Risk Factor For Ischemic Stroke Research Articles

Gut Microbe-Generated Metabolite Trimethylamine-N-Oxide and Ischemic Stroke

Trimethylamine-N-oxide (TMAO) is a gut microbiota-derived metabolite, the production of which in vivo is mainly regulated by dietary choices, gut microbiota, and the hepatic enzyme flavin monooxygenase (FMO), while its elimination occurs via the kidneys. The TMAO level is positively correlated with the risk of developing cardiovascular diseases. Recent studies have found that TMAO plays an important role in the development of ischemic stroke. In this review, we describe the relationship between TMAO and ischemic stroke risk factors (hypertension, diabetes, atrial fibrillation, atherosclerosis, thrombosis, etc.), disease risk, severity, prognostic outcomes, and recurrence and discuss the possible mechanisms by which they interact. Importantly, TMAO induces atherosclerosis and thrombosis through lipid metabolism, foam cell formation, endothelial dysfunction (via inflammation, oxidative stress, and pyroptosis), enhanced platelet hyper-reactivity, and the upregulation and activation of vascular endothelial tissue factors. Although the pathogenic mechanisms underlying TMAO’s aggravation of disease severity and its effects on post-stroke neurological recovery and recurrence risk remain unclear, they may involve inflammation, astrocyte function, and pro-inflammatory monocytes. In addition, this paper provides a summary and evaluation of relevant preclinical and clinical studies on interventions regarding the gut-microbiota-dependent TMAO level to provide evidence for the prevention and treatment of ischemic stroke through the gut microbe–TMAO pathway.

Incremental clinical value of intraplaque neovascularization in predicting recurrent ischemic stroke

AbstractObjectiveCarotid intraplaque neovascularization (IPN) detected by contrast‐enhanced ultrasound (CEUS) is a risk factor for recurrent ischemic stroke. However, it is still unclear whether IPN can be used to accurately identify patients with recurrent ischemic stroke in clinical practice. Herein, we investigated the clinical predictive value of IPN for recurrent ischemic stroke in a real‐world setting.MethodsWe enrolled 200 patients with ischemic stroke and atherosclerotic carotid stenosis who were followed up for 2 years. The endpoint was recurrent ischemic stroke. Cox regression and subgroup analyses were employed to assess whether treatment affected the relationship between IPN and recurrent ischemic stroke. The net classification index (NRI) and integrated discriminant improvement index (IDI) were used to validate the additional clinical value of IPN in identifying recurrent ischemic stroke.ResultsDuring the 2‐year follow‐up, 36 patients experienced recurrent ischemic stroke. Cox regression analyses showed that IPN (grade 2), hypoechoic plaque, high homocysteine levels, and smoking were independent risk factors for recurrent ischemic stroke. Additional IPN evaluation may increase the NRI (0.512; 95% confidence interval [CI]: 0.083–0.624) and IDI (0.151; 95% CI: 0.010–0.213) for identifying high‐risk patients with recurrent ischemic stroke. In addition, in the subgroup undergoing revascularization, the proportion of IPN (grade 2) was significantly higher in patients with recurrent ischemic stroke than in patients with nonrecurrent ischemic stroke (p = 0.001).InterpretationIn clinical settings, IPN, assessed by CEUS, may provide additional clinical value for predicting recurrent ischemic stroke, helping to identify patients with ischemic stroke who require close follow‐up.

The Relationship Between Type 2 Diabetes Mellitus and The Incidence of Acute Ischemic Stroke

