Proportion Of Ischemic Strokes Research Articles

Abstract WP132: National Trends In Utilization And Outcomes Of Acute Ischemic Stroke And Intracerebral Hemorrhage Patients Undergoing Gastrostomy Tube Placement

Background and Purpose: Persistent dysphagia requiring gastrostomy tube placement continues to be a major issue for stroke patients. We performed analysis to evaluate trends in utilization of gastrostomy tube placement and associated rates of death among acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients over a 10-year period. Methods: We obtained data for patients admitted to hospitals in United States from 2009 to 2018 with a primary diagnosis of IS or ICH using a large national database. We determined rate and pattern of utilization and associated in-hospital outcomes of gastrostomy tube placement among IS and ICH patients. Results: A total of 50551 (7.05%) and 136922 (2.45%) patients underwent gastrostomy tube placement among the 716777and 5567538patients admitted with ICH and IS, respectively. There was a 3.2-fold decrease in patients who gastrostomy tube placement among patients with IS (2.3% in 2009 vs 0.7% in 2018; P<0.001), and by a 1.5-fold decrease for those with ICH (7.8% in 2009 vs 5.3% in 2018; P<0.001). The rates of in-hospital mortality among patients undergoing gastrostomy tube placement remained unchanged throughout the 10 years for patients with IS (5.2% in 2009 vs 4.9% in 2018; p = 0.54) but decreased by fold for those with ICH (7.58% in 2009 vs 2.7% in 2010; p = 0.01). The length of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS (16.2 ±15.7versus 3.6±4.3, p<.0001) and those with ICH (24.4±22.1 versus 6.0±7.5, p<.0001). The cost of hospitalization remained significantly higher in patients undergoing gastrostomy tube placement compared with those who did not for both patients with IS ($140563± 172413 versus $ 37950.2± 45101.6, p<.0001) and those with ICH ($254519± 251973 versus $ 62133.3± 90833.9, p<.0001). Conclusions: Between 2009 and 2018, there has been a significant reduction in the proportion of IS and ICH patients who underwent gastrostomy tube placement. However, the length and cost of hospitalization remained significantly higher among patients who underwent gastrostomy tube placement.

Abstract TP169: Post-Neonatal Stroke In Children With Critical Congenital Heart Defects

Background: Critical congenital heart defects (CCHD) are a subset of mostly cyanotic lesions that require intervention within the first days to weeks of life for survival. For children born with CCHD, the neonatal period is considered the time of highest risk for brain injury as abnormalities in fetal circulation can lead to vulnerabilities in cerebral perfusion prior to corrective cardiac procedures. The prevalence and timing of cerebrovascular events associated with CCHD after the neonatal period is less clear. Methods: We performed a cross-sectional analysis using the National Inpatient Sample database from 2012-2018. We included all children aged 1-18 years hospitalized with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We created multivariable linear and logistic regression models to assess differences in age at stroke onset and mortality after stroke. Results: We identified 4,647 pediatric strokes, 162 (3.5%) of which were associated with CCHD. Adjusting for demographic and clinical covariates, the median age at time of stroke was lower in CCHD patients across all stroke subtypes (Figure). Children with CCHD experienced a higher proportion of IS compared to children without CCHD (75.3% vs 49.5%, P<0.001); and a lower proportion of ICH and SAH (10.5% vs 25.7% and 14.2% vs 24.9%; both P = 0.002). In-hospital mortality for the entire sample following stroke was 10.4% for IS, 14.5% for ICH, and 13.4% for SAH. Adjusting for demographics and confounders, presence of CCHD doubled the odds of death following stroke (OR 2.05; 95% CI 1.35-3.11). Conclusion: Beyond the first year of life, children with CCHD have earlier age at stroke onset and higher post-stroke mortality compared to children without CCHD. Continued vigilance and monitoring of potential neurological complications is warranted in children with CCHD.

