Risk Factor For Ischemic Stroke Research Articles

Atrial Fibrilasyonu olan Hastalarda Tiroid Fonksiyon Bozukluğunun Değerlendirilmesi

Objective: Atrial fibrillation is a common cardiac arrhythmia and is an important risk factor for ischemic stroke and heart failure. Thyroid hormones have important effects on the cardiovascular system. In this study, we aimed to evaluate the relationship between atrial fibrillation (AF) and thyroid disorders.
 Materials and Methods: 587 newly diagnosed AF patients who applied to the Cardiology Clinic between January and December 2022 were included in this study. Thyroid function tests of the patients were examined.
 Results: The mean age of the patients included in the study was 62.2 ± 9.8 years. 62% of the patients were female, and 38% were male. Euthyroid in 539 patients (91.7%), hypothyroidism in 2 patients (0.3%), subclinical hypothyroidism in 11 patients (2%), hyperthyroidism in 23 patients (3.9%), and subclinical hyperthyroidism in 12 patients (2.1%).
 Conclusion: Atrial Fibrillation is associated with both hyperthyroidism and hypothyroidism. Thyroid dysfunctions are more common in patients with AF than in the normal population. Patients with AF should be screened for thyroid disorders.

Management and Prognosis of Acute Stroke in Atrial Fibrillation.

Atrial fibrillation (AF) is an important risk factor for ischemic stroke (IS). Oral anticoagulation (OAC) significantly reduces the risk of IS in AF but also increases the risk of systemic bleeding, including intracerebral hemorrhage (ICH). AF-related strokes are associated with greater disability and mortality compared to non-AF strokes. The management of patients with AF-related strokes is challenging, and it involves weighing individual risks and benefits in the acute treatment and preventive strategies of these patients. This review summarizes the current knowledge of the acute management of ischemic and hemorrhagic stroke in patients with AF, and the prognosis and potential implications for management both in the acute and long-term setting.

Abstract 013: Hippocampal Neuroinflammation Occurs After Focal Cerebral Ischemic Stroke That May Contribute To Post-Stroke Memory Loss

Chronic hypertension is a leading risk factor for ischemic stroke. Post-stroke dementia occurs in up to 80% of stroke survivors, and its prevalence is increasing due to an aging population. Memory is impaired in rodent models of transient middle cerebral artery occlusion (tMCAO). However, the impact of cerebral ischemia on brain regions involved in memory that are distant from the ischemic site, such as the hippocampus, remains unclear, but may involve neuroinflammation that is known to disrupt memory. We tested the hypothesis that neuroinflammation occurs in the hippocampus after tMCAO, contributing to memory dysfunction, and is more severe during chronic hypertension. Adult normotensive male Wistar rats and spontaneously hypertensive rats (SHR) underwent 45 minutes of ischemia induced using the intravascular filament method of tMCAO and seven days of reperfusion (or sham; n=6-8/group). A novel object recognition task was used days 5-7 post-tMCAO, and recognition index calculated to assess long-term memory function. Neuroinflammation in the hippocampal CA1 region of ipsi- and contralesional hemispheres was assessed immunohistochemically: microglial activation using Iba1 staining and neuronal expression of tumor necrosis factor alpha (TNFα). Data are mean ± SEM and comparisons made via a two-way ANOVA to determine the interaction between hypertension and stroke with a post-hoc Tukey test. Sham operated SHR and Wistar rats performed similarly well in the memory task and had recognition indices 0.65-0.70. However, memory was impaired in rats that had tMCAO, with recognition indices decreasing to 0.52±0.02 in Wistar rats and 0.52±0.03 in SHR (F 1,24 =21.60; p<0.01). Ischemia increased the number of TNFα expressing neurons regardless of hypertensive status in hippocampus of ipsi- (F 1,25 =7.87; p<0.01) and contra-lesional hemispheres (F 1,25 =4.22; p<0.05). There was a significant effect of ischemia on microglial activation in the hippocampus of both SHR and Wistar rats that only occurred ipsi-lesionally (F 1,24 =5.48; p<0.05). These findings demonstrate that hippocampal neuroinflammation is present seven days after transient focal cerebral ischemia that may contribute to post-stroke memory impairment.

