Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4119428-A4119428, November 12, 2024. Background:Stroke remains a leading cause of mortality and disability. The narrow temporal window and limited availability of, and eligibility for thrombolytic therapy or endovascular thrombectomy are major therapeutic limitations in treating stroke. Neuroprotective therapies that could be given early to replace or augment these existing therapies are needed to improve stroke outcomes. We showed that monosialoganglioside (GM1) containing nanoliposomes composed of phosphatidylcholine, cholesterol and GM1 (70/25/5% molar ratios, NLGM1) protect against hypoxic injury likely through Nrf2-dependent upregulation of antoxidant enzymes.Aims:To test if post-occlusion NLGM1 treatment could reduce 1) acute stroke injury following middle cerebral artery occlusion (MCAO) and 2) chronic injury following photothrombotic (PT) stroke injury.Methods:20 week old C57BL/6 mice underwent MCAO for 60 minutes and then injected with saline or NLGM1 (1 or 2 mg IV) prior to reperfusion. Neurologic deficit score and brain infarct % area were measured the next day. Separately, mice underwent PT injury followed by injection of saline or NLGM1 (1 or 2 mg immediately and 2 hours post-injury) and cognitive/behavior tests done 1-90 days post injury.Results:Following MCAO, there was reduced neurologic impairment, infarct volume and brain edema with NLGM1 versus saline control (Fig. 1). Following PT injury, there was reduced neurologic, cognitive and motor impairment from Day 2-90 post-injury with NLGM1 versus saline control (Fig. 2). In both stroke models, there was no difference in efficacy between 1 and 2 mg NLGM1 doses.Conclusions:Treatment of mice with NLGM1 following MCAO or PT stroke injury resulted in improved structural (infarct size, edema) and functional (cognitive, behavior, motor) outcomes in the acute (MCAO) and chronic (PT) timeframes. NLGM1 is a potential novel therapeutic agent for stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4137665-A4137665, November 12, 2024. Background:Nearly one million individuals in the U.S. experience ischemic stroke annually and one-year recurrent stroke risk may exceed 10%. American Heart Association (AHA) Get-With-The-Guidelines-Stroke® Registry (GWTG-S) data suggests that up to 40% of stroke patients are discharged with an undocumented or cryptogenic etiology which may lead to suboptimal secondary prevention. Consequently, improved cardiology and neurology collaboration and evidence-based post-stroke evaluation may help identify stroke etiology, reduce recurrent stroke risk and improve outcomes.Methods:In 2022, the AHA, in collaboration with HCA Healthcare and HCA Healthcare Foundation, designed and launched Getting to the Heart Of StrokeTM(GTTHOS) in 10 HCA Healthcare comprehensive stroke centers to improve: 1) cardiology and neurology stroke care collaboration, 2) evidence-based post-stroke diagnostic evaluation and 3) assessment of social determinants of health and barriers to care. Components included a learning collaborative model, virtual performance improvement consultations, Plan-Do-Study-Acts, multidisciplinary teams, custom and existing GWTG-S metrics and performance improvement feedback.Results:Using existing and custom GWTG-S data, GTTHOS centers increased rates of documented stroke etiology (58.06% vs. 48.63%), while decreasing cryptogenic stroke rates (31.01% vs. 34.89%) and lack of a documented stroke etiology (10.93% vs. 16.48%) (all comparisons on discharge, follow-up vs. baseline, p

