Stroke In Individuals Research Articles

Left Atrial Dynamics Is Altered in Young Adults With Cryptogenic Ischemic Stroke: A Case-Control Study Utilizing Advanced Echocardiography.

BackgroundIschemic stroke in young individuals often remains cryptogenic. Some of these strokes likely originate from the heart, and atrial fibrosis might be one of the etiological mechanisms. In this pilot study, we investigated whether advanced echocardiography findings of the left atrium (LA) of young cryptogenic stroke patients differ from those of stroke‐free controls.Methods and ResultsWe recruited 30 cryptogenic ischemic stroke patients aged 18 to 49 years and 30 age‐ and sex‐matched stroke‐free controls among participants of the SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study (NCT01934725). We measured basic left ventricular parameters and detailed measures of the LA, including 4‐dimensional volumetry, speckle tracking epsilon, strain rate, and LA appendix orifice variation. Data were compared as continuous parameters and by tertiles. Compared with controls, stroke patients had smaller LA reservoir volumes (10.2 [interquartile range, 5.4] versus 13.2 [5.4] mL; P=0.030) and smaller positive epsilon values (17.8 [8.5] versus 20.8 [10.1]; P=0.023). In the tertile analysis, stroke patients had significantly lower left atrial appendage orifice variation (3.88 [0.75] versus 4.35 [0.90] mm; P=0.043), lower LA cyclic volume change (9.2 [2.8] versus 12.8 [3.5] mL; P=0.023), and lower LA contraction peak strain rate (−1.8 [0.6] versus −2.3 [0.6]; P=0.021). We found no statistically significant differences in left ventricular measures.ConclusionsThis preliminary comparison suggests altered LA dynamics in young patients with cryptogenic ischemic stroke, and thus that LA wall pathology might contribute to these strokes. Our results await confirmation in a larger sample.

Direction-Specific Jaw Dysfunction and Its Impact on Tongue Movement in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis.

Purpose The current study tested jaw movement characteristics and their impact on tongue movement for speech production in individuals with amyotrophic lateral sclerosis (ALS). Specifically, the study examined tongue and jaw movement in multiple directions during jaw opening and closing strokes in individuals with ALS and controls. Method Twenty-two individuals with ALS and 22 controls participated in the current study. Tongue and jaw movements during the production of the words "Iowa" and "Ohio" (produced in a carrier phrase) were recorded using electromagnetic articulography. Tongue and jaw distances were measured for jaw opening and closing strokes. Distance was measured in the anterior-posterior and superior-inferior dimensions (retraction, advancement, lowering, and raising). Results Findings revealed that individuals with ALS exaggerated their jaw opening movements, but not their jaw closing movements, compared to controls. Between the groups, a comparable tongue lowering distance was observed during jaw opening movements. In contrast, reduced tongue raising was observed during the jaw closing movements in individuals with ALS compared to controls. Conclusion The findings suggest that individuals with ALS produce excessive jaw opening movements in the absence of excessive jaw closing movements. The lack of excessive jaw closing movements results in reduced tongue raising in these individuals. Excessive jaw opening movements alone suggest a direction-specific jaw dysfunction. Future studies should examine whether excessive jaw raising can be facilitated and if it enhances tongue raising movement for speech production in individuals with dysarthria secondary to ALS.

Effects of Genetic Variants on Stroke Risk.

Effects of Genetic Variants on Stroke Risk.

Physical activity, cardiorespiratory fitness, and cardiovascular outcomes in individuals with atrial fibrillation: the HUNT study.