Causal Paradigm Between Common Comorbidities of Cardiovascular and Metabolism-Related Diseases in Elderly: Evidence from Cross-Sectional and Mendelian Randomization Studies.

Comorbidity is a common problem among elderly people, significantly damaging individuals' health and healthcare systems. However, observational studies may be susceptible to residual confounding factors and bias. The present study aimed to assess the causal effect of common chronic disease comorbidity using the Mendelian randomization (MR) approach. Data for the present study were obtained from a community survey conducted between 2018 and 2020 in four counties in Ganzhou City, southern China. A cross-sectional survey was conducted using a multi-stage stratified random sampling method. A total of 1756 valid questionnaires were collected to analyze common chronic disease comorbidities. Genetic variants associated with hypertension, diabetes, stroke, and hyperlipidemia-related factors were selected as instrumental variables for univariate and multivariate MR analyses. The self-reported prevalence of chronic disease in the older adult population in Southern China was 68.1%, with hypertension (46.1%), diabetes (10.5%), and hyperlipidemia (8.5%) being the three most common conditions. The prevalence of chronic disease comorbidity was 20.7% among the 12 chronic diseases studied. Hypertension was identified as a predictor of diabetes (OR [95% CI]: 1.114 [1.049, 1.184], p < 0.001), and diabetes mellitus was equally identified as a risk factor for hypertension (OR [95% CI]: 1.118 [1.069, 1.187], p < 0.001). Furthermore, high triglyceride levels were identified as a risk factor for hypertension (OR [95% CI]: 1.262 [1.129, 1.411], p < 0.001). In contrast to intracranial hemorrhages, hypertension had a significant impact on ischemic stroke (OR [95% CI]: 1.299 [1.161, 1.454], p < 0.001). The causal association between multiple cardiovascular and metabolism-related diseases is mediated by hypertension, with a bidirectional cause-and-effect relationship between hypertension and diabetes. Hypertension is a risk factor for ischemic stroke, and the hyperlipidemia-related factor triglycerides (TG) influence hypertension. Therefore, prioritizing hypertension prevention and control in the elderly is critical for effective chronic disease management.

Self-Efficacy and Self-Care as Risk Factors for Ischemic Stroke: Development and Validation of a Nomogram.

This study addresses the knowledge gap on how self-efficacy and self-care affect stroke risk as factors and develops a valuable tool for clinicians to assess stroke risk. From January 2022 to January 2023, this nested-case control study was conducted. Medical data including gender, age, ethnicity, locality, education, marital status, employment, caregiver, social environment, blood viscosity, Barthel Index, modified Rankin Scale (mRS), stroke risk score, self-care score, and self-efficacy score were collected. Logistic regression was used to predict stroke risk, and a nomogram was developed and validated. 240 patients were included in the analysis. Stroke risk score (OR: 3.513; p = 0.005), self-efficacy score (OR: 0.753; p = 0.048), and self-care score (OR: 0.817; p = 0.018) were predictors of ischemic stroke. Internal validation was carried out, with a C-index of 0.774, and the Hosmer-Lemeshow test indicated a good fit (p = 0.92). The calibration plot also shows that this nomogram model has good calibration abilities. The decision curve analysis (DCA) results show a threshold probability range of 10-95%. A nomogram has been developed with good validity, calibration, and clinical utility, including self-care and self-efficacy as risk factors for predicting ischemic stroke.

Correlation between Atherogenic Index of Plasma and Lipid Profile with Cognitive Function and Their Effect on Outcome in Ischemic Stroke Patients

