Late Stroke Research Articles

Feasibility of a 10-week community-based mobile health rehabilitation program using the WalkWithMe application in late sub-acute and chronic stroke survivors in a low resource setting: A pilot study

ABSTRACT Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

The long-term impact of lesion set in the surgical ablation of atrial fibrillation during mitral valve surgery: multi-center propensity-score weighted study

ObjectiveThis study aimed to assess the effect of the lesion sets for surgical ablation (SA) of atrial fibrillation (AF) on long-term outcomes and identify the optimal lesion set. MethodsBetween 2005 and 2017, 1825 patients underwent SA concomitant to mitral valve (MV) surgery in the participating institutions. Of these, 529 underwent left atrial (LA) ablation, whereas the remainder had biatrial (BA) ablation. The clinical and rhythm outcomes were compared, considering death as a competing event. Inverse probability treatment weighting (IPTW) was used to mitigate the selection bias. ResultsThe patients undergoing LA ablation were younger and less frequently had long-standing AF with a shorter duration or required concomitant tricuspid valve surgery. Adjusted analysis showed that LA ablation was associated with a lower risk of early pacemaker implantation (odds ratio, 0.16; 95% confidence interval [CI], 0.07-0.38; p<0.001) than BA ablation. Over a median follow-up of 70.4 months (interquartile 44.1-111.2 months), the LA ablation group presented a higher risk of AF recurrence (subdistribution hazard ratio [SHR]1.26; 95% CI 1.12-1.41; p<0.001), with a 5-year cumulative incidence of 34.2% compared to 28.6% in the BA group. The risk of late mortality (SHR, 1.17; 95% CI, 0.74-1.86; p=0.507) and stroke (SHR, 1.21; 95% CI, 0.82-1.79; p=0.345) did not differ between the groups ConclusionIn patients undergoing SA concomitant to MV surgery, both lesion sets provided comparable incidence of mortality and stroke. However, BA ablation was associated with a superior rhythm outcome at the expense of a higher risk of early pacemaker implantation.

Endovascular thrombectomy vs best medical management for late presentation acute ischaemic stroke with large vessel occlusion without CT perfusion or MR imaging selection: A systematic review and meta-analysis

BackgroundThe efficacy and safety of endovascular thrombectomy (EVT) beyond 6 hours from stroke onset for patients with large vessel occlusion (LVO) selected without CT perfusion(CTP) or MR imaging(MRI) is undetermined. We conducted a systematic review and meta-analysis of the current literature comparing outcomes for late presenting patients with LVO treated by best medical management (BMM) with those selected for EVT based only on non-contrast CT(NCCT)/CT angiography(CTA) (without CTP or MRI). MethodsPRISMA guidelines were employed. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months. Secondary outcomes were symptomatic intracranial haemorrhage (sICH) and mortality at 3 months. Data were analysed using the random-effects model. ResultsSix studies of 2083 patients, including three randomised controlled trials, were included; 1271 patients were treated with EVT and 812 patients with BMM. Compared to BMM, patients treated with EVT demonstrated higher odds of achieving functional independence (39.0 % EVT vs 22.0 % BMM; OR = 2.55, 95 %CI 1.61-4.05,p < 0.0001, I2 = 74 %). The rates of sICH (OR = 2.09, 95 %CI 0.86-5.04,p = 0.10) and mortality (OR = 0.62, 95 %CI 0.35-1.10,p = 0.10) were not significantly different between each cohort. ConclusionCompared to BMM, late presenting stroke patients selected for EVT eligibility with NCCT/CTA only and treated with EVT achieved significantly higher rates of functional independence at 90 days, without increasing the incidence of sICH or mortality. Whilst these findings indicate that NCCT/CTA only may be used for EVT eligibility selection for patients who present beyond 6 hours from stroke onset, the results should be interpreted with caution due to the substantial heterogeneity between studies.