AimsAtrial fibrillation (AF) confers higher risk of mortality and morbidity, but the long-term impact of physical activity (PA) and cardiorespiratory fitness (CRF) on outcomes in AF patients is unknown. We, therefore, examined the prospective associations of PA and estimated CRF (eCRF) with all-cause mortality, cardiovascular disease (CVD) mortality, morbidity and stroke in individuals with AF.Methods and resultsWe followed 1117 AF patients from the HUNT3 study in 2006–08 until first occurrence of the outcomes or end of follow-up in November 2015. We used Cox proportional hazard regression to examine the prospective associations of self-reported PA and eCRF with the outcomes. Atrial fibrillation patients meeting PA guidelines had lower risk of all-cause [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.75] and CVD mortality (HR 0.54, 95% CI 0.34–0.86) compared with inactive patients. The respective HRs for CVD morbidity and stroke were 0.78 (95% CI 0.58–1.04) and 0.70 (95% CI 0.42–1.15). Each 1-metabolic equivalent task (MET) higher eCRF was associated with a lower risk of all-cause (HR 0.88, 95% CI 0.81–0.95), CVD mortality (HR 0.85, 95% CI 0.76–0.95), and morbidity (HR 0.88, 95% CI 0.82–0.95).ConclusionHigher PA and CRF are associated with lower long-term risk of CVD and all-cause mortality in individuals with AF. The findings support a role for regular PA and improved CRF in AF patients, in order to combat the elevated risk for mortality and morbidity.

Abstract TP143: Credibility, Expectancy and Satisfaction With Community-Based Telepractice Treatment for Aphasia

Introduction: Telepractice has been used successfully to treat acute stroke in individuals in rural communities. Less progress has been made in using this approach for the treatment of post-stroke conditions such as aphasia. Few studies have examined telepractice approaches to treat aphasia in community settings. Hypothesis: Community-based telepractice approaches for the treatment of post-stroke aphasia are: (1) credible and individuals with will aphasia will expect to achieve improved outcomes and (2) clients with aphasia will be satisfied with the telepractice approach at the conclusion of treatment. Methods: 30 individuals with post-stroke aphasia were enrolled in the community-based aphasia treatment program that consisted of a maximum of 12 treatment sessions. Treatment sessions were tailored to the needs of the person with aphasia (PWA) and based on a Language Oriented Treatment Approach. The primary outcomes for the study were credibility, expected outcomes and satisfaction with the program. Treatment credibility and expected outcomes were measured at enrollment using the Credibility-Expectancy Scale. Client satisfaction was measured post-treatment using the Client Satisfaction Scale-8. Results: The mean age of the sample was 61 years and the mean Western Aphasia Battery-Revised (WAB-R) aphasia quotient score was 75 indicating mild-moderate aphasia impairment. The average credibility score at enrollment was 22/27 indicating the participants believed the treatment approach was logical and useful. The average expected improvement from the aphasia treatment that was reported at the time of enrollment was 68%. Those participants who completed the aphasia treatment reported a mean CSQ-8 score of 31/32 indicating high satisfaction with the treatment approach. Conclusions: Telepractice treatments for the comprehensive treatment for aphasia have been slow to emerge. This approach is feasible, credible and acceptable to PWA. This study also showed telepractice treatment for aphasia is satisfying to PWA. Future studies should be designed to explore both community-based and home-based telepractice approaches to improve access to care for PWA.

Population screening for atrial fibrillation by student pharmacists at health fairs

BackgroundIndividuals with unrecognized atrial fibrillation (AF) may be at an increased risk of stroke. There is a need to develop a sustainable and reproducible population-based screening model to identify unrecognized AF. ObjectiveThe objective of this study is to evaluate AF screening and education at student pharmacist–driven health fairs. MethodsScreening for AF was performed by student members of the American Pharmacist Association Academy of Student Pharmacists with preceptor oversight. Participants were screened using the KardiaMobile device (AliveCor, Mountain View, CA), a Food and Drug Administration–cleared device that interprets a medical-grade electrocardiogram in 30 seconds. Student pharmacists also calculated a CHA₂DS₂-VASc score. Participant education was provided using an American Heart Association AF patient information sheet. Learning assessment was evaluated with 3 multiple choice questions. ResultsStudents screened a total of 697 participants over a 6-month period at 13 health fairs. Overall, 71% of the participants were women aged 56 ± 15 years (mean ± SD). Sixteen of the participants (2.3%) who were screened received results indicating possible AF. None of the participants with a possible positive finding had symptoms suggestive of AF. Of these 16 participants, 11 (69%) had a CHA₂DS₂-VASc score greater than or equal to 2 (2.7 ± 0.7). Most participants answered each learning assessment question correctly. More than 95% of participants believed that screening for AF at health fairs was important or very important. ConclusionStudent pharmacist–driven health fairs were shown to be feasible models to screen for AF and were effective in providing AF education to the public. Student pharmacists also cultivated a clinical skill that is transferable to their future practice setting, including the community pharmacy setting. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in individuals with previously undetected AF.