Dyslipidemia is one of the main risk factors for both ischemic stroke and cognitive impairment. Atherogenic index of plasma (AIP) has been shown to correlate with mortality and clinical outcomes in stroke, but studies about its association with cognitive impairment in ischemic stroke is still limited. We aimed to determine the correlation between AIP and lipid profile and cognitive function and their effect on outcome in ischemic stroke patients. A cross-sectional study involving 50 ischemic stroke patients in the Haji Adam Malik General Hospital was conducted from August 2021 to March 2022. We measured the cholesterol level and calculated the AIP then divided them into 3 risk categories which were high (AIP&gt;0.21); intermediate (AIP&gt;0.11and ≤0.21) and low (≤0.11). We performed cognitive assessment and stroke outcome at the 7th day of stroke onset. Data analysis was conducted with Spearman correlation test. The subjects were predominantly male (60%) with median age of 55 (34-68) years. Most of the subjects had AIP level of high risk (54%) and were cognitively impaired (66%). There was no significant association between AIP and both global cognition and each cognitive domain. However, there were significant negative correlations between total cholesterol (r=-0.31, p=0.03) and LDL-C level (r=-0.30, p=0.03) and attention. There was also a significant negative correlation between cognitive function and stroke outcome (r=-0.61, p=0.01). Higher total cholesterol and LDL-C levels showed negative correlation with cognitive function, mainly attention. Poorer cognitive function correlated with worse outcome in ischemic stroke patients.

Risk factors for postoperative acute ischemic stroke in advanced-aged patients with previous stroke undergoing noncardiac surgery: a retrospective cohort study

BackgroundThe current study aimed to investigate the incidence and risk factors for postoperative acute ischemic stroke (PAIS) in advanced-aged patients (≥ 75 years) with previous ischemic stroke undergoing noncardiac surgery.MethodsIn this single-center retrospective cohort study, all advanced-aged patients underwent noncardiac surgery from 1 January, 2019, to 30 April, 2022. Data were extracted from hospital electronic medical records. Multivariable logistic regression analysis was performed to determine predictors of PAIS. Multivariable linear or logistic regression analysis was performed to determine predictors of outcomes due to PAIS.ResultsTwenty-four patients (6.0%) of the 400 patients developed PAIS. Carotid endarterectomy (CEA), length of surgery and preoperative Modified Rankin scale (mRS) ≥ 3 were significant predictors of PAIS. CEA was associated with increased risk of PAIS (OR 4.14; 95%CI, 1.43–11.99). Each additional minute in length of surgery had slightly increased the risk of PAIS (OR, 1.01; 95%CI, 1.00-1.01). Compared with reference (mRS < 3), mRS ≥ 3 increased odds of PAIS (OR, 4.09;95%CI, 1.12–14.93). Surgery type and length of surgery were found to be significant predictors of in-hospital expense (P < 0.001) and hospital stays (P < 0.05).ConclusionsCEA, length of surgery and preoperative mRS ≥ 3 may increase the development of PAIS in advanced-aged patients (≥ 75 years) with previous stroke undergoing noncardiac surgery. PAIS increased in-hospital mortality and prolonged hospital stay.

Lipids, Blood Pressure, and Diabetes Mellitus on Risk of Cardiovascular Diseases in East Asians: A Mendelian Randomization Study

Elevated blood pressure, dyslipidemia, and impaired glycemic control are well-established cardiovascular risk factors in Europeans, but there are comparatively few studies focused on East Asian populations. This study evaluated the potential causal relations between traditional cardiovascular risk factors and disease risk in East Asians through a 2-sample Mendelian randomization approach. We collected summary statistics for blood pressure parameters, lipid subsets, and type 2 diabetes mellitus liability from large genome-wide association study meta-analyses conducted in East Asians and Europeans. These were paired with summary statistics for ischemic heart disease (IHD), ischemic stroke (IS), peripheral vascular disease, heart failure (HF) and atrial fibrillation (AF). We performed univariable Mendelian randomization analyses for each exposure-outcome pair, followed by multivariable analyses for the available lipid subsets. The genetically predicted risk factors associated with IHD and AF were similar between East Asians and Europeans. However, in East Asians only genetically predicted elevated blood pressure was significantly associated with IS (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p<0.0001) and HF (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p<0.0001), whereas nearly all genetically predicted risk factors were significantly associated with IS and HF in Europeans. In conclusion, this study provides supportive evidence for similar causal relations between traditional cardiovascular risk factors and IHD and AF in both East Asian and European ancestry populations. However, the identified risk factors for IS and HF differed between East Asians and Europeans, potentially highlighting distinct disease etiologies between these populations.