A comparative analysis of the performances of a syngas port injection plus gasoline direct injection combined-injection spark-ignition engine under lean-homogeneous charge and Lean-Stratified Charge modes

This study conducts a comparative analysis of the performances of a syngas port injection plus gasoline direct injection combined-injection spark-ignition engine operating in Lean-Homogeneous Charge (LHC) and Lean-Stratified Charge (LSC) modes. Results demonstrate that adjusting direct injection timing achieves LHC with early intake stroke injection and LSC with late compression stroke injection. Regarding mixture charge, increasing excess air ratio (λ) or syngas injection proportion (SIP) in LHC mode improves mixture homogeneity, while a higher SIP in LSC mode enhances mixture distribution for ignition. Concerning combustion characteristics, both modes benefit from lower λ and higher SIP with increased peak cylinder pressure, heat release rate, flame speed, and in-cylinder temperature. A higher λ extends CA0-10 and CA10-90, while a higher SIP shortens these durations. Regarding emissions, a higher λ positively affect HC, CO, and NOx emissions, whereas a higher SIP reduces HC, CO and soot but increases NOx emissions. The comparison between LHC and LSC highlights the superior combustion efficiency of LSC, whereas LHC excels in emission control.

Variations in Risk Factors across Different Periods of Stroke and Transient Ischemic Attack Recurrence.

Accurately discerning periods of heightened risk of stroke or transient ischemic attack (TIA) recurrence and managing modifiable risk factors are essential for minimizing overall recurrence risk. This study identified differences in the timing of stroke or TIA recurrence based on risk factors and patient characteristics to develop strategies for reducing recurrence in clinical practice. We retrospectively selected patients with ischemic stroke or TIA at the Korea University Ansan Hospital Stroke Center between March 2014 and December 2021 using the prospective institutional database of the Korea University Stroke Registry. We collected demographic, clinical data, and categorized participants by recurrence timing (early within or late after 3 months). Using multinomial logistic regression analysis, we examined variables associated with early and late recurrent stroke or TIAs. Among 3,646 patients, 255 experienced a recurrent stroke or TIA and 3,391 experienced their first stroke or TIA. Multinomial logistic regression analysis revealed significant associations between early recurrent stroke or TIA and diabetes mellitus (odds ratio [OR]: 1.98, 95% confidence interval [CI]: 1.25-3.15), other determined etiologies in the Trial of Org 10172 in the Acute Stroke Treatment classification (OR: 3.00, 95% CI: 1.37-6.61), and white matter changes (OR: 1.97, 95% CI: 1.17-3.33). Late recurrence showed a significant correlation with TIA (OR: 2.95, 95% CI: 1.52-5.71) and cerebral microbleeds (OR: 2.22, 95% CI: 1.32-3.75). Substantial differences in factors contribute to stroke or TIA recurrence based on timing. Managing the risk of recurrence in clinical practice necessitates accurate identification of heightened risk periods and rigorous control of modifiable risk factors.

Branch Thrombus after Endovascular Treatment with Arch Branched Devices for Aortic Arch Pathologies

