoperfusion but also BBB breakdown and/or brain tissue damage. Therefore, this study aimed to investigate this course using 99mTc-ECD SPECT. MethodsBetween 2011 and 2019, we enrolled seven patients (one male and six female patients) with RCVS without ischemic or hemorrhagic stroke or posterior reversible encephalopathy syndrome. 99mTc-ECD SPECT was performed repeatedly in each patient. SPECT data were statistically analyzed using an easy Z-score imaging system. ResultsThunderclap headache was the initial symptom in all the patients and was most commonly triggered by bathing (three patients). All the patients exhibited vasoconstriction and reduced cerebral uptake of 99mTc-ECD during the acute stage. Follow-up assessment from 3 to 16 months showed that reduced cerebral uptake persisted in all the patients, even after the vasoconstriction had resolved. ConclusionReduced cerebral uptake of 99mTc-ECD persisted in the late stage of RCVS, even after vasoconstriction and headache subsided. BBB breakdown and/or brain tissue damage may underlie this phenomenon. 99mTc-ECD SPECT is an effective neuroimaging method to detect brain functional abnormalities, reflecting BBB breakdown or tissue damages, throughout the treatment course of RCVS.

Migraine and its relation to other risk factors in patients with acute ischemic stroke and acute coronary syndrome

BackgroundMigraine has been recently studied as a risk factor for ischemic stroke (IS) and a possible link to a broader range of ischemic vascular disorders including angina and myocardial infarction is suggested.Objectivesto study migraine and its relation to other risk factors in patients with acute IS and acute coronary syndrome (ACS).Patients and methodsWe studied 200 patients, 114 patients had acute IS and 86 patients with ACS, in addition to 850 control participants. All patients were subjected to detailed clinical and laboratory evaluation; including evaluation of traditional risk factors. All stroke patients were subjected to CT scan. Diagnosis of acute coronary syndrome was established clinically by ECG and cardiac specific enzymes. Migraine was diagnosed according to the international headache society and assessment of migraine severity was measured by the Migraine Disability Assessment (MIDAS) questionnaire.ResultsIn patients with ischemic stroke, Risk Ratios (RR) of migraine was 3.3 for all migrainous patients, higher for migraine with aura (MA). In the cardiovascular group, it was 2.75 and again higher in MA. A positive correlation between migraine severity and both stroke severity and cardiac affection severity was found though non-significant in the cardiovascular group. There was no significant difference in hospital outcome in migrainous patients in both groups.ConclusionsPatients with migraine have higher risk than non-migrainous patients for both cerebrovascular and coronary vascular diseases. Risk is stronger in MA in both conditions. Considering migraine in risk stratification of cerebrovascular and cardiovascular diseases is recommended.

Revealing the magic of acupuncture based on biological mechanisms: A literature review.

Acupuncture has been used to treat various disease for more than 3,000 years in China and other Asian countries. As a complementary and alternative therapy, it has gained increasing popularity and acceptance among public and healthcare professionals in the West. Over the past few decades, basic and clinical research on acupuncture has made considerable progress. Internationally recognized evidence from clinical studies has been published, a preliminary system to clinically evaluate acupuncture has been created, and some clinical guidelines have been formulated. Moreover, scientists have strived to explore the physiological and biological mechanisms of acupuncture. Some basic studies have indicated that acupuncture has various actions, such as analgesic, muscle relaxing, anti-inflammatory, mild anxiolytic, and antidepressant actions, with possible biological mechanisms such as central sensitization, neurotransmitters, the intestinal flora, immune regulation, oxidative stress, and neuroinflammation. The current review describes the common indications for acupuncture recommended by the WHO and the use of acupuncture in China, the United States, Australia, and several other countries. This review then summarized the mechanisms by which acupuncture treats common conditions including lower back pain (LBP), ischemic stroke, depression, and irritable bowel syndrome (IBS) and it also cited specific acupuncture points for treating these conditions. The hope is that this review will provide useful information for both acupuncturists and researchers to better understand the mechanisms of acupuncture and reasons for its usage.

