Risultati per: Infezione da Helicobacter pylori: review

Stroke, Volume 53, Issue Suppl_1, Page ATP208-ATP208, February 1, 2022. Introduction:Hypertrophic cardiomyopathy (HCM) predisposes to adverse cerebrovascular events (ACEs) including ischaemic stroke, transient ischaemic attack (TIA), thromboembolic event (TEE) and peripheral embolism (PE). Concomitant atrial fibrillation (AF), which is more prevalent in the HCM population, confers even higher risk. Our aims are to report the prevalence of ACEs in HCM patients and to determine the additional clinical risks of AF on the prognosis of this population.Methods:A systematic literature search was performed on PubMed, Scopus, Embase/ Ovid and Cochrane library from inception to 20thMarch 2021. No limitations on language or date of publication were applied. The primary outcome of this review was to examine and compare the prevalence of ischaemic stroke in the HCM population with or without AF. Secondary outcomes were to identify their risk of non-stroke clinical outcomes such as TIA, non-specified TEE and PE. Non-specified TEE in our paper only referred to thromboembolic events whereby their types were not specified in the included studies. Meta-analysis was performed using StataSE 16 software, and heterogeneity was assessed usingI2test.Results:A total of 713 studies were identified, and 35 articles with 42,570 patients were included. The pooled prevalence of stroke/ TIA was 7.45% (95% confidence interval [CI] 5.80 – 9.52,p= 0.000) across 24 studies in the overall HCM population of 37,643 patients. AF contributed to a significantly higher risk of non-specified TEE (Risk ratio [RR] 4.49, 95% CI 1.88 – 10.73,p= 0.0007,I2= 87.0) and total stroke/ TIA (RR 3.26, 95% CI 1.75 – 6.08,p= 0.0002,I2= 76.0) in our study population. Within the apical HCM (ApHCM) population, the prevalence of stroke/ TIA was 9.30% (95% CI 6.64 – 12.87,p= 0.316).Conclusion:Our study concludes that concomitant AF diagnosis increases the risk of developing thromboembolic events and the stroke-related mortality rate. Although the prevalence of stroke/ TIA in the ApHCM subtype was slightly higher than the overall HCM population, further studies investigating the clinical outcomes of HCM subtypes are warranted.

Stroke, Volume 53, Issue Suppl_1, Page AWMP97-AWMP97, February 1, 2022. Background and Purpose:Recent evidence suggests that patients with atrial fibrillation (AF) detected after stroke (AFDAS) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke (KAF). We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF.Methods:We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until 30-June-2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death.Results:We included 21 studies comprising 22,566 patients with ischemic stroke or transient ischemic attack. Patients with AFDAS had a lower CHA2DS2-VASc score (standardized mean difference [SMD] -0.47, 95% confidence interval [95% CI] -0.60, -0.34), and lower prevalence of vascular comorbidities including coronary artery disease (odds ratio [OR] 0.50, 95%CI 0.42, 0.61), congestive heart failure (OR 0.37, 95% CI 0.31, 0.44), peripheral artery disease (OR 0.44, 95%CI 0.29, 0.68), and previous stroke (RD 0.38, 95% CI 0.25, 0.58). Patients with AFDAS had a higher left ventricular ejection fraction (SMD 0.25, 95% CI 0.20, 0.30) and smaller mean atrial diameter (SMD -0.65, 95% CI -0.99, -0.31) than those with KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types.Conclusions:We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum.