Abstract WP179: Impact Of Different Cardiac Rhythm Monitoring Strategies On Secondary Stroke Prevention: A Systematic Review And Network Meta-analysis Of Randomized Controlled Clinical Trials

Background and Purpose: Prolonged cardiac rhythm monitoring can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF). We sought to evaluate the potential utility of available prolonged cardiac rhythm monitoring strategies with respect to secondary stroke prevention. Methods: We searched Medline and Scopus databases to identify randomized controlled clinical trials (RCTs) comparing AF detection, anticoagulation initiation and stroke recurrence rates in patients with history of recent IS or transient ischemic attack (TIA) receiving cardiac rhythm monitoring with implantable loop recorders (ILRs), 30-days external loop recorders or Holter monitors. We performed a network meta-analysis to combine direct and indirect evidence for any given pair of monitoring devices that were evaluated within a trial and reported effect estimates with risk ratios (RRs) and corresponding 95% confidence intervals (95%CIs). Results: We identified 5 RCTs including a total of 2202 patients (mean age 68 years, 40% women). In indirect analyses the likelihood of AF detection and anticoagulation initiation was higher for both ILR (RR=8.48, 95%CI: 3.41, 21.06; RR=3.29, 95%CI: 1.70-6.39) and external loop recorders (RR=3.06, 95%CI: 1.66, 5.61; RR=1.63, 95%CI: 1.03-2.58) compared to Holter devices. The probability of AF detection and anticoagulation initiation was lower for Holter and external loop recorders compared to ILR devices (RR=0.36, 95%CI: 0.15, 0.85 and RR=0.50, 95%CI: 0.25-0.98, respectively). No difference in the risk of stroke recurrence was found in the indirect comparisons of different cardiac rhythm monitoring strategies. Conclusion: The likelihood of AF detection and anticoagulation initiation after an ischemic stroke or TIA is higher with ILRs compared to both external loop recorders and Holter devices.

Cerebral and spinal neurological complications in patients with COVID-19: authors’ clinical experience and literature review

Objective ‒ to highlight the high probability and features of neurological complications in patients with COVID-19 pneumonia.Materials and methods. A retrospective cohort study was done of 57 patients with COVID-19 pneumonia who were treated at the COVID-location of the Department of Vascular and Minimally Invasive Neurosurgery and Neurology of the Clinical Emergency Hospital of Lviv in the period from June 29 to September 28, 2020 (91 day).Results. Out of the 57 patients 14 (24.6 %) were selected by prospective analysis that had a clear association between COVID-19 pneumonia and neurological complications. Neurological complications of COVID-19 were manifested as ischemic stroke in 57.1 % of patients, encephalopathy with convulsions and without seizures ‒ in 35.7 %, polyneuropathy with tetraparesis, secondary purulent-inflammatory lesions of the spine ‒ in 7.2 %. Neurological complications occurred on average (20. 4 ± 6.1) days after the onset of the disease.Conclusions. Lesions of the spine and structures in the spinal canal after coronavirus infection had a significant spread along the axis of the spine and severe course. The largest (57.1 %) was the proportion of ischemic stroke in the structure of neurological complications of COVID-19, which indicated the severity of the coronavirus infection and its aggressive effect on the nervous system. The effectiveness of treatment of COVID-19 neurological complications depends on the urgency of hospitalization of patients, as evidenced by the correlation between favorable treatment outcomes and the time from disease onst to admission to either therapeutic (r = + 0.37) or neurological department (r = +0.32).

Stroke Seasonality and Weather Association in a Middle East Country: A Single Tertiary Center Experience.

Background: Stroke is a medical condition that leads to major disability and mortality worldwide. Some evidence suggests that weather and seasonal variations could have an impact on stroke incidence and outcome. However, the current evidence is inconclusive. Therefore, this study examines the seasonal variations and meteorological influences on stroke incidence and outcome in the largest city in Saudi Arabia.Methods: From February 2016 to July 2019, we retrospectively reviewed data from all patients with acute ischemic (AIS) or hemorrhagic stroke (HS) admitted to the stroke unit in a tertiary academic center in Saudi Arabia. The corresponding daily meteorological data were obtained for the same period. We considered the months from November to March as the cold season and April to October as the hot season.Results: The final cohort included 1,271 stroke patients; 60.89% (n = 774) cases occurred in the hot season, while 39.1% (n = 497) in the cold season. Males accounted for 69.6% (n = 884) of the cases. The proportion of ischemic stroke was 83.2% [hot season 83.9% (n = 649) vs. cold season 82.3% (n = 409)]. We found no statistically significant difference between seasons (hot or cold) in stroke incidence, severity [National Institutes of Health Stroke Scale (NIHSS)], hospital course (pneumonia, thromboembolism, intensive care stay, or length of stay), or outcome [modified Rankin scale (mRS) on discharge and death].Conclusions: In Riyadh, Saudi Arabia, our study found no impact of weather or seasonal variations on stroke incidence, hospital course, or outcomes. However, our findings warrant further research in different country regions.

