Status In Acute Ischemic Stroke Research Articles

Development and validation of a novel nomogram model predicting the unfavorable outcome based on NAR and collaterals status for patients with AIS

IntroductionStroke is a leading cause of disability and mortality globally. This study aimed to develop a prognostic nomogram based on neutrophil-to-albumin ratio (NAR) and collateral status in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO). Material & method590 AIS patients with LVO assessed for regional leptomeningeal collateral (rLMC) were retrospectively enrolled, and randomly divided into a training set (n = 414) and a testing set (n = 176). Unfavorable functional outcome was defined as a modified Rankin scale (mRS) score of 3 to 6 at 3 months. We assessed the accuracy and clinical utility of the nomogram using calibration plots, area under the curve (AUC), decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). ResultsBoth NAR and rLMC were independently associated with unfavorable outcome at 3 months (OR=8.96, p=0.0341; OR=0.89, p=0.0002, respectively). The developed nomogram (akaike information criterion (AIC)=398.77), which included NAR, rLMC and other factors, showed good performance (the AUC for the development and validation cohorts was 0.848 and 0.840 respectively) and improved the predictive value compared to a model without NAR and rLMC, according to an overall NRI of 3.27% (p=0.2401), overall IDI of 3.27% (p=0.2414), and a higher AUC (0.848 vs 0.831). ConclusionsNAR can serve as an independent predictor in AIS patients with anterior LVO, and the nomogram incorporating NAR and rLMC is reliable in predicting unfavorable outcome. Further studies with larger sample sizes are needed to validate and extend these findings.

Abstract WP151: Prevailing Income-Based Disparities in Acute Ischemic Stroke and Cardiovascular Events in Young Hospitalized Adults With Cannabis Use Disorder: Insights From a Population-Based Analysis

Introduction: Cannabis use and low socioeconomic status are recognized as distinct risk factors for stroke and cardiovascular pathologies. This observational study aims to investigate the association between income status in acute ischemic stroke (AIS) and cardiovascular events among young, hospitalized adults with dependent cannabis use or cannabis use disorder (CUD). Methods: We analyzed young adult hospitalizations (18-44 years) with known CUD from the 2020 National Inpatient Sample. Propensity score-matched analysis (1:1) was used to compare comorbidities, including AIS and cardiovascular events, between the high-income quartile (HIQ) and low-income quartile (LIQ) within the CUD cohort. Results: Out of the young adult admissions, a total of 286,855 individuals were identified as dependent cannabis users. After propensity matching, we divided the CUD cohort into 63,355 patients with HIQ (41.1% female) and LIQ (41.4% female). While both cohorts exhibited comparable ages and racial distribution (>65% white), the individuals from LIQ cohort were predominantly from South (45.7% vs. 27.9%), visiting rural hospitals (13.9% vs. 1.3%), with Medicaid (56.3% vs. 41.1%) as the predominant payer. Additionally, LIQ cohort had a higher prevalence of drug abuse (65.5% vs. 58.4%), tobacco use (24.9% vs. 22.6%), HTN (17% vs. 14.7%), chronic pulmonary disease (13.2% vs. 12.7%), DM (8% vs. 6.6%), and obesity (10.9% vs. 10.0%). Additionally, in-hospital outcomes like AIS (0.5% vs. 0.3%) and MACCE (2% vs. 0.8%) were higher in the LIQ cohort. After adjusting for confounding factors, the risk of AIS in the HIQ cohort was 37% lower than in the LIQ cohort (OR: 0.63 [95% CI: 0.42-0.96]). (all-p<0.05). Conclusion: Higher prevalence of CVD risk factors in the LIQ-CUD group and lower odds of AIS-related admissions in the HIQ-CUD group warrant targeted interventions and policy measures to understand and address behavioral risk of cannabis use by economic status and disparities in MACCE.