The aim of this study was to describe the occurrence of branch thrombosis following endovascular treatment of aortic arch pathology using an arch branched device (ABD) and to determine whether this is influenced by clinical and geometric parameters. In this retrospective observational study of patients treated with an ABD in three centres, the primary endpoint was thrombus formation within a branch during follow up. Secondary endpoints were technical success, serious adverse events (SAEs), early and late death, stroke, and re-interventions. Geometric measurements (tortuosity index and curvature) were determined on pre-operative and post-operative computed tomography angiographies. Thirty nine patients were treated and 68 antegrade branches were analysed (innominate artery, n = 27; common carotid artery [CCA], n = 40; left subclavian artery [LSA], n = 1). Thrombus was identified within seven branches (10%) on surveillance imaging (innominate artery, n = 6; CCA, n = 1; LSA, n = 0; p = .021) and was associated with a wider distal bridging stent diameter (median 14.0 mm [interquartile range {IQR} 2.0] vs. 8.7 mm [IQR 5.9]; p = .026), a higher degree of reversed tapering (4.3 mm [IQR 1.4] vs. 1.2 mm [IQR 2.8]; p = .023), use of polyethylene terephthalate (Dacron) covered (vs. expanded polytetrafluoroethylene) bridging stents (23% vs. 2%; p = .011), and higher body mass index (BMI) (32.1 kg/m2 [IQR 7.5] vs. 25.7 kg/m2 [IQR 5.4]; p = .029), but not with pre-operative or post-operative tortuosity index or curvature or alterations. Regarding secondary outcomes, the technical success rate was 97%, SAEs occurred in 15 patients (38%), early and late death rates were 8% and 23%, respectively, and early and late stroke rates were 5% and 23%, respectively. The risk of developing branch thrombosis after endovascular intervention with an ABD is considerable, especially of innominate artery branches, characterised by Dacron covered large diameter bridging stents, and in patients with a high BMI. Large prospective studies are required to analyse factors associated with branch thrombosis.

Endovascular treatment of stroke in the late time window with large vessel occlusion using the ASPECTS as an imaging screening criterion

To assess the Alberta Stroke Program Early CT Score (ASPECTS) screening tool for effectiveness in endovascular treatment of late time window stroke with large vessel occlusion. A retrospective analysis was performed of individuals administered endovascular treatment in our neurology department between 2016 and 2020 for ischemic stroke induced by acute large vessel occlusion in the anterior circulation and ASPECTS ≥ 6. Detailed baseline and endovascular treatment data were collected. Patients were assigned to 2 groups based on stroke onset time, including the 0–6 h (treated within 6 h of stroke onset) and 6–24 h (earlier/unknown time of onset, up to 24 h from the last time of appearing normal) groups. Both groups were compared for baseline information, revascularization rates, symptomatic intracranial hemorrhage, and 90-day functional independence. Totally 221 individuals were enrolled. The 0–6 h and 6–24 h groups had 129 and 92 patients, respectively, whose median ages were 64 and 63 years, respectively. Both groups were similar in previous medical history, NIHSS score at onset, lesion location and surgical complications. The 6–24 h group had elevated intracranial atherosclerotic stenosis (48.9 vs. 33.3%, P = 0.020) and revascularization (96.7 vs. 86.8%, P = 0.011) rates versus the 6–24 h group. Upon adjustment for age, sex, National Institutes of Health Stroke Scale, ASPECTS, Intracranial atherosclerosis, intraoperative tirofiban, stent detachment, successful recanalization, and symptomatic intracranial hemorrhage, the 0-6 h group had a higher rate of individuals achieving functional independence (mRS score of 0–2; 52.7 vs. 47.8%, OR = 0.242 [0.070–0.833], P = 0.024). However, the rates of individuals with a favorable outcome (mRS scores of 0–3) were similar in both groups (66.7 vs. 69.6%; OR = 0.564 [0.140–2.266], P = 0.419) as well as 90-d mortality (OR = 0.889 [0.170–4.660], P = 0.889). The ASPECTS is effective for screening individuals for endovascular treatment of stroke in the late time window with large vessel occlusion. The ASPECTS should be considered a simple and practical patient screening strategy for stroke centers without multimodal imaging evaluation.

Postoperative atrial fibrillation is associated with late mortality independently of patient comorbidities: a systematic review and reconstructed individual patient data meta-analysis