Circulation, Volume 150, Issue Suppl_1, Page A4148102-A4148102, November 12, 2024. Introduction:Ischemic stroke and renal failure frequently coexist, impairing patient outcomes. Comprehending this association is imperative in formulating a multidisciplinary methodology to augment patient outcomes and quality of life.Objective:We offer estimates showing the evolution of kidney dysfunction related ischemic stroke from 1990 to 2021. It will utilize disability-adjusted life years (DALYs), years of life lost (YLLs) and age-standardized death rates (ASDR) to find discrepancies overall survival outcomes in both sexes.Methods:Data on ASDR, DALY, and YLL were extracted from the GBD database. After examining global trends, we analyzed continents, socio-demographic index (SDI) and World Bank income level classification of countries. Using Joinpoint regression, the average annual percentage changes (AAPC) were determined.Results:The ASDR for kidney dysfunction related ischemic stroke showed a declining trend globally between 1990 and 2021. The ASDR was 7.29(95%UI: 4.68-10.07) in 1990 and dropped to 4.24 (AAPC: -1.73; 95% CI: -1.76 to -1.69) in 2021. DALYs dropped from 130.3(95%UI: 90.36-172.67) in 1990 to 82.1 (AAPC: -1.47; 95% CI: -1.50 to -1.44) in 2021. YLL had a consistent decline from 1980 to 2021, with an AAPC of -1.66 (95% CI: -1.69 to -1.62). High-middle and middle SDI region had higher death rates throughout the study period.Asia and America had lower ASDRs, whereas Europe and Africa had higher ASDRs across the board. Africa’s AAPC was -0.37 (95% CI: -0.4 to -0.32) between 1990 and 2021. Similarly, Europe’s AAPC of -2.85 (95% CI: -2.93 to -2.77) showed a decline from 1990 to 2021. Asia’s AAPC showed a drop, coming in at -1.19 (95% CI: -1.22 to -1.15). America’s AAPC was -1.97 (95% CI: -2.02 to -1.91).According to world bank income levels, upper-middle and lower-middle income countries had higher ASDRs.Conclusion:Due to similar risk factors and bidirectional effects, the combination of ischemic stroke and renal failure worsens patient outcomes. In order to effectively address the intricate interactions between various illnesses and enhance patient prognosis, an in-depth investigation of the reasons behind stark disparities in death rates is necessary.

Circulation, Volume 150, Issue Suppl_1, Page A4140907-A4140907, November 12, 2024. Background:Stroke remains a leading cause of mortality and morbidity globally, with a notably increasing incidence among young adults. Despite this trend, detailed insights into mortality trends specifically for young adults suffering from ischemic stroke (IS) are sparse.Methods:Leveraging data from the CDC’s Wide-ranging Online Data for Epidemiologic Research database, we identified individuals aged 15 to 44 with IS-related mortality. We calculated age-adjusted mortality rates (AAMR) per million persons and analyzed annual percent changes. Subgroup analysis was conducted to examine differences by age, gender, race, and geographic region.Results:From 1999 to 2020, there were 9,906 ischemic stroke-related deaths among young adults. The overall AAMR for ischemic stroke-related mortality increased from 4.19 in 1999 to 5.20 in 2020 (p-trend

Circulation, Volume 150, Issue Suppl_1, Page A4145862-A4145862, November 12, 2024. Introduction:The association between elevated levels of high-sensitivity cardiac troponin I (cTnI) and clinical outcomes in stroke patients has been documented. Nevertheless, the precise significance of cTnI and its potential as a biomarker in ischemic stroke (IS) remains unclear. Our study sought to evaluate the correlation between serum cTnI levels and early neurological deterioration (END) in individuals experiencing stroke related to atrial fibrillation (AF).Methods and Materials:In this multicentric study, we enrolled consecutive patients with stroke related to atrial fibrillation (AF) from 2020 to 2023. Exclusion criteria for this study comprised large vessel stenosis/occlusion and previously identified etiologies upon admission. All patients underwent a comprehensive etiological assessment. Early neurological deterioration (END) was defined as a rise in the NIHSS score of at least 2 points from baseline to the 48-hour assessment.Results:A total of 1611 patients with stroke related to atrial fibrillation (AF) were assessed. In the multivariable analysis, cTnI (odds ratio [OR] = 1.32, 95% confidence interval [CI] 0.96–1.62; P < 0.005) remained statistically significant after controlling for confounding factors. The initial NIHSS score (OR = 0.98, 95% CI 0.92–1.11; P < 0.005) showed a positive association with early neurological deterioration (END), whereas the utilization of anticoagulants (OR = 0.61, 95% CI 0.51–0.74; P < 0.001) and new oral anticoagulants (OR = 0.71, 95% CI 0.37–1.36; P < 0.005), exhibited a negative association.Conclusion:Our study concluded that troponin elevation in patients with AIS may be attributed to the cumulative impact of comorbidities alongside neurological status, thereby highlighting the prognostic importance of troponin assessment.

