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7 pages, 467 KiB

Open AccessArticle

When Can an Emergency CTA Be Dispensed with for TIA Patients?

by Jens-Christian Altenbernd, Razvan Gramada, Eugen Kessler, Jakob Skatulla, Eduard Geppert, Jens Eyding and Hannes Nordmeyer

J. Clin. Med. 2022, 11(19), 5686; https://doi.org/10.3390/jcm11195686 - 26 Sep 2022

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Abstract

Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient’s risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to [...] Read more.

Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient’s risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity. Material and Methods: Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups—group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies. Results: Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores. Conclusions: We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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13 pages, 917 KiB

Open AccessArticle

Association between CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen Stroke Risk Scores and Functional Outcomes in Acute Ischemic Stroke Patients Who Received Endovascular Thrombectomy

by Hyung Jun Kim, Moo-Seok Park, Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, JoonNyung Heo, Jin Kyo Choi, Kyung-Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye-Yeon Choi, Sung-Il Sohn, Jeong-Ho Hong, Jong Yun Lee, Jang-Hyun Baek, Gyu Sik Kim, Woo-Keun Seo, Jong-Won Chung, Seo Hyun Kim, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han-Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon-Duk Seo, Yoonkyung Chang, Hyo Suk Nam and Tae-Jin Song Show full author list Hide full author list

J. Clin. Med. 2022, 11(19), 5599; https://doi.org/10.3390/jcm11195599 - 23 Sep 2022

Cited by 1 | Viewed by 1459

Abstract

Background: CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen stroke risk scores are used to estimate thromboembolism risk. We aimed to investigate the association between unfavorable outcomes and stroke risk scores in patients who received endovascular thrombectomy (EVT). Methods: This [...] Read more.

Background: CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen stroke risk scores are used to estimate thromboembolism risk. We aimed to investigate the association between unfavorable outcomes and stroke risk scores in patients who received endovascular thrombectomy (EVT). Methods: This study was performed using data from a nationwide, multicenter registry to explore the selection criteria for patients who would benefit from reperfusion therapies. We calculated pre-admission CHADS₂, CHA₂DS₂-VASc, ATRIA, and Essen scores for each patient who received EVT and compared the relationship between these scores and 3-month modified Rankin Scale (mRS) records. Results: Among the 404 patients who received EVT, 213 (52.7%) patients had unfavorable outcomes (mRS 3–6). All scores were significantly higher in patients with unfavorable outcomes than in those with favorable outcomes. Multivariable logistic regression analysis indicated that CHADS₂ and the ATRIA score were positively correlated with unfavorable outcomes after adjusting for body mass index and variables with p < 0.1 in the univariable analysis (CHADS₂ score: odds ratio [OR], 1.484; 95% confidence interval [CI], 1.290–1.950; p = 0.005, ATRIA score, OR, 1.128; 95% CI, 1.041–1.223; p = 0.004). Conclusions: The CHADS₂ and ATRIA scores were positively correlated with unfavorable outcomes and could be used to predict unfavorable outcomes in patients who receive EVT. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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11 pages, 856 KiB

Open AccessArticle

Spontaneous Hyperventilation Is Common in Patients with Spontaneous Cerebellar Hemorrhage, and Its Severity Is Associated with Outcome

by Zhuangzhuang Miao, Huajian Wang, Zhi Cai, Jin Lei, Xueyan Wan, Yu Li, Junwen Wang, Kai Zhao, Hongquan Niu and Ting Lei

J. Clin. Med. 2022, 11(19), 5564; https://doi.org/10.3390/jcm11195564 - 22 Sep 2022

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Abstract

Background: The spontaneous hyperventilation (SHV) accompanying spontaneous cerebellar hemorrhage has yet to attract a sufficient amount of attention. This study aimed to analyze the incidence of SHV in spontaneous cerebellar hemorrhage patients and its risk factors as well as its association with the [...] Read more.