Relationship between Vitamin D Status in Acute Ischemic Stroke for Assessing Initial Severity and Short-Term Outcome in a Tertiary Level Hospital, Bangladesh

Recent studies suggest that vitamin D, a neuroprotective prohormone, which has a potential protective role against neurovascular injury. Low vitamin D levels were modestly associated with risk of stroke and stroke fatality. Objective: This study aimed to investigate the relationship of vitamin D status among acute ischemic stroke patients for assessing initial severity and short-term outcome. Methods: Fifty one acute ischemic stroke patients and 51 matched healthy control subjects participated in the study. Subjects were divided according to vitamin D level into deficient, insufficient, and sufficient groups. National Institute of Health Stroke Scale (NIHSS) on admission and after 72h and modified Rankin Scale (mRS) on discharge and after 3months were performed for all patients. Results: Acute ischaemic stroke patients (9.8%) had significantly lower serum vitamin D levels compared to healthy subjects (5.8%). In patients, serum vitamin D level ranged from 5 to 41ng/ml with a mean of 19.4±9.98ng/ml. In controls, serum vitamin D levels ranged from 6 to 48ng/ml with a mean of 30.3±10.48 ng/ml. Vitamin D deficiency and insufficiency were significantly prevalent among stroke patients (66.7%) compared to healthy controls (51.9%). Significant correlation was detected between serum vitamin D and NIHSS scores on admission and after 72hrs (p=0.007). Significant correlation was also detected between serum vitamin D and mRS scores on discharge and after 3months (p=0.004). The patients with 'not sufficient' vitamin D (i.e. deficient and insufficient) were 11.2 time more likely to report severe stroke (p=0.006). Conclusion: Vitamin D deficiency increases the risk of acute ischemic stroke and is associated with increased initial stroke severity and worse short-term outcome. J. of Sci. and Tech. Res. 4(1): 119-128, 2022

RAPID CT Perfusion-Based Relative CBF Identifies Good Collateral Status Better Than Hypoperfusion Intensity Ratio, CBV-Index, and Time-to-Maximum in Anterior Circulation Stroke.

Information of collateral flow may help to determine eligibility for thrombectomy. Our aim was to identify CT perfusion-based surrogate parameters of good collateral status in acute anterior circulation ischemic stroke. In this retrospective study, we assessed the collateral status of 214 patients who presented with acute ischemic stroke due to occlusion of the MCA M1 segment or the carotid terminus. Collaterals were assessed on dynamic CTA images analogous to the multiphase CTA score by Menon et al. CT perfusion parameters (time-to-maximum, relative CBF, hypoperfusion intensity ratio, and CBV-index) were assessed with RAPID software. The Spearman rank correlation and receiver operating characteristic analyses were performed to identify the parameters that correlate with collateral scores and good collateral supply (defined as a collateral score of ≥4). The Spearman rank correlation was highest for a relative CBF < 38% volume (ρ = -0.66, P < .001), followed by the hypoperfusion intensity ratio (ρ = -0.49, P < .001), CBV-index (ρ = 0.51, P < .001), and time-to-maximum > 8 seconds (ρ = -0.54, P < .001). Good collateral status was better identified by a relative CBF < 38% at a lesion size <27 mL (sensitivity of 75%, specificity of 80%) compared with a hypoperfusion intensity ratio of <0.4 (sensitivity of 75%, specificity of 62%), CBV-index of >0.8 (sensitivity of 60%, specificity of 78%), and time-to-maximum > 8 seconds (sensitivity of 68%, specificity of 76%). Automated CT perfusion analysis allows accurate identification of collateral status in acute ischemic stroke. A relative CBF < 38% may be a better perfusion-based indicator of good collateral supply compared with time-to-maximum, the hypoperfusion intensity ratio, and the CBV-index.

Vitamin D Status in Acute Ischemic Stroke: Relation To Initial Severity and Short-Term Outcome

Objective: To assess the vitamin D levels among patients presenting with acute ischemic stroke and relationship of these levels with short-term outcome and the severity of stroke.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2019 to Feb 2021.&#x0D; Methodology: A total of 300 patients with ischemic stroke diagnosed by the consultant medical specialist or neurologist on the basis of clinical and neuro-radiological findings were included in this study. Serum Vitamin D levels were assessed along with other baseline investigations among the study participants. Severity of stroke was assessed via National Institutes of Health Stroke scale and short-term outcome was assessed by modified Rankin scale.&#x0D; Results: Out of 300 patients of acute ischemic stroke, 183 (62.3%) were males while 117 (37.3%) were females. 151 (50.3%) of the patients had Vitamin D levels within range while 149 (49.7%) had deficient vitamin levels. On National Institutes of Health Stroke scale, 163 (54.3%) had mild, 87 (29%) had mild to moderately severe, 33 (11%) had severe and 17 (5.7%) had very severe symptoms. Statistical analysis revealed that short-term outcome and stroke severity had a statistically significant relationship (p-value &lt;0.05) with Vitamin D deficiency among patients suffering from acute ischemic stroke.&#x0D; Conclusion: Almost half of the patients presenting with acute ischemic stroke had vitamin D deficiency in our study. Those having vitamin D deficiency had more chances of having severe form of ischemic stroke and poor short-term outcome.