Stroke, Volume 53, Issue Suppl_1, Page AWMP4-AWMP4, February 1, 2022. Background and Purpose:Tenecteplase is being evaluated as an alternative intravenous (IV) thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized controlled clinical trials. However, several research teams have published their real-world experience with tenecteplase for the treatment of AIS.Methods:We searched Medline and Scopus for non-randomized clinical trials and observational cohort studies (prospective or retrospective) comparing IV tenecteplase (at any dose) to IV alteplase for patients with AIS. We calculated the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) for the association of tenecteplase vs. alteplase use and outcomes of interest. We pooled estimates using random-effects models. The primary outcome was the probability of modified Rankin scale (mRS) score of 0-2 at 90 days. Non-inferiority of tenecteplase vs. alteplase for the primary outcome in the meta-analysis was set at margins of 1.3% and 5% based on a recent survey.Results:We identified 6 studies comparing IV tenecteplase (n=583) to IV alteplase (n=904). Patients receiving tenecteplase had higher odds of successful recanalization (OR=2.82, 95%CI: 1.12, 7.11; adjusted OR=2.38, 95%CI: 1.18, 4.81) and early neurological improvement (OR=4.88, 95%CI: 2.03, 11.71; adjusted OR=7.60, 95%CI: 1.97, 29.41) when compared to alteplase. Tenecteplase was non-inferior (when applying the 5% non-inferiority margin) to alteplase for the primary outcome of mRS 0-2 at 90 days (absolute risk difference=0.06, 95%CI: -0.04, 0.15; OR=1.20, 95%CI: 0.86, 1.67; adjusted OR=1.24, 95%CI: 0.88, 1.76). No difference in the risk of symptomatic intracranial hemorrhage was uncovered between the two groups (OR=0.96, 95%CI: 0.45, 2.07; adjusted OR=0.92, 95%CI: 0.47, 1.81).Conclusion:Real world evidence suggests that tenecteplase has a comparable efficacy and safety profile to alteplase for the treatment of AIS, while being possibly superior in achieving successful reperfusion and early neurological improvement.

Stroke, Volume 53, Issue Suppl_1, Page ATP147-ATP147, February 1, 2022. Background and Purpose:Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion of the anterior circulation (AC-LVO). Randomized trials of posterior circulation large vessel occlusion (PC-LVO) patients have failed to show a benefit of EVT over medical therapy (MEDT). We performed a systematic review and meta-analysis to understand better whether EVT is beneficial for PC-LVO.Methods:Using the Nested Knowledge AutoLit living review platform, we identified randomized control trials and prospective studies that reported functional outcomes in patients with PC-LVO treated with EVT versus MEDT. The primary outcome variable was 90-day modified Rankin Scale (mRS) 0-3, and secondary outcome variables included 90-day mRS 0-2, 90-day mortality, and rate of symptomatic intracranial hemorrhage (sICH). A separate random effects model was fit for each outcome measure to calculate pooled odds ratios.Results:Three studies with 1,248 patients, 860 in the EVT arm and 388 in the MEDT arm, were included in the meta-analysis. The favorable outcome rate (mRS 0-3) in EVT patients was 39.9% (95% CI: 30.6-50.1%) versus 24.5% in MEDT patients (95% CI: 9.6-49.8%). EVT patients had higher mRS 0-2 rates (31.8% [95% CI: 25.7-38.5%] versus 19.7% [95% CI: 7.4-42.7%]) and lower mortality (42.1% [95% CI: 35.9-48.6%] versus 52.8% [95% CI: 33.3-71.5%]) compared to MEDT patients, but neither result was statistically significant. EVT patients were more likely to develop sICH (OR=10.36; 95% CI: 3.92-27.40).Conclusions:EVT treatment of PC-LVO trended toward superior functional outcomes and reduced mortality compared to MEDT despite a trend toward increased sICH in EVT patients. Existing randomized and prospective studies are insufficiently powered to demonstrate a benefit of EVT over MEDT in PC-LVO patients.

