Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Stroke, Volume 56, Issue Suppl_1, Page AWMP93-AWMP93, February 1, 2025. Background:Chronic total internal carotid artery occlusion (CTO) can be associated with a high (22-25%) annual risk of stroke with limited therapeutic options. Total endovascular reconstruction (TER) is increasingly feasible but mid-term and long-term outcomes have not been reported.Methods:Data from all patients treated with carotid CTO treated with TER over the past 18years were collected in a database. Patients were selected based on the presence of angiographically proven symptomatic carotid occlusion, adequate landing zone and concurrent impairment of cerebrovascular reserve or recurrent ischemia despite maximal medical therapy. They were treated via a femoral approach using conventional CTO techniques with balloon expandable and/or self-expanding stents. Neurological evaluation of NIHSS, mRankin and carotid U/S were performed at discharge, 30days, and all subsequent follow-up. All TIA, stroke, death, and MI were recorded during follow-up. Angiographic follow-up was performed between 6-12months when possible.Results:Twenty-six symptomatic patients with a mean age of 65±7.8years were treated. Technical success was achieved in 22/26 (85%) on first attempt and in 3/4 on second attempt for total success rate of 25/26(96%). Total 30-day stroke/death/MI was 6.9% (2 ICH, both in first 3 years of experience). There were no recurrent events during 15.2±9.8months (median 12) of follow-up. Restenosis was found in 5/26 (19.2%) of patients; 2/5 were in unstented segments of the ICA. There was one case of asymptomatic carotid occlusion at 7months. The median mRS dropped from 2 to 1 at follow-up.Conclusion:TER is feasible in most patients with carotid CTO and is associated with a 30-day event rate lower than reported for STA-MCA bypass surgery. It is associated with good long-term stroke reduction despite a 19.2% risk of restenosis. Carotid re-occlusion is rare. Randomized trials are needed to validate this approach.

Stroke, Volume 56, Issue Suppl_1, Page ATP274-ATP274, February 1, 2025. Background:Intracranial artery stenosis (ICAS) is a progressive pathological process. No study has focused on changes in long-term disease burden associated with the progression from asymptomatic to symptomatic ICAS stages, which inform future preventive strategies and health management.Methods:We performed an ambispective cohort study that included consecutive patients with 50% or greater ICAS diagnosed by transcranial Doppler from January 2016 to May 2022. All patients received follow-ups through August 2023. The primary outcomes were ischemic stroke, all-cause mortality, and global cognitive decline.Results:Of 1872 eligible patients, 1628 (87.0%) were interviewed (1004 [61.7%] with asymptomatic ICAS; 624 [38.3%] with symptomatic ICAS). The mean age of the patients was 62.4±13.3 years. During a median follow-up of 3.7 years (IQR, 2.4-5.2), 60 (6.0%) patients with asymptomatic ICAS had a first-ever ischemic stroke, 63 (6.3%) died, and 7.6% had self-reported cognitive decline (global Everyday Cognition scale ≥ 2). During a median follow-up of 3.8 years (IQR, 2.2–5.4), 98 (15.7%) patients with symptomatic ICAS had recurrent ischemic stroke, 93 (14.9%) died, and 18.2% had self-reported cognitive decline. The cumulative incidence of ischemic stroke and all-cause mortality by five years were 7.5% (95% CI, 5.4%-9.6%) and 7.7% (95% CI, 5.5%-9.9%) among patients with asymptomatic ICAS, while those in patients with symptomatic ICAS were 18.2% (95% CI, 14.7%-21.8%) and 17.9% (95% CI, 14.0%-21.8%), respectively. Symptomatic ICAS conveyed an increased hazard of ischemic stroke (adjusted HR 2.54, 95% CI 1.82–3.54; P < 0.001) and all-cause mortality (adjusted HR 2.27, 95% CI 1.63-3.16; P < 0.001) compared with asymptomatic ICAS. In multivariable analysis, only hypertension independently predicted stroke occurrence in the asymptomatic ICAS group (adjusted HR 4.06, 95%CI 1.60-10.33, P = 0.003).Conclusions:The long-term disease burden increases 2-3-fold when asymptomatic ICAS progresses to symptomatic ICAS. Our study underscores the necessity of intensive management, particularly blood pressure control