Risk Factor For Cerebrovascular Complications Research Articles

Prediction of cerebrovascular complications of coronary artery bypass grafting in patients without significant stenosis of the carotid arteries

Introduction. Аpproximately 20% of all patients referred for coronary bypass surgery (CABG) have hemodynamically insignificant carotid artery stenoses. It is known that a decrease in the elasticity of the walls of the arteries of the brain due to atherosclerosis is a risk factor for cerebrovascular complications in cardiac surgery. The purpose of the work. Construction of prognostic models determining the probability of decompensation of chronic cerebral ischemia (CIG) and the development of early postoperative cognitive dysfunction (POCD) in patients with hemodynamically insignificant carotid artery stenosis in the hospital period of CABG performed under conditions of artificial circulation.Material and methods. 58 patients with < 50% carotid artery stenosis were examined, age – 56.2 [52.0; 63.0] years. Neurological, neuropsychological and laboratory-instrumental examinations were performed 2–3 days before and 8–9 days after the operation. The degree of narrowing of the carotid arteries was determined by color duplex scanning. Regression and ROC analyses were performed.Results. Decompensation of HIGM on day 8–9 of CABG was detected in 51.7%, early POCD – in 63.8% of patients. The prognostic criteria for the decompensation of the CIG and the development of early POCD were: a long history of arterial hypertension, low myocardial contractility, estimated by the preoperative index «left ventricular ejection fraction», a low average value of plasma glucose in the intraoperative period and the development of a systemic inflammatory reaction, estimated on the SOFA scale of «5 or more points» in 1–2 days after CABG.Conclusion. With the help of the obtained prognostic models, it is possible to stratify the probability of decompensation of HIGM and the development of early POCD in order to prescribe preventive treatment in a timely manner.

Promising Anti-stroke Signature of Voglibose: Investigation through In- Silico Molecular Docking and Virtual Screening in In-Vivo Animal Studies.

Postprandial hyperglycemia considered to be a major risk factor for cerebrovascular complications. The current study was designed to elucidate the beneficial role of voglibose via in-silico in vitro to in-vivo studies in improving the postprandial glycaemic state by protection against strokeprone type 2 diabetes. In-Silico molecular docking and virtual screening were carried out with the help of iGEMDOCK+ Pymol+docking software and Protein Drug Bank database (PDB). Based on the results of docking studies, in-vivo investigation was carried out for possible neuroprotective action. T2DM was induced by a single injection of streptozotocin (90mg/kg, i.v.) to neonates. Six weeks after induction, voglibose was administered at the dose of 10mg/kg p.o. for two weeks. After eight weeks, diabetic rats were subjected to middle cerebral artery occlusion, and after 72 hours of surgery, neurological deficits were determined. The blood was collected for the determination of serum glucose, CK-MB, LDH and lipid levels. Brains were excised for determination of brain infarct volume, brain hemisphere weight difference, Na+-K+ ATPase activity, ROS parameters, NO levels, and aldose reductase activity. In-silico docking studies showed good docking binding score for stroke associated proteins, which possibly hypotheses neuroprotective action of voglibose in stroke. In the present in-vivo study, pre-treatment with voglibose showed a significant decrease (p<0.05) in serum glucose and lipid levels. Voglibose has shown significant (p<0.05) reduction in neurological score, brain infarct volume, the difference in brain hemisphere weight. On biochemical evaluation, treatment with voglibose produced significant (p<0.05) decrease in CK-MB, LDH, and NO levels in blood and reduction in Na+-K+ ATPase, oxidative stress, and aldose reductase activity in brain homogenate. In-silico molecular docking and virtual screening studies and in-vivo studies in MCAo induced stroke, animal model outcomes support the strong anti-stroke signature for possible neuroprotective therapeutics.

Cervical Artery Dissections with and without stroke, risk factors and prognosis: a Chilean prospective cohort

We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort.Methods: Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used.Results: 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97–8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38–5.78, P = 0.005) and vessel occlusion (OR 4.45, 95% CI 1.38–14.38, P = 0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16–0.74, P = 0.006) and longer symptom onset to admission (O–A) time (OR 0.79, 95% CI 0.70–0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, P = 0.008) and O–A time (OR 0.80, 95% CI 0.69–0.92, P = 0.002) remained independently associated with stroke.Conclusion: CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.