Circulation, Volume 150, Issue Suppl_1, Page A4139311-A4139311, November 12, 2024. Background:Low educational attainment and income are associated with a higher risk of adverse cardiovascular (cv) outcomes.Research Question:The impact of lower education and income levels on the risk of cv death defined as ischemic heart disease, ischemic stroke, or peripheral artery disease associated mortality, and how this compares to traditional cv risk factors including overweight/obesity, hypertension, type 2 diabetes, smoking history, frequent alcohol consumption, physical activity, and family history for heart disease.Methods:In this prospective study involving 396,614 participants of the United Kingdom Biobank (UKB) with no history of ischemic heart disease, ischemic stroke, or peripheral artery disease at enrollment, we divided participants into five groups according to annual household income as defined in UKB, and six groups of educational attainment created using the International Standard Classification of Education. Five BMI (kg/m2) categories were created (

Circulation, Volume 150, Issue Suppl_1, Page A4139938-A4139938, November 12, 2024. Introduction:Stroke is the second leading cause of death worldwide and the leading cause of disability. Without a plasma biomarker care is often delayed. The brain is rich in lipids, which readily cross the blood-brain barrier, and therefore represent a target for biomarkers of stroke. The study aimed to determine the lipidomic changes in plasma in stroke patients through an untargeted and targeted analysis.Methods:A cohort of 482 patients from the INTERSTROKE study was included in the analysis. This included 241 stroke patients (120 ISCH, 121 HEM) and 241 age and sex-matched controls. A LC/MS/MS platform was used to perform a detailed lipidomic and oxylipidomic analysis of plasma. Biomarker analysis was performed using the Random Forest Classification algorithm (RFC).Results:Lipidomic analysis identified 141 lipid species and 32 oxylipins significantly altered in ISCH stroke compared to control and 167 lipid species and 34 oxylipins in HEM stroke. Between ISCH and HEM stroke there were in 87 significant lipids. There was a 141 % increase in phosphatidylserine (PS) 40:6 (p< 0.0001) in patients with HEM stroke compared to ISCH, whereas prostaglandin E2 was found to be 94% higher (p

Circulation, Volume 150, Issue Suppl_1, Page A4142748-A4142748, November 12, 2024. Background:Embolic stroke of undetermined source (ESUS) represents approximately 20% of ischemic strokes. The optimal treatment strategy for secondary prevention remains uncertain for patients with ESUS. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of direct oral anticoagulants (DOACs) versus aspirin therapy in patients with a history of ESUS.Methods:PubMed, Embase, Cochrane and Web of science databases were systematically searched for eligible trials until March 2024. The primary outcome of interest was recurrent stroke. Major bleeding and clinically relevant non-major bleeding (CRNMB) were assessed as safety outcomes. We pooled hazard rations (HRs) with 95% confidence intervals (CIs) for analysis.Results:Four RCTs comparing direct oral anticoagulants (DOACs) versus aspirin were included comprising 13,970 patients, of whom 6,989 (50%) were randomized to the DOACs group. The mean follow-up was 16 months. Compared to aspirin, DOACs did not reduce the incidence of recurrent stroke (HR: 0.95; 95% CI: 0.81-1.09; p=0.44), ischemic stroke (HR: 0.91; 95% CI: 0.79-1.06; p=0.23), all-cause mortality (HR: 1.11; 95% CI: 0.87-1.42; p=0.40), and major bleeding (HR: 1.56; 95% CI: 0.85%-2.86; p=0.15). However, patients in the DOACs group presented significantly higher incidence of CRNMB (HR: 1.54; 95% CI: 1.23-1.92; p=0.0002) when compared with the aspirin group.Conclusion:Compared with aspirin, DOACs use was associated with an elevated risk of CRNMB and did not demonstrate superior efficacy in preventing recurrent stroke among patients with ESUS.

Circulation, Volume 150, Issue Suppl_1, Page A4148181-A4148181, November 12, 2024. Background:Following an ischemic stroke, a serious complication known as hemorrhagic transformation (HT) might jeopardize patient outcomes. Inflammatory indicators, such as the neutrophil-to-leukocyte ratio (NRR), and lipid markers, such as the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, have been investigated as HT predictors. Recent research has delved further into the predictive significance of these biomarkers for ischemic stroke outcomes.Objectives:To systematically review the literature on the predictive value of NLR and LDL to HDL ratios for HT in ischemic stroke patients, incorporating recent findings that enhance our understanding of these biomarkers.Methods:A detailed search of electronic databases was conducted to gather studies focusing on NLR and LDL to HDL ratios as predictors for HT in ischemic stroke. The selection process followed strict inclusion criteria, and the quality of studies was rigorously assessed.Results:The paper discusses new findings that emphasize the impact LDL and NLR play in influencing HDL ratios and, hence, HT prediction. Following an ischemic stroke, an increased incidence of HT, especially parenchymal hematoma (PH), has been associated with greater NLR. A high neutrophil-to-HDL ratio (NHR) has also been identified as a possible predictor of poor prognosis in ischemic stroke, underscoring its significance in predicting HT. Furthermore, the LDL-to-HDL ratio has been connected to long-term clinical outcomes like death and recurrent myocardial infarction, which may be associated with HT risk.Conclusions:In individuals with ischemic stroke, NLR and LDL-to-HDL ratios are potential HT indicators. The addition of current data underscores the potential of these ratios not just as HT indicators but also as markers for broader stroke-related effects. More studies are needed to validate these results and provide consistent recommendations for their use in clinical practice.

