Risultati per: Circulation

Stroke, Volume 54, Issue Suppl_1, Page ATP177-ATP177, February 1, 2023. Introduction:The determinants of fast and slow progressor phenotypes of infarct growth in anterior circulation large vessel occlusion (ACLVO) remain poorly understood. Previous studies have shown a potential link between baseline serum glucose and acute infarct growth. We assessed whether presenting serum glucose is independently associated with fast or slow progression of infarct growth in ACLVO stroke.Methods:Retrospective analysis of patients with acute stroke due to intracranial ICA or proximal MCA occlusion across two comprehensive stroke centers from 2014-2019. Baseline CTP or MRI were obtained within 24hours of stroke onset. Fast progressors (ischemic core > 70ml, 0-6 h) and slow progressors (

Stroke, Volume 54, Issue Suppl_1, Page ATP2-ATP2, February 1, 2023. Introduction:Recent publications suggest a positive added effect of iv-thrombolysis (IVT) in patients that undergo endovascular treatment (EVT). It is hypothesized that thrombolytics might have a beneficial impact on microcirculation beyond recanalization. We aim to analyze the potential impact of IVT in patients who underwent a repeated CTP after interhospital transfer.Methods:We retrospectively screened 116 patients transferred to our comprehensive stroke center from a primary stroke center capable to perform CTP from June 2021 to August 2022. We collected clinical and radiological data of patients that underwent CTP at both centers, which were analyzed with Rapid software. A neurointerventionalist assessed the occlusion location in CTA.Results:Twenty-eight patients with anterior circulation occlusion underwent two multimodal studies, median time between CTPs was 168[142-190]min. Fifteen (53.6%) patients received IVT in the primary stroke center and 13(46.4%) received EVT. Reperfusion occurred in 3(10.7%) cases, migration to distal segments in 5(17.9%). Among the 20 patients without changes in the occlusion location, CTP volumes remained stable (Tmax >6s 61[41-141]ml vs 62[24-178], p=0.72; Tmax >10s 19[8-96] vs 13[0-105], p=0.55; CBF30 0[0-66] vs 0[0-65], p=0.99). CTP volumes tended to decrease with IVT, but a modest increase was observed in patients that did not receive IVT (Tmax >6s -17[-29,+8]ml vs +22[-8,+42], p=0.08; Tmax >10s -8[-16,+6] vs +6[0,+37], p=0.10; CBF10s (p=0.06) and CBF

Stroke, Volume 54, Issue Suppl_1, Page AWMP79-AWMP79, February 1, 2023. Introduction:Intracranial atherosclerotic disease (ICAD) remains a major source of stroke worldwide, with high recurrence risk. Prior evaluation of posterior circulation ICAD patients enrolled in the prospective VERiTAS and MYRIAD studies revealed regional hypoperfusion, assessed by large vessel flow measurements using quantitative MRA (QMRA), predicts subsequent vertebrobasilar stroke risk. We examined whether a similar approach to regional flow assessment using QMRA predicted stroke risk in anterior circulation ICAD patients enrolled in MYRIAD.Methods:MYRIAD enrolled patients with recent TIA or stroke attributable to 50-99% stenosis of proximal intracranial artery; the primary outcome was ischemic stroke in the territory of the stenotic artery with 1 year of follow-up. Secondary outcomes included new in-territory infarcts on MRI at 6-8 weeks. Flow was measured in the major intracranial arteries at baseline using QMRA. We designated patients as low- or normal-flow status based on an algorithm assessing distal flow and collateral capacity using age-normalized MCA and hemispheric (aggregate of ipsilateral ACA, MCA, and PCA) flows. Different thresholds for flow status categorization were tested to determine the optimal algorithm for stroke risk prediction.Results:Of 73 enrolled subjects with symptomatic anterior circulation ICAD, 7 (9.6%) patients had recurrent stroke. Z-score thresholds for age-normalized flow ranging from -0.5 to -1.5 were examined. The optimal thresholds identified were as follows: -1 for the MCA and -0.75 for hemispheric flow. 24 (33%) patients were categorized as low-flow status based on these thresholds; recurrent stroke occurred in 21% of low-flow patients vs. 4% of normal-flow patients (OR 6.2 (95% CI 1.1-34.7, p=0.04). However, flow status was not predictive of recurrent infarct on imaging among 61 patients with 6-8 week MRI (32% in low-flow vs. 26% in normal-flow patients).Conclusions:Similar to the predictive value in the posterior circulation, distal flow status assessed through QMRA regional flow measurement appears to be predictive for recurrent clinical (but not imaging-based) stroke. Identification of high-risk patients has implications for future investigation of therapeutic interventions.