Background: Ischemic stroke is a cerebrovascular disease characterized by focal or global neurological deficits with clinical signs lasting 24 hours or more caused by disruption of blood supply to the brain. Stroke is the second leading cause of death in the world with 6.7 million deaths every year. The prevalence of stroke in Indonesia according to Riskesdas in 2018 reached 10.9%, namely around 2,120,362 people in Indonesia. Type 2 diabetes mellitus is a major risk factor for ischemic stroke. Data from the International Diabetes Federation (IDF) shows that in 2021 there will be 537 million cases of DM in adults aged 20-79 years, with an estimated increase to 643 million in 2030. With the estimated number of sufferers of type 2 diabetes mellitus continuing to increase, it can be concluded that ischemic stroke sufferers also continue to increase. Methods: Observational analytic with cross-sectional design. Sampling was taken from medical record data at the Regional General Hospital. Dr. Chasbullah Abdulmadjid Bekasi City with a total of 87 patients who met the inclusion criteria Results: The results of research conducted using Chi-Square Analysis showed that there was no significant relationship between type 2 diabetes mellitus and acute ischemic stroke with a P value of 0.698. The results of the Pearson Chi-Square analysis and Fisher exact test accepted H0 and rejected H1 (there was no relationship). Conclusions: There is no significant relationship between type 2 diabetes mellitus and the incidence of acute ischemic stroke Keywords: Type 2 diabetes mellitus, Ischemic, Stroke

Abstract 4124839: Does Anticoagulation Status Before LAA Thrombus Detection Influence Stroke Risk?

Introduction: Thrombus in the left atrial appendage (LAA) is known to be one of the risk factors for ischemic stroke, and after the detection of LAA thrombus, anticoagulation therapy is usually administered. However, the role of anticoagulation therapy before the detection of LAA thrombus in the prognosis is still unclear. Hypothesis: We assessed the hypothesis that the anticoagulation status at the time of LAA thrombus detection with transesophageal echocardiography (TEE) affects the future incidence of ischemic stroke. Methods: Patients who underwent TEE and were found to have LAA thrombus were included. Patients were divided into two groups based on their anticoagulation status before TEE. To exclude strokes that might occur due to the detected LAA thrombus itself, landmark analysis was performed by excluding patients who had a stroke or died within 30 days after detection of the LAA thrombus. The difference in the 7-year cumulative incidence of ischemic stroke was assessed using the Gray-test. Fine-Gray proportional hazard regression was utilized to assess the impact of anticoagulation status on ischemic stroke. Results: Among 183 patients detected with LAA thrombus, 15 suffered ischemic stroke or death within 30 days of detection, and 168 patients were included in this study. Of these, 58 patients were treated with anticoagulation therapy before the index detection of LAA thrombus (PreAC group). Patients in the PreAC group were older (median 76 years [interquartile range 51-88 years] vs. 74 years [38-89 years], P = 0.032) than those in the non-PreAC group. The rates of CHA2DS2-VASc score ≥ 2 (93% vs. 89%, P = 0.582), male sex (64% vs. 70%, P = 0.488), and history of atrial fibrillation (98% vs. 95%, P = 0.667) were similar between the two groups. The cumulative ischemic stroke rate was higher in the PreAC group than in the non-PreAC group (P = 0.048, Figure). Even after adjusting for CHA2DS2-VASc score, anticoagulation therapy before detection of LAA thrombus was significantly associated with the cumulative incidence of ischemic stroke (P = 0.049). Conclusions: Anticoagulation status before the detection of LAA thrombus is a determinant of a higher incidence of ischemic stroke. The background mechanisms suggesting a tendency toward thrombus generation even when treated with anticoagulation are proposed.

Gut commensal Parabacteroides distasonis exerts neuroprotective effects in acute ischemic stroke with hyperuricemia via regulating gut microbiota-gut-brain axis.