Matrix metallopeptidase 9 and placental growth factor may correlate with collateral status based on whole-brain perfusion combined with multiphase computed tomography angiography

ABSTRACT Objective The aim of this study was to find out the relationship between serum biomarkers and cerebral collateral status in acute ischemic stroke with cerebral large artery atherosclerosis. Methods We enrolled patients with ischemic stroke due to large artery atherosclerosis within 7 days of symptom onset, age 18–80 years, from August 2016 to December 2017. Twelve biomarkers representing different pathophysiological mechanisms were tested after admission. Whole-brain perfusion combined with multiphase computed tomography angiography was performed to assess cerebral collateral structure and function. Results Fifty-two patients completed the test of candidate biomarkers and recruited in this study. The mean age was 55.0 (11.1) years, 42 (80.8%) patients were male, 20 (38.5%) had poor collateral, 36 (69.2%) patients had anterior circulation stenosis or occlusion. Compared with poor collateral group, the level of MMP-9 (135,475.00 pg/ml vs. 103,612.00 pg/ml, p = 0.040) and PGF (5.75 pg/ml vs. 3.46 pg/ml, p = 0.046) was significantly higher in good collateral group. The adjusted OR (95%CI) of MMP-9 and PGF were 5.533 (1.10–27.74, p = 0.038), 7.73 (1.41–42.39, p = 0.018), respectively. sTie-2 level had a positive correlation with proportion of Tmax 4–6 (r = 0.302, p = 0.033) and HMW-KGN had negative correlation with proportion of Tmax 6–8 (r = −0.338, p = 0.02). After adjustment, the correlation of sTie-2 level and proportion of Tmax 4–6 was statistically significant (p = 0.003), and correlation of HMW-KGN and Tmax6-8 was not statistically significant (p = 0.056). Discussion Serum PGF and MMP-9 levels may correlate with collateral status based on MP-CTA in acute ischemic stroke patients with cerebral large artery atherosclerosis. Higher PGF and MMP-9 concentration associated with good collateral status.

Response by Mechtouff and Nighoghossian to Letter Regarding Article “Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion”

Response by Mechtouff and Nighoghossian to Letter Regarding Article “Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion”

Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion.

In ischemic stroke, inflammatory status may condition the development of collateral circulation. Here we assessed the relationship between systemic inflammatory biomarkers and collateral status in large vessel occlusion before mechanical thrombectomy. HIBISCUS-STROKE is a cohort study including acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. MMP-9 (matrix metalloproteinase-9) and MCP-1 (monocyte chemoattractant protein-1) were measured on blood sampling collected at admission. Collateral status was assessed on pretreatment Digital subtraction angiography and categorized into poor (Higashida score, 0-2) and good (Higashida score, 3-4). A multiple logistic regression model was performed to detect independent markers of good collateral status. One hundred and twenty-two patients were included, of them 71 patients (58.2%) had a good collateral status. In univariate analysis, low MMP-9 levels (P=0.01), high MCP-1 levels (P<0.01), a low National Institute of Health Stroke Score (P=0.046), a high diastolic blood pressure (P=0.049), the absence of tandem occlusion (P=0.046), a high Alberta Stroke Program Early CT Score (P<0.01) and a low volume on the diffusion-weighted imaging (P<0.01) were associated with good collateral status. Following multivariate analysis, low MMP-9 levels (P=0.02) and high MCP-1 levels (P<0.01) remained associated with good collateral status. Low MMP-9 and high MCP-1 levels were associated with good pretreatment collateral status in patients with acute ischemic stroke with large vessel occlusion. These results might suggest a relationship between collateral status and inflammation.

Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

BackgroundA growing body of evidence indicated that vitamin D has a potential protective role against neurovascular injury. Low serum vitamin D has been associated with increased risk for incident stroke and stroke fatality.ObjectiveThis study aimed to investigate vitamin D status among acute ischemic stroke patients and examine its relation to initial severity and short-term outcome.Subjects and methodsForty-eight acute ischemic stroke patients and 48 matched healthy control subjects participated in the study. Subjects were divided according to vitamin D level into deficient, insufficient, and sufficient groups. National Institute of Health Stroke Scale (NIHSS) on admission and after 72 h and modified Rankin Scale (mRS) on discharge and after 3 months were performed for all patients.ResultsStroke patients had significantly lower serum vitamin D levels compared to healthy subjects. Vitamin D deficiency and insufficiency were significantly prevalent among patients compared to healthy controls. Significant negative correlation was detected between serum vitamin D and NIHSS scores on admission and after 72 h. Significant negative correlation was also detected between serum vitamin D and mRS scores on discharge and after 3 months. An increased risk of stroke of 2.88 times was found in patients with insufficient vitamin D in comparison to sufficient subgroup, and this likelihood increases to be 13.78 times in the deficient compared to sufficient subgroups.ConclusionVitamin D deficiency increases the risk of acute ischemic stroke and is associated with increased initial stroke severity and worse short-term outcome.

Elevated brain oxygen extraction fraction measured by MRI susceptibility relates to perfusion status in acute ischemic stroke

Recent clinical trials of new revascularization therapies in acute ischemic stroke have highlighted the importance of physiological imaging to identify optimal treatments for patients. Oxygen extraction fraction (OEF) is a hallmark of at-risk tissue in stroke, and can be quantified from the susceptibility effect of deoxyhemoglobin molecules in venous blood on MRI phase scans. We measured OEF within cerebral veins using advanced quantitative susceptibility mapping (QSM) MRI reconstructions in 20 acute stroke patients. Absolute OEF was elevated in the affected (29.3 ± 3.4%) versus the contralateral hemisphere (25.5 ± 3.1%) of patients with large diffusion–perfusion lesion mismatch (P = 0.032). In these patients, OEF negatively correlated with relative CBF measured by dynamic susceptibility contrast MRI (P = 0.004), suggesting compensation for reduced flow. Patients with perfusion–diffusion match or no hypo-perfusion showed less OEF difference between hemispheres. Nine patients received longitudinal assessment and showed OEF ratio (affected to contralateral) of 1.2 ± 0.1 at baseline that normalized (decreased) to 1.0 ± 0.1 at follow-up three days later (P = 0.03). Our feasibility study demonstrates that QSM MRI can non-invasively quantify OEF in stroke patients, relates to perfusion status, and is sensitive to OEF changes over time. Clinical trial registration: Longitudinal MRI examinations of patients with brain ischemia and blood brain barrier permeability; clinicaltrials.org: NCT02077582

Abstract TP162: Patterns of Pre-Stroke Atherosclerotic Stenosis and Pretreatment Collateral Status in Acute Ischemic Stroke

Background: To date, there is no consensus regarding the factors associated with collaterals in acute ischemic stroke. Our study attempts to examine variables associated with pretreatment collaterals. Methods: From our hospital stroke registry, we retrospectively recruited 115 patients with acute anterior circulation infarct considered for endovascular reperfusion therapy. Collateral score (0-3) was rated using pretreatment CT angiography. Score of 0 or 1 (≤50% filling of the occluded territory) was considered as poor collaterals. The patterns of steno-occlusion other than culprit occlusion for infarct were classified into intracranial or extracranial atherosclerotic stenosis based on the location of steno-occlusion (&gt; 50% on CTA). Results: Forty five of the 115 patients had poor collaterals. Variables (with univariate P&lt; 0.1) associated with collaterals were, as pretreatment variables, older age ( ≥65 years) (P=0.067), hypertension (P=0.034), diabetes (P=0.093), initial NIHSS (P=0.002), location of culprit occlusion for infarct (P=0.001), intracranial stenosis (P=0.003), and as treatment or post-treatment variables, use of intravenous tissue plasminogen activator (P=0.004), successful recanalization (TICI grade 2b or 3: P=0.009), symptomatic intracranial hemorrhage (P=0.004), final infarct size (P&lt;0.001). When multivariable logistic regression for poor collaterals was performed using the pretreatment variables, internal carotid artery occlusion and intracranial stenosis were significantly associated with poor collaterals (Table). Conclusions: Coincidental intracranial atherosclerotic stenosis is associated with pretreatment poor collaterals during acute stage of stroke. It might be because collateral flow is assumed to be largely dependent on flow from non-occluded intracranial arteries neighboring to culprit vascular lesion for infarct.