Ischemic Stroke and Acute Coronary Syndrome (ACS) in COVID-19 patients: Mechanisms and Role of Coagulopathy

Background: COVID-19 has a devastating impact on patients not only due to the severity of pulmonary disease but also the multitude of other manifestations. Objective: We discuss here myocardial ischemia and stroke, associated with COVID-19, from a hyper-coagulation perspective. Method: Original studies, case reports, and systematic reviews from different databases were studied for this review article. Results: Elevated inflammatory markers [e.g. ferritin, C-reactive protein, interleukins, antiphospholipid antibodies] together with elevated D-dimer levels point to an inflammatory source of activation of the coagulation cascade. Furthermore, the features of macro and microthrombi, because of dysregulated coagulation, point to local thrombosis as well as distant thrombo-embolism. Conclusion: Inflammation cascade and changes in coagulation markers leading to coagulopathy in COVID-19 patients emphasize the need to develop investigation techniques that can independently guide therapy.

November 2021 Stroke Highlights

November 2021 <i>Stroke</i> Highlights

TIMING OPTIMIZATION OF HEAD AND NECK CT ANGIOGRAPHY VIA THE INVERSE PROBLEM ALGORITHM: in vivo SURVEY FOR 1001 PATIENTS IN 2020–2021

This study processed the recent in vivo survey results for over a thousand patients and optimized their neck and head CT angiography triggered timing (CTA-TT) via the inverse problem algorithm, which ensured the maximal ratio of both left and right arterial to upper sinuses (LRA/US). These results are instrumental in examining the ischemic stroke syndromes along the neck and head. These 1001 patients were randomly categorized into test surveyed (802 patients) and verification group (199 patients), then a six factors semi-empirical formula was constructed by the STATISTICA program. The six factors were assigned a patient’s biological data and preset of the CTA facility; namely Age, mean arterial pressure (MAP), heart rate (HR), contrast media dose (CMD), Pre (injected pressure of CMD), and body surface area (BSA). Each factor was normalized into dimensionless values and incorporated into the dataset matrix [Formula: see text] to analyze the coefficient matrix [Formula: see text]. The derived semi-empirical formula closely correlated with experimental data, according to the loss function [Formula: see text], correlation coefficient [Formula: see text], and variance of 0.8965. The formula verification for 199 more patients (verification group) yielded a correlation coefficient [Formula: see text]. Thus, it can be used for the CTA-TT estimation of patients without their preliminary tests, avoiding unnecessary irradiation. The estimated LRA/US was [Formula: see text] for the verification group in this study. A simplified three-factor formula, featuring only age, MAP, and BSA, was also proposed.

TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?

Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). The choice of optimal drug for anticoagulation after TAVR remains debated. Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P< 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95%CI: 1.17-2.29; P< 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95%CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95%CI: 0.68-1.99; P=0.57) did not differ among groups. In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.

Rivaroxaban in patients with atrial fibrillation: from research to real practice (based on REGistry of Long-term AnTithrombotic TherApy-2 (REGATA))

Introduction. Despite the large evidence base for the use of rivaroxaban, cohort studies are interesting because shows the possibility of anticoagulant therapy in patients with high thromboembolic and bleeding risk and a burden of comorbidity in practice.Aim: to evaluate the efficacy and safety of rivaroxaban therapy in patients with atrial fibrillation in prospective REGATTA registry.Materials and methods. This study is a fragment of a single-center prospective REGATA registry (Registry of Long-term Antithrombotic Therapy (NCT043447187), conducted on the basis of the National Research Center of Cardiology of the Ministry of Health of the Russian Federation. 152 patients with high thromboembolic risk (median CHA2DS2-VASc = 4) received rivaroxaban therapy (median follow-up 1.5 years). The efficacy endpoint was the sum of cardiovascular complications (including cardiovascular death, ischemic stroke, and acute coronary syndrome). The safety endpoint bleedinds BARC types 2-5.Results. The frequency of cardiovascular events (combining cardiovascular death, ischemic stroke and acute coronary syndrome) was 5.8/100 patient-years. The use of a “reduced” dose of rivaroxaban was an independent predictor of the development of fatal cardiovascular complications. The rate of major bleeding was 3.7/100 patient-years, and the rate of clinical relevant bleedings was 19.4 /100 patientyears. The predictors of major/ clinical relevant bleedings were chronic kidney disease with a decrease in creatinine clearance of less than 50 ml/min and the anamneses of major/ clinical relevant bleedings.Conclusion. The main requirement for improving the safety of anticoagulants is follow up, focused in all changes in the cardiovascular and somatic status of the patient during treatment.