Stroke, Volume 53, Issue Suppl_1, Page ATP49-ATP49, February 1, 2022. Background:With the advent of extended window endovascular therapy (EVT) for acute ischemic stroke (AIS), interhospital transfer is increasingly frequent. However, not all patients who are transferred undergo EVT. To use resources judiciously, stroke centers need to identify which patients are most likely to benefit from EVT prior to transfer.Methods:We performed a retrospective study of AIS patients transferred for potential EVT at our neurovascular center between 2015 and 2018. We noted whether pre-acceptance imaging was available for visual review on LifeImage, RAPID perfusion software, or Telestroke PACS. The primary outcome was EVT on arrival.Results:530 AIS patients were included. 270 underwent EVT (50.9%); 156 (29.4%) had pre-acceptance imaging reviewed; 275 (51.9%) received IVtPA. Of all patients who were transferred, performance of pre-transfer CTA was significantly associated with EVT (57% vs 40%, p

Stroke, Volume 53, Issue Suppl_1, Page AWP123-AWP123, February 1, 2022. Introduction:Whilst surgical decompression in malignant middle cerebral artery infarction is well established, its role in malignant posterior circulation infarction (MPCI) is unclear. Recent small cohort studies suggest that neurosurgery in this group may be beneficial. This systematic review and meta-analysis aims to compare outcomes of MPCI patients undergoing surgical intervention versus medical therapy.Methods:Medline, Embase and Cochrane were searched from inception until 2 April 2021. Studies were included if they evaluated patients with posterior circulation stroke treated with neurosurgical intervention. Observational cohort studies and case series with death and functional outcome data were included. Death was defined as Glasgow Outcome Scale (GOS) 1 and modified Rankin scale (mRS) 6, or extracted from the text. Favourable functional outcome was defined as mRS 0-2, GOS 4-5, Barthel Index 91-100 or extracted from text at the latest follow-up period. 6673 studies were filtered, with 31 studies included for data extraction, of which 8 studies included both a surgical and medical therapy group. Random effects meta-analysis, analysis of proportions and meta-regression were performed.Results:The medical therapy cohort (n=235) had significantly better odds of good functional outcome (GFO) than the surgical cohort. There was no significant difference in odds of death between the two groups (Figure 1). Amongst surgical patients (n=184), 18% died and 55% had GFO. On meta-regression, the proportion of patients with atrial fibrillation and hydrocephalus was negatively associated with odds of death and GFO respectively (both p

Stroke, Volume 53, Issue Suppl_1, Page AWP203-AWP203, February 1, 2022. Background and Purpose:To assess the effects of oral factor Xa inhibitors for prevention of ischemic stroke in patients without a history of atrial fibrillation.Methods:Systematic review of randomized clinical trials (RCTs) testing oral factor Xa inhibitors in patients without a history of atrial fibrillation that reported ischemic stroke.Results:Twenty-two RCTs reported 1194 ischemic strokes: five RCTs testing apixaban (75 ischemic strokes), one RCT each testing betrixaban (52 ischemic strokes) and edoxaban (1 ischemic stroke), and 15 RCTs testing rivaroxaban (1066 ischemic strokes). Three double-blinded RCTs reported statistically significant reductions in ischemic stroke: Two comparing rivaroxaban 2.5mg twice daily versus placebo in patients with cardiovascular disease (COMPASS, hazard ratio (HR) 0.51, 95%CI 0.38-0.68 and COMMANDER-HF, HR 0.64, 95%CI 0.43-0.95), and a third trial compared betrixaban 80mg daily with enoxaparin followed by placebo in patients hospitalized for acute medical illness (APEX, relative risk 0.53, 95%CI 0.30-0.94). Compared with aspirin, rivaroxaban 5mg twice daily significantly reduced ischemic stroke in patients with chronic atherosclerosis in COMPASS (HR 0.69, 95%CI 0.53-0.90), but in contrast rivaroxaban 15mg daily vs. aspirin showed no reduction in ischemic stroke in patients with recent embolic stroke in the large NAVIGATE ESUS trial (HR 1.01, 95%CI 0.81-1.26). Comparisons from 18 other RCTs were inconclusive, although trends consistently showed numerically fewer ischemic strokes among those assigned oral fXa inhibitors compared with placebo.Conclusions:There is convincing evidence that oral factor Xa inhibitors reduce ischemic stroke in patients without a history of atrial fibrillation. The strongest evidence was for rivaroxaban 2.5mg twice daily when given with aspirin in patients with cardiovascular disease. Reduction in ischemic stroke by other dosages, by other factor Xa inhibitors, and when given without antiplatelet agents is less certain. The contribution of atrial fibrillation-related stroke unlikely accounts for the observed reductions.