Hyperuricemia is considered as an independent risk factor for acute ischemic stroke (AIS), and some AIS patients are accompanied by an increase in serum uric acid. Recent studies have highlighted the important role of gut microbiota in both hyperuricemia and AIS, but there is little available data on the relationship between gut microbiota and the pathogenesis of AIS with hyperuricemia (HAS). Here we profiled the gut microbiota composition in 63 HAS patients and 269 non-HAS patients through 16s rRNA sequencing. Male rat with hyperuricemia were subjected to middle cerebral artery occlusion (MCAO) to establish HAS model and were then treated with Parabacteroides distasonis. Subsequently, the neurological deficit, pathological damages and blood-brain barrier disruption were evaluated. Moreover, the levels of ROS, inflammatory cytokines, NF-𝜿B pathway related protein, and vascular density markers were determined. There were significant differences of gut microbiota composition between HAS patients and non-HAS patients, and a significant decrease in the abundance of Parabacteroides in HAS patients compared to non-HAS patients. Animal experiments showed that supplementation with P. distasonis increased beneficial commensal bacteria, significantly improved neurological deficits, pathological damages and BBB disruption, as well as reduced the level of serum uric acid in HAS rats. We further demonstrated that P. distasonis treatment decreased ROS level and increased SOD2 level, thereby reducing oxidative stress. Meanwhile, P. distasonis effectively inhibited NF-𝜿B signal pathway and reduced the production of inflammatory cytokines, including TNF-α and IL-1β, alleviating the inflammatory response. Notably, P. distasonis treatment increased the levels of vascular density markers including cluster of differentiation 31 (CD31) and alpha-smooth muscle actin (α-SMA), ameliorating vascular damage in HAS rats. Together, these findings highlighted the important role of P. distasonis in the pathogenesis of HAS, and its mechanism was involved in the regulation of gut microbiota-gut-brain axis, which implied a novel strategy against HAS.

Mendelian randomization studies of lifestyle-related risk factors for stroke: a systematic review and meta-analysis

ObjectiveStroke risk factors often exert long-term effects, and Mendelian randomization (MR) offers significant advantages over traditional observational studies in evaluating the causal impact of these factors on stroke. This study aims to consolidate and evaluate the relationships between potential causal factors and stroke risk, drawing upon existing MR research.MethodsA comprehensive search for MR studies related to stroke was conducted up to August 2023 using databases such as PubMed, Web of Science, Embase, and Scopus. This meta-analysis examines the relationships between potential causative factors and stroke risk. Both random-effects and fixed-effects models were utilized to compile the dominance ratios of various causative elements linked to stroke. The reliability of the included studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology incorporating Mendelian Randomization (STROBE-MR) guidelines.ResultsThe analysis identified several risk factors for stroke, including obesity, hypertension, low-density lipoprotein cholesterol (LDL-C), chronic kidney disease (CKD), and smoking. Protective factors included high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR), and educational attainment. Subgroup analysis revealed that type 2 diabetes mellitus (T2DM), diastolic blood pressure (DBP) are risk factors for ischemic stroke (IS).ConclusionThis study confirms that variables such as obesity, hypertension, elevated LDL-C levels, CKD, and smoking are significantly linked to the development of stroke. Our findings provide new insights into genetic susceptibility and potential biological pathways involved in stroke development.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42024503049.

Congenital Hypofibrinogenemia is a Potential Risk Factor for Ischemic Stroke

Congenital Hypofibrinogenemia is a Potential Risk Factor for Ischemic Stroke

Causal associations of Sjögren's syndrome with cardiovascular disease: A two-sample Mendelian randomization study

Study objectivesObservational and cohort studies have associated Sjögren's syndrome (SS) with various types of cardiovascular disease (CVD), yet causal relationships have not been established. We employed Mendelian randomization (MR) to investigate potential causal links between SS and CVD in the general population. MethodsWe conducted a two-sample MR analysis using data from four distinct sources for 11 genome-wide significant single nucleotide polymorphisms (SNPs) associated with SS and data for 13 types of CVD sourced from FinnGen, IEU OpenGWAS, and GWAS catalog. The inverse variance weighted method was selected as the primary analytical approach, complemented by various sensitivity analyses. ResultsMR analyses provide evidence of a significantly increased risk of ischemic stroke associated with genetically predicted SS (odds ratio [OR], 1.0237; 95 % CI, 1.0096 to 1.0379; p = 0.0009), as well as suggestive evidence of a potential causal relationship between SS and an increased risk of chronic heart failure (OR, 1.0302; 95 % CI, 1.0020 to 1.0592; p = 0.0355). Sensitivity analyses reinforced these associations, demonstrating robustness and consistency across multiple statistical methods. The secondary analysis, conducted after outlier correction using MR-PRESSO and RadialMR methods, reaffirmed these associations and also indicated a suggestive causal link between SS and non-rheumatic valvular heart disease (OR, 1.0251; 95 % CI, 1.0021 to 1.0486; p = 0.0323). ConclusionsThis study demonstrates that genetically predicted SS is a potential causative risk factor for ischemic stroke, chronic heart failure, and non-rheumatic valvular heart disease on a large-scale population. However, further research incorporating ancestral diversity is required to confirm a causal relationship between SS and CVD.