Abstract Background Early postoperative atrial fibrillation (POAF) is the most common complication within the first days after cardiac surgery. It is hypothesized to result from perioperative stressors such as inflammation, oxidative stress, and increased adrenergic tone, along with an advanced arrhythmogenic substrate resulting from advanced age and cardiovascular comorbidities including hypertension, heart failure, or chronic obstructive pulmonary disease (COPD).[1, 2] Although prior studies have demonstrated an association between in-hospital POAF and late mortality or stroke, it is questionable whether these long-term adverse events result from the occurrence of early-POAF or, rather, from the advanced cardiovascular risk profile that partly underlies the development of early-POAF.[3] Purpose To investigate the association of early-POAF with late mortality (primary outcome) and stroke (secondary outcome) in patients undergoing cardiac surgery after adjustment for age and the cardiovascular risk profile. Methods A systematic search, covering PubMed, EMBASE, and the Cochrane Library, was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without new-onset POAF during hospitalization. Articles meeting the criteria, which included Kaplan-Meier (KM) curves along with risk tables, were included for a pooled analysis of late mortality and stroke. Individual time-to-event data were reconstructed from the KM curves and incorporated into a multivariable frailty Cox model. The model included adjustments for age, sex, preoperative cardiovascular comorbidity profile (hypertension, diabetes mellitus [DM], peripheral artery disease [PAD], history of stroke, heart failure, and COPD), type of surgery, and a frailty term (study variable). Results In total, 28 studies were included in the analysis for late mortality (N=112931), and 9 studies in the analysis for late stroke (N=35004). Overall, 31039 patients had early-POAF with a pooled incidence of 29.7% (95% CI: 25.7-34.1%). Patients developing POAF were older (68.5 vs. 64.1 years old, p&amp;lt;0.001), had a more frequent history of PAD (9.5% vs. 7.8%, p=0.026), a history of stroke (9.3% vs. 7.6%, p&amp;lt;0.001), heart failure (17.2% vs. 15.1%, p&amp;lt;0.001), and COPD (12.5% vs. 9.7%, p&amp;lt;0.001). Unadjusted analysis showed that POAF was strongly associated with increased late mortality (Hazard Ratio [HR]=1.64, 95% CI: 1.59 to 1.69, p&amp;lt;0.001) and late stroke (HR=1.46, 95% CI: 1.36 to 1.58, p&amp;lt;0.001) (Figure 1). POAF was an independent predictor for late mortality (HR=1.46, 95% CI: 1.36 to 1.58, p&amp;lt;0.001) but not for late stroke (HR=1.10, 95% CI: 0.85 to 1.43, p=0.48) after adjustment for age, cardiovascular comorbidity profile, type of surgery, and frailty (study term). Conclusion Early-POAF after cardiac surgery is an independent predictor of mortality in the years following discharge after cardiac surgery, regardless of age, cardiovascular comorbidity profile, and type of surgery.Figure 1

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device.

One of the strategies to prevent stroke after coronary artery bypass grafting (CABG) may be the use of a device for proximal anastomosis without partial clamp of the ascending aorta. We retrospectively investigated early and late outcomes in consecutive 881 patients undergoing isolated CABG using Heartstring for proximal anastomosis from January 2008 to December 2022, to reveal the validity to use it. All patients underwent preoperative imaging workups to evaluate neurovascular atherosclerosis. The mean age of the patients was 68.9 years, 20% were female and 13% had previous history of stroke. CABG was on-pump beating heart (52.2%) or off-pump (47.8%) with a mean number of distal anastomoses of 3.38 ± 0.93, using 1.62 ± 0.53 Heartstring devices under different aortic manipulations. In-hospital mortality was 2.0% and perioperative stroke rate was 0.9%, none of them died during hospital stay. During the follow-up period of 70 ± 47 months, the overall actuarial survival rates were 86 and 66%, and major adverse cardiac and cerebrovascular events (MACCEs)-free rates were 86 and 70% at 5 and 10 years, respectively. On multivariable analysis, risk factors for late death included male, previous history of stroke, postoperative sternomediastinitis, late new-onset stroke, and MACCEs, but did not include the perioperative stroke. Low stroke rate, as low as 0.9%, after CABG using Heartstring for proximal anastomosis, although under a variety of aortic manipulations, may contribute to the improved long-term prognosis.