Background: The spontaneous hyperventilation (SHV) accompanying spontaneous cerebellar hemorrhage has yet to attract a sufficient amount of attention. This study aimed to analyze the incidence of SHV in spontaneous cerebellar hemorrhage patients and its risk factors as well as its association with the outcome. Methods: We retrospectively reviewed the medical records of all spontaneous cerebellar hemorrhage patients who underwent surgical treatment at Tongji Hospital from July 2018 to December 2020. Arterial blood gas (ABG) test results and clinical characteristics, including demographics, comorbidities, imaging features, laboratory tests, and therapy choices, were collected. The Glasgow Outcome Scale was used to assess the outcome at two weeks and six months after admission. Results: A total of 147 patients were included, and of these patients 44.9% had spontaneous hyperventilation. Hypertension (OR, 3.175; CI, 1.332–7.569), usage of sedation drugs (OR, 3.693; CI, 1.0563–8.724), and hypernatremia (OR, 2.803; CI, 1.070–7.340) seemed to positively correlate to SHV occurrence. Hematoma removal had an inverse association with SHV (OR, 0.176; CI, 0.068–0.460). Patients with poor and good outcomes had significant differences in pH, PaCO₂, and HCO₃⁻ values, and the severity of SHV was associated with the PaCO₂ level. Conclusions: Spontaneous hyperventilation is common in patients with spontaneous cerebellar hemorrhage, and its severity is associated with the outcome. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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15 pages, 886 KiB

Open AccessArticle

Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)

by Moriz Herzberg, Franziska Dorn, Christoph Trumm, Lars Kellert, Steffen Tiedt, Katharina Feil, Clemens Küpper, Frank Wollenweber, Thomas Liebig and Hanna Zimmermann

J. Clin. Med. 2022, 11(15), 4619; https://doi.org/10.3390/jcm11154619 - 08 Aug 2022

Cited by 4 | Viewed by 1834

Abstract

There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients [...] Read more.

There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0–2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65–82) and 77 (CI 66–83) years, respectively. Except for baseline NIHSS (15 (CI 10–18) vs. 11 (CI 6–16), p < 0.001) and ASPECTS (9 (CI 7–10) vs. 9 (CI 8–10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7–42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2–8) vs. 2 (CI 2–7)/(CI 2–2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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11 pages, 285 KiB

Open AccessArticle

A Comparative Analysis of Functional Status and Mobility in Stroke Patients with and without Aphasia

by Zbigniew Guzek, Wioletta Dziubek, Małgorzata Stefańska and Joanna Kowalska

J. Clin. Med. 2022, 11(12), 3478; https://doi.org/10.3390/jcm11123478 - 16 Jun 2022

Cited by 2 | Viewed by 1709

Abstract

All researchers agree that aphasia is a serious consequence of a stroke, but they also report contradictory data regarding the functional outcome. The aim of this study was, therefore, to assess the functional outcomes of stroke patients with and without aphasia, who were [...] Read more.

All researchers agree that aphasia is a serious consequence of a stroke, but they also report contradictory data regarding the functional outcome. The aim of this study was, therefore, to assess the functional outcomes of stroke patients with and without aphasia, who were undertaking a regular rehabilitation programme. Materials and Methods: The study group consisted of 116 post-stroke patients, including 54 patients without aphasia (G1) and 62 patients with aphasia (G2). The following tests were used before (T1) and after (T2) rehabilitation measurement points: Barthel Index (BI), Sitting Assessment Scale (SAS), Berg Balance Scale (BBS), Trunk Control Test (TCT), Test Up & Go (TUG) and the Timed Walk Test (TWT). Results: The group of post-stroke patients with aphasia had a significantly longer time since a stroke on admission, a significantly longer length of stay in the ward and significantly worse SAS and TCT scores at T2, compared to patients without aphasia. Both groups achieved significant improvement in all studied parameters (SAS, TCT, BI, BBS, TUG and TWT). Aphasia was a predictor of functional status in the stroke patients group, but only at the time of admission to the ward. Conclusions: Patients with and without aphasia have an equal likelihood of improving their functional status and returning to independence. Aphasia should not be an absolute factor that excludes stroke patients from research studies on their functional status. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