Abstract TP84: Prognostic Factor of Intracranial Vertebral Artery Dissection: High Resolution Vessel Wall Magnetic Resonance Imaging Study

Background: Vertebral artery dissection (VAD) is well recognized cause of stroke in young and middle aged individuals. But, prognostic factor of posterior circulation ischemic stroke or transient ischemic attack (TIA) caused by intracranial VAD has been rarely discussed. Our aim was to evaluate the predictors of poor outcomes in posterior circulation ischemic stroke caused by intracranial VAD. Methods: We retrospectively reviewed patients with posterior circulation ischemic stroke or TIA caused by intracranial VAD using high-resolution vessel wall MRI who were recruited from Samsung Medical Center Stroke Registry (between January 1, 2011 and April 30, 2019). Poor outcomes were defined as a 3-months modified Rankin scale (mRS) score ≥ 2. Results: We registered 96 patients (74 males; mean age, 58.9±14.2 years) with acute posterior circulation ischemic stroke or TIA caused by intracranial VAD. Trauma history associated with VAD was presented in 23 (24%) of patients. Headache and neck pain around neurological symptom onset were presented in 41 (42.7%) and 19 (19.8%) of patients, respectively. Dissecting aneurysm, bilateral vertebral artery involvement, basilar artery involvement and wall hematoma with dissection were presented in 26 (27.1%), 26 (27.1%), 12 (12.5%) and 66 (68.8%) of patients, respectively. Of the 96 VADs, 26 (27.1%) presented with focal stenosis, 21 (21.9%) with multifocal stenosis, and 57 (59.4%) with occlusion. Lateral medulla involvement and multiple territory involvement were presented in 35 (36.5%) and 31 (32.3%) of patients. Recurrence rate of ischemic stroke or TIA within 90 days of symptom onset was 6.25%. Twenty-nine patients (30.2%) had poor outcomes at 3 months. Lateral medulla involvement was an independent predictor for poor outcome (odds ratio=3.293, 95% confidence interval=1.301-8.333, p=0.012). Conclusion: Posterior circulation ischemic stroke or TIA caused by intracranial VAD is associated with relatively benign clinical course. But the presence of lateral medulla involvement is independent predictor for poor outcome. Patients presenting lateral medullary infarction caused by intracranial VAD should be monitored closely.

Urinary and fecal incontinence in stroke survivors followed in general practice: A retrospective cohort study.

Investigating the short- and long-term health outcomes after stroke is a public health priority. We aimed to analyse the incidence of urinary and fecal incontinence within 10 years of stroke in individuals followed in general practice in Germany. Individuals who had received an initial stroke diagnosis at one of 1262 general practices in Germany between January 2006 and December 2015 were included (index date). Individuals without stroke were matched (1:1) to those with stroke based on propensity scores by using a "greedy" algorithm and logistic regression with sex, age, index year, and 17 comorbidities diagnosed in the 12 months before the index date. The main outcome of the study was the incidence of urinary and fecal incontinence within 10 years of stroke. This study analysed data for 16,181 individuals with stroke and 16,181 without stroke. Within 10 years of the index date, 22% and 11% of men with and without stroke received a diagnosis of urinary incontinence (log-rank P<0.001); the prevalence of urinary incontinence was 34% in female stroke survivors and 17% in females with no history of stroke (log-rank P<0.001). The respective proportions of fecal incontinence were 5% and 2% for men (log-rank P<0.001) and 6% and 3% for women (log-rank P<0.001). Overall, stroke was positively associated with both urinary incontinence (men: hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.10-2.61; women: HR 2.36, 95% CI 2.14-2.61) and fecal incontinence (men: HR 2.43, 95% CI 1.88-3.13; women: HR 2.60, 95% CI 1.98-3.41). This study, using data from Germany, suggests that general practitioners should regularly screen for urinary and fecal incontinence in the decade following stroke.