Clinical Characteristics of Ischemic Stroke Patients

Background Stroke is a leading cause of mortality and disability around the world. It is responsible for 10% of all fatalities and about 5% of all disabilities. Risk factors include age, hypertension (HTN), dyslipidemia, and atrial fibrillation. The incidence of acute ischemic stroke (AIS) is increasing among young adults compared to older ones. It has a direct impact on their quality of life and working activities while also burdening the healthcare system. Aim The aim of this study is to investigate the possible risk factors for ischemic stroke in patients who are under 50 years old. Methods This is a single-center retrospective record review of patients with ischemic stroke from 2010 to 2022. Eighty patients who had an ischemic stroke at an age below 50 were included in the analysis. Patients above or equal to 50 years old who had ischemic stroke and all patients with hemorrhagic stroke were excluded. Baseline characteristics, length of hospitalization, and in-hospital mortality were compared with different comorbidities. Results The mean age was 36.65 among males and females who had an ischemic stroke. 56.8% of them were non-Saudi, while 43.2% were Saudis. Diabetes, hypertension, and dyslipidemia were among the most frequent comorbidities among patients who had ischemic stroke, with a percentage of 82.7%. Other comorbidities, such as autoimmune disease, thrombophilia, and heart failure, were present. Conclusion There are different comorbidities found in patients who have had an ischemic stroke and are under 50 years old. However, diabetes and hypertension remain the most common risk factors.

Association of remnant cholesterol with intracranial atherosclerosis in community-based population: The ARIC study

ObjectiveTo evaluate the association between remnant cholesterol (remnant-C) and intracranial atherosclerotic disease (ICAD) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). MethodsWe studied 1,564 participants with data on lipid profiles and high-resolution vessel wall MRI (VWMRI) from the ARIC-NCS. Remnant-C was computed as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C). The primary outcomes were the presence of intracranial plaques and luminal stenosis. Contributors were separated into four different groups based on remnant-C (22 mg/dL) and LDL-C (100 mg/dL) levels to investigate the function of remnant-C vs. LDL-C on ICAD. Multivariable logistic regression models were utilized to estimate the correlation among the discordant/concordant remnant-C and LDL-C, and ICAD. ResultsA total of 1,564 participants were included (age 76.2 ± 5.3). After multivariable adjustment, log remnant-C was correlated with greater ICAD risk [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.01 to 1.83]. The lower remnant-C/higher LDL-C group and the higher remnant-C/lower LDL-C group manifested a 1.53-fold (95% CI 1.06 to 2.20) and 1.52-fold (95% CI 1.08 to 2.14) greater risk of ICAD, relative to those having lower remnant-C/low LDL-C. Additionally, remnant-C ≥ 22 mg/dL distinguished participants at a greater risk of the presence of any stenosis compared to those at lower levels, even in participants with optimal levels of LDL-C. ConclusionsElevated levels of remnant-C were connected to ICAD independent of LDL-C and traditional risk factors. The mechanisms of remnant-C association with ICAD probably offer insight into preventive risk-factor of ischemic stroke.

Risk factors for ischemic stroke in men and women aged 45–74 years

Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.

Trends and burden of diabetes in patients with atrial fibrillation during 2007–2018: A Finnish nationwide cohort study

AimsWe assessed the temporal trends in the prevalence of diabetes and in its associations with outcomes among patients with atrial fibrillation (AF). MethodsThe registry-based FinACAF study covered all patients with incident AF in Finland between 2007 and 2018. Ischemic stroke (IS) and mortality rates were computed using Poisson regression model. ResultsWe identified 229565 patients (50.0% female; mean age 72.7 years; mean follow-up 4.0 years) patients with incident AF. The prevalence of diabetes increased steadily from 15.5% in 2007 to 26.3% in 2018. A decrease in IS and mortality rates was observed during the study period both in patients with and without diabetes. Diabetes was associated with IS and mortality (adjusted incidence rate ratios with 95% confidence intervals 1.22 (1.17–1.26) and 1.32 (1.29–1.34), respectively). The impact of diabetes on IS risk remained stable, while its effect on mortality increased slightly during the observation period. ConclusionsThe prevalence of diabetes has increased considerably among patients with AF between 2007 and 2018. There have been substantial improvements in the prognosis of AF patients with diabetes. However, diabetes remains a significant risk factor for IS and mortality in this patient population.