11 pages, 1257 KiB

Open AccessArticle

Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source

by Minho Han, JoonNyung Heo, Jae Wook Jung, Il Hyung Lee, Joon Ho Kim, Hyungwoo Lee, Young Dae Kim and Hyo Suk Nam

J. Clin. Med. 2022, 11(11), 3073; https://doi.org/10.3390/jcm11113073 - 29 May 2022

Viewed by 2140

Abstract

We investigated the association of low ankle-brachial index (ABI < 0.9) with major adverse cardiovascular events (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) as well as whether the association differed by ESUS subtype. This retrospective single-center study [...] Read more.

We investigated the association of low ankle-brachial index (ABI < 0.9) with major adverse cardiovascular events (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) as well as whether the association differed by ESUS subtype. This retrospective single-center study included ESUS patients who underwent transesophageal echocardiography and ABI during hospitalization. ESUS was classified as ESUS with minor cardioembolic source, arteriogenic embolism, two or more causes, or no cause. Arteriogenic embolism was defined and classified as complex aortic or non-stenotic relevant artery plaque. MACE was defined as stroke recurrence, acute coronary syndrome, hospitalization for heart failure, or death. Overall, 829 patients were included, with a median follow-up of 45.8 months. Of these, 42 (5.1%) and 370 (44.6%) had low ABI and arteriogenic embolism, respectively. ABI < 0.9 was independently associated with MACE (hazard ratio [HR]: 2.038, 95% confidence interval [CI]: 1.093–3.801) and all-cause mortality (HR: 3.608, 95% CI: 1.538–8.465) according to the multivariable Cox regression analysis. Between ESUS subtypes, low ABI was independently associated with MACE (HR: 2.513, 95% CI: 1.257–5.023) and all-cause mortality (HR: 5.681, 95% CI: 2.151–15.008) in arteriogenic embolism patients, especially in those with complex aortic plaque. However, in non-arteriogenic embolism patients, low ABI was not related to MACE and mortality. In ESUS patients, low ABI was linked to MACE and all-cause mortality, especially in those with arteriogenic embolisms from complex aortic plaque. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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20 pages, 5539 KiB

Open AccessArticle

Endovascular Treatment of Chronic Subdural Hematomas through Embolization: A Pilot Study with a Non-Adhesive Liquid Embolic Agent of Minimal Viscosity (Squid)

by Andrey Petrov, Arkady Ivanov, Larisa Rozhchenko, Anna Petrova, Pervinder Bhogal, Alexandru Cimpoca and Hans Henkes

J. Clin. Med. 2021, 10(19), 4436; https://doi.org/10.3390/jcm10194436 - 27 Sep 2021

Cited by 8 | Viewed by 3661

Abstract

Objective: Endovascular embolization using non-adhesive agents (e.g., ethylene vinyl alcohol copolymer with suspended micronized tantalum dissolved in dimethyl sulfoxide; Squid, Balt Extrusion) is an established treatment of brain arteriovenous malformations, dural arteriovenous fistulas, and hypervascular neoplasms. Middle meningeal artery (MMA) embolization is a [...] Read more.