Clinical Implications of Serial Glucose Measurements in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Serial glucose might more accurately reflect glycemic status in acute ischemic stroke (AIS) than presenting glucose. We sought to investigate the clinical implications of various parameters of serial glucose on the outcomes of patients with AIS treated with intravenous thrombolysis (IVT). This was a single-center, prospective, observational study of stroke patients treated with IVT. Blood glucose (BG) was serially measured at 6-time points during the first 24 h of IVT. The primary endpoint analyzed was a good outcome at 3 m. Among the 492 patients in the cohort (age, 70 ± 12 y; men, 57%), the overall BG level was 131 ± 33 mg/dl. At 3 m, 40.4% of the patients had a good outcome. Patients with good outcomes had significantly lower mean BG (121 vs 128 mg/dl) and higher coefficient of variance (CoV, 17% vs 14%) but no differences in the others. For patients with higher mBG (every 30 mg/dl), the likelihood of achieving a good outcome decreased (OR 0.82, 95% CI 0.67–1.02). For patients with higher CoV (every 10%), the likelihood of a good outcome increased (OR 1.38, 95% CI 1.12–1.71). The results showed that higher mBG and lower CoV were consistently associated with worse outcomes in IV-thrombolyzed stroke patients, suggesting that lowering BG might be potential therapeutic target.

NIHSS sub-item scores predict collateral flow in acute middle cerebral artery infarction.

The status of collateral vessels has important clinical implications in acute ischemic stroke. To evaluate which components of ischemic symptoms were predictive of pretreatment collateral status, we tested the hypothesis that sub-item scores from the National Institutes of Health Stroke Scale (NIHSS) are associated with leptomeningeal collateral status in acute ischemic stroke with middle cerebral artery (MCA) occlusion. This study included consecutive patients with acute M1 occlusion who underwent revascularization treatment for acute MCA infarction. We evaluated clinical factors and the NIHSS score according to the collateral status assessed by multiphase perfusion computed tomography. Eighty-six patients were included (48 good collateral status, 38 poor collateral status). The patients with poor collateral status were more likely to have a higher total NIHSS score (18 versus 11, p < 0.001) and atrial fibrillation (65.8% versus 41.7%, p = 0.026) than patients with good collateral flow. In a multiple logistic regression, the NIHSS sub-items such as profound "facial palsy" (score 2 versus 0-1) and "visual field defect" (score 2 versus 0-1) were independently associated with poor collateral status. Among the NIHSS sub-items, severe facial palsy and visual field defect were associated with poor collateral status in acute MCA stroke with M1 occlusion. Decision on whether to treat these patients endovascularly should be made more cautiously due to the possibility of a poor outcome.

Glycemic Status and In-hospital Complications in Acute Ischemic Stroke

Although on-admission high glycemic status in acute ischemic stroke (AIS) patients is associated with poor in-hospital outcome, the impact of on-admission different glycemic status in AIS is less clear. This prognostic cohort study was aimed to evaluate the association of on-admission high glycemic status with in-hospital complications of AIS patients. This study was conducted by measurement of random blood glucose (RBG) in 90 AIS patients within 24 hours of hospitalization. The patients were divided into three groups based on their RBG in mg/dl: Group A &lt;120, Group B 120-180 and Group C &gt;180. The average age was 59 years and 35.6% patients were diabetic. In AIS patients, higher RBG was associated with increased in-hospital complications regardless of a history of diabetes mellitus (p=0.047, 0.040, 0.003 and 0.015 for urinary tract infection, bed sore, electrolyte imbalance and mixed complications respectively). Optimal glucose targets in hospitalized patients with AIS are currently undetermined. Glycemic and nonglycemic interventions should be studied for their impact on in-hospital complications and cost.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 44-48