Aspiration thrombectomy of M2 segment in acute ischemic stroke: The clinical reality in a neurovascular reference center

ObjectiveOur study aimed to evaluate safety, efficacy and clinical outcomes in patients with acute ischemic stroke with occlusion of M2 segment treated with thromboaspiration. Materials and methodsA retrospective study was conducted in patients with ischemic stroke of M2 segment undergoing endovascular thromboaspiration. The time period analyzed was from October 2015 until February 2021. Thromboaspiration was performed with AXS Catalyst 5 (Stryker) or AXS Catalyst 6 (Stryker) catheters. The following parameters were assessed: risk factors for ischemic stroke, National Institutes of Health Stroke Scale (entry and discharge), pre-procedural fibrinolysis, pre-procedural and 24-h Alberta Stroke Program Early CT Score, recanalization time, number of passages for recanalization, Thrombolysis in cerebral infarction scale score, periprocedural complications, Modified Rankin Scale score at 90 days from procedure and mortality. Results90 patients were included in the study. The mean age was 75 ± 11.1 with National Institutes of Health Stroke Scale at entry 13 ± 5 and 8 ± 4 at discharge. Pre-procedural fibrinolysis were performed in 40 patients. Pre-procedural Alberta Stroke Program Early CT Score were 8.8 ± 1.3 and 6.9 ± 2.4 after 24 h from the procedure. Time of recanalization from onset of symptoms was 300 ± 82 min. Number of passages for recanalization were 1.8 ± 1.1. Thrombolysis in cerebral infarction scale score ≥ 2b were obtained in 90 % of procedures. After 90 days 33 % of patient obtained an Modified Rankin Scale between 0 and 1 (between 0 and 2 was 40 %). We didn't detect any complication in 64 % of cases (subarachnoid haemorrhage in 2 %, HI1 and HI 2 in 15 %, PH1 in 9 % of patients, PH2 in 6 % of patients). ConclusionsThis paper confirms the usefulness and safety of thrombospiration in patients with ischemic stroke in the M2 segment with low intra-operative risks, high technical success and positive impact on the outcome of the patients.

Association between Triglyceride glucose index in type 2 diabetes mellitus patients and acute ischemic stroke

Background: The stroke is a leading cause of mortality and disability globally. Diabetes mellitus increases the risk of stroke. It was observed that the risk of stroke is usually higher among the young diabetic patients. It was evident that pre-diabetic patients have a great risk of stroke as the presence of glucose in blood results in vascular endothelial dysfunction, increased early-age arterial stiffness, systemic inflammation and thickening of the capillary basal membrane.In this study we aimed to determine the association between Triglyceride Glucose Index in Type-2 diabetes mellitus patients and acute ischemic stroke. &#x0D; Methods: The present prospective observational study was undertaken to elucidate the association between Triglyceride glucose index in type 2 diabetes mellitus patients and acute ischemic stroke.A total of 75 patients with acute ischemic stroke and had history of diabetes mellitus during the period of study were included in the study.&#x0D; Results: In our study the mean age of the patients was 58.74±11.37 years and the majority of the patients were males (57%) followed by 43% females. The average NIHSS score of study participants was 5. The mean FPG value was as 6.13±2.03 (mmol/l), mean TC was 5.76±1.4 (mmol/l), mean TG 1.98±0.93 was (mmol/l) and mean TyG index was 8.76±0.28.&#x0D; Conclusion: The present study concluded that the TyG index is an important risk factor of ischemic stroke as it was observed that the patients with higher TyG index has higher incidence of ischemic stroke.

The Role of the Low-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio as an Atherogenic Risk Factor in Young Adults with Ischemic Stroke: A Case-Control Study.