Acute disseminated encephalomyelitis in a SARS-CoV2 seropositive child

Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have various clinical presentations. Neurological manifestations of SARS-CoV-2 have been described in adults but such presentations in children are rare. The different neurological manifestations associated with SARS-CoV-2 are headache, seizures, anosmia, ischemic stroke, encephalopathy, transverse myelitis, and Guillain-Barre Syndrome. Here, we describe a case of SARS-CoV-2 seropositive child presenting as acute disseminated encephalomyelitis.

Cerebrovascular Disease after Allogeneic Hematopoietic Stem Cell Transplantation: Incidence, Manifestations, Risk and Clinical Outcome

BackgroundThe incidence, manifestations and risk of cerebrovascular disease (CVD) are not well known in recipients of allogeneic hematopoietic stem cell transplantation (HSCT). CVD, including ischemic or hemorrhagic stroke and posterior reversible encephalopathy syndrome (PRES), are important and potentially life-threatening post-transplant complications. Notably, there are few supporting results to explore these complications. We therefore aim to investigate the incidence, risk factors, and survival of post-transplant CVD.Patients and MethodsWe included in this study 459 adult patients undergoing allogeneic HSCT at an Asian tertiary medical center between January 2003 and December 2015. A total 24 patients documented post-transplant ischemic or hemorrhagic stroke and PRES according to clinical neurologic signs and brain MRI. Clinical features, cumulative incidence, risk factors and survival for post-transplant CVD in recipients of HSCT were collected and analyzed.ResultsPost-transplant CVD occurred in 24 (5.2%) of 459 HSCT patients. One patient suffered from PRES initially, and subsequent ischemic stroke two months later. The cumulative incidences at days 100, one year and two years were 0.8%, 2.8% and 3.2% in ischemic stroke (n = 10), and 1.2%, 2.2% and 3.0% in hemorrhagic stroke (n = 10), respectively. In addition, the cumulative incidences of PRES (n = 5) at days 100, one year and two years were 0.2%, 1.2% and 1.2%, respectively. In the multivariate analysis, thrombotic microangiopathy (TMA) prior to CVD (adjusted hazard ratio [HR] 10.30, 95% confidence interval [CI]: 3.37-31.51) and high-dose ara-c (HiDAC) ≥ 3 courses prior to transplant (adjusted HR 4.91, 95% CI: 1.42-16.95) were identified as independent risk factors of post-transplant CVD. There was a trend as a risk factor in patients with grade III-IV acute GVHD (P= 0.094). For patients with post-transplant stroke, there were significantly lower disease-free survival (P= 0.016) and overall survival (P= 0.004).ConclusionThe occurrence of CVD, especially for ischemic or hemorrhagic stroke after allogeneic HSCT, was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of post-transplant CVD play roles to improve outcome. Patients with TMA prior to CVD and treatment of more than three HiDAC courses prior to transplant are at risk of CVD. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection and treatment of this complication.. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cardiovascular and cerebrovascular events in patients with intracerebral hemorrhage: Clinical characteristics and long-term predictors

Few studies have examined the long-term prognosis of Chinese patients with intracerebral hemorrhage (ICH). This study assessed the clinical characteristics and predictors of vascular events occurring within 5 years after ICH.We included consecutive patients diagnosed with first-ever ICH between June 2013 and December 2014. Based on follow-up data (collected until December 2019), we used multivariable logistic regression to examine the clinical characteristics and long-term predictors of vascular events (including recurrent ICH, ischemic stroke, and acute coronary syndrome) in patients who survived more than 30 days after ICH.Across the 307 patients in our analysis, the 5-year mortality rate was 28.01%. Within 5 years after ICH, major vascular events were observed in 62 patients (17.82%, 95% CI 13.78–21.82%). We observed high incidence of recurrent ICH (8.91%) and ischemic stroke (10.06%), but low incidence of acute coronary syndrome (1.15%). Most cases of recurrent ICH (80.65%) occurred within 3 years after ICH. Age ≥56 years and history of ischemic stroke or transient ischemic attack (TIA) were identified as predictors of cardiovascular and cerebrovascular events.ICH survivors are at high risk of both cardiovascular and cerebrovascular events, especially older patients (≥56 years) and those who experienced ischemic stroke or TIA prior to their first ICH. Recurrent ICH is more likely to occur within the first three years after first ICH than at later times. Clinicians should monitor patients closely for adverse events, particularly during the first three years after initial ICH.