Abstract P134: PR Interval Length is Associated With Presence of the White Matter Lesions: Insights From the Epidemiological LIFE-Adult Study

Background: PR interval prolongation is associated with increased risk for atrial fibrillation (AF). AF is a known risk factor for cerebrovascular complications including microbleeds and stroke. This might explain the occurrence of white matter lesions (WML) and consequent cognitive dysfunction. The aim of the current study was to analyze the relationship between PR interval and WML in an epidemiological study. Methods: The LIFE-Adult-Study is a population-based cohort study of randomly selected participants from Leipzig, Germany. In this cross-sectional analysis, individuals without AF, with available brain MRI and ECG were included. The Fazekas scale was used to quantify the amount of WML and was graded into four Fazekas stages: 0=none; 1=punctate foci; 2= beginning confluence; 3=large confluent areas. Stages 2-3 were considered as advanced WML. Results: The study population comprised 2421 individuals (age 59±15 years, 1287 (53.2%) males). The median PR interval was 160 ms (IQR 143; 179). There were 319 (13.2%) individuals with advanced WML (stages 2 and 3). These probands were significantly older, had more often cardiovascular comorbidities, diabetes and stroke than patients without WML (all p&lt;0.005). On univariable analysis, PR interval (OR 1.012, 95%CI 1.008-1.016, p≤0.001) and PR interval ≥160 ms (OR 2.1, 95%CI 1.6-2.7, p≤0.001) were significantly associated with advanced WML. On multivariable analysis, age, arterial hypertension, stroke and PR interval (OR 1.005, 95%CI 1.000-1.009, p=0.044) demonstrated significant association with advanced WML. Furthermore, in other multivariable model PR interval ≥160ms demonstrated significant association with WML (OR 1.431, 95%CI 1.089-1.881, p=0.010). Conclusions: The PR interval is associated with advanced WML.

Analysis of risk factors for cerebrovascular complications after carotid endarterectomy

Objective: To evaluate the related risk factors of cerebrovascular complications after carotid endarterectomy (CEA) and to improve the efficacy of CEA in the treatment of ischemic stroke. Methods: The clinical data of 295 patients with atherosclerotic carotid artery stenosis who underwent CEA in the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2013 to March 2017 were retrospectively analyzed. Results: As the results of the single-factor analysis of logistics, severe lower limb artery stenosis (RR=5.667, P=0.017), systolic blood pressure before the carotid artery clamping (RR=6.659, P=0.010), diastolic blood pressure before the carotid artery clamping (RR=3.981, P=0.046), stump pressure (RR=5.359, P=0.021), diastolic blood pressure after surgery (RR=9.550, P=0.002), diastolic blood pressure of the first day after surgery (RR=7.932, P=0.005) were influencing factors of postoperative cerebrovascular complications after CEA. The results of multi-factor analysis of logistic regression indicated that diastolic blood pressure before the carotid artery clamping (RR=0.953, P=0.024) and stump pressure to basic systolic blood pressure index (SSI)>0.25 (RR=0.086, P=0.049) were independent risk factors for postoperative cerebrovascular complications after CEA. Conclusion: Systolic blood pressure before carotid artery clamping and SSI>0.25 are independent risk factors for postoperative cerebrovascular complications after CEA. Close follow-up and drug treatment for patients after CEA might be beneficial to reduce postoperative carotid artery restenosis.

Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

Risk factors for cerebrovascular complications developing during or after carotid endarterectomy (CEA) include preoperative impairments in cerebral hemodynamics, as detected by the demonstration of decreased cerebrovascular reactivity (CVR) to acetazolamide on brain perfusion SPECT. Central benzodiazepine receptor binding potential (CBRBP) and cerebral blood flow (CBF) images on SPECT provide high sensitivity and high specificity for detecting misery perfusion in patients with chronic unilateral major cerebral artery occlusive disease. The aim of the present study was to determine whether preoperative CBRBP/CBF images on SPECT could identify patients at risk for new cerebral ischemic events, including neurologic deficits and cerebral ischemic lesions on diffusion-weighted MRI, or cerebral hyperperfusion after CEA and to compare the predictive accuracy of CBRBP/CBF with that of CVR to acetazolamide on SPECT. CBF, CVR, and CBRBP were assessed using N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) and (123)I-iomazenil SPECT before CEA in 112 patients with unilateral internal carotid artery stenosis (≥ 70%). CBF measurement using (123)I-IMP SPECT was also performed immediately and 3 d after CEA. A region of interest was automatically placed in the middle cerebral artery territory in both cerebral hemispheres using a 3-dimensional stereotactic region-of-interest template. Diffusion-weighted MRI was performed within 3 d before and 24 h after surgery. A preoperative increase in the affected side-to-contralateral side asymmetry on CBRBP/CBF value was the only significant independent predictor of postoperative new cerebral ischemic events (95% confidence intervals [CI], 1.145-1.608; P = 0.0004) or post-CEA hyperperfusion (95% CI, 1.244-2.252; P = 0.0007). There was no difference in the ability to predict post-CEA hyperperfusion when comparing the area under the receiver-operating-characteristic curve of the affected side-to-contralateral side asymmetry on CBRBP/CBF and that of the CVR in the affected hemisphere. However, the former value (0.924; 95% CI, 0.854-0.972) was significantly greater than the latter value (0.782; 95% CI, 0.697-0.852) for the prediction of new postoperative cerebral ischemic events (P < 0.05). Preoperative CBRBP/CBF images on SPECT can more accurately identify patients at risk for cerebrovascular complications occurring during or after CEA when compared with preoperative CVR to acetazolamide.

Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

Anticoagulant therapy has been anticipated to increase the risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and the incidence of symptomatic CVC in left-sided NVE. In a prospective cohort study, the CVC incidence was compared between NVE patients with and without ongoing warfarin. Among 587 NVE episodes, 48 (8%) occurred in patients on warfarin. A symptomatic CVC was seen in 144 (25%) patients, with only three on warfarin. CVC were significantly less frequent in patients on warfarin (6% vs. 26%, odds ratio [OR] 0.20, 95% confidence interval [CI] 0.06-0.6, p = 0.006). No increase in haemorrhagic lesions was detected in patients on warfarin. Staphylococcus aureus aetiology (adjusted OR [aOR] 6.3, 95% CI 3.8-10.4) and vegetation length (aOR 1.04, 96% CI 1.01-1.07) were risk factors for CVC, while warfarin on admission (aOR 0.26, 95% CI 0.07-0.94), history of congestive heart failure (adjusted OR 0.22, 95% CI 0.1-0.52) and previous endocarditis (aOR 0.1, 95% CI 0.01-0.79) correlated with lower CVC frequency.

L'hypertension artérielle et un âge de plus de 70 ans sont les principaux facteurs de risque d'accidents vasculaires cérébraux chez les patients en fibrillation auriculaireHypertension and age over 70 years are the two most important risk factors for stroke in patients with atrial fibrillation

In a registry of 250 patients treated for atrial fibrillation (160 recurrent, 90 permanent forms), we prospectively looked for associated risk factors for cerebrovascular complications. After a 4-years follow-up, 19 patients had presented a cerebral accident (13 strokes, 4 transient ischemic attacks, 2 cerebral hemorrhages). Prognostic factors for cerebrovascular complications were hypertension, valvular heart disease, and age > or = 70 years. When restricting the analysis to stroke and transient ischemic attacks, prognostic factors were limited to hypertension and age > or = 70 years. In conclusion, hypertension and age > or = 70 years are the main independent risk factors for cerebral ischemic attacks in out-of-hospital patients treated for atrial fibrillation.

L’hypertension artérielle et un âge de plus de 70 ans sont les principaux facteurs de risque d’accidents vasculaires cérébraux chez les patients en fibrillation auriculaire

In a registry of 250 patients treated for atrial fibrillation (160 recurrent, 90 permanent forms), we prospectively looked for associated risk factors for cerebrovascular complications. After a 4-years follow-up, 19 patients had presented a cerebral accident (13 strokes, 4 transient ischemic attacks, 2 cerebral hemorrhages). Prognostic factors for cerebrovascular complications were hypertension, valvular heart disease, and age ≥70 years. When restricting the analysis to stroke and transient ischemic attacks, prognostic factors were limited to hypertension and age ≥70 years. In conclusion, hypertension and age ≥70 years are the main independent risk factors for cerebral ischemic attacks in out-of-hospital patients treated for atrial fibrillation.

Long-term prognosis of ischemic stroke in young adults.

Prognostic information is provided for 74 young adults (age 16-40 yrs, mean age at stroke 29.5 yrs), who suffered from ischemic stroke and survived the first month after the stroke. The patients were followed for 13-26 yrs; in total for 1190 yrs after their stroke. At follow-up 12 of the patients were dead, mostly from severe underlying disease that was complicated by ischemic stroke. In 3 cases death was unrelated to cerebrovascular disease. Among the surviving 62 patients, 7 had experienced recurrent ischemic events (3 reinfarctions, 4 TIA:s). These 7 patients all had risk factors for cerebrovascular complications already at the time of their primary stroke. It is concluded that the long-term prognosis for ischemic stroke in the young adult is favourable. The recovery from neurological deficits is usually good (exceptions are occlusions within the internal carotid and middle cerebral arteries), the risk for recurrence is low (1.1-1.2% annually), and the social prognosis with respect to working capacity and family relation is fair.