Dyslipidemia is a major atherogenic risk factor for ischemic stroke. Stroke patients tend to have high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). Therefore, it is noteworthy that there has been an increase in ischemic stroke cases in young and elderly individuals in recent years. This study investigated the TC/HDL-C ratio and the LDL-C/HDL-C ratio, which may be more specific and common lipid parameters in young patients with ischemic stroke. This study aimed to demonstrate the sensitivity and specificity of TC/HDL-C and LDL-C/HDL-C ratios as atherogenic markers for young adult ischemic strokes. This trial was conducted as a retrospective case-control study. A total of 123 patients (patient group) and 86 healthy individuals (control group) aged 18-50 years were randomly selected from four different hospitals. Lipid parameters and TC/HDL-C and LDL-C/HDL-C ratios were compared between these two groups. The mean age was 38.8 ± 7.3 years in patients and 37.7 ± 9 years in controls (p > 005). The HDL-C levels were 39.1 ± 10.8 mg/dL in patients and 48.4 ± 13.8 mg/dL in controls (p < 0.001). LDL-C/HDL-C ratios were 3.23 ± 1.74 and 2.38 ± 0.87, and TC/HDL-C ratios were 5.24 ± 2.31 and 4.10 ± 1.25 in the patient and control groups, respectively (p < 0.001). The LDL-C/HDL-C and TC/HDL-C cutoff values in ROC analyses were 2.61 and 4.40 respectively; the AUCs (95% CI) were determined to be 0.680 (0.608-0.753) and 0.683 (0.610-0.755) (p < 0.001), respectively. An increased risk of stroke was observed in those with a high LDL-C/HDL-C ratio (OR = 1.827; 95% CI = 1.341-2.488; p < 0.001). Our study obtained similar results when we compared the mean TC and LDL-C levels between the two groups. However, considering the TC/HDL-C and LDL-C/HDL-C ratios, it is noteworthy that there was a significant difference between the patient and control groups.

Atrial Fibrillation in Adult Congenital Heart Increase Ischemic Stroke Risk Even at Low CHA2DS2-VASc Score.

The population of adults with congenital heart diseases (ACHDs) is expanding, and atrial fibrillation (AF) emerges as a crucial risk factor for ischemic stroke. However, the evidence regarding the impact of AF on the incidence of ischemic stroke in ACHDs remains limited. In this study, we aimed to investigate the prevalence and effect of AF among ACHDs and assess the suitability of the traditional CHA₂DS₂-VASc score in this specific population. Data of ACHDs from 2000 to 2010 were retrospectively collected from the Taiwan National Health Insurance Research Database. We divided ACHDs into those with and without AF, and ischemic stroke incidence was studied among ACHD subtypes and those who received anticoagulant therapy with warfarin or not according to CHA₂DS₂-VASc score. 36,530 ACHDs were retrieved from the database. ACHDs had a 4.7-15.3 times higher AF risk than did the general population, which varied based on the age group. ACHDs with AF had 1.45 times higher ischemic stroke risk than those without AF (p = 0.009). Ischemic stroke incidence among ACHDs with AF aged 50 years was 1.46 times higher than those without AF (p = 0.207). Ischemic stroke incidence was over 1.47% even in those with a low CHA₂DS₂-VASc score (0-1) with or without anticoagulant therapy. During the 12-year follow-up, ACHDs with AF were found to have an increased risk of ischemic stroke. The ischemic stroke incidence was high, even in those with a low CHA₂DS₂-VASc score (0-1).

Early Epileptic Seizures after Ischemic Stroke: Their Association with Stroke Risk Factors and Stroke Characteristics.