Abstract TP56: Comparison of Collateral Status in Acute Ischemic Stroke: Simulated 2-phase CTA versus Simulated 3-phase CTA

Purpose: We hypothesized that two-phase (the arterial phase and the phase between the peak and late venous phases) CTA may work comparably with 3-phase CTA, and sought to compare a simulated 3-phase CTA with a simulated 2-phase CTA for assessment of collaterals. Methods: We enrolled 155 patients (76 male; median, 72 years) who underwent 9.6-cm, 70-kVp perfusion CT (PCT) for 60 seconds within 8 hours after symptom onset and had occlusion in the ICA (ICA with/without M1; n=63) or M1 segment (with/without M2 segment; n=92). PCT data were reconstructed with a section width of 1 mm, and were used to create the simulated 3-phase CTA (3-CTA; peak arterial, peak venous, and late venous phase; 3 seconds each) with an increment of 4.5 seconds. Another 3-second CTA immediately after peak venous phase was additionally generated, which consisted of the second CTA of the simulated 2-phase CTA (2-CTA) with the peak arterial CTA. Each CTA was reconstructed into 25-mm axial maximum intensity projections, and was assessed by 2 independent reviewers at a separate session. For the 2-CTA, good collaterals were determined when the ipsilateral side showed both similar vascular filling and enhancement (ASPECT&gt;7) compared to the contralateral brain on the peak arterial CTA. For the 3-CTA, we followed the published criteria to determine good/poor collaterals. Results: Interobserver agreements were excellent (k=0.931 for 3-CTA; k=0.929 for 2-CTA). Consensus review determined good and poor collaterals in 97 and 58 patients, respectively, on 3-CTA. All 97 patients with good collaterals on 3-CTA showed good collaterals on 2-CTA; 2 out of 58 patients with poor collaterals on 3-CTA were determined to have good collaterals on 2-CTA, showing no significant difference (P=0.5, McNemar test). Conclusion: Compared to the simulated 3-phase CTA, the simulated 2-phase CTA has comparable diagnostic performance for determining the status of collateral circulation.

Abstract TP38: Core Growth Speed as a Marker of Collateral Circulation Status in Acute Ischemic Stroke with Known Onset Time

Objective: We aimed to evaluate the parameter core growth speed (CGS) as a marker of collateral circulation status (CC) in acute ischemic stroke, and to compare it with other brain perfusion-derived markers of collateral capacity. Methods: We retrospectively studied acute ischemic stroke patients who were evaluated with urgent computed tomography perfusion (CTP) and CT angiography. Inclusion criteria comprised known time of onset and anterior circulation proximal occlusion. Collateral circulation was assessed on CTP-source images and rated as poor (0-1) vs. good (2-3) following a previously published scale. CTP maps were computed using Neuroscape 2.0 software by Olea Medical. Infarct core volume was calculated as the brain tissue with &gt;70% reduction in cerebral blood flow (CBF) as compared to the unaffected side. CGS was obtained by dividing core volume by the time from stroke onset to CTP acquisition. Relative cerebral blood volume (rCBV), relative CBF, and hypoperfusion index ratio (HIR = Tmax&gt;10s/Tmax&gt;6s) were used as comparators. Results: We included 41 patients (mean age 71 years; median NIHSS 17; median onset-CTP time 150 minutes). We observed a positive correlation between CGS and HIR (ρ= 0.517 p&lt; 0.001), and negative correlations between rCBV and CGS (ρ= -0.669 p&lt;0.0001), and rCBF and CGS (ρ= -0.749 p&lt;0.0001). Collateral circulation was categorized as poor or good in 15 and 26 patients respectively. A gradual descend in CGS was seen as CC improved (p=0.0005). A logistic regression model adjusted by rCBV, rCBF and HIR identified CGS as independently associated with CC. The association of CGS with good CC in a ROC curve was highly significant (p=0.002, area under the curve 0.8). Conclusion: Core growth speed is robustly associated with collateral circulation status. This parameter can be directly obtained from infarct core volume without the need to process other perfusion or angiographic images, if the time of onset is well known.