Stroke, Volume 53, Issue Suppl_1, Page AWP62-AWP62, February 1, 2022. Introduction:Despite aerobic exercise (AE) testing being a key recommendation for stroke rehabilitation, less than half of physical therapists working with individuals post-stroke perform this practice. Concern for adverse cardiovascular events and inadequate guidance on how to conduct AE testing for individuals with stroke and comorbidity are key barriers. This review aims to describe submaximal AE testing protocols with evidence of safety, defined as less than 11% occurrence of serious adverse events, for people with subacute stroke and comorbidity.Methods:MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTDiscus were searched from inception to October 29, 2020. Published studies that involved submaximal AE testing with individuals with subacute stroke and reported on adverse events during testing were included. Two reviewers independently conducted title and abstract, and full-text screening. One reviewer conducted data extraction, verified by a second reviewer.Results:Sixteen studies involving 595 participants were included. Hypertension (35%), cardiovascular disease (14%) and atrial fibrillation (8%) were the most common cardiovascular comorbidities, while, diabetes (25%), dyslipidemia (23%) and smoking history (11%) were the most common general comorbidities affecting participants with stroke. Evidence of safety for individuals with stroke and comorbidity was found for incremental bicycle (n=5), recumbent stepper (n=3), body weight support treadmill (n=1) and upper extremity ergometer (n=1) protocols; constant load bicycle (n=1) and body weight support treadmill (n=1) protocols; and field (n=10) protocols. Heart rate (95%), blood pressure (82%) and oxygen consumption (72%) monitoring were most frequently done. Test termination criteria based on volition/fatigue (59%) and heart rate (55%) were most commonly reported.Conclusion:A range of submaximal AE testing protocols utilizing diverse exercise modalities can be safely conducted on people with subacute stroke and comorbid conditions that are perceived to increase the risk for serious adverse events. These protocols can be used to guide the development of more specific clinical practice guidelines for conducting AE testing on individuals with stroke and comorbidity.

Stroke, Volume 53, Issue Suppl_1, Page A76-A76, February 1, 2022. Introduction:The best stroke imaging modality to select patients for endovascular therapy (EVT) beyond 6 hours (extended window) is not well established.Objective:To assess the value of additional advanced imaging.Methods:A meta-analysis in accordance with PRISMA guidelines was conducted. We searched on MEDLINE/Pubmed, SCOPUS, EMBASE, CENTRAL, and reference lists until July 22, 2021, including randomized clinical trials (RCT) and observational studies describing 90 days outcomes in anterior circulation large vessel occlusion (LVO) ischemic stroke. Our primary outcome was functional independence, defined as modified Rankin Scale score (mRS): 0-2. Secondary outcomes were mortality and symptomatic intracranial hemorrhage (sICH). We used fixed effects model to estimate the pooled mRS for all patients and the proportion of patients with each outcome, both for all studies and by imaging modality.Results:Four RCTs (n=236) and 19 observational studies (n=1495) that met the inclusion criteria were included for meta-analysis. Patients selected by advanced imaging had a pooled estimate of functional independence in 45% (95% confidence interval [CI], 40% to 50% I2=62%), and 51% (95%CI, 43% to 60% I2=68.2%) without additional imaging. [Low certainty of evidence] Pooled mortality rate was 13% (95%CI,9% to 17%, I2=57.5%) vs 16% (95%CI,10% to 23%, I2=63.9), symptomatic intracranial hemorrhage (sICH) was 5% (95%CI,2% to 8% I2=33.6%) vs 4% (95%CI,2% to 7%, I2=66.4%) in both groups respectively [Low certainty] The overall pooled estimate of functional independence was 47% (95%CI, 43% to 52%, I2=65.2%) [Low certainty], with mean mRS of 2.88 (95%IC, 2.36 to 3.4) [moderate certainty] in all included patients indistinctly of the imaging modality.Limitations:substantial heterogenicity and not direct comparison of imaging modalities in most of the studies.Conclusion:This meta-analysis suggests that functional independence in patients with stroke who underwent EVT on the extended window can be achieved in a high proportion of patients despite the use or not of additional advanced imaging. Both groups also presented similar mortality and sICH.