Characteristics and risk of stroke in emergency department patients with acute dizziness

BackgroundAcute dizziness is a common symptom in the emergency department (ED), with strokes accounting for 3 %–5 % of cases. We investigated the risk of stroke in ED patients with acute dizziness and compared stroke characteristics diagnosed during and after the ED visit. MethodsWe identified adult patients with acute dizziness, vertigo, or imbalance using a hospital research-based database. Patients with abdominal or flank pain were used as the comparison group. Patients with dizziness were 1:1 matched to comparison patients. Each patient was traced for up to one year until being hospitalized for a stroke. ResultsOut of the 24,266 eligible patients, 589 (2.4 %) were hospitalized for stroke during the ED visit. For the remaining 23,677 patients, the risk of stroke at 7, 30, 90, and 365 days after ED discharge was 0.40 %, 0.52 %, 0.71 %, and 1.25 % respectively. Patients with dizziness had a higher risk of stroke compared to the comparison group at 7, 30, 90, and 365 days. The risk ratios decreased from 5.69 (95 % confidence interval [CI], 3.34–9.68) to 2.03 (95 % CI, 1.65–2.49). Compared to patients hospitalized for stroke during the ED visit, those hospitalized for stroke after the ED visit had greater stroke severity despite a lower initial triage acuity. Patients with early stroke (≤7 days) after ED discharge were less likely to have hypertension, diabetes, hyperlipidemia, and atrial fibrillation. They mostly experienced posterior circulation stroke. Patients with late stroke (>7 days) were older and less likely to have hypertension and hyperlipidemia but more likely to have a history of prior stroke and ischemic heart disease. Their strokes were mainly located in the anterior circulation territory. ConclusionsThe risk of stroke after ED discharge was higher in patients with dizziness than in the comparison group, with gradually decreasing risk ratios in the following year. Patients hospitalized for stroke during and after the ED visit had different profiles of vascular risk factors and clinical characteristics.

Functional Training for Lower Extremities in Stroke Survivors: A Scoping Review.

Engaging in meaningful and repetitive goal-oriented functional tasks can effectively enhance neuroplasticity and facilitate recovery following a stroke. This particular approach has primarily been studied in relation to functional outcomes and has predominantly focused on late subacute and chronic stroke patients. However, there is a lack of information regarding the standardized protocol of lower extremity functional training, its constituent elements, and its impact on motor recovery during the early subacute phase of stroke. The aim of this study was to examine the available evidence related to the intervention protocol of lower extremity functional training in order to identify common training elements and assess their impact on motor and functional outcomes in stroke survivors. A systematic search was conducted on PubMed and Scopus, covering the period from 2000 to 2022. A total of 1786 articles were retrieved and screened based on predefined inclusion criteria. A total of 36 articles were included in this review. The primary findings were classified into categories such as intervention protocols for functional training and their constituent elements, outcome measures utilized, minimalclinically important differences (MCID) reported, and the conclusions drawn by the respective studies. Only a limited quantity of studies reported on the intervention protocol of lower extremity functional training. The majority of these studies focused on the efficacy of functional training for enhancing gait and balance, as evaluated through functional outcome assessments, particularly in the context of chronic stroke patients. In most studies, the evaluation of outcomes was typically based on statistical significance rather than clinical significance.In light of these findings, it is recommended that future studies be conducted during the early subacute phase of stroke to further investigate the impact of functional training on motor outcomes. This will contribute to a broader understanding of the benefits of functional training in facilitating motor recovery in the lower extremities and its clinical significance in stroke survivors.