Stroke, Volume 54, Issue Suppl_1, Page AWP102-AWP102, February 1, 2023. Introduction:Side-to-side relative reduction in end-diastolic velocity (EDV) of the common carotid artery (CCA) may discriminate ipsilateral anterior circulation large vessel occlusion (LVO), which will contribute faster patient triage for reperfusion therapy. We evaluated the discriminative accuracy of this simple sonographic index for anterior circulation LVO in acute stroke population, including intracerebral hemorrhage (ICH).Methods:Among patients with acute stroke admitted to our institute between 2016-2018, those who underwent both carotid ultrasonography and head MRA or CTA within 24 hours after last known normal time were reviewed. Relative EDV reduction was calculated as a ratio by dividing the CCA EDV lower side by the EDV higher side. Anterior circulation LVO was defined as occlusion of the internal carotid artery (ICA) or M1 segment of the middle cerebral artery on the lower EDV side. Discriminative performance of relative EDV reduction for anterior circulation LVO was assessed by receiver operating characteristics analysis.Results:A total of 688 patients (411 males; median age 77 years; 87 with anterior circulation LVO) were analyzed. When compared to no occlusion, value of relative EDV reduction was remarkably lower in ICA occlusion, followed by that in M1 occlusion (Figure). Area under the curve (AUC) of relative EDV reduction for ICA occlusion was 0.96 (95% confidence interval [CI] 0.94-0.99) with an appropriate cut-off value of 0.50 (sensitivity 94%, specificity 94%). When the discrimination target was set to anterior circulation LVO, the AUC was 0.78 (95% CI 0.72-0.85) with an appropriate cut-off value of 0.67 (sensitivity 69%, specificity 83%). At this cut-point, 51% of patients with M1 occlusion was classified as false negative.Conclusions:The discriminative performance of the relative CCA EDV reduction in acute stroke population was excellent for ICA occlusion and acceptable for anterior circulation LVO.

Stroke, Volume 54, Issue Suppl_1, Page ATP133-ATP133, February 1, 2023. Background and Purpose:The efficacy of mechanical thrombectomy (MT) for posterior circulation large vessel occlusions has not been fully elucidated. We investigated the efficacy and safety of MT for posterior circulation stroke (PCS) compared with anterior circulation stroke (ACS).Methods:We analyzed 885 consecutive patients who underwent MT for acute ischemic stroke between January 2013 and December 2020 at six comprehensive stroke centers. The patients were divided into two groups; the PCS and ACS group. The procedural and clinical outcomes were compared between the groups.Results:A total of 767 patients (PCS group, 83; ACS group, 684), were analyzed. PCS patients were significantly younger (75 vs. 79, P = 0.008) and had a higher NIHSS score at baseline (23 vs 19, p=0.012) and longer door to puncture time (97 vs 73 min, p=0.009). The rate of male (67.0 vs 46.9% p

Stroke, Volume 54, Issue Suppl_1, Page ATP137-ATP137, February 1, 2023. Background:Prior studies have shown rescue intracranial angioplasty and/or stenting (PTAS) is safe and efficacious in acute large vessel occlusion (LVO) of the anterior circulation with underlying intracranial atherosclerotic disease (ICAD). We investigated the safety and efficacy of acute intracranial angioplasty and/or stenting in patients with posterior circulation intracranial atherosclerosis-related occlusion (ICAS-O).Methods:Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between January 2016- May 2022, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage (ICH), the mortality rate at discharge, and recanalization rate and favorable clinical outcome, modified thrombolysis in cerebral infarction score (mTICI) and favorable clinical outcome (modified Rankin Scale (mRS), were examined. The outcomes between acute PTAS + MT in the anterior and posterior circulation were compared.Results:There were a total of 75 acute ischemic stroke (AIS) patients who underwent rescue PTAS, of which 15 (20.0 %) were posterior circulation ICAS-O group. Baseline characteristics were similar between the groups except for gender (6.7 % vs 45.0) and atrial fibrillation (21.7% vs 0.0%). There was no statistical difference in discharge NIH Stroke Scale (mean, 18 vs 23%, P = 0.860) or favorable outcome (modified Rankin Scale ≤ 2) at 90 days (46.7% vs 38.7 %, P = 0.477) between the posterior and anterior ICAS-O groups respectively. Symptomatic ICH rate tended to be higher in the anterior group (11.7 vs 6.7%, P = 0.495).Conclusions:Rescue angioplasty and/or stenting seem safe treatment options for posterior circulation ICAS-related LVO. Further larger multicenter prospective studies are required to corroborate the results of our study.