ESTIMATING HEALTH IMPACT OF EXPOSURE TO PM2.5, NO2 AND O3 USING AIRQ+ MODEL IN KERMAN, IRAN

Air pollutants have harmful effects on the human health and exacerbate morbidity and mortality. The aim of this study is to assess the short-and long-term effects of the suspended particulate matter with the diameter of smaller than 2.5 m (PM2.5), nitrogen dioxide (NO2), and ozone (O3) on the mortality cases in city of Kerman in 2016 and 2017. In this study, AirQ+ software presented by European Center for Environment and Health and World Health Organization (WHO) was employed. Daily mean concentration of PM2.5, mean hourly concentration of NO2, and maximum 8-h O3 concentration were used to assess the health impact of human exposure to these pollutants. The mean concentration of PM2.5, NO2, and O3 in the studied years was higher than the WHO guideline and the mean concentration of NO2 and O3 was less than the WHO guideline. In the short-term health impact assessment, the death caused by stroke in individuals above 25 years old due to O3 had the highest attributable proportion with 2.48% in 2016 and 2.39% in 2017.Also, in the long-term health impact assessment, the highest attributable proportion for natural death caused by PM2.5 was 15.24% in 2016 and 15.15% in 2017. In general, exposure to air pollutants is a risk factor; therefore, the implementation of sustainable control policies including population growth, urbanization, and traffic control is suggested to avoid the health impacts and economic damages.

Effect of an educational intervention on knowledge and perception of individuals at risk for stroke in Tabuk, Saudi Arabia.

Objectives:To assess the effect of an educational program on the knowledge and perception of stroke in individuals at risk.Methods:This quasi experiment study, conducted in Health Education Clinics at King Salman Armed Forces Hospital, was designed to assess the knowledge of people who were at risk for stroke, before and after delivering educational content. This content comprised 4-minute face-to-face explanation by a trained educator, 99-second video clip and a short hand-out. The assessment was performed by administering a structured questionnaire.Results:A total of 313 people participated in this study. Before the intervention, 63.6% understood stroke to be due to a disturbance in blood flow resulting in loss of brain function. After delivery of the educational content, the percentage raised to 97.1%. Thirty-Four and Eight percent (109) of participants stated they knew stroke symptoms, and 55.96% knew 2 to 4 symptoms prior to intervention. Our educational content raised these percentages to 98.4% and 79.8% respectively. Good knowledge of stroke symptoms and risk factors was associated with younger age and higher level of education.Conclusion:Educational content by means of one-to-one interaction with trained educators, video clips and handouts results in significant improvement in understanding of stroke symptoms and risk factors among at-risk participants.

Biopsychosocial Factors Affecting Quality of Life in Post-stroke Patients: A Path Analysis Evidence from Surakarta Hospital, Central Java

Background : Basic health research shows that the prevalence of non-communicable diseases has in­creased, including cancer, stroke, chronic kidney disease, diabetes mellitus, and hypertension. The impact of these changes can cause one of them to decrease the quality of life of patients. Stroke in individuals can cause several changes including physical, social and psychological changes that will affect the quality of life. This study aimed to analyze the determinants of the quality of life of pa­tients post stroke. Subjects an d Met h od: This study was a cross sectional study conducted at Surakarta City Hos­pital, from September to October 2019. The sample used was 200 patients post stroke. The sam­pling technique used purposive sampling. The dependent variable was the quality of life of patients post stroke. The independent variables were age, gender, employment status, patient income, fa­mi­ly income, attack status, post-stroke comorbidity, duration of illness, marital status, family sup­port, level of functional disorders, and depression status. The data were collected by questionnaire. The data were analyzed by path analysis with the Stata 13 program. Result : The quality of life of post-stroke patients increased directly in patients with married status (b=1.79; 95% CI=0.24 to 3.35; p=0.024), have a job (b=1.93; 95% CI=0.13 to 3.72; p=0.035), good fa­mily support (b=2.17; 95% CI=0.46 to 3.88; p=0.013), and mild functional disorders (b=1.68; 95% CI=0.11 to 3.25; p=0.036). Quality of life decreased directly in patients aged ≥60 years old (b=-1.99; 95% CI=-3.80 to -0.17; p=0.032), female gender (b=-1.74; 95% CI=-3.28 to -0.19; p= 0.027), stro­­kes more than 1 time (b=-1.87; 95% CI=-3.59 to -0.15; p=0.033), sick ≥6 months (b=-2.12 ; 95% CI=-3.87 to -0.36; p=0.018), have comorbidities (b=-1.96; 95% CI=-3.67 to -0.24; p= 0.025), and de­pression (b=-1.40; 95% CI=-2.97 to 0.16; p=0.078). Quality of life was indirectly affected by age, ill­ness, marital status, family support, family income, and employment status. Conclusions: The quality of life of post-stroke patients increased directly affected by marital sta­tus, employment status, family support, and functional disorders. Quality of life was directly affec­ted by age, gender, attack status, duration of illness, comorbidity and depression. Keywords : stroke, quality of life, path analysis. Cor r espondence: Maki Zamzam. Master Program of Public Health Sciences, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java. Email: makizz477@gmail.com. Mobile: +6281251543935. Journal of Epidemiology and Public Health (2020), 5(1): 1-14 https://doi.org/10.26911/jepublichealth.2020.05.01.01.