Using Serum Biomarkers for Identifying Unstable Carotid Plaque: Update of Current Evidence.

Carotid atherosclerosis is responsible for a great proportion of ischemic strokes. Early identification of unstable or vulnerable carotid plaques, and therefore, of patients at high risk for stroke, is of significant medical and socioeconomical value. We reviewed the current literature and discussed the potential role of the most important serum biomarkers in identifying patients with carotid atherosclerosis who are at high risk for atheroembolic stroke.

Abstract P128: Impact of the COVID-19 Pandemic in Houston on Stroke Care in a Health System of 10 Stroke Centers

Introduction: We assessed the impact of COVID-19 pandemic on stroke admissions and care metrics within a health system of 10 stroke centers, with 4 comprehensive stroke centers (CSC) in the greater Houston region. Methods: Between January-June 2019 and January-June 2020, we compared the proportion of ischemic strokes (total & direct CSC presentations) & intracerebral hemorrhage (ICH) relative to total admissions using logistic regression, and among the direct CSC presentations, we compared door to tPA and thrombectomy times using Wilcoxon Rank Sum. Results: A total of 4808 cases were assessed (Table 1). There was an initial drop of ~30% in cases at the pandemic onset (Fig.1). Numerically fewer patients in the 2020 period were seen at primary and CSCs (Table 1). Compared to 2019, there was a significant reduction in transferred patients [N(%), 829 (36) vs. 637 (34), p=0.02], in hospital strokes [N(%), 111 (5) vs. 69 (4), p=0.04], and mild strokes (NIHSS 1-5) [N (%), 891 (43) vs. 635 (40),p=0.02], and no significant differences in the proportions of total ischemic strokes [OR (95% CI)=0.92 (0.79, 1.06), p=0.23], direct CSC presentations [OR (95% CI) =0.96 (0.86, 1.08), p=0.48] and ICH [OR (95% CI) =1.14 (0.98, 1.33), p=0.08] in 2020 (Fig. 1). Among the direct ischemic strokes at CSCs, there were similar mean (SD) (mins) door to tPA [44 (17) vs. 42 (17), p=0.14] but significantly prolonged door to thrombectomy times [94 (15) vs. 85 (20), p=0.005] in 2020. Conclusion: COVID-19 pandemic led to reduced mild stroke admissions, transfers and in hospital stroke alerts, & prolonged door to thrombectomy times. Identifying reasons to mitigate this discrepancy is crucial for next pandemic preparedness.

Abstract P656: Cardioembolic Risk Factors and Ischemic Stroke a Mendelian Randomization Analysis

Background: Cardioembolic stroke accounts for a large proportion of ischemic stroke. Observational studies have shown that several risk factors are associated with cardioembolic stroke. However, whether such associations reflect causality remains unknown. Objectives: We aimed to determine whether established and provisional cardioembolic risk factors are causally associated cardioembolic stroke, and whether they have pathways of causal influence on other ischemic stroke subtypes. Methods: Genetic instruments for atrial fibrillation (AF), myocardial infarction (MI), some electrocardiogram (ECG) indices and NT-pro BNP were obtained from large genetic consortiums. Summarized data of ischemic stroke and its subtypes were extracted from the MEGASTROKE consortium. Causal estimates were calculated by applying inverse variance-weighted analysis and other methods. Results: Genetically predicted AF was significantly associated with higher odds of ischemic stroke (OR 1.20, 95% CI 1.16-1.24, P=6.53х10 -30 ) and cardioembolic stroke (OR 1.95, 95% CI 1.85-2.06, P=8.81х10 -125 ). Genetically predicted MI was significantly associated with higher odds of large artery stroke (OR 1.487, 95% CI 1.25-1.77, P=9.53х10 -6 ). Suggestive associations were found between genetically determined resting heart rate and higher odds of ischemic stroke (OR 1.01, 95% CI 1.00-1.02, P=0.005), large artery stroke (OR 1.02, 95% CI 1.00-1.04, P=0.026) and cardioembolic stroke (OR 1.02, 95% CI 1.00-1.04, P=0.028). There was no causal association of P-wave terminal force in the precordial lead V1 (PTFVI), P-wave duration (PWD), N-terminal-pro-brain Natriuretic Peptide (NT-pro BNP) or PR interval with ischemic stroke or any subtypes. Conclusion: Genetic predisposition to AF and heart rate are associated with cardioembolic stroke. No evidence of causality relationship of MI, PTFVI, PWD, NT-pro BNP and PR interval on cardioembolic stroke is found.

Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Background Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

A cross sectional study of lipid profile in stroke patients

Background: Atherosclerosis affects multiple vascular beds, accounting for nearly all of coronary heart disease and some proportion of ischemic strokes. Serum lipid levels have an effect on the short-term mortality due to strokes. But in some studies, there was no dyslipidemia in patients who presented with acute stroke. It is important to evaluate the serum lipid levels in both the types of strokes to guide lipid lowering therapy which can reduce incidence of stroke and related mortality. This study is undertaken to evaluate the role of serum lipids in patients of stroke in our centre.Methods: It is a cross sectional study, conducted on 176 patients of stroke, who were assessed by NIHSS stroke scale clinically. Serum lipid profile was measured in all patients. Data was entered in Microsoft Excel and analysed by descriptive statistics. Chi Square test was used for association of qualitative variables. A p value<0.05 was considered statistically significant.Results: In this study conducted on 176 patients, LDL values were deranged more in CVA-bleed group compared to CVA-infarct group. BMI was the best anthropometric measure that correlated with LDL. LDL was also the most common parameter that was deranged in nonsmokers (61.8%) whereas in smokers, total cholesterol (66.3%) was most commonly deranged. Triglyceride and VLDL values were deranged more commonly in diabetic group than in non-diabetic group. A total of 123 out of 145patinets with CVA- infarct, had deranged lipid profile and among patients with CVA- bleed 24 out of 32 had deranged lipid profile.Conclusions: Results of this study shows significant derangement in lipid profile especially in LDL cholesterol levels in both infarct and bleed group, therefore starting statin therapy would prove to be beneficial in preventing recurrence of stroke.

Reperfusion therapy in ischemic stroke

Aim. To assess the main results of thrombolytic therapy (TLT) in patients with ischemic stroke (IS) in the Regional Vascular Center at the premises of Emergency Hospital in Ufa. Material and methods . A retrospective study of the TLT use was carried out in patients with acute cerebrovascular accident (CVA) who were admitted to the hospital from January 1, 2014 to December 26, 2017 The inclusion criteria were all IS cases in which patients received alteplase (actilyse) in accordance with the thrombolysis protocol. Results. There was a decrease in the number of patients with acute CVA hospitalized in the department for CVA patients. The proportion of ischemic stroke increased from 76,3% in 2014 to 79,1% in 2017 Annually, there was an increase in the number of patients with onset-to-door time <4,5 hours and reduction in door-to-needle time for thrombolysis from 1,5 hours in 2014 to 52,5 minutes in 2017 The share of TLT procedures increased from 2,4% in 2014 to 7,3% in 2017 In total, 180 (4,8%) procedures was performed. In 96% of patients there was a significant regression of neurologic deficit according to the NIH Stroke Scale after reperfusion therapy for the entire period. A complication of TLT was hemorrhagic transformation (HT), which was symptomatic in 8 (4,4%) patients. The highest 30-day mortality rate after TLT was in 2014 — 7,7%, the lowest in 2015 — 2,3%. For the entire study period, this parameter was 3,8% . Conclusion. During the study period of TLT in IS patients, there was a positive trend in the number of patients with onset-to-door time <4,5 hours and a reduction in door-to-needle time for thrombolysis. We also observed increase of total thrombolysis procedure amount, and most patients had significant neurological deficit improvement. The incidence of significant complications and mortality after TLT was lower than in the Russian Federation. The safety of TLT is based on adherence to uniform patient selection criteria and thrombolysis protocol. A personalized approach in selecting patients for TLT is a predictor of the hemorrhagic complications. The adherence to the thrombolysis algorithm and guidelines of patient management after thrombolysis contributes to the successful use of this treatment method in IS patients.