Circulation, Volume 147, Issue 5, Page 361-363, January 31, 2023.

Stroke, Volume 54, Issue 2, Page 327-336, February 1, 2023. Background:Sex disparities in acute large vessel occlusion (LVO) following endovascular treatment (EVT) have been recently reported. However, there is uncertainty about the effect of sex differences on functional outcomes after EVT, particularly in an Asian population. The present study aimed to compare the clinical and safety outcomes between men and women with anterior circulation LVO treated with EVT.Methods:We analyzed data from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke: a Prospective Multicenter Registry Study) Registry, which was conducted at 111 hospitals from 26 provinces in China between November 2017 and March 2019. Men and women with anterior circulation LVO treated with EVT were matched using propensity scores. After a 1:1 propensity score matching, we compared the clinical outcomes including 90-day ordinal modified Rankin Scale distribution (primary outcome), procedure duration, successful reperfusion, symptomatic intracranial hemorrhage, and mortality. Furthermore, we explored sex modification on the primary outcome in subgroup analysis.Results:Of 1321 patients, 483 (36.6%) were women and 838 (63.4%) were men. The mean age for women and men were 68 and 62 years old, respectively. Among 578 patients identified after matching, there were no sex differences (men versus women) in 90-day ordinal modified Rankin Scale distribution (median [interquartile range], 4 [1–5] versus 3 [1–5],P=0.464), successful reperfusion (86.5% versus 91.0%,P=0.089), symptomatic intracranial hemorrhage (6.5% versus 7.9%,P=0.512), and mortality within 90 days (17.7% versus 17.0%,P=0.826). However, men had a longer median procedure duration than women (86 [52–128] versus 72 [48–110] minutes, β=14.51, [95% CI, 4.19–24.84];P=0.006). Subgroup analysis showed that in patients with National Institutes of Health Stroke Scale score

Circulation, Volume 147, Issue 3, Page 271-275, January 17, 2023.

Circulation, Volume 147, Issue 2, Page 178-182, January 10, 2023.

Circulation, Volume 147, Issue 1, Page 4-4, January 3, 2023.

Circulation, Volume 147, Issue 1, Page 1-3, January 3, 2023.

Objective
Mucosal-associated invariant T (MAIT) cells are the most abundant T cells in human liver. They respond to bacterial metabolites presented by major histocompatibility complex-like molecule MR1. MAIT cells exert regulatory and antimicrobial functions and are implicated in liver fibrogenesis. It is not well understood which liver cells function as antigen (Ag)-presenting cells for MAIT cells, and under which conditions stimulatory Ags reach the circulation.

Design
We used different types of primary human liver cells in Ag-presentation assays to blood-derived and liver-derived MAIT cells. We assessed MAIT cell stimulatory potential of serum from healthy subjects and patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt stent, and patients with inflammatory bowel disease (IBD).

Results
MAIT cells were dispersed throughout healthy human liver and all tested liver cell types stimulated MAIT cells, hepatocytes being most efficient. MAIT cell activation by liver cells occurred in response to bacterial lysate and pure Ag, and was prevented by non-activating MR1 ligands. Serum derived from peripheral and portal blood, and from patients with IBD stimulated MAIT cells in MR1-dependent manner.