THE ASSOCIASON OF VITAMIN D RECEPTOR GENE (VDR) POLYMORPHISMS WITH HIGH BLOOD PRESSURE IN STROKE PATIENTS OF UKRAINIAN POPULATION

The aim: To study the association of the polymorphisms VDR gene with high blood pressure in stroke patients in the Ukrainian population. Materials and methods: Venous blood of 170 patients with atherothrombotic ischemic stroke (AIS) and 124 healthy individuals (control group) was used for genotyping. Four polymorphisms (FokI, BsmI, ApaI, TaqI) of gene VDR were examined with PCR-RFLP methodology. Statistical analysis was performed by using SPSS-17.0 program. Results: The correlation of genotypes of polymorphic variants of FokI, BsmI, ApaI and TaqI of the VDR gene with the development of ischemic atherothrombotic stroke in individuals with normal and high blood pressure was detected. Statistical analysis of the obtained data revealed that among carriers of genotypes F/F, b/b, a/a, a/A, and T/T patients with AI have statistically significantly higher incidence of hypertension than patients in the control group. Conclusions: It was found that persons with genotypes F/F, b/b, a/a, a/A, and T/T showed a statistically significant relationship between hypertension and the development of IAS. The application of logistic regression has made it possible to establish that the risk of IAS in people with normal blood pressure and genotype F/f is 3.2 times higher than in normotensive homozygotes for the F-allele.

Estimated societal costs of stroke in the UK based on a discrete event simulation.

ABSTRACTBackgroundthere are around 100,000 new stroke cases and over a million people living with its consequences annually in the UK. This has large impacts on health and social care, unpaid carers and lost productivity. We aimed to estimate associated costs.Methodswe estimated 2014/2015 annual mean cost per person and aggregate UK cost of stroke for individuals aged ≥40 from a societal perspective. Health and social care costs in the first and subsequent years after stroke were estimated from discrete event simulation modelling, with probability of progression and length of receipt of different health and social care services obtained from routine registry and audit data. Unpaid care hours and lost productivity were obtained from trial data. UK unit costs were applied to estimate mean costs. Epidemiological estimates of stroke incidence and prevalence were then applied to estimate aggregate costs for the UK.Resultsmean cost of new-onset stroke is £45,409 (95% CI 42,054-48,763) in the first year after stroke and £24,778 (20,234–29,322) in subsequent years. Aggregate societal cost of stroke is £26 billion per year, including £8.6 billion for NHS and social care. The largest component of total cost was unpaid care (61%) and, given high survival, £20.6 billion related to ongoing care.Conclusionthe estimated aggregate cost of stroke substantially exceeds previous UK estimates. Since most of the cost is attributed to unpaid care, interventions aimed at rehabilitation and reducing new and recurrent stroke are likely to yield substantial benefits to carers and cost savings to society.

Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders

BackgroundAs new heart rhythm monitoring technologies emerge, subclinical atrial fibrillation (AF) signifies a future challenge to health care systems. The pathological characteristics of this condition are largely unknown. ObjectivesThis study sought to characterize the natural history of subclinical AF in at-risk patients from the general population. MethodsThe authors studied 590 individuals ≥70 years of age with ≥1 of hypertension, diabetes, previous stroke, or heart failure, without history of AF, undergoing long-term implantable loop recorder monitoring as part of the LOOP (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-risk Individuals) study. Baseline assessments included N-terminal pro–B-type natriuretic peptide (NT-proBNP). All day-to-day heart rhythm and symptom data were extracted from the device. Endpoints included AF burden, AF progression, symptom reports, and heart rate during AF. ResultsA total of 685,445 monitoring days were available for analysis. Adjudicated AF episodes lasting ≥6 min were detected in 205 participants (35%). The AF burden was median 0.13% (interquartile range: 0.03% to 1.05%) of the monitoring time and changed by a factor of 1.31 (95% CI: 1.02 to 1.68) per doubling of NT-proBNP. AF episodes were present 2.7% (interquartile range: 1.0% to 15.7%) of monitoring days after debut. Progression to 24-h episodes was seen in 33 of the AF patients (16%), whereas 46 (22%) had no AF episodes in the last 6 months of monitoring or longer. Symptoms were absent in 185 (90%) at debut, and 178 (87%) never reported AF-related symptoms during follow-up. The averaged heart rate during AF was 96 (interquartile range: 83 to 114) beats/min, 24 (interquartile range: 9 to 41) beats/min faster than daytime sinus rates. ConclusionsAlthough previously unknown AF was highly prevalent, the burden was low, and progression was limited. In addition, symptoms were scarce, and the heart rate was only modestly elevated. (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-risk Individuals [LOOP]; NCT02036450)

Prevalence and Associated Stroke Risk of Human Immunodeficiency Virus-Infected Patients With Atrial Fibrillation - A Nationwide Cohort Study.

Patients infected with human immunodeficiency virus (HIV) are at increased risk of cardiovascular diseases. However, little is known regarding the risk of ischemic stroke in HIV-infected individuals with atrial fibrillation (AF). From the Korean National Health Insurance Service (NHIS) database from January 1, 2005 to December 31, 2016, we analyzed 962,116 patients with prevalent non-valvular AF aged ≥18 years. The overall HIV prevalence in AF patients was 0.17% (1,678 of 962,116). Oral anticoagulant (OAC)-naïve non-valvular AF (NVAF) patients with HIV had increased risks of ischemic stroke/systemic embolism (SE) [adjusted hazard ratio (HR) 1.37; 95% confidence interval (CI), 1.21-1.54], and major bleeding (adjusted HR 1.29; 95% CI, 1.15-1.46), compared with those without HIV. The incidence of ischemic stroke/SE in NVAF patients with HIV without any risk factors was similar to that of those without HIV at intermediate risk (i.e., male CHA2DS2-VASc score of 1) (2.04 vs. 2.18 events per 100 person-years). However, the use of OACs in AF patients with HIV was suboptimal, being only 8.9% at the time of AF diagnosis and 31.8% throughout the study period. The risks of ischemic stroke/SE and major bleeding were significantly higher in HIV-infected patients compared with non-HIV-infected patients with AF. Despite this, the actual use of OACs among AF patients with HIV was suboptimal.

Treatment of Extracranial Arterial Dissection: the Roles of Antiplatelet Agents, Anticoagulants, and Stenting.

Cervicocephalic arterial dissection (CeAD) is the most commonly identified cause of stroke in young healthy individuals. The management of acute ischemic stroke due to the diagnosed or suspected CeAD is well established and is appropriate for thrombolysis. There is a substantial risk of stroke recurrence in the early post-stroke period. The optimum method of stroke prevention in the subacute period remains debatable. In our review, we focused on the management of recurrent stroke in CeAD, the choice of various antithrombotic agents for stroke risk reduction with regard to specific pathogenetic mechanisms of dissections, and the utility of endovascular therapy. Recent studies suggest that various pathogenetic types of CeAD based on radiologic characteristics may be associated with greater risk of thrombogenicity, especially in the early post-stroke period. The use of anticoagulants has been shown to be effective in the eliminating microembolic signals (MES) detected by transcranial Doppler (TCD). The only randomized trial that compared combinations of antiplatelet agents and vitamin K-agonist anticoagulation did not find significant difference in risk of stroke, major bleeding, or mortality. The benefit of dual antiplatelet therapy cannot be excluded. Limited data on the use of direct oral anticoagulant agents (DOAC) is currently available. Endovascular therapy with stenting, while potentially effective, may pose significant risk of complications. Therefore, it needs to be carefully considered on a case-to-case basis. The recurrence of ischemic stroke in patients with CeAD is overall rare. No significant difference in treatment with various antiplatelet and anticoagulant agents has been shown in randomized trials. Only a few studies were based on radiological characteristics of dissections. An ongoing randomized trial is investigating the role of MES and the efficacy of antiplatelet versus anticoagulation agents. The role of DOAC agents has yet to be determined in clinical trials. Stenting in CeAD is an effective revascularization technique and may be considered in selected patients. However, current data is only based on low evidence level findings from small studies, lacking longitudinal outcomes and prognosis.