Temporal trends of the burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from 1999 to 2019

BackgroundHigh levels of low-density lipoprotein cholesterol (LDL-C) can lead to the occurrence and development of atherosclerosis, which is one of the important risk factors for ischemic stroke (IS). However, details regarding the evolution of the IS burden attributable to high LDL-C in China has not been available. The objective of this study was to examine the changes over time, from 1990 to 2019, in the burden of IS attributed to high levels of LDL-C in China and to estimate the individual impacts of age, period, and cohort on the burden of IS associated with high LDL-C.MethodsDetailed data on IS burden attributable to high LDL-C from 1990 to 2019 in China were extracted from the Global Burden of Disease (GBD) Study 2019. The numbers and age-standardized rates of IS-related mortality and disability-adjusted life years (DALYs) attributable to high LDL-C were assessed by age and sex. The annual percentage change (APC) and average annual percentage change (AAPC) in the burden of IS due to high LDL-C were analyzed using Joinpoint regression model. The age-period-cohort analysis was carried out to assess the individual impacts of age, period, and cohort on the trends over time of mortality and DALY rate.ResultsThe number of IS-related deaths and DALYs due to high LDL-C in China were 182.7 thousand and 4.43 million in 2019, respectively, both more than double the corresponding numbers reported in 1990. However, despite these increased, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) remained unchanged. In 2019, men under 84 years of age had higher death and under 79 years of age had higher DALYs than women. However, above these ages, the gender disparities were reversed. Furthermore, age-specific rates of death, as well as DALY of IS attributable to high LDL-C in 2019 increased with age for both women and men, except for death in adults over 95 years old; and were greater in men than in women. From 1990 to 2019, males consistently had a higher ASMR and ASDR than females in China. During 1990–2019, the ASMR in women slightly decreased before 1997, sharply increased from 1997 to 2004, and then continuously decreased from 2004 to 2019, with an overall AAPC value of -0.4% (95% CI -0.8%, -0.0%). However, for the ASMR of men in China, the overall trend is upward and the AAPC is 0.5%(95% CI 0.1%, 0.8%). The ASDR in women and men had the similar trend as the ASMR over the time, with an AAPC of -0.4% (95% CI -0.7%, -0.1%) and 0.3% (95% CI 0.1%, 0.5%), respectively. The age-period-cohort analysis indicated a rise in period effects and a decline in cohort effects on mortality and DALY rate associated with IS caused by high LDL-C in both genders. Age effect on mortality rates from IS due to high LDL-C showed an exponential increased with age in all women and men except for the 60–69 age group and over 95 age group. The age relative risk of IS DALY rate due to high LDL-C increased with age in both genders except for 65–74 age group and over 95 age group.ConclusionsFrom 1990 to 2019, the burden of IS caused by high LDL-C in China significantly increased among both sexes combined and among men, while significantly decreased among women. Elderly have a substantial burden of IS attributable to high LDL-C. Therefore, effective and tailored strategies based on gender and age for IS primary prevention and management of IS and high LDL-C are urgently needed in China.

Machine learning identification of risk factors for ischaemic stroke in patients with heart failure with reduced ejection fraction but without atrial fibrillation: A report from WARCEF trial