Stroke, Volume 53, Issue Suppl_1, Page AWMP49-AWMP49, February 1, 2022. Background:D-dimer has been evaluated as an independent marker of ischemic stroke. The non-existence of a clear consensus and pooled data about the use of D-dimer as a predictive biomarker for assessing the risk of stroke recurrence led us to perform this systematic review and meta-analysis.Methods:Studies reporting the risk of stroke recurrence with varying degrees of high D-dimer levels were screened through August 2021 using PubMed/Medline, Scopus, EMBASE and Web of Science databases and relevant keywords. Random effects models by Dersimonian & Laird were used for meta-analysis and subgroup analysis. I2statistics were used for heterogeneity assessment. The leave-one-out method was used for sensitivity analysis.Results:This systematic review included 5040 patients from 9 studies consisting of >60% males. There was a high burden of cardiovascular comorbidities, smoking and diabetes in stroke patients with or without associated diagnoses and high D-dimer levels. Compared to low D-dimer levels, higher plasma D-dimer levels were associated with ~80% (aOR 1.79, 95% CI: 1.24-2.59) increased risk of stroke recurrence. The odds of stroke recurrence were significantly high in the stroke cohorts including patients with mean age

Stroke, Volume 53, Issue Suppl_1, Page ATP67-ATP67, February 1, 2022. Background and Purpose:Stroke is among the leading causes of death and disability worldwide. Despite the prevalence of cognitive impairment post-stroke, there is uncertainty regarding the optimal type of rehabilitation intervention to improve cognitive functioning in people post-stroke. This systematic review and meta-analysis evaluates the effectiveness of rehabilitation interventions across multiple domains of cognitive function, namely, memory, attention, executive function, perception, apraxia and neglect, as well as general cognitive functioning.Methods:Five databases were searched from inception to August 2019. Eligible studies included randomised controlled trials (RCTs) of rehabilitation interventions for people with stroke when compared to other active interventions or standard care where cognitive function was an outcome.Results:Sixty-four RCTs (n= 4,005 participants) were included. Multiple component interventions improved general cognitive functioning (MD:1.56, 95% CI 0.69 to 2.43) and memory (SMD:0.49, 95% CI 0.27 to 0.72) compared to standard care. Physical activity interventions improved neglect (MD:13.99, 95% CI 12.67 to 15.32) and balance (MD:2.97 to 95% CI 0.71, 5.23) compared to active controls. Non-invasive brain stimulation (NIBS) impacted neglect (MD:20.79, 95% CI 14.53 to 27.04) and function (MD:14.02, 95% CI 8.41 to 19.62) compared to active controls. Neither cognitive rehabilitation (MD:0.37, 95% CI -0.94 to 1.69) or occupational-based interventions (MD:0.45, 95% CI -1.33 to 2.23) had a significant effect on cognitive function compared to standard care.Conclusion:The evidence regarding the effects of rehabilitation interventions for improving cognitive deficits post-stroke is uncertain. Finings must be considered in the context of moderate and high risk of bias across various methodological domains. There is some evidence to support multiple component interventions, physical activity interventions and NIBS protocols. However, findings must be interpreted with caution given the heterogeneity of interventions and outcome measures used across studies.

