Abstract P684: Treatment of Hypercoagulability-Induced New Neurovascular Events Using Enoxaparin vs DOACs (THINNED): A Retrospective Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Danielle Golub ◽  
Sakinah Sabadia ◽  
Shadi Yaghi ◽  
Aneek Patel ◽  
Christopher Hernandez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Recurrent Stroke ◽  
Antiplatelet Agent ◽  
Retrospective Chart Review ◽  
Initial Study ◽  
Stroke Recurrence ◽  
Vessel Infiltration

Introduction: The incidence of stroke is higher in patients with malignancy, especially within a few months of diagnosis and in more aggressive cancers. This phenomenon may be explained by an inherent hypercoagulable state, tumor embolism, vessel infiltration, or as a side effect from cancer treatment. Notably, stroke in cancer patients is associated with poor functional outcomes and reduced survival. Currently, however, there are no clear guidelines for antithrombotic management for prevention of recurrent strokes in these patients. Methods: We conducted a single-center retrospective chart review from 2013-2019. All adult patients with an ischemic stroke occurring with active malignancy and who then received either a direct oral anticoagulant (DOAC) or low molecular weight heparin (LMWH) were included. Patients with hemorrhagic stroke, an intracranial malignancy, or who were immediately admitted to hospice were excluded. Results: A total of 55 patients were included with a mean age of 71.8 years (range 28-96), 60% females, 87.3% first-time strokes, and 54.9% with metastatic disease. After stroke, 25 patients received a DOAC and 30 received LMWH for anticoagulation with a mean follow-up of 403 days. Between these two groups, most presentation and treatment characteristics were similar except for baseline hypertension, hyperlipidemia, additional initiation of an antiplatelet, and follow-up time. There was no difference in either stroke recurrence (DOAC vs LMWH: OR 2.61 [0.51-13.45], p=0.252) or time to recurrent stroke (DOAC vs LMWH: HR 1.68, p=0.446), but both analyses required adjustment for additional initiation of an antiplatelet—which was significantly protective regardless of anticoagulation choice (p=0.021* and p=0.017*, respectively). There was a trend towards improved survival if placed on a DOAC (HR 0.27, p=0.051), even after adjusting for metastatic disease. Conclusions: In this initial study of cancer patients with ischemic stroke, anticoagulation choice made no difference on stroke recurrence; however, addition of an antiplatelet agent was significantly protective. There was also a trend towards improved survival on a DOAC. Additional prospective data incorporating a larger sample size could further validate these findings.

Symptomatic Intracranial Atherosclerosis: Natural History of Medical Management Beyond the Hyperacute Stage of Ischemic Stroke in the Post-SAMMPRIS Era

2018 ◽  
Vol 1 (1) ◽  
pp. 68-72
Author(s):  
Anand G. Vaishnav ◽  
Radhika A. Vaishnav
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Recurrent Stroke ◽  
Imaging Techniques ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Stroke Recurrence ◽  
Atherosclerotic Stenosis ◽  
History Of

Background: A major cause of ischemic stroke (IS) worldwide, especially in Asia, is intracranial atherosclerotic stenosis (ICAS), which is also associated with the high risk of recurrent stroke. Objective: The aim of our study was to determine the natural history of symptomatic ICAS ischemic stroke (ICAS IS) patients. Materials and Methods: We collected data on acute ICAS IS patients beyond the hyperacute IS phase to determine stroke recurrence and mortality at a tertiary care neurology hospital. Data were collected on basic demographics and traditional risk factors such as hypertension, coronary artery disease, diabetes mellitus, tobacco abuse, and hyperlipidemia, and statistical analysis was done. The primary endpoint was to measure the unfavorable outcome as defined by recurrent stroke or death from any cause. Results: The mean follow-up time for the total 87 patients was 24.5 months. Nine patients (10.3%) had an unfavorable outcome in the follow-up period; 2 (2.3%) of them had recurrent IS. Age was a predictor of the unfavorable outcome ( P = .0025), whereas hyperlipidemia was present more in patients with the favorable outcome ( P = .033). There was a tendency for patients with poor outcomes to have a higher National Institutes of Health Stroke Scale at their onset of stroke. Conclusions: Aggressive medical treatment was associated with a relatively low risk of recurrent stroke in our ICAS IS population. This study provides groundwork for larger studies that can take into account clinical and newer imaging techniques to improve secondary prevention in ICAS IS patients.