Conclusion
Our findings reveal previously unrecognised roles of liver cells in Ag metabolism and activation of MAIT cells, repression of which creates an opportunity to design antifibrotic therapies. The presence of MAIT cell stimulatory Ags in serum rationalises the observed activated MAIT cell phenotype in liver. Increased serum levels of gut-derived MAIT cell stimulatory ligands in patients with impaired intestinal barrier function indicate that intrahepatic Ag-presentation may represent an important step in the development of liver disease.

Circulation, Volume 146, Issue 19, Page 1478-1482, November 8, 2022.

Circulation, Volume 146, Issue Suppl_1, Page A15299-A15299, November 8, 2022. Introduction:Fontan-associated liver disease (FALD) contributes to adverse outcomes late after the Fontan procedure. Elevated Magnetic Resonance Elastography-derived Liver Stiffness (MRE-LS) is associated with higher Fontan pressure and Fontan circulatory failure (FCF). How MRE-LS changes over time and if it can predict adverse outcomes has not been studied.Methods:Single center retrospective study of individuals >10 years-old post-Fontan with >1 MRE-LS study between 2010-2020. Absolute change in liver stiffness (shear modulus in kilopascals, kPa) was defined as the difference between first and second MRE-LS measures. Demographic and clinical data were collected. FCF was defined as the composite outcome of death, transplant, VAD placement, or unscheduled cardiac hospitalization following index MRE. To compare the effect of magnitude of change in liver stiffness, patients were ordered from lowest negative to highest positive (Quartile 1-4) change.Results:77 individuals were included (mean age at first MRI 19.9±6.7 years, 47% female). Baseline MRE-LS was 4.4±1.0 kPa, follow-up MRE-LS was 4.1±1.1 kPa with mean time between MRE examinations of 46±27 months. The median annual change in MRE-LS was -0.06 (IQR -0.2-0.05) kPa/year. There was no association between change in MRE-LS and age ventricular dysfunction, or Fontan pressure. FCF occurred in 18 (23%) individuals, and those with FCF had a greater increase in MRE-LS (0.12±0.83 vs -0.42±0.96 kPa, p=0.04, Figure).Conclusions:MRE-LS remains stable over short-term follow-up in most individuals with Fontan circulation. However, those with greater positive change in liver stiffness were more likely to experience adverse outcomes. An increase in MRE-LS is a potential non-invasive biomarker of clinical decompensation.Figure: Probability of endpoint-free survival based on the change in liver stiffness quartiles (4 = largest increase in MRE-LS). Tick marks on curves indicate patients censored.

Circulation, Volume 146, Issue Suppl_1, Page A10926-A10926, November 8, 2022. Introduction:Many prediction algorithms for warfarin maintenance dose (WD) were constructed based on the clinical and genetic information of the patients without extracorporeal circulation devices (ECDs). However, it is unclear whether might be useful for the patients with ECD, such as left ventricular assist devices (LVAD), who still require warfarin.Hypothesis:The WD algorithms constructed using non-ECD patients could be useful for LVAD patients.Methods:An observational study, the Human Genome Research Ethics Committee of OU approved (#756), was conducted at the Osaka University (OU) Hospital on 108 LVAD patients receiving warfarin therapy. Genetic polymorphisms of CYP2C9*1, *3, and VKORC1-1639G >A were tested using TaqMan genotyping assay kits. WD was defined as the administered dose during the periods when the PT-INR value was within its target range. We investigated the difference between the actual warfarin dose (AWD) and the calculated warfarin dose (CWD) using an algorithm proposed by the International Warfarin Pharmacogenetics Consortium (IWPC), which we verified with 125 Japanese non-ECD patients previously (Eur J Clin Pharmacol, 75:901).Results:The percentage of patients whose difference between CWD and AWD was within 20% of AWD showed no significant difference between the LVAD and the non-ECD (%; I, LVAD, 41.7, non-ECD, 49.6, p=0.23). The root mean squared percentage error (RMSPE) to the AWD was similar between the groups (%; LVAD, 42, non-ECD, 37). As the algorithm requires if amiodarone is concomitant with warfarin, we probed the effect of the amiodarone dose on the CWD. Interestingly, RMSPE of the LVAD with ≥ 200 mg/day of amiodarone (≥ 200A) was higher compared to those with < 200 mg/day (