Stroke, Volume 53, Issue Suppl_1, Page AWP9-AWP9, February 1, 2022. Objective:Intracranial tumor is considered a contraindication to IV tPA for presumed acute ischemic stroke (AIS), though evidence differentiating rate of intracranial hemorrhage (ICH) in benign versus malignant neoplasm is lacking. A systematic review of published cases of standard-dose IV tPA for AIS within 4.5 hours of symptom onset and intracranial tumor was performed.Methods:PubMed, Embase, and Cochrane were used to identify articles for inclusion. Case reports, letters to the editor, conference proceedings, cohort studies, case series, literature reviews, and case-control studies that included patients given standard dose IV tPA for presumed AIS within 4.5 hours of symptom onset, who were found to have an intracranial tumor, were included. The primary outcome measure was the rate of ICH.Results:Twenty-three studies met inclusion criteria, involving 495 patient cases. One of the included case-control studies presented data only in the form of an odds ratio (OR), with OR 0.72 (p=0.16) for risk of ICH out of 297 benign brain tumors as compared to controls. They found an OR for ICH of 2.33 (p value

Stroke, Volume 53, Issue Suppl_1, Page AWP221-AWP221, February 1, 2022. Background:Early diagnosis through symptom recognition is vital in acute stroke management. However, women who experience stroke are more likely than men to receive a missed or delayed diagnosis.Aims:To assess sex differences in the symptom presentation of stroke and whether these differences are associated with a delayed or missed diagnosis.Methods:PubMed, EMBASE and the Cochrane Library were systematically searched up to January 2021 for all studies that reported on symptoms in both adult women and men with diagnosed stroke (ischaemic or haemorrhagic) and transient ischaemic attack and were published in English. Sex-stratified proportions for each symptom were extracted and pooled. The relative risk (RR) of a symptom being present in women relative to men with 95% confidence intervals (CI) was also calculated and pooled, as well as the RR of a delayed or missed stroke diagnosis.Results:Pooled results from 21 eligible articles showed that the top three symptoms were similar between women and men – limb weakness (72% vs. 66%), hemiparesis (56% vs. 55%), and weakness of the face, arm or leg (55% vs. 55%). However, the top 4th and 5th symptoms found in women were generalised non-specific weakness (49%) and motor deficit (46%), whereas in men these were motor deficit (46%) and ataxia (44%). In addition, crude RR showed that women were more likely to have higher risk than men of presenting with confusion (RR 1.16, CI 1.01-1.32), dysphagia (RR 1.29, CI 1.13-1.48), dysphasia (RR 1.11, CI 1.00-1.24), fatigue (RR 1.42, CI 1.05-1.92), generalised weakness (RR 1.56 CI 1.23-1.98), headache (RR 1.14, CI 1.01-1.30), urinary incontinence (RR 1.25, CI 1.17-1.33), loss of consciousness (RR 1.30, CI 1.12-1.51), and mental status change (RR 1.37, CI 1.18-1.58), and lower risk of presenting with dizziness (RR 0.87, CI 0.80-0.95), dysarthria (RR 0.89, CI 0.82-0.95), imbalance (RR 0.68, CI 0.57-0.81), paraesthesia (RR 0.74, CI 0.58-0.93), and trouble walking (RR 0.83, CI 0.70-0.99). Finally, pooled RR of delayed or missed diagnosis for women compared to men was not statistically significant (RR 1.19, CI 0.94-1.49).Conclusion:Though women and men commonly presented with similar symptoms, some sex differences were present which needs consideration in stroke evaluation.