Potential improvement in combustion performance of a natural gas rotary engine mixed with hydrogen by novel bluff-body

Hydrogen/natural gas blends fuel is considered one of the ideal alternative fuels for improving the thermal efficiency and reducing carbon emissions of rotary engine. In order to further enhance the combustion and power performance of rotary engine, a new method of the setting of bluff bodies in the cylinder was proposed. The influence of bluff-body settings in the cylinder on the combustion, power performance, and NO generation was numerically studied under different ignition timings. The results indicated that in-cylinder bluff-body settings could influence flame propagation by affecting the turbulent kinetic energy and mixture distribution during the process from the late compression stroke to the combustion stroke. Further, for any fixed bluff-body shape in the cylinder, there is a trade-off relationship between the non-blockage ratio and squish velocity at the cylinder block center section as the ignition timing is progressively advanced or delayed. Consequently, considering the above trade-off relationship, the triangular slotted bluff-body in combination with an ignition timing of 30° CA (BTDC) could be used to achieve the maximum improvement in the combustion and power performance of rotary engine. The peak pressure exhibited a growth of 4.83%, and the indicated mean effective pressure increased by 1.46%.

Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

ObjectiveLeft atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting. MethodsOn-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics. ResultsElectronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; P = .05; I2 = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; P = .002; I2 = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; P < .001; I2 = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; P = .06; I2 = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; P = .003; I2 = 71% and RR, 0.87; 95% CI, 0.84-0.91; P < .001; I2 = 70%, respectively). No benefit of LAAC in patients without AF was found. ConclusionsConcomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.

A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke

IntroductionAt present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation.MethodChinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI).ResultsA total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was [SMD = 1.40, 95%CI(1.16,1.63), p < 0.001]; the score of Fugl-Meyer Assessment Scale was [SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001]; the score of NIHSS was [SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001]; the result of China Stroke Scale score was [SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001].ConclusionIn comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients.Trial registrationThis meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022.

Clinical benefits of surgical ablation during isolated aortic valve replacement: a nationwide study.

To compare the early- and long-term clinical outcomes of concomitant surgical ablation (SA) for atrial fibrillation (AF) during isolated aortic valve replacement (AVR) using data from the Korean National Health Insurance Service Database. Of 23,332 adult patients who underwent AVR between 2003 and 2019, those with underlying AF with or without concomitant SA were extracted, and propensity score matching analysis was performed. Overall, 1,741 patients with underlying AF with (n = 445, group A) or without (n = 1,296, group N) concomitant SA during isolated AVR were enrolled, from whom 435 pairs were matched in a 1:1 ratio using propensity score matching analysis. The operative mortality and early postoperative morbidities, including bleeding reoperation, stroke, permanent pacemaker implantation and acute kidney injury were comparable between the groups. The overall survival showed no differences between the groups. However, the cumulative incidence of new-onset late ischaemic stroke was significantly lower in group A than group N in propensity score-matched patients [2.3 vs 3.5 per 100 patient-years, adjusted hazard ratio (95% confidence interval) 0.64 (0.43-0.96), Group A versus Group N, respectively]. The cumulative incidence of other morbidities such as reoperation, permanent pacemaker implantation and progression to chronic renal failure showed no difference between groups. The incidence of late ischaemic stroke was significantly lower when concomitant SA was performed during isolated AVR in patients with underlying AF. Therefore, concomitant SA should be actively considered in patients with underlying AF undergoing isolated AVR to prevent the occurrence of late ischaemic stroke.

Statistical analysis of flow field variations via independent component analysis

The link between in-cylinder flow and subsequent combustion in a single-cylinder gasoline spark-ignition engine is analyzed via independent component analysis (ICA). Experimentally, the two in-plane components of the velocity are measured in the central cylinder plane by high-speed particle image velocimetry (PIV) with the engine running slightly lean at 1500 rpm in skip-fired mode. In 213 cycles, measurements are made during the late compression stroke before ignition with approximately 1° crank-angle temporal resolution. ICA then decomposes the set of 213 flow fields at each time step, yielding a set of “source” flow patterns—the independent components (IC). The temporal coherence between the ICs is then examined in a persistence analysis, comparing each IC with the one from the previous time step starting at ignition timing and going backwards in time. The results show which ICs persist how long throughout the compression stroke. To investigate the link between the ICs and combustion, the crank angle at which 10% of the fuel are burned (CA10) in each cycle is correlated with the extent to which a given IC can be found in each flow field. The most persistent IC can be traced over more than half of the 70 degrees crank angle over which images were acquired. The IC that correlates best with CA10 visually more resembles some of the flow features found in conditional averaging of fast-burning versus slow-burning cycles.