Взаимосвязь цитокиново-нейротрофического профиля с когнитивным и функциональным статусом в остром периоде ишемического инсульта

Взаимосвязь цитокиново-нейротрофического профиля с когнитивным и функциональным статусом в остром периоде ишемического инсульта

Redox status in acute ischemic stroke: correlation with clinical outcome.

Connection between oxidative stress and clinical outcome in acute ischemic stroke (AIS) has been poorly investigated. This study was aimed to assess redox state (through measurement of oxidative stress markers) of patients with acute ischemic stroke during different stages of follow-up period, and to find association between values of mentioned markers and clinical outcome. The investigation was conducted on 60 patients (both sexes, aged 75.90 ± 7.37 years) who were recruited in intensive care units at the Special Hospital for Cerebrovascular Diseases "Sveti Sava," Belgrade. After verification of AIS, patients were followed up in four interval of time: (1) at admission, (2) within 24 h after AIS, (3) within 72 h after AIS, and (4) 7 days after AIS. At these points of time, blood samples were taken for determination of oxidative stress parameters [index of lipid peroxidation (measured as TBARS), nitric oxide (NO) in the form of nitrite ([Formula: see text]), superoxide anion radical ([Formula: see text]), hydrogen peroxide (H2O2)], and enzymes of antioxidant defense system [superoxide dismutase (SOD) and catalase (CAT)] using spectrophotometer. Present study provides new insights into redox homeostasis during ischemic stroke which may be of interest in elucidation of molecular mechanisms involved in this life-threatening condition. Particular contribution of obtained results could be examination of connection between redox disruption and clinical outcome in these patients. In that sense, our finding have pointed out that [Formula: see text] and NO can serve as the most relevant adjuvant biomarkers to monitor disease progression and evaluate therapies.

Abstract T P107: Change of Day-to-Day BP Variability and Perfusion Status in Acute Ischemic Stroke

Purpose: We investigated how BP is changed over elapsed time according to the perfusion status at acute stage of ischemic stroke. Methods: Patients arrived within 24 hours of symptom onset and have symptomatic occlusion at MCA and ICA were consecutively identified. Among them, we included those were not eligible or failed for recanalization therapy at acute stage. According to the occluded site and perfusion lesion volume, they were dichotomized into upper one-third (large PLV) and others (small-to-medium PLV). For the first consecutive 5 days, daily BP parameters of followings: mean, maximum-minimum and standard deviation (SD) between groups were compared using repeated measures ANOVA. Results: Of enrolled 129 subjects (mean age, 69.3 ± 12.7 years-old and median NIHSS score, 6), cut-offs of large PLV were 143 ml for MCA and 232 ml for ICA. At the day of hospital arrival, mean, maximum-minimum and SD of systolic BP were 136.8, 55.6 and 14.4 mmHg and those at 5th day were 136.2, 32.9 and 11.8 mmHg, respectively. Patients with large PLV were significantly associated with higher maximum-minimum and SD compared to those with small-to-medium PLV (P &lt; 0.001) not averaged value with adjustments for age and baseline NIHSS score (Figure 1). Conclusion: Perfusion status at acute stage of ischemic stroke would be related with day-to-day change of BP variability.

Relationship between depressive symptoms and cognitive status in acute ischemic stroke

Depressive symptoms and cognitive impairment frequently occur already in the acute phase of ischemic stroke. The aim of the study was to determine whether there was an association between depressive symptoms and different domains of the cognitive status in acute ischemic stroke patients and to identify cognitive domains that significantly correlated with the presence of depressive symptoms. The study comprised 40 acute ischemic stroke patients (26 men and 14 women) aged 45-78 years, with 8-16 years of education. The presence of depressive symptoms was assessed using the self-reported Beck's Depression Inventory (BDI), whereas the cognitive status was evaluated using a comprehensive neuropsychological testing battery measuring performance in different cognitive domains. The following domains were evaluated: executive function, language, immediate recall, delayed recall, attention, divergent reasoning, and visual-constructive performance in two dimensions. The multiple regression analysis was applied. The results showed a significant association between the presence of depressive symptoms and different cognitive domains. The domain of language was found to be a significant partial predictor of depression, with poorer performance in this domain correlating with a higher prevalence of depressive symptoms.