Abstract Background The prediction of ischaemic stroke in patients with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation (AF) remains challenging and risk stratification based clinical factors alone has limited discrimination. Our aim was to evaluate the performance of machine learning (ML) to identify risk factors for ischaemic stroke in such HFrEF patients. Methods We performed a post-hoc analysis of the WARCEF trial, only including patients without prior history of AF, and censoring those who developed incident AF during follow-up. We evaluated the performance of 9 ML models to identify risk factors for incident stroke, using metrics including area under the curve (AUC), precision, specificity, and decision curve analysis. The importance of each feature in constructing the model was quantified using SHapley Additive exPlanations (SHAP) values. Results We included 2,213 patients with HFrEF but without AF (mean age 59±12 years; 79% male). Of these, 74 (3.3%) had an ischaemic stroke during mean follow-up of 3.5±1.8 years. Out of the 29 patient-demographics variables, 12 were selected for the ML training. All ML models demonstrated high AUC values, outperforming the CHA2DS2-VASc score (Figure 1). The logistic regression model exhibited a slight deviation from this trend. The XGBoost model achieved an AUC of 0.86 (95% confidence interval [CI]: 0.72-0.99), while the Random Forest model showed an AUC of 0.85 (95% CI: 0.74-0.96). Similarly, the Support Vector Machine and Light Gradient Boosting Machine models recorded AUCs of 0.85 (95% CI: 0.72-0.97) and 0.83 (95% CI: 0.70-0.96), respectively. Each of these models attained precision and specificity scores of 1.0, indicating high performance. These models consistently provided significant net clinical benefits. Key risk factors for stroke identified across these models were creatinine clearance and blood urea nitrogen. The use of warfarin appears to be protective. Conclusions Machine-learning models can identify risk factors for ischaemic stroke in patients with HFrEF but without AF. Worsening renal failure was predictive of an incident stroke, while warfarin use was protective against stroke (Figure 2).Figure 1Figure 2

Maintenance of sinus rhythm is associated with lower incidence of stroke in patients with drug-refractory atrial fibrillation

Abstract Introduction Recent studies have demonstrated that early rhythm control for first-line treatment of atrial fibrillation (AF) improved cardiovascular outcomes. However, there is limited data regarding the long-term outcome of patients who failed antiarrhythmic drugs and who refuse radiofrequency catheter ablation (RFCA). Methods Patients with AF who were refractory to antiarrhythmic drugs and had refused further rhythm control attempts via RFCA were retrospectively identified and propensity-score matched with who had been treated with RFCA. The primary outcome of interest was all-cause mortality or ischemic stroke. Results A total of 169 patients who refused rhythm control with RFCA and propensity-score matched 169 patients who had been treated with RFCA were included for analysis. During a mean follow-up of 4.3[2.3;6.9] years, maintenance of sinus rhythm was more achieved in RFCA group (7 [4.1%] in Refuse group vs. 133 [78.7%] in RFCA group, p<0.001). the incidence of ischemic stroke was significantly higher in patients who refused RFCA compared with patients who underwent RFCA (24 [14.2%] vs. 6 [3.5%], log-rank p<0.001), but all-cause mortality was not significantly different (log-rank p=0.8). Refusal of attempted rhythm control via RFCA was an independent risk factor for ischemic stroke on multivariate Cox analysis (hazard ratio 3.2; 95% confidence interval 1.2 to 8.53, p=0.02). The risk of major adverse cardiovascular events (MACE) were also significantly higher in Refuse group (31 [18.3%] vs. 12 [7.1%], HR 3.83, 95% CI 1.57-9.37, p=0.003). Conclusion In patients with antiarrhythmic drug-refractory AF, maintenance of sinus rhythm was significantly different dependent on rhythm control via RFCA, therefore the risk of stroke was significantly higher in patients who refused rhythm control via RFCA compared with that of those treated with RFCA.

A novel method to detect carotid artery in-stent restenosis.

Carotid artery stenosis is a major risk factor for ischemic stroke. Despite carotid artery stenting, in-stent restenosis (ISR) remains challenging. Pigs serve as an ideal ISR model. This study aims to establish a novel porcine model of carotid ISR using open-loop and closed-loop stents and to assess ISR with optical coherence tomography (OCT) and histopathology, comparing incidence and vascular response between stent types. Twelve adult male Bama miniature pigs underwent carotid stenting with either open-loop or closed-loop stents. The animals received antiplatelet therapy pre- and postimplantation. Postimplantation evaluations at 90days included carotid digital subtraction angiography (DSA), OCT, histopathological examination, and electron microscopy. Both stent types showed ISR as detected by OCT and DSA. OCT revealed comparable neointimal proliferation within stent struts for both types, with no significant differences in stent, lumen, and neointimal dimensions. Histopathological analysis and electron microscopy provided insights into tissue responses and healing processes following stent implantation. No significant difference in ISR incidence was found between the stent types based on a χ2 test (p=.110). OCT and hematoxylin-eosin staining exhibit the highest consistency in evaluating neointimal area. The novel porcine ISR model demonstrated similar ISR outcomes for open-loop and closed-loop stents. OCT proved to be a highly consistent and valuable tool for evaluating stent and arterial conditions, comparable to histopathological findings. However, due to a small sample size, the validity of these preliminary findings requires further investigation to be confirmed.