Stroke, Volume 53, Issue Suppl_1, Page AWP179-AWP179, February 1, 2022. Background and Purpose:Prolonged cardiac rhythm monitoring can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF). We sought to evaluate the potential utility of available prolonged cardiac rhythm monitoring strategies with respect to secondary stroke prevention.Methods:We searched Medline and Scopus databases to identify randomized controlled clinical trials (RCTs) comparing AF detection, anticoagulation initiation and stroke recurrence rates in patients with history of recent IS or transient ischemic attack (TIA) receiving cardiac rhythm monitoring with implantable loop recorders (ILRs), 30-days external loop recorders or Holter monitors. We performed a network meta-analysis to combine direct and indirect evidence for any given pair of monitoring devices that were evaluated within a trial and reported effect estimates with risk ratios (RRs) and corresponding 95% confidence intervals (95%CIs).Results:We identified 5 RCTs including a total of 2202 patients (mean age 68 years, 40% women). In indirect analyses the likelihood of AF detection and anticoagulation initiation was higher for both ILR (RR=8.48, 95%CI: 3.41, 21.06; RR=3.29, 95%CI: 1.70-6.39) and external loop recorders (RR=3.06, 95%CI: 1.66, 5.61; RR=1.63, 95%CI: 1.03-2.58) compared to Holter devices. The probability of AF detection and anticoagulation initiation was lower for Holter and external loop recorders compared to ILR devices (RR=0.36, 95%CI: 0.15, 0.85 and RR=0.50, 95%CI: 0.25-0.98, respectively). No difference in the risk of stroke recurrence was found in the indirect comparisons of different cardiac rhythm monitoring strategies.Conclusion:The likelihood of AF detection and anticoagulation initiation after an ischemic stroke or TIA is higher with ILRs compared to both external loop recorders and Holter devices.

Stroke, Ahead of Print. Stroke disproportionately affects racial minorities, and the level to which stroke treatment practices differ across races is understudied. Here, we performed a systematic review of disparities in stroke treatment between racial minorities and White patients. A systematic literature search was performed on PubMed to identify studies published from January 1, 2010, to April 5, 2021 that investigated disparities in access to stroke treatment between racial minorities and White patients. A total of 30 studies were included in the systematic review. White patients were estimated to use emergency medical services at a greater rate (59.8%) than African American (55.6%), Asian (54.7%), and Hispanic patients (53.2%). A greater proportion of White patients (37.4%) were estimated to arrive within 3 hours from onset of stroke symptoms than African American (26.0%) and Hispanic (28.9%) patients. A greater proportion of White patients (2.8%) were estimated to receive tPA (tissue-type plasminogen activator) as compared with African American (2.3%), Hispanic (2.6%), and Asian (2.3%) patients. Rates of utilization of mechanical thrombectomy were also lower in minorities than in the White population. As shown in this review, racial disparities exist at key points along the continuum of stroke care from onset of stroke symptoms to treatment. Beyond patient level factors, these disparities may be attributed to other provider and system level factors within the health care ecosystem.

Stroke, Volume 53, Issue 2, Page 319-327, February 1, 2022. Background and Purpose:Recent evidence suggests that young women (18–45 years) may be at higher risk of ischemic strokes than men of the same age. The goal of this systematic review is to reconcile and synthesize existing evidence of sex differences among young adults with ischemic strokes.Methods:We searched PubMed from January 2008 to July 2021 for relevant articles and reviews and consulted their references. We included original studies that (1) were population based and (2) reported stroke incidence by sex or sex-specific incidence rate ratios of young adults ≤45 years. We excluded studies that (1) omitted measurements of error for incidence rates or incidence rate ratios, (2) omitted age adjustment, and (3) were not in English. Statistical synthesis was performed to estimate sex difference by age group (≤35, 35–45, and ≤45) and stroke type.Results:We found 19 studies that reported on sex-specific stroke incidence among young adults, including 3 that reported on overlapping data. Nine studies did not find a statistically significant sex difference among young adults ≤45 years. Three studies found higher rates of ischemic stroke among men among young adults ≥30 to 35 years. Four studies found more women with ischemic strokes among young adults ≤35 years. Overall, in young adults ≤35 years, the estimated effect size favored more ischemic strokes in women (incidence rate ratio, 1.44 [1.18–1.76],I2=82%) and a nonsignificant sex difference in young adults 35 to 45 years (incidence rate ratio, 1.08 [0.85–1.38],I2=95%).Conclusions:Overall, there were 44% more women ≤35 years with ischemic strokes than men. This gap narrows in young adults, 35 to 45 years, and there is conflicting evidence whether more men or women have ischemic strokes in the 35 to 45 age group.