Background and Objectives: A growing number of stroke survivors face various stroke complications, including new-onset epileptic seizures (ESs). Post-stroke ESs are divided into early and late ESs based on the time of onset after stroke. Early ESs are associated with worse stroke outcomes, longer hospitalization and an increased risk of late ESs. A variety of risk factors for early ESs are being studied in order to prevent their occurrence. Therefore, we aim to determine the association of early ESs with ischemic stroke risk factors and characteristics. Materials and Methods: A total of 166 patients, treated for ischemic stroke in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, were enrolled in a prospective cohort study. Initially, data about stroke risk factors, localization, severity and treatment were collected, followed by an observation period of 14 days for early ESs. Results: Early ESs occurred in 11 (6.6%) participants. The probability of early ESs after ischemic stroke among males and females (LogRank = 1.281; p > 0.05), younger (≤65 y) and older (>65 y) participants (LogRank = 0.129; p > 0.05) was the same. The presence of ischemic stroke risk factors, such as atrial fibrillation (LogRank = 0.004; p > 0.05), diabetes mellitus (LogRank = 1.168; p > 0.05) and dyslipidemia (LogRank = 0.092; p > 0.05), did not increase the probability of early ESs. However, participants without a prior history of arterial hypertension (LogRank = 4.453; p < 0.05) were more likely to develop early ESs. Stroke localization (anterior versus posterior) (LogRank = 0.011; p > 0.05), stroke severity (LogRank = 0.395; p > 0.05) and type of treatment (specific versus non-specific) (LogRank = 1.783; p > 0.05) did not affect the probability of early ESs.

Correction to: Risk Factors for Ischemic Stroke After Acute Coronary Syndrome.

Correction to: Risk Factors for Ischemic Stroke After Acute Coronary Syndrome.

Hyperglycemia exacerbates ischemic stroke not through increased generation of hydrogen peroxide

Diabetes is one of the significant risk factors for ischemic stroke. Hyperglycemia exacerbates the pathogenesis of stroke, leading to more extensive cerebral damage and, as a result, to more severe consequences. However, the mechanism whereby the hyperglycemic status in diabetes affects biochemical processes during the development of ischemic injury is still not fully understood. In the present work, we record for the first time the real-time dynamics of H2O2 in the matrix of neuronal mitochondria in vitro in culture and in vivo in the brain tissues of rats during development of ischemic stroke under conditions of hyperglycemia and normal glucose levels. To accomplish this, we used a highly sensitive HyPer7 biosensor and a fiber-optic interface technology. We demonstrated that a high glycemic status does not affect the generation of H2O2 in the tissues of the ischemic core, while significantly exacerbating the consequences of pathogenesis. For the first time using Raman microspectroscopy approach, we have shown how a sharp increase in the blood glucose level increases the relative amount of reduced cytochromes in the mitochondrial electron transport chain in neurons under normal conditions in awake mice.

Exosomal circCNOT6L Regulates Astrocyte Apoptotic Signals Induced by Hypoxia Exposure Through miR99a-5p/SERPINE1 and Alleviates Ischemic Stroke Injury.

Circular RNAs are involved in intervention strategies for treating ischemic stroke (IS). However, circCNOT6L (hsa_circ_0006168) has not yet been reported in IS. Thus, we aimed to explore the potential role of circCNOT6L and its molecular mechanism in IS. In this study, we first found that the expression of both exosomal circCNOT6L (P = 0.0006) and plasma circCNOT6L (P = 0.0054) was down-regulated in IS patients compared with controls. Clinically, a negative correlation was observed between the relative expression level of circCNOT6L and the National Institutes of Health Stroke Scale (NIHSS) score and infarct volume of the brain. Simultaneously, the relative expression level of circCNOT6L was negatively associated with multiple risk factors for IS, such as mean platelet volume (MPV), red cell distribution width (RDW), very low-density lipoprotein (VLDL), and serum potassium, whereas it was positively correlated with high-density lipoprotein (HDL). In vitro, circCNOT6L silencing blocked cell viability and proliferation, while it promoted cell apoptosis of astrocytes undergoing oxygen-glucose deprivation/reperfusion (OGD/R) treatment. Mechanistically, the RNA antisense purification (RAP) assay and luciferase reporter assay revealed that circCNOT6L acts as a miRNA sponge to absorb miR-99a-5p and then regulates the expression of serine proteinase inhibitor (SERPINE1). In the further rescue experiment, overexpressing SERPINE1 could rescue the cell apoptotic signals due to circCNOT6L depletion. In conclusion, CircCNOT6L attenuated the cell apoptotic signal of astrocytes via the miR99a-5p/SERPINE1 axis and then alleviated injury after hypoxia induced by ischemic stroke.