Objective: Endovascular embolization using non-adhesive agents (e.g., ethylene vinyl alcohol copolymer with suspended micronized tantalum dissolved in dimethyl sulfoxide; Squid, Balt Extrusion) is an established treatment of brain arteriovenous malformations, dural arteriovenous fistulas, and hypervascular neoplasms. Middle meningeal artery (MMA) embolization is a relatively new concept for treating chronic subdural hematomas (CSDH). This study aimed to evaluate the safety and effectiveness of the use of Squid in the endovascular treatment of CSDH. Methods: Embolization was offered to patients with CSDH with minimal or moderate neurological deficits and patients who had previously undergone open surgery to evacuate their CSDH without a significant effect. Distal catheterization of the MMA was followed by embolization of the hematoma capsule with Squid 12 or Squid 18. Safety endpoints were ischemic or hemorrhagic stroke and any other adverse event of the endovascular procedure. Efficacy endpoints were the feasibility of the intended procedure and a ≥ 50% reduction of the maximum depth of the CSDH confirmed by follow-up computed tomography (CT) after >3 months. Results: Between November 2019 and July 2021, 10 patients (3 female and 7 male, age range 42–89 years) were enrolled. Five patients had bilateral hematomas, and five patients had previously been operated on with no significant effect and recurrent hematoma formation. The attempted embolization was technically possible in all patients. No technical or clinical complication was encountered. During a post-procedural follow-up (median 90 days), 10 patients improved clinically. A complete resolution of the CSDH was observed in 10 patients. The clinical condition of all enrolled patients during the so-far last contact was rated mRS 0 or 1. Conclusion: A distal catheterization of the MMA for the endovascular embolization of CSDH with Squid allowed for the devascularization of the MMA and the dependent vessels of the hematoma capsule. This procedure resulted in a partial or complete resolution of the CSDH. Procedural complications were not encountered. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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9 pages, 1230 KiB

Open AccessArticle

Mechanical Thrombectomy in Acute Terminal Internal Carotid Artery Occlusions Using a Large Manually Expandable Stentretriever (Tiger XL Device): Multicenter Initial Experience

by Volker Maus, Sabeth Hüsken, Vladimir Kalousek, Grzegorz Marek Karwacki, Hannes Nordmeyer, Ilka Kleffner, Werner Weber and Sebastian Fischer

J. Clin. Med. 2021, 10(17), 3853; https://doi.org/10.3390/jcm10173853 - 27 Aug 2021

Cited by 8 | Viewed by 2714

Abstract

Background: The recently introduced Tigertriever XL Device for treatment of cerebral vessel occlusions combines manual adjustability and maximum length in one device. In this study, we report our initial experience with the Tigertriever XL in terminal ICA occlusions. Methods: Retrospective multicenter analysis of [...] Read more.

Background: The recently introduced Tigertriever XL Device for treatment of cerebral vessel occlusions combines manual adjustability and maximum length in one device. In this study, we report our initial experience with the Tigertriever XL in terminal ICA occlusions. Methods: Retrospective multicenter analysis of acute terminal ICA occlusions treated by mechanical thrombectomy using the Tigertriever XL Device. Results: 23 patients were treated using the Tigetriever XL due to an acute occlusion of the terminal ICA. The overall successful reperfusion rate after a median of two maneuvers using the Tigertriever XL Device was 78.3% (mTICI 2b-3). In 43.5% (10/23) additional smaller devices were applied to treat remaining occlusions in downstream territories, which resulted in a final successful reperfusion rate of 95.7%. Device related complications did not occur. Two symptomatic intracerebral hemorrhages (sICH) were observed. Conclusions: The Tigertriever XL Device might be a helpful tool in the treatment of ICA terminus occlusions with large clot burden resulting in high reperfusion rates. This is mainly related to the manual adjustability of the device combined with the maximum length. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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8 pages, 237 KiB

Open AccessArticle

Admission Hydration Status and Ischemic Stroke Outcome—Experience from a National Registry of Hospitalized Stroke Patients

by Yoav Eizenberg, Ehud Grossman, David Tanne and Silvia Koton

J. Clin. Med. 2021, 10(15), 3292; https://doi.org/10.3390/jcm10153292 - 26 Jul 2021

Cited by 5 | Viewed by 1711

Abstract

Reduced intravascular volume upon ischemic stroke (IS) admission has been associated with in-hospital complications, disability, and reduced survival. We aimed to evaluate the association of the urea-to-creatinine ratio (UCR) with disability or death at discharge, length of stay, in-hospital complications, and mortality during [...] Read more.