Abstract WMP53: Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Introduction: Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods: A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results: There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion: Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018

BackgroundInfective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years.MethodsMedical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018.ResultsA Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality.ConclusionsOur study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.

What after cryptogenic stroke – NOAC for everyone or ICM for some?

Atrial fibrillation (AF) is by far the most common cause of stroke with cardiovascular etiology. It is commonly believed that a significant proportion of ischemic strokes of an unknown cause are in fact also embolic (ESUS). This leads to consideration that patients after ESUS are potential candidates for chronic NOAC treatment. However, the therapeutic strategy constructed in such a simple way has been verified negatively in recent randomized trials. It is uncertain whether the pharmaceutical industry will be interested in continuing research in a subpopulation of ESUS patients with a particularly high risk of AF. However, it is now possible to strive for extended ECG monitoring aimed at detecting paroxysmal AF that is not detected by standard post-stroke diagnostic workup. In both scenarios, pragmatic and economic considerations make it necessary to develop a method of proper patients selection. The discussed analysis of data collected during the CRYSTAL-AF study, discussed by me, allows to better understand the imperfection of the current thinking about ESUS and provides information that may development the creation of an optimal model for dealing with this group of patients.

Abstract WMP54: Updated Population Trends in Substance Abuse Preceding Stroke in Young Adults: 1993/1994 to 2015

Objective: To update trends on documented substance abuse among young adults (18-54 years old) with stroke within the Greater Cincinnati/Northern Kentucky Stroke Study population, to include preliminary results from 2015. Background: Substance abuse is associated with stroke. In our population, we previously reported increases in overall substance abuse, smoking history, and use of alcohol or drugs &lt;24 hours prior to stroke onset. We also found increased illicit drug use in the 35 to 54 age group from 1993/94 through 2010. We now report trends after adding 2015 preliminary results. &gt;Design/Methods: Using ICD-9 discharge codes 430-436, potential acute stroke events are identified among 18- to 55-year-old residents of the 5 county study region. Five one-year study periods are included (7/93-6/94, 1999, 2005, 2010, 2015). Study nurses abstract all events which then undergo physician review. We searched for trends in smoking history, illicit drug use, heavy alcohol consumption, overall substance abuse (current smoking, alcohol, and illicit drug), and urine/blood test positive for alcohol or illicit drugs at presentation. Results: There were 2220 stroke events (75 % ischemic). Sex and age distribution remained stable; however, percent black increased from 35% to 46% between 1993/94 and 2015, as did the proportion of ischemic strokes (74% to 77%). Current smoking and alcohol use remained stable while illicit drug use increased significantly overall and within the age subgroups of 18-34 years and 35-54 years (see table). Conclusions: Illicit drug use continues to increase among young adults with stroke. Even though the possibility of testing bias needs to be explored further, our reported results are likely an under estimation of true rates as there are no readily available tests for new designer drugs which have become more available since the early 2000’s. Future analysis will also focus on the relationship between our findings and the U.S. opioid epidemic.

Abstract 47: Incidence of Cervical Artery Dissection Across Age Groups

Introduction: Dissection of a cervical artery has been well described as a cause of ischemic stroke in the young. The role of dissection as a cause of stroke among older adults is less clear, but there are no obvious reasons why older patients would have less of a predisposition to dissection than younger patients. Hypothesis: We hypothesized that the incidence of dissection-related ischemic stroke would remain constant across age. Methods: We used inpatient discharge data included in the 2012-2015 releases of the National Inpatient Survey (NIS). We used previously validated ICD-9-CM codes to identify adults who were hospitalized with ischemic stroke and a concomitant diagnosis of either carotid- or vertebral-artery dissection. We compared the prevalence of concomitant dissection among stroke hospitalizations across patient subgroups defined by age. Survey weights provided by the NIS were used to calculate nationally representative estimates. Population estimates from the U.S. census were used to calculate the incidence of hospitalization with stroke and concomitant dissection per million person-years. Results: From 2012-2015, there were 17,325 hospitalizations with ischemic stroke and a concomitant dissection in the US. The prevalence of cervical-artery dissection among stroke hospitalizations was highest among those under 40 years of age and gradually decreased across increasing 10-year age intervals (Figure 1A). On the other hand, the overall incidence of hospitalization for stroke and concomitant dissection increased with increasing age (Figure 1B). Conclusions: In a nationally representative sample, we found that cervical-artery dissection accounts for a greater proportion of ischemic strokes among younger patients, but the absolute incidence of dissection-related stroke increases with age.