Truncal pulsion in acute ischemic stroke – Clinico-anatomical correlation

Context: Truncal pulsion is a compelling sensation of being pulled to one side, in the context of normal motor and sensory functions and normal co-ordination. It is seen in a variety of ischemic strokes.&#x0D; Aims: This article aims at identifying ischemic stroke syndromes associated with truncal pulsion, with review of the neural substrate responsible, to help in recognition and reporting.&#x0D; Settings and Design: This was a prospective study conducted at Department of Neurology, at Pushpagiri institute of medical sciences and research centre, Thiruvalla, Kerala, India, over a period of 5 years, among patients with acute ischemic stroke.&#x0D; Methods and Material: We studied all patients with acute ischemic stroke, who were admitted to our department, over a five-year period. Patients presenting with truncal pulsion were shortlisted and were assessed by investigators independently. All patients underwent MRI brain, which was assessed by investigators 1 and 2, independently. The demographic profile, risk factors, clinical features, neuroimaging findings and outcomes were analysed using SPSSv21.&#x0D; Results: A total of 1456 patients with acute ischemic strokes were identified, of which 27 with truncal pulsion were included in the study. The common sites of infarction resulting in truncal pulsion were lateral medulla, cerebellum, thalamus, pons and midbrain. One patient had infarct involving anterior cingulate. Truncal pulsion was ipsilateral in infarcts involving medulla and cerebellum and contralateral in infarcts involving the pons, midbrain, mesencephalo-diencephalic junction, thalamus and cingulate.&#x0D; Conclusions: Truncal pulsion, a compelling sensation of falling, is a disabling symptom occurring in a variety of strokes and it poses significant challenge in neuro-rehabilitation.&#x0D;

Cardio-Cerebral Infarction Syndrome (CCIS): Definition, Diagnosis, Pathophysiology and Treatment

Acute ischemic stroke (AIS) and coronary artery disease are the major causes of death in Palestine and in the world. Ischemic stroke and acute coronary syndrome have similar vascular risk factors and may evolve as a complication of the respective other disease. The prevalence of coronary artery disease has been reported in one fifth of stroke patients. high incidence rate of acute myocardial infarction (AMI) after recent ischemic stroke and the high risk of acute ischemic stroke after recent myocardial infarction has been reported in several clinical or observational studies. Patients are at increased risk of ischemic stroke following recent myocardial infarction, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, but may be harmful in many conditions. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality. So that acute or recent problem in the heart or brain that could result in an acute infarction of the other. In this review we describe the definition and new classification of the cardio-cerebral infarction syndrome with 3 subtypes that reflect the definition, pathophysiology and treatment options.

Hyperintense Acute Reperfusion Marker on FLAIR in Patient with Possible Contrast-Induced Encephalopathy Following Cerebral Angiography

Contrast-induced encephalopathy (CIE) is a rare complication of angiography and endovascular intervention following administration of iodinated intravenous contrast agents. Neuroimaging findings of CIE usually show cerebral edema, leptomeningeal enhancement, and parenchymal signal abnormality on fluid-attenuated inverse recovery (FLAIR). Hyperintense acute reperfusion marker (HARM) generally implies an enhancement of the subarachnoid cerebrospinal fluid space on brain FLAIR imaging in cases of acute ischemic stroke or hyperperfusion syndrome. We report a case of possible CIE following cerebral angiography, accompanied by HARM sign.

The Association of Adverse Pregnancy Outcomes and Cardiovascular Disease: Current Knowledge and Future Directions.

Adverse pregnancy outcomes are associated with increased risk for future cardiovascular disease. The goal of this review is to share what is currently known about the increased risk and to identify areas for future research. Severe studies have identified a strong association between adverse pregnancy outcomes and cardiovascular disease such as heart failure, valvular disease, ischemic heart disease, stroke, hypertension, and metabolic syndrome. The recognition of this increased risk is reflected in recent changes in prevention guidelines. The guidelines now recognize sex-specific risks such as preeclampsia and preterm delivery and recommend incorporating a pregnancy history to identify them earlier. However, no robust risk prediction tools incorporating these pregnancy risk factors have been developed and validated. While smaller clinical trials have been performed in reducing cardiovascular risk factors in the postpartum timeframe, there remains a paucity of large-scale randomized clinical trials that continue to show a risk reduction in these women. While there is increasing recognition of the long-term cardiovascular risks associated with adverse pregnancy outcomes, there remains a need for interventional studies aimed at reducing this risk and for incorporation of pregnancy risk factors into traditional cardiovascular risk prediction tools.