Reduced intravascular volume upon ischemic stroke (IS) admission has been associated with in-hospital complications, disability, and reduced survival. We aimed to evaluate the association of the urea-to-creatinine ratio (UCR) with disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year. Using a national registry, we identified hospitalized IS patients without renal failure. Disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year were studied by UCR, and associations between UCR levels and each outcome were assessed adjusting for age, sex, stroke severity, comorbidities, use of statins, and use of diuretics. In total, 2212 patients were included. Levels (median (25–75%)) for the main study variables were: urea 5.16 (3.66–6.83) mmol/L; creatinine 80 (64–92) µmol/L; and UCR 65 (58–74). Levels of UCR were significantly higher in patients with disability or death at discharge (p < 0.0001), those with complications during hospitalization (p = 0.03), those with infection during hospitalization (p = 0.0003), and those dead at 1 year (p < 0.0001). Analysis by UCR quartile showed that rates of disability or death at discharge, infections, complications overall, and death at 1 year in patients with UCR in the 4th quartile were significantly higher than in others. Risk-factor-adjusted analysis by UCR quartiles demonstrated an inconsistent independent association between UCR and disability or death after ischemic stroke. A high 1-year mortality rate was observed in IS patients with elevated UCR, yet this finding was not statistically significant after controlling for risk factors. Our study shows inconsistent associations between hydration status and poor functional status at discharge, and no association with length of stay, in-hospital complications (infectious and overall), and 1-year mortality. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

10 pages, 3491 KiB

Open AccessArticle

Concomitant Acute Ischemic Stroke and Upper Extremity Arterial Occlusion: Feasibility of Mechanical Thrombectomy of the Upper Limb Using Neurointerventional Devices and Techniques

by Dominik F. Vollherbst, Christian Ulfert, Volker Maus, Timan Boujan, Hans Henkes, Martin Bendszus and Markus A. Möhlenbruch

J. Clin. Med. 2021, 10(14), 3189; https://doi.org/10.3390/jcm10143189 - 20 Jul 2021

Viewed by 2058

Abstract

Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, [...] Read more.

Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, while there are different pharmacological, surgical and endovascular treatment options for an acute occlusion of the UL arteries. Here, we describe the practicability, efficacy and safety of neurointerventional devices and techniques for MT of upper extremity arterial occlusions. Materials and Methods: A retrospective analysis of prospectively collected patient databases from four neurovascular centers was performed. Clinical and imaging data, as well as procedural parameters, were assessed. Results: Seven out of 6138 patients (incidence: 0.11%) presenting with an AIS due to the occlusion of craniocervical arteries requiring MT and a concomitant occlusion of the brachial (4/7), axillary (2/7), or ulnar (1/7) artery causing acute ULI were identified. Craniocervical MT was technically successful in all cases. Subsequent MT of the upper limb was performed using neurointerventional thrombectomy techniques, most frequently stent retriever thrombectomy (in 4/7 cases) and direct aspiration (in 7/7 cases). MT achieved successful recanalization in 6/7 cases, and the UL completely recovered in all six cases. In one case, recanalization was not successful, and the patient still had a marginally threatened extremity after the procedure, which improved after pharmacological therapy. Conclusion: In the rare case of AIS requiring MT and concomitant acute upper extremity arterial occlusion, MT of the UL arteries using neurointerventional devices and techniques is practical, effective, and safe. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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7 pages, 1482 KiB

Open AccessArticle

An Updated Meta-Analysis of RCTs of Colchicine for Stroke Prevention in Patients with Coronary Artery Disease

by Aristeidis H. Katsanos, Lina Palaiodimou, Christopher Price, Marios Themistocleous, Robin Lemmens, Ioannis Michopoulos, Marios K. Georgakis, Christian Weimar, Peter Kelly and Georgios Tsivgoulis

J. Clin. Med. 2021, 10(14), 3110; https://doi.org/10.3390/jcm10143110 - 14 Jul 2021

Cited by 5 | Viewed by 2232

Abstract

Emerging evidence from randomized controlled clinical trials (RCTs) suggests that colchicine has cardiovascular benefits for patients with coronary disease, including benefits for stroke prevention. We performed an updated systematic review and meta-analysis of all RCTs reporting on stroke outcomes during the follow-up of [...] Read more.