Circulation, Volume 150, Issue Suppl_1, Page A4146756-A4146756, November 12, 2024. Introduction:Stroke is one of the leading causes of morbidity and mortality in the United States resulting in significant health and socioeconomic burden. Accordingly, examining the temporal trends of stroke is essential for the development of effective stroke management strategies and prevention.Research Question:Is there a change in stroke mortality trends in the United States over the past 3 decades?Aim:To investigate trends in stroke mortality in the United States over the past three decades, focusing on gender and age-specific variations.Methods:We analyzed the Global Burden of Diseases 2019 database for stroke mortality trends stratified by age and gender. Trends were expressed using annual percentage change (APC) and average APC (AAPC) calculated via Joinpoint Trend Analysis Software (v5.2.0, NCI).Results:A total of 4,968,927 stroke-related mortality were reported during the time period of 1990-2019. An overall decline in the stroke-related death has been identified, with females displaying a declining mortality from 1990 to 2019 with AAPC of -0.238 (95%CI: -0.291 to -0.183; p

Circulation, Volume 150, Issue Suppl_1, Page A4138663-A4138663, November 12, 2024. Background:Clinical implications of high peak nighttime home blood pressure (BP) are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in individuals with ≥1 cardiovascular risk factor.Methods:In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days at baseline using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare). Peak nighttime home SBP was defined as average of the highest three values over the 14-night measurement period. Occurrence of cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) was determined over a mean 7.1 years’ follow-up.Results:This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male). After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), stroke risk was significantly higher in individuals with peak nighttime home SBP in the highest (Q5, ≥149.0 mmHg) versus lowest quintile (Q1,

Circulation, Volume 150, Issue Suppl_1, Page A4120716-A4120716, November 12, 2024. Background:Studies have shown that dual antiplatelet therapy (DAPT) is superior to aspirin monotherapy in patients with minor stroke or transient ischemic attacks. However, there is limited evidence regarding the efficacy and safety of DAPT in mild-to-moderate stroke.Aims:We conducted a systematic review and meta-analysis to evaluate whether DAPT is superior to single antiplatelet among patients with mild to moderate ischemic stroke.Methods:PubMed/MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception till March 2024 for published randomized controlled trials (RCTs) and observational studies that compared aspirin plus clopidogrel versus aspirin monotherapy in patients with mild-to-moderate stroke. R version 4.3.2 was used to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs).Results:A total of 4 studies reporting data for 15,173 patients were included. DAPT was associated with a reduced risk of early neurological deterioration (END) (RR: 0.55, 95% CI: 0.28 to 1.05, p = 0.07 Figure 1A) and recurrent ischemic stroke (RR: 0.65, 95% CI: 0.41 to 1.04, p = 0.07 Figure 1B) without reaching statistical significance. The risk of recurrent hemorrhagic stroke (RR: 0.94, 95% CI: 0.47 to 1.86, p = 0.86 Figure 2A), all-cause death (RR: 0.75, 95% CI: 0.52 to 1.08 Figure 2B), or myocardial infarction (RR: 0.83, 95% CI: 0.45 to 1.54 Figure 2C) was comparable across the two groups. DAPT was not associated with an increased risk of any bleeding event (RR: 0.70, 95% CI: 0.36 to 1.36 Figure 2D).Conclusion:DAPT possibly reduces the risk of END and recurrent ischemic stroke as compared to aspirin monotherapy in mild or moderate stroke without increasing the risk of bleeding events.