Intravenous thrombolysis for ischemic stroke in the Veneto region: the gap between eligibility and reality.

Intravenous thrombolysis (IVT) is the treatment of choice for most patients with acute ischemic stroke. According to the recently updated guidelines, IVT should be administered in absence of absolute exclusion criteria. We aimed to assess the proportion of ischemic strokes potentially eligible and actually treated with IVT, and to explore the reasons for not administering IVT. We prospectively collected and analyzed data from 1184 consecutive ischemic stroke patients admitted to the 22 Stroke Units (SUs) of the Veneto region from September 18th to December 10th 2017. Patients were treated with IVT according to the current Italian guidelines. For untreated patients, the reasons for not administering IVT were reported by each center in a predefined model including absolute and/or relative exclusion criteria and other possible reasons. Out of 841 (71%) patients who presented within 4.5h of stroke onset, 704 (59%) had no other absolute exclusion criteria and were therefore potentially eligible for IVT according to the current guidelines. However, only 323 (27%) patients were eventually treated with IVT. Among 861 (73%) untreated patients, 480 had at least one absolute exclusion criterion, 283 only relative exclusion criteria, 56 only other reasons, and 42 a combination of relative exclusion criteria and other reasons. Our study showed that only 46% (323/704) of the potentially eligible patients were actually treated with IVT in the SUs of the Veneto region. All healthcare professionals involved in the acute stroke pathway should make an effort to bridge this gap between eligibility and reality.

P6384High proportion of ischemic strokes may be due to low adherence to oral anticoagulation guidelines among patients with atrial fibrillation and stroke risk factors

P6384High proportion of ischemic strokes may be due to low adherence to oral anticoagulation guidelines among patients with atrial fibrillation and stroke risk factors

Number of ischemic strokes potentially eligible for revascularization treatments in an Italian Comprehensive Stroke Center: a modeling study.

To rationally plan acute services, the proportion of ischemic strokes that may be eligible for revascularization treatments should be estimated. We aimed to estimate the proportion of patients directly admitted to an Italian Comprehensive Stroke Center who may be eligible for intravenous thrombolysis (IVT), combined IVT and endovascular thrombectomy (ET), or direct ET according to the current guidelines. We conducted a retrospective analysis based on data prospectively collected from 876 consecutive adult ischemic stroke patients who were directly admitted to the Stroke Unit of the University Hospital of Verona within 12h of stroke onset. A theoretical model was created to calculate the proportion of patients potentially eligible for revascularization treatments. In our cohort, 289 (33%) patients would be eligible for IVT alone, 193 (22%) for combined IVT and ET, and 39 (4%) for direct ET with level of evidence IA according to the current guidelines. According to our theoretical model, more than half of the ischemic stroke patients directly admitted to Verona Stroke Unit within 12h of stroke onset would be eligible for IVT and more than a quarter for ET. Systems of care should promptly organize to offer each patient the best treatment.

Stroke in Adults With Coarctation of the Aorta: A National Population-Based Study.

BackgroundAdults with repaired coarctation of the aorta (CoA) have reduced long‐term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era.Methods and ResultsThis was a cross‐sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population. To test this hypothesis, we compared the age at stroke in patients with and without a diagnosis of CoA using simple and multivariable weighted linear regression. Among 4 894 582 stroke discharges, 207 had a diagnosis of CoA. Patients with CoA had strokes at significantly younger age compared with patients without CoA: 18.9 years younger for all‐cause stroke (P<0.001), 15.9 years younger for ischemic stroke (P<0.001), and 28.5 years younger for hemorrhagic stroke (P<0.001), after adjusting for potential confounders. There was no significant difference in the proportion of ischemic strokes between those with and without CoA (79.2% versus 83.0%, P=0.50). However, CoA patients had a higher proportion of subarachnoid hemorrhage (11.8% versus 4.8%, P=0.039) than those without CoA. Among patients who had a hemorrhagic stroke, the prevalence of unruptured intracranial aneurysms was higher in patients with CoA compared with those without CoA (23.3% versus 2.5%, P=0.002).ConclusionsPatients with CoA have both ischemic and hemorrhagic strokes at significantly younger ages compared with the general population.