Emerging evidence from randomized controlled clinical trials (RCTs) suggests that colchicine has cardiovascular benefits for patients with coronary disease, including benefits for stroke prevention. We performed an updated systematic review and meta-analysis of all RCTs reporting on stroke outcomes during the follow-up of patients with a history of cardiovascular disease randomized to colchicine treatment or control (placebo or usual care). We identified 6 RCTs including a total of 11,870 patients (mean age 63 years, 83% males) with a mean follow-up of 2 years. Colchicine treatment was associated with a lower risk of stroke during follow-up, compared to that of placebo or usual care (risk ratio = 0.49, 95% confidence interval: 0.31–0.80; p = 0.004), without heterogeneity across the included studies (I² = 0%, p for Cochran’s Q = 0.52). In the subgroup analysis, no heterogeneity (p = 0.77) was identified in the effect of colchicine on stroke prevention between patients with recent acute (RR = 0.55, 95% CI: 0.15–2.05) or chronic stable (RR = 0.43, 95% CI: 0.21–0.89) coronary artery syndromes. In conclusion, we found that colchicine treatment decreases the stroke risk in patients with a history of atherosclerotic cardiovascular disease. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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12 pages, 687 KiB

Open AccessArticle

Anemia Is a Risk Factor for the Development of Ischemic Stroke and Post-Stroke Mortality

by Jayoon Heo, Tae-Mi Youk and Kwon-Duk Seo

J. Clin. Med. 2021, 10(12), 2556; https://doi.org/10.3390/jcm10122556 - 09 Jun 2021

Cited by 13 | Viewed by 3270

Abstract

Background: anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk [...] Read more.

Background: anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk of ischemic stroke and the risk of death after ischemic stroke. Methods: The study included patients from National Health Insurance Service cohort, from January 2005 to December 2015. Anemia patients were defined as those with confirmed diagnostic codes and related medications in the sample cohort, and patients under the age of 18 were excluded. To perform a comparative analysis with the control group, twice as many patients were extracted by propensity score matching. The effects of anemia on the development of ischemic stroke were analyzed. Results: A total of 58,699 patients were newly diagnosed with anemia during the study period. In anemia group, the rate of ischemic stroke occurring within 1 year was 0.550%, and the rate was 0.272% in the control group. The odds ratio of anemia related to ischemic stroke was 1.602 (95% confidence intervals (CI) 1.363–1.883). During the follow-up period, 175 out of 309 (56.6%) died in anemia group, and 130 out of 314 (41.4%) died in control group. The anemia group showed a higher risk of death than the control group (Hazard ratio 1.509, 95% CI 1.197–1.902). Conclusion: Analysis of the nationwide health insurance data revealed that anemia is one of the risk factors for the development of ischemic stroke, and also an independent prognostic factor affecting post-stroke mortality. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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10 pages, 619 KiB

Open AccessArticle

Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine

by Jordi Kühne Escolà, Simon Nagel, Verena Panitz, Tilman Reiff, Alexander Gutschalk, Christoph Gumbinger and Jan Christoph Purrucker

J. Clin. Med. 2021, 10(9), 1956; https://doi.org/10.3390/jcm10091956 - 02 May 2021

Cited by 2 | Viewed by 3998

Abstract

Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = [...] Read more.

Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017. Management of patients suffering AIS with and without prior oral anticoagulation treatment was characterized, including potential vs. actual treatment with intravenous thrombolysis (IVT) and reasons for withholding it. Results: n = 359 patients had suffered an AIS, of whom 63 (17.5%) were under treatment with oral anticoagulants (VKA, n = 24; NOAC, n = 39). Administration of IVT was more common in patients who had not received prior oral anticoagulation treatment (20.3% vs. 3.2%, p < 0.001). NOAC intake was the primary reason for withholding IVT in 37% of orally anticoagulated patients who were found potentially eligible for IVT. Furthermore, patients under oral anticoagulation tended to be transported to the comprehensive stroke center more often (23.8% vs. 13.9%, p = 0.056). Conclusions: AIS in patients on oral anticoagulation treatment is a frequent reason for telestroke consultation, and NOAC intake constitutes an important barrier to administering IVT. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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10 pages, 642 KiB

Open AccessArticle

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

by Marc E. Wolf, Beate Luz, Ludwig Niehaus, Pervinder Bhogal, Hansjörg Bäzner and Hans Henkes

J. Clin. Med. 2021, 10(8), 1599; https://doi.org/10.3390/jcm10081599 - 09 Apr 2021

Cited by 118 | Viewed by 16122

Abstract

Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University [...] Read more.

Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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9 pages, 251 KiB

Open AccessArticle

Gender Differences in Risk Factor Profile and Clinical Characteristics in 89 Consecutive Cases of Cerebral Venous Thrombosis

by Zoltan Bajko, Anca Motataianu, Adina Stoian, Laura Barcutean, Sebastian Andone, Smaranda Maier, Iulia-Adela Drăghici, Andrada Cioban and Rodica Balasa

J. Clin. Med. 2021, 10(7), 1382; https://doi.org/10.3390/jcm10071382 - 30 Mar 2021

Cited by 8 | Viewed by 2337

Abstract

Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular [...] Read more.

Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular disorder. Materials and methods: We retrospectively reviewed the medical records of 89 consecutive cases of CVT at a tertiary neurology clinic in Târgu Mures, Romania, between June 2009 and January 2021 to analyze the gender-related differences in etiology, clinical presentation, and outcome. Results: Women comprised 62.5% of the cohort. Females were significantly younger than males (37.3 years versus 48.8 years, respectively, p = 0.001), and the main risk factors were hormone related in 37.9% of the cases, followed by primary thrombophilia (34.4%), smoking (25.8%), obesity (17.2%), infections (17.2%), mechanical factors (17.2%), cancer (8.6%), systemic autoimmune disorders (8.6%), and hematological disorders (8.6%). In male patients, the main risk factors were smoking (41.9%), primary thrombophilia (29%), infections (22.6%), heavy alcohol consumption (16.1%), and venous thromboembolism in the medical history (12.9%). Frequency of headache was higher in females than in males (75.9% versus 67.7%), whereas frequency of coma (6.5% in males versus 1.7% in females) and dizziness (19.4% in males versus 10.3% in females) was higher in males. CVT onset was acute in 41.4% of females and 38.7% of males. The Rankin score at discharge was significantly lower in females compared with males (0.6 versus 1.6), reflecting a more favorable short-term outcome. Mortality was 6.4% in males and 1.7% in females. Conclusions: CVT is a multifactorial disorder that has a broad spectrum of risk factors with important gender-related differences in clinical manifestation and prognosis. Female patients, especially those with hormone-related risk factors, have a more favorable outcome than male patients. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

11 pages, 1484 KiB

Open AccessArticle

The Effect of the 2019 Novel Coronavirus Pandemic on Stroke and TIA Patient Admissions: Perspectives and Risk Factors

by Luke Carson, Christopher Kui, Gemma Smith and Anand K. Dixit

J. Clin. Med. 2021, 10(7), 1357; https://doi.org/10.3390/jcm10071357 - 25 Mar 2021

Cited by 2 | Viewed by 1934

Abstract

Background: The 2019 novel coronavirus pandemic has generated concern from stroke specialist centres across the globe. Reductions in stroke admissions have been reported, despite many expecting an increase due to the pro-thrombotic nature of 2019 novel coronavirus. Aims: To assess the impact of [...] Read more.