Circulation, Volume 150, Issue Suppl_1, Page A4142841-A4142841, November 12, 2024. Background:Emerging data reveal the importance of metabolomics in identifying specific amino acids and their metabolites as markers of hypercoagulability and stroke. Hypercoagulability, measured by a global hemostasis assay, is associated with thrombotic risk in patients with acute ischemic stroke (AIS).Hypothesis:AIS Patients undergoing coronary intervention compared to healthy controls (HC) exhibit dysregulated amino acid metabolomics that is associated with coagulation.Methods:Serum samples were collected from HC and AIS patients during the intervention. Untargeted metabolomics was performed using a Thermo-Scientific Q Exactive Plus Orbitrap mass spectrometer with Vanquish Horizon Binary UPLC. Metabolomics results were normalized relative to control subjects and compared to patients with AIS. Whole blood samples were used for the TEG assay, and the results were compared between patients with AIS and HC. Hypercoagulability was defined as platelet-fibrin clot strength (P-FCS) >66.5 mm.Results:AIS patients undergoing interventional procedures (n=12) and HC (n=17) were included. Among AIS patients, 50% were black, 67% were male, and 67% were obese. AIS patients vs. controls had elevated levels of P-FCS (67±3mm vs. 62±2mm) and a higher prevalence of hypercoagulability (83% vs. 0%) (p

Circulation, Volume 150, Issue Suppl_1, Page A4144421-A4144421, November 12, 2024. AbstractBackground:Stroke is a leading cause of death and disability worldwide and a significant burden on healthcare systems globally. Despite the effectiveness of tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke (IS), many patients arrive at the emergency department beyond the window to perform intravenous thrombolysis.Study objectives:This study investigated factors contributing to the delayed presentation of acute patients with stroke to emergency departments across governorate hospitals in Oman and assessed neurological function at 90 days using the Modified Rankin Scale.Methods:A prospective observational cohort multi-center study was conducted involving 512 participants with acute ischemic stroke symptoms who arrived at the emergency departments more than 4.5 hours after symptom onset. Data were collected using questionnaires administered to participants or their relatives to identify reasons for delayed arrival. Key variables included socio-demographic characteristics, symptom type, mode of arrival, and follow-up outcomes. Statistical analysis was performed to assess associations between these variables and participant outcomes.Results:The mean age of the participants was 61.96 years, with a majority being male (65.2%) and Omani nationals (81.3%). The most common symptoms were upper limb weakness (67.8%), lower limb weakness (60.4%), and inability to speak (56.7%). The primary mode of transfer to the hospital was by a relative (62.3%). Significant findings included; Delayed Arrival: Confusion, falls, and facial weakness were associated with the fastest median arrival times, while memory loss, loss of facial sensation, and abnormal eye movements were associated with the longest delays. Reasons for Delay: Common reasons for delay included lack of awareness of stroke symptoms (36.7%), believing symptoms would self-resolve (29.7%), and not knowing the importance of timely hospital arrival (31.9%). Outcomes: At 90 days, 36.3% had mild disability, 50.0% had moderate to severe disability, and 13.7% had died.Conclusion:Delayed hospital arrival in participants with stroke is influenced by various factors, including symptom type, mode of arrival, and socio-demographic characteristics. Enhancing public awareness about stroke symptoms and the importance of timely medical intervention could improve outcomes. This study provides valuable insights for improving stroke management and patient education in Oman.

Circulation, Volume 150, Issue Suppl_1, Page A4140006-A4140006, November 12, 2024. Background:Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases.Aims:This study aimed to assess the timing of MCS initiation associated with the risk of AIS in patients with AMI-CS.Methods:A retrospective of the National Inpatient Sample data analysis (January 2016–December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score-matching analyses between the groups.Results:From 2016 to 2020, the use of IABP decreased from 35.89% to 30.21%, whereas Impella use increased from 8.49% to 15.27% and ECMO use increased from 2.05% to 2.90%.The incidence of AIS in patients with AMI-CS receiving MCS remained stable over the study period; 3.55% in 2016 and 4.54% in 2020 (P trend = 0.277). Among 78,405 weighted patients with AMI-CS receiving MCS, 82.77% (n=64,895) and 17.23% (n=13,510) underwent early and late MCS initiation, respectively. The patients with late MCS initiation had higher risks of AIS (5.74% vs. 3.60%; adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI], 1.19-1.79; p

Circulation, Volume 150, Issue Suppl_1, Page A4145961-A4145961, November 12, 2024. Introduction:Approximately 20% of ischemic strokes are linked to a cardioembolic source, with 80% of cardioembolic strokes being attributed to atrial fibrillation. This study aimed to investigate the impact of non-valvular atrial fibrillation (NVAF) on mortality and recurrent stroke following a minor stroke event, considering AF as the most prevalent sustained cardiac rhythm disorder associated with stroke.Methods and Materials:Consecutive patients experiencing minor acute ischemic stroke (NIHSS