Abstract TMP110: Antithrombotic Therapy and Risk of Stroke Recurrence in Children With Congenital and Acquired Cardiac Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elizabeth Pulcine ◽  
Mike Seed ◽  
Leonardo Brandao ◽  
Mahmoud Slim ◽  
Manohar Shroff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antithrombotic Therapy ◽  
Recurrent Stroke ◽  
Hemorrhagic Transformation ◽  
Palliative Surgery ◽  
Left Ventricular ◽  
Stroke Recurrence ◽  
Inclusion Criteria ◽  
Arterial Ischemic Stroke

Background: Antithrombotic therapy (ATT) is currently recommended for stroke prevention in pediatric cardioembolic arterial ischemic stroke (CE-AIS) where the risk of recurrence is high. Methods: We conducted a retrospective study of a prospectively enrolled cohort of neonates and children with radiologically-confirmed cardioembolic arterial ischemic stroke (CE-AIS) from January 2003 - December 2017. We evaluated the clinical and radiographic predictors of hemorrhagic transformation (HT) and stroke recurrence to assess the safety and efficacy of ATT. Results: Eighty-two children met inclusion criteria [53.7% males and 28% neonates; median age 0.43 (IQR: 0.08 - 4.23) years]. Stroke recurred in 11 children at a median of 32 days (IQR: 5.5 - 93) from the index event. Most recurrent infarcts were silent (n=6; 54.5%) and found on follow-up neuroimaging with an average follow-up interval of 4.1 ±3 .5 years. Procedure-related recurrence took place in 1 (9.1%) child. Ten (90.9%) children were receiving antithrombotic therapy at the time of recurrence: 8 (72.7%) were on anticoagulant therapy (ACT) and 2 (18.2%) were on a combination of antiplatelet (ATP) and ACT. HT occurred in 20 of 82 children (24.4%), all of whom were receiving ACT, 5 (6.1%) of whom were symptomatic. Four (4.9%) had systemic hemorrhage. There was no difference in the frequency of stroke recurrence between those with and without HT [3 (15.0%) vs. 8 (12.9%); p=1.00]. Children with univentricular physiology were less likely to have HT [15% vs. 43.5%; p=0.03] and had higher rates of recurrent stroke, prior to definitive cardiac repair, despite receiving ATT. Stroke recurrence was highest in those with cyanotic congenital heart disease (CHD) pre-surgery (3/11), cyanotic CHD post-palliative surgery with residual right-to-left-shunt (3/11) and in those with cardiomyopathy (4/11). HT was not associated with ATP vs. ACT use nor combination therapy. Conclusion: ATT appears to be relatively safe in children with CE-AIS. However, ATT warrants further optimization to prevent stroke recurrence, particularly in those with single ventricle physiology and reduced left ventricular function.

Abstract 1122‐000169: The Carotid Web and Ischemic Stroke ‐ A Case Report

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Aravind Reddy ◽  
Neil Suryadevara ◽  
Hesham Masoud ◽  
Palma Shaw ◽  
Karen Albright
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Literature Review ◽  
Medical Therapy ◽  
Systematic Literature Review ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Patient Case