Reimagining Cryptogenic Stroke Care: Collaborative Care and Inpatient Insertable Cardiac Monitors for Detection of Atrial Fibrillation

BACKGROUND Atrial fibrillation (AF) is a known risk factor of ischemic stroke, and AF‐related stroke is twice more likely to be fatal. Long‐term cardiac rhythm monitoring using insertable cardiac monitors (ICMs) has greater diagnostic yield compared with conventional monitoring in detecting AF, and the clinical utility of ICMs is established in cryptogenic stroke, strokes attributable to large‐artery atherosclerosis, and strokes attributable to small‐vessel disease. A registry‐based study was conducted to evaluate the inpatient implantation of ICMs and the feasibility of vascular and interventional neurologists as implanters using novel collaborative clinical care pathway for cryptogenic stroke. METHODS Multiyear data from a hospital‐based registry at a comprehensive stroke center were reviewed to evaluate inpatient ICM implantation and test feasibility of vascular and interventional neurologists as implanters of ICMs together with cardiology using a novel collaborative care pathway. Reviewed data included the number of ICMs, implantation trend, inpatient versus outpatient setting, time to ICM implantation, inpatient workflow, including defined roles of team members, and AF detection rate. RESULTS A total of 290 ICMs for cryptogenic stroke were implanted when patients were in the hospital and 78 as outpatients after discharge during the study period of 3 years. Most inpatient ICM implants were performed by vascular and interventional neurology (n = 181), and ICM use for cryptogenic stroke increased by 130%. The average time to inpatient ICM implant was 4.1 days, with 77% in 5 days and 95.5% within 10 days poststroke. The average time to out‐patient ICM placement was 57 days. AF detection rate of 36.5% was noted at 24 months with a collaborative care pathway. CONCLUSION Inpatient implantation of ICMs is feasible and was performed safely and efficiently by vascular and interventional neurology together with cardiology using a collaborative care pathway. An increase in use of ICMs and higher AF detection rates were noted. Findings support innovative efforts to improve access and close the gaps in the delivery of cryptogenic stroke care to ultimately reduce the secondary stroke burden.

Global burden of ischemic stroke attributable to high body mass index in 204 countries and territories, 1990–2021

BackgroundA high body mass index (hBMI) is one of the major risk factors for ischemic stroke (IS), although independent estimates of the global burden and trend of IS attributable to hBMI are unclear.MethodsStudy data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study and analysed by age, sex, year, and geographical location. The sociodemographic index (SDI) and the human development index (HDI) were used as indicators of national socioeconomic status. Geographic distributions and trends were assessed by calculating the estimated annual percentage change (EAPC). Associations between the age-standardized death rate (ASMR) or disability-adjusted life year rate (DALY) and socioeconomic status were analysed.ResultsDeaths and DALYs increased worldwide from 1990–2021, with increases of 95.74% for the former and 133.00% for the latter; the ASMR and ASDR decreased, with an ASMR and ASDR-related EAPCs of -1.10 (95% CI: -1.24–-0.96) and 0.04 (95% CI:-0.47–0.55), respectively; women had greater numbers of deaths and DALYs, and the majority of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by Eastern Europe, North Africa, the Middle East, and Central Asia. The ASMR-related EAPCs were associated with the ASMR in 1990 (R = -0.35, P < 0.001) and the SDI in 2021 in different countries (R = -0.66, P < 0.001); these patterns were similar to those of the ASDR; the HDI in 2021 was associated with the ASMR-related EAPC (R = -0.71, P < 0.001) and the ASDR-related EAPC in different countries (R = -0.71, P < 0.001).ConclusionsThe number of deaths and DALYs from ischemic stroke attributable to hBMI worldwide increased substantially from 1990–2021. Successful population-wide initiatives targeting hBMI may mitigate a wide range of burdens on this disease. Taking into account variations in the SDI burden, future prevention and control strategies must be developed and implemented according to country-specific development status.