Background: The 2019 novel coronavirus pandemic has generated concern from stroke specialist centres across the globe. Reductions in stroke admissions have been reported, despite many expecting an increase due to the pro-thrombotic nature of 2019 novel coronavirus. Aims: To assess the impact of the pandemic and subsequent lockdown on stroke admissions and transient ischaemic attack referrals at the Royal Victoria Infirmary, Newcastle-Upon-Tyne, and additionally on patient behaviours affecting modifiable risk factors or perspectives related to accessing healthcare. Methods: A single-centre retrospective data analysis was carried out on a “lockdown” cohort of suspected stroke patients admitted between 11 March to 26 May 2020 and a “pre-lockdown” cohort admitted in 2019. Differences in weekly admissions, weekly referrals, onset-to-presentation time and weekly thrombolysis cases were examined. Further analysis interrogated these cohorts separated by Bamford classification and stroke mimics (such as seizure/hemiplegic migraine/functional neurology). A binary-format questionnaire was separately administered to admitted patients from 15 April to 5 June 2020. Results: Significant reductions in weekly posterior circulation infarct (−43%, p = 0.017) and stroke-mimic (−47%, p < 0.001) admissions and weekly referrals diagnosed as non-transient ischaemic attack (−55%, p = 0.002) were observed in the lockdown cohort, with no differences in onset-to-presentation time. Over 25% of questionnaire respondents reported less physical activity, increased isolation and delaying their presentation due to the pandemic. Conclusions: This study provides evidence of reduced stroke-mimic and posterior circulation infarct admissions. Questionnaire findings suggest that patients need to be informed to ensure they appropriately seek medical advice. Significant communication at the stroke-primary care interface is needed to support referral pathways and management of modifiable risk factors. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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10 pages, 2469 KiB

Open AccessArticle

Diagnostic Accuracy in Teleneurological Stroke Consultations

by Jordi Kühne Escolà, Simon Nagel, Christina Verez Sola, Eva Doroszewski, Hannah Jaschonek, Alexander Gutschalk, Christoph Gumbinger and Jan C. Purrucker

J. Clin. Med. 2021, 10(6), 1170; https://doi.org/10.3390/jcm10061170 - 11 Mar 2021

Cited by 3 | Viewed by 1810

Abstract

Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological [...] Read more.

Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological diagnosis and hospital discharge diagnosis were compared. Diagnoses were then grouped into two main categories: cerebrovascular disease (CVD) and noncerebrovascular disease. Test characteristics were calculated. Results: Out of 1078 consultations, 52% (n = 561) had a final diagnosis of CVD. Patients with CVD could be accurately identified via teleneurological consultation (sensitivity 95.2%, 95% CI 93.2–96.8), but we observed a tendency towards false-positive diagnosis (specificity 77.4%, 95% CI 73.6–80.8). Characteristics of patients with a false-negative CVD diagnosis were similar to those of patients with a true-positive diagnosis, but patients with a false-negative CVD diagnosis had ischemic heart disease less frequently. In retrospect, one patient would have been considered a candidate for intravenous thrombolysis (0.2%). Conclusions: Teleneurological consultations are accurate for identifying patients with CVD, and there is a very low rate of missed candidates for thrombolysis. Apart from a lower prevalence of ischemic heart disease, characteristics of “stroke chameleons” were similar to those of correctly identified CVD patients. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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Review

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13 pages, 3050 KiB

Open AccessReview

COVID-19 and Delayed Cerebral Ischemia—More in Common Than First Meets the Eye

by Pervinder Bhogal, Levansri Makalanda, Ameer E. Hassan, Dave Fiorella, Tommy Andersson, Muhammad Ahmad, Hansjörg Bäzner, Ounali Jaffer and Hans Henkes

J. Clin. Med. 2021, 10(12), 2646; https://doi.org/10.3390/jcm10122646 - 16 Jun 2021

Cited by 3 | Viewed by 2191

Abstract

Since the arrival of the global COVID-19 pandemic scientists around the world have been working to understand the pathological mechanisms resulting from infection. There has gradually been an understanding that COVID-19 triggers a widespread endotheliopathy and that this can result in a widespread [...] Read more.

Since the arrival of the global COVID-19 pandemic scientists around the world have been working to understand the pathological mechanisms resulting from infection. There has gradually been an understanding that COVID-19 triggers a widespread endotheliopathy and that this can result in a widespread thrombosis and in particular a microthrombosis. The mechanisms involved in the microthrombosis are not confined to infection and there is evidence that patients with aneurysmal sub-arachnoid haemorrhage (SAH) also suffer from an endotheliopathy and microthrombosis. In this article we attempt to shed light on similarities in the underlying processes involved in both diseases and suggest potential treatment options. Full article

(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)

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