Thirty-year risk of ischemic stroke in individuals with sickle cell trait and modification by chronic kidney disease: The atherosclerosis risk in communities (ARIC) study.

Sickle cell trait (SCT) has been associated with hypercoagulability, chronic kidney disease (CKD), and ischemic stroke. Whether concomitant CKD modifies long-term ischemic stroke risk in individuals with SCT is uncertain. We analyzed data from 3602 genotyped black adults (female = 62%, mean baseline age = 54 years) who were followed for a median 26 years by the Atherosclerosis Risk in Communities Study. Ischemic stroke was verified by physician review. Associations between SCT and ischemic stroke were analyzed using repeat-events Cox regression, adjusted for potential confounders. SCT was identified in 236 (7%) participants, who more often had CKD at baseline than noncarriers (18% vs 13%, P = .02). Among those with CKD, elevated factor VII activity was more prevalent with SCT genotype (36% vs 22%; P = .05). From 1987-2017, 555 ischemic strokes occurred in 436 individuals. The overall hazard ratio of ischemic stroke associated with SCT was 1.31 (95% CI: 0.95-1.80) and was stronger in participants with concomitant CKD (HR = 2.18; 95% CI: 1.16-4.12) than those without CKD (HR = 1.09; 95% CI: 0.74-1.61); P for interaction = .04. The hazard ratio of composite ischemic stroke and/or death associated with SCT was 1.20 (95% CI: 1.01-1.42) overall, 1.44 (95% CI: 1.002-2.07) among those with CKD, and 1.15 (95% CI: 0.94-1.39) among those without CKD; P for interaction = .18. The long-term risk of ischemic stroke associated with SCT relative to noncarrier genotype appears to be modified by concomitant CKD.

Prospectively collected lifestyle and health information as risk factors for white matter hyperintensity volume in stroke patients.

Most studies of white matter hyperintensity volume (WMHV) in stroke patients lack reliable information on antecedent exposure to vascular risk factors. By leveraging prospective cohort data, we explored associations between lifestyle and health factors assessed 1year prior to stroke and WMHV in individuals who experienced an ischemic stroke. This analysis was nested within two large prospective studies of initially healthy individuals. Information on lifestyle factors and health conditions was collected prior to the stroke event through annual or biannual questionnaires. For individuals who experienced their first confirmed ischemic stroke and had available magnetic resonance imaging, we measured WMHV using a validated semiautomated method. Linear regression was used to explore associations between lifestyle factors and health conditions and log-transformed WMHV. We measured WMHV in 345 participants with a first ischemic stroke event (mean age = 74.4years; 24.9% male). After multivariate adjustment, history of diabetes was associated with decreased WMHV (p value = 0.06) while history of transient ischemic attack (p value = 0.09) and hypertension (p value = 0.07) were associated with increased WMHV. Most lifestyle factors and health conditions measured 1year prior to stroke were not associated with WMHV measured at the time of ischemic stroke. Future studies could examine whether long term exposure to these factors impacts diffuse microvascular ischemic brain injury among stroke patients.

Glucagon-Like Peptide 1 Receptor Agonists Protect Against Stroke In Patients With Diabetes: A Systematic Review And Meta-Analysis

Background and Aims: Glucagon-like peptide 1 receptor (GLP-1R) agonists, a novel class of antidiabetic agents, have been reported to exert neuroprotective effects in experimental stroke models, especially if treatment starts before stroke. We aimed to assess available data regarding the risk of stroke in diabetic individuals treated with GLP-1R agonists.

Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation

The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.