Mechanical thrombectomy by stent retriever for the treatment of arterial ischemic stroke in a pediatric patient with acute lymphoblastic leukemia: A case report

Introduction: Arterial ischemic stroke (AIS) caused by occlusion of large vessels in childhood is a devastating rare condition that can contribute to long-term disabilities. Childhood leukemia is identified as a recognized risk factor for ischemic strokes. Mechanical thrombectomy is standard of care for large vessel occlusions in adults. However, there are still no definite recommendations regarding application and outcomes of endovascular thrombectomy and the devices used for pediatric patients with arterial ischemic stroke. Case presentation: We report a 13-year-old female with acute lymphoblastic leukemia who developed AIS due to thrombosis in the left internal carotid and proximal middle cerebral artery in the induction phase of treatment. The patient underwent successful mechanical thrombectomy via Solumbra by using “Embolus Retriever with Interlinked Cages (ERIC)” stent retriever and Sofia plus catheter which resulted in successful recanalization of ICA and MCA. Discussion: Selected pediatric patients with AIS due to large vessel occlusions can benefit from mechanical thrombectomy. Although the recently published literature demonstrated the efficacy and safety of MT in children, strong guideline recommendations are still absent. At present, the last AHA/ASA guidelines for early management of AIS recommends intravenous thrombolysis and endovascular therapy in adults, whereas controversy still exists in children. An urgent approach within the defined therapeutic time frame and a multidisciplinary team specialized in pediatric stroke with professional trained interventional neuroradiologist is essential for achieving optimal results. Conclusion: Mechanical thrombectomy provides promising results with high rates of arterial recanalization and favorable outcomes in pediatric patients with AIS.

Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium.

In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection. The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022. Incidence of neurological complications was estimated as number of events per hospital days and per admission using Poisson regression. Associations between neurological complications and risk factors were assessed using multivariable Poisson regression. 713 patients were included. Median age = 56years (interquartile range (IQR) = 45-65). Neurological complications reported in 61/480 patients (12.7%) with the majority being ischemic stroke (2.9%), intracranial hemorrhage (ICH) (2.8%), and seizures (2.6%). Multivariable analysis for neurological complications per admitted days showed comorbid neurological conditions (incidence rate ratio (IRR) = 6.35, 2.57-15.7) were an independent risk factor for ischemic stroke. Extracorporeal membrane oxygenation (IRR = 5.32, 1.52-18.6), low-middle income countries (LMIC) vs high income countries (HIC) (IRR = 4.70, 1.62-13.7), and age >55 (IRR = 3.66, 1.23-10.9) were independent risk factors for ICH. Co-morbid neurological conditions (IRR = 3.43, 1.11-10.6), LMIC vs HIC (IRR = 8.69, 2.15-35.2), July-December 2020 vs January-June 2020 (IRR = 0.17, 0.04-0.69) and age >55 (IRR = 4.05, 1.15-14.3) were independent risk factors for seizure. Decision-making should incorporate salient risk factors to inform management of SARS-CoV2 infection and avoid neurological complications.

Investigation of Hemorheological Parameters in Ischemic Stroke Patients.