Nowoczesna protekcja w nadciśnieniu tętniczym i przewlekłym zespole wieńcowym

Clinical pattern of hypertension is the result of the interaction of two mechanisms: pressure (the consequences of increasing transmural pressure) and atherosclerosis (accelerated development of atherosclerotic plaques). The first mechanism leads to hemorrhagic brain stroke, myocardial hypertrophy with development of heart failure or aortic dissection aneurysm, the second to ischaemic brain stroke, acute (ACS) and chronic coronary syndrome (CCS), peripheral atherosclerotic lesions. New genetic studies confirm the involvement of both mechanisms in the development of cardiovascular events. Individuals with genetic variant enabling lower LDL cholesterol (LDL-C) and lower blood pressure values are significantly less likely to develop cardiovascular complications. Numerous randomized trials prove that in patients with hypertension the combined use of hypotensive and hypolipidemic drugs (polypill) brings greater clinical benefits than hypotensive monotherapy. Epidemiological observations confirm the validity of the current therapeutic paradigm. The preventive goal of optimal pharmacological treatment (OMT) of CCS is to prevent the first and subsequent episodes of ACS. The essence of atherosclerotic coronary artery disease is the development of atherosclerotic plaque (lipid accumulation) with accumulation of platelets on its eroded surface (atherothrombosis). Pharmacotherapy should be based primarily on the “principle of anti-atherosclerotic treatment” (containing statins and angiotensin-converting enzyme inhibitors [ACE-I]). Both groups of drugs in a different way positively influence the atherosclerotic plaque. Statins reduce its volume and suppress the inflammatory process, however, it is necessary to lower LDL-C below 55 mg/dL (70 mg/dL). Inhibitors of the converting enzyme inhibiting the renin–angiotensin–aldosterone system activity (anti-inflammatory effect) lead to its fibrosis and stabilization of the plaque. New combinations of drugs lowering LDL-C with ACE-I such as atorvastatin and perindopril enable effective treatment with one tablet. The second indispensable element of optimal pharmacological treatment is the “principle of anticoagulant treatment” containing acetylsalicylic acid and one of the drugs from the group of P2Y 12 inhibitors or rivaroxaban. Other drugs such as beta-blockers, calcium antagonists, prolonged action nitrates, ivabradine, cytoprotective drugs are used depending on the individual indications.

Protective effect and mechanism of Qishiwei Zhenzhu pills on cerebral ischemia-reperfusion injury via blood-brain barrier and metabonomics

Stroke is an acute cerebrovascular disease caused by the sudden rupture of cerebral blood vessels or vascular obstruction from brain tissue damage or dysfunction, thereby preventing blood flow into the brain. Cerebral ischemia-reperfusion injury (CI/RI), a common syndrome of ischemic stroke, is a complex pathological process whose physiological mechanism is still unclear. Qishiwei Zhenzhu pills (QSW), a famous Tibetan medicine preparation, has the effect of tranquilizing by heavy settling, dredging channels and activating collaterals, harmonizing Qi and blood, restoring consciousness, and inducing resuscitation. Here, we investigated the protective effect of QSW on CI/RI in rats and its potential mechanism. First, the volatile and liposoluble components in QSW were determined using gas chromatography-mass spectrometry (GCMS). After 24 h of CI/RI, the neuroprotective effect was determined by evaluating the neurological function, cerebral infarction, histopathology, and blood-brain barrier (BBB) function. Immunofluorescence, real-time quantitative PCR (RT-qPCR), and western blot (WB) were used to detect the expression of matrix metalloproteinase 9 (MMP-9), claudin-5, and occludin. Finally, GCMS metabonomics was used to identify different metabolites and analyze metabolic pathways. The results showed that 88 volatile components and 63 liposoluble components were detected in QSW. Following the experimental stroke operation, it was observed that rats administered QSW pretreatment had improved neurological function, reduced infarct volume (P < 0.01), increased Nissl bodies (P < 0.05), improved histopathology, and reduced BBB disruption. Immunofluorescence, RT-qPCR, and WB results showed that MMP-9 level in the brain tissue of the QSW pretreatment group had a decreasing trend and the expression of claudin-5 and occludin had a tendency to increase. Eleven metabolites related to lipid metabolism, fatty acid metabolism, and energy metabolism, were identified via GC–MS metabonomics. Our study shows that QSW preconditioning has a neuroprotective effect on CI/RI; however, its mechanism requires further study.