Introduction : Case report: 63 year old African American woman with history of hypertension presented with acute onset of expressive aphasia. Her neurologic exam and NIHSS was significant for moderate aphasia with paraphasic errors and impairment of repetition. She was outside the treatment window for IV thrombolytic therapy. CT angiography of the head and neck in the ED showed moderate 60–70% stenosis of the left internal carotid artery secondary to a carotid web. She was admitted to the stroke service and started on DAPT with ASA and clopidogrel. MRI brain was obtained, which confirmed a small acute infarct in the posterior margin of the left sylvian fissure. Methods : Intervention and Follow‐up: Vascular surgery and interventional neurology were consulted to discuss the treatment options for the patient’s carotid web. Give the unique nature of the patient’s web with its triple lumen appearance, carotid endarterectomy (CEA) was favored over stenting, and the patient underwent left CEA. There were no immediate complications, and she was continued on DAPT for 21 days, then ASA monotherapy. One month follow‐up carotid dopplers of the left ICA showed patent flow without significant stenosis. On follow‐up evaluations at 3 and 12 months, the patient’s speech deficits had improved significantly and she reported no new stroke‐like symptoms. Results : Literature Review: Carotid webs (CaW) may be a potentially underrecognized cause of ischemic strokes. CaW are thin, fibrous tissue that extends from the wall of the carotid artery into the lumen in a shelf‐like projection. It is believed to be a variant of fibromuscular dysplasia. It is hypothesized that blood stasis on the downstream surface of the web may result in thrombus formation and thromboembolic stroke. The optimal treatment for CaW remains unclear, however there is some evidence to suggest that antiplatelet therapy alone may be insufficient to prevent recurrent stroke, with rates of recurrent stroke of 30–50% from a systematic literature review. Furthermore, there have been no reports of CaW positive remodeling over time, so patients likely remain at elevated risk for ischemic stroke without intervention. Conclusions : Discussion: Case series as well as systematic literature review have shown high rates of stroke recurrence in CaW patients treated with medical therapy alone. Data is still limited, however, CEA and carotid artery stenting (CAS) appear to be safe and effective revascularization procedures for CaW, with potentially significant reduction in recurrent stroke risk. CEA was preferred in our patient case due to the triple‐lumen appearance of the carotid web (Figure). CaW is a relatively underappreciated cause of ischemic strokes and the optimal management is not well‐established, however medical therapy alone appears to be sub‐optimal with high rates of stroke recurrence. Our patient case shows that carotid revascularization can be safe may be effective in preventing stroke recurrence.

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

scholarly journals Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lisha Hou ◽  
Mier Li ◽  
Ju Wang ◽  
Yawen Li ◽  
Qianwen Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Exercise Duration ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Face To Face ◽  
Baseline Information ◽  
Exercise Type ◽  
The Relationship

AbstractThe relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

Abstract 181: Determinants of Intracranial Atherosclerotic Enhancement on Vessel Wall MRI in Patients with Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adam de Havenon ◽  
Nabeel Chauhan ◽  
Jennifer Majersik ◽  
David Tirschwell ◽  
Ka-Ho Wong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vessel Wall ◽  
Recurrent Stroke ◽  
Pulse Sequences ◽  
High Rate ◽  
Stroke Recurrence ◽  
Anterior Circulation ◽  
Post Contrast

Introduction: Enhancing intracranial atherosclerotic plaque on high-resolution vessel wall MRI (vwMRI) is a reliable marker of recent thromboembolism, and confers a recurrent stroke risk of up to 30% a year. Post-contrast plaque enhancement (PPE) on vwMRI is thought to represent inflammation, but studies have not fully examined the clinical, serologic or radiologic factors that contribute to PPE. Methods: Inpatients with acute ischemic stroke due to intracranial atherosclerosis were prospectively enrolled at a single center from 2015-16. vwMRI was performed on a 3T Siemens Verio and included 3D DANTE pulse sequences, pre- and post-contrast (for PPE identification). Three experienced neuroradiologists interpreted vwMRI using a validated multicontrast technique. The Chi-squared, Fisher’s Exact, and Student’s t-test were used for intergroup differences, and logistic regression was fitted to the primary outcome of PPE. Results: Inclusion criteria were met by 35 patients. Atherosclerotic plaques were in the anterior circulation in 21/35 (60%) and PPE was diagnosed in 20/35 (57%) of stroke parent arteries. PPE predictors are shown in Table 1 with logistic regression in Table 2 . Conclusion: PPE is associated with stenosis, which was expected, but the association with HgbA1c is novel. All patients with HgbA1c >8 had PPE and a one point HgbA1c rise increased the odds of PPE 3-fold. Hyperglycemia induces vascular oxidative stress by generating reactive oxygen species, quenching nitric oxide, and triggering an inflammatory cascade. Given the high rate of stroke recurrence in PPE patients, aggressive HgbA1c reduction may be a viable treatment target and warrants additional study.