The aim of this study is to determine whether there are any changes in hemorheological parameters, including whole blood viscosity (WBV), plasma viscosity, erythrocyte aggregation, and erythrocyte deformability, in acute ischemic stroke patients, and to establish their relationship with stroke etiology. The study also aims to observe the changes in these parameters, if any, over time and after treatment, and to assess the correlation between risk factors for ischemic stroke and neuroimaging findings. This was a prospective observational study including 70 patients diagnosed with acute ischemic stroke within the first 3 days of the onset of symptoms and 96 healthy controls. Stroke patients were categorized based on TOAST criteria, and hemorheological parameters were measured at admission and on the fifth day post-treatment. Erythrocyte aggregation and deformability were measured using a laser ektacytometer, and viscosity assessment was conducted with a rotational viscometer. Stroke patients exhibited significant differences from the control group in aggregation amplitude, aggregation index, and aggregation half-time (p = 0.001, p = 0.013, p = 0.009, respectively) and showed elevated maximum value of elongation index (p = 0.000). No significant differences in WBV and plasma viscosity were observed between the groups. Post-treatment, the small vessel occlusion subgroup demonstrated a notable reduction in WBV. Additionally, homocysteine levels showed a positive correlation with scattered white matter lesions in basal ganglia and infratentorial regions (p = 0.002, p = 0.039, respectively). Increased predisposition to erythrocyte aggregation may contribute to the occurrence of acute ischemic stroke. Moreover, gaining the ability of erythrocytes to deform and increase blood flow may serve as a compensatory mechanism in the chronic vascular disease process. The risk factors for ischemic stroke may exhibit connections to specific areas within the brain.

The influence of specific weather types on stroke occurrence: an analysis of 23,000 patients from Augsburg, Germany

ABSTRACT For the first time, the relationships between large-scale weather types and local stroke events in the urban area of Augsburg, Germany are analyzed. Over 23,000 stroke cases (2006 – 2020) were standardized to account for long-term trends and seasonality. Using ERA5 reanalysis data, a composite analysis identified stroke-related atmospheric variables, while seasonal weather types were classified via the neural network algorithm of self-organizing maps. Cyclonic westerlies during the cold season, which transport warm air masses from the Atlantic Ocean to Germany, were a major risk factor for ischemic stroke, while colder easterly conditions reduced stroke incidence. In the warm season, both anticyclonic conditions and westerly/northerly air advection, leading to slightly warmer or distinctly colder temperatures, were linked to increased ischemic stroke risk. Additionally, hemorrhagic strokes in the cold season were triggered by weather conditions contrary to those associated with ischemic strokes and transitory ischemic attacks.

Weekly Journal Scan: Risk factors for recurrent ischaemic stroke in patients with atrial fibrillation on oral anticoagulation.

Weekly Journal Scan: Risk factors for recurrent ischaemic stroke in patients with atrial fibrillation on oral anticoagulation.

Incidence and Risk factors of Ischemic Stroke in Patients with Cancer-associated Venous Thromboembolism: From the COMMAND VTE Registry-2

BackgroundIschemic stroke is a serious complication in patients with cancer-associated venous thromboembolism (VTE), although data remain scarce in the direct oral anticoagulant (DOAC) era. ObjectiveTo investigate the incidence and identify predictive risk factors of ischemic stroke in patients with cancer-associated VTE (CAVTE). MethodsFrom the COMMAND VTE Registry-2 enrolling 5197 VTE patients across 31 centers in Japan between January 2015 and August 2020, we selected 1507 patients with active cancer. We calculated the cumulative incidence function of ischemic stroke accounting for the competing risk of death, and investigated risk factors of ischemic stroke in a subdistribution hazard model of multivariable analysis. ResultsDuring a median follow-up period of 1020 days, 71 patients (4.7%) developed ischemic stroke, and the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years. Independent risk factors of ischemic stroke included pancreatic cancer (HR: 4.24 [95%CI: 2.13-8.43]), ovarian cancer (HR: 2.82 [95%CI: 1.31-6.08]), lung cancer (HR: 2.35 [95%CI: 1.20-4.57]), dyslipidemia (HR: 1.76 [95%CI: 1.01-3.09]), metastasis (HR: 1.70 [95%CI: 1.02-2.82]), higher D-dimer level at VTE diagnosis (HR: 1.09 [95%CI: 1.04-1.14]), and younger age (HR: 0.84 [95%CI: 0.71-0.999]). ConclusionsIn this large VTE registry in the DOAC era, the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years in patients with CAVTE, and several independent risk factors of ischemic stroke were identified, including pancreatic cancer, ovarian cancer, lung cancer, dyslipidemia, metastasis, higher D-dimer levels at VTE diagnosis, and younger age.