Surgical Outcomes of Centrifugal Continuous-Flow Implantable Left Ventricular Assist Devices: Heartmate 3 versus Heartware Ventricular Assist Device.

Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD). Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications. In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure. The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.

Abstract TP207: Endovascular Treatment in the Late Time Window: Strict Perfusion Imaging Screening Criteria in Case Selection

Background and purpose: Clinical-imaging mismatch or perfusion imaging mismatch criteria per DAWN (Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) or DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), respectively were recommended for case selection for endovascular treatment (EVT) of acute ischemic stroke (AIS) in the late time window outside 6 hours of stroke onset. We aimed to compare the clinical functional outcomes in EVT patients with and without strict perfusion imaging screening criteria in the late time window. Methods: AIS patients with anterior circulation large vessel occlusion (LVO) presenting within 6 to 24h hours after symptom onset were selected from a retrospectively collected thrombectomy cohort database (RESTORE). According to the imaging criteria of DAWN and DEFUSE-3, we compared proportions of patients with a favorable functional outcome (defined as a modified Rankin Scale [mRS] score of 0-2) at 90 days between the DAWN or DEFUSE-3 patients (D/D) and the non-DAWN or DEFUSE-3 (non-D/D) patients. Results: Among 265 adult patients with anterior circulation LVO who received EVT within 6 to 24 hours after symptom onset, 142 patients met either DAWN or DEFUSE-3 imaging criteria. D/D group independently predicted favorable functional outcome at 90 days (50.7% vs. 35.0%, aOR 0.514; 95% CI 0.273-0.966, p=0.039) adjusted for age, sex, previous stroke, hypertension, atrial fibrillation, coronary heart disease, pre-EVT collateral score, successful recanalization, onset to CT time. Conclusions: In AIS patients with anterior circulation LVO in the late time window, our real world data support the guideline that DAWN or DEFUSE-3 imaging criteria are strongly recommended for EVT case selection.

Abstract 95: Associations of Ischemic Stroke With Known Stroke Susceptibility Loci Vary by Age

Objective: The goal of this study was to test whether the strength of association of stroke-associated genetic variants differs by age of stroke onset. Background: In the MEGASTROKE GWAS study, 55 variants were robustly associated with ischemic stroke in predominantly older populations. Yet limited research has been carried out to date to understand how these genetic associations are modified by age, which could provide clues to the underlying biological mechanisms of these associations. Methods: Analyses were based on 16,000 stroke cases of European ancestry identified from the Stroke Genetics Network (SiGN) and Early Onset Ischemic Stroke Consortium and 24,838 stroke-free controls. We tested if the associations of each variant with stroke differed by age using two complementary approaches. First, we used a case-control logistic regression model testing for the associations of stroke with variant, age, and a variant*age interaction term and second, we used a case-only approach, testing for an association of variant with age of stroke onset. All analyses were adjusted for sex and population structure. Results: We identified six variants whose associations were significantly modified by age (p ≤ 0.001) by either analysis; 5 variants by the case-control analysis and 4 variants by the case-only analysis. Among these were 2 variants at the ABO locus that have been previously shown to be more strongly associated with early compared to late onset stroke, tagging blood groups A and O, respectively, and a variant in WNT2B that has previously been associated with early, but not late, onset ischemic stroke in a small case-control study. Conclusions: Six out of 55 variants previously associated with ischemic stroke in large GWAS studies show differential effects by age, with the stroke risk allele more strongly associated with early onset stroke for 5 variants or more strongly associated with older onset stroke (1 variant). Future work is needed to understand the reasons for this age dependency. Disclosures: None. Study Supported By: R01NS100178, R01NS105150, R01NS114045