Abstract 81: Recurrent Stroke Risk After Angioplasty and Stenting for Symptomatic Intracranial Stenosis: Data From the SAMMPRIS Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Colin Derdeyn ◽  
David Fiorella ◽  
Tanya Turan ◽  
Jean Montgomery ◽  
Bethany Lane ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Endpoint ◽  
Imaging Modality ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Stent Restenosis ◽  
Primary Endpoints ◽  
Angioplasty And Stenting ◽  
In Stent Restenosis

Purpose: To investigate the incidence and clinical characteristics of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting for symptomatic intracranial stenosis. Methods: Primary endpoints in SAMMPRIS (Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke) after 30 days past enrollment were defined as ischemic stroke in the territory or any stroke or death within 30 days of a subsequent revascularization procedure. Endpoints were independently and blindly adjudicated. Study records and imaging studies of subjects randomized to the stent arm with post-30 day primary endpoints were reviewed. Instent restenosis (ISR) was categorized as severe (>70%), moderate (50-69%) or mild (< 50%) based on consensus of two reviewers. Findings were categorized as definite, probable, or indeterminate based on imaging modality and study quality. Results: 224 subjects were randomized to the stent arm and 33 suffered a primary endpoint within 30 days of enrollment. Nineteen of the remaining 191 subjects (9.9%) suffered a primary endpoint during follow up (median follow up of 32.4 months). Eighteen had an ischemic stroke in the territory and one had a symptomatic intracranial hemorrhage after repeat angioplasty for in stent restenosis (ISR). In the 18 patients with ischemic stroke, the vascular imaging findings were: complete stent occlusion in 2 (1 of these was acutely revascularized and severe underlying ISR was identified), severe ISR by catheter angiography in 5, severe ISR or occlusion by computed tomographic angiography (CTA) in 1, probable ISR by CTA or magnetic resonance angiography (MRA) in 3, moderate stenosis on angiography in 2 (1 with ISR and 1 with a residual stenosis), indeterminate in 2, normal in 2, and not done in 1. Lesion locations included: distal internal carotid (6), petrous carotid (1), basilar (5), middle cerebral (6), and vertebral (1) arteries. Median time to recurrent stroke was 7.7 months from enrollment (2.2 to 28.2 months). Conclusions: The incidence of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting in the SAMMPRIS trial was nearly 10% over a mean follow-up of almost 3 years. In stent restenosis was associated with the majority of recurrent strokes.

Abstract 17130: Variables Associated With Uncontrolled Blood Pressure Early After Stroke

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Saviour Achilike ◽  
Austin Wang ◽  
Gabretta Cooksey ◽  
Evelyn Hinojosa ◽  
Munachi Okpala ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Uncontrolled Blood Pressure ◽  
Factors Associated ◽  
Multivariable Analyses ◽  
Medication Complexity ◽  
Ischemic Attack

Introduction: Uncontrolled blood pressure (BP) is a major risk factor for recurrent stroke; however, up to 50% of stroke survivors have uncontrolled BP 6 months after stroke. Characterization of factors associated with uncontrolled BP early after stroke discharge (DC) may help to identify patients for BP interventions. Hypothesis: We sought to identify factors associated with uncontrolled BP in the first month after stroke discharge. We hypothesized that African American (AA) race, insurance status, medication complexity, and hospital BP prior to discharge would be associated with uncontrolled BP. Methods: We identified hypertensive patients with ischemic or hemorrhagic stroke or transient ischemic attack scheduled to follow-up in the stroke clinic 2 to 4 weeks after hospital DC. Office BP was obtained using BpTRU, an automated machine that averages five unattended BP measures. Uncontrolled BP was defined using 2017 American College of Cardiology Guidelines as BP ≥ 130/80 mmHg. We used univariate logistic regression to assess relationships between uncontrolled BP and selected variables. Variables with statistically significant associations in the univariate models and variables associated with uncontrolled BP in the literature were included in the multiple logistic regression model. Results: Of the 230 patients identified, 55.7% had uncontrolled BP at clinic follow-up. In univariate and multivariable analyses, AA race, young stroke (age < 50), and systolic BP (SBP) 24-hours prior to DC were significantly associated with uncontrolled BP early after stroke DC. BP medication complexity was not associated with uncontrolled BP in this study. Conclusions: AA race, young age, and elevate SBP in the 24 hours prior to of stroke DC were associated with uncontrolled BP early after stroke. These variables can be used to identify patients who may benefit from early interventions aimed at reducing the risk of uncontrolled BP after stroke and stroke recurrence.

Sign in / Sign up

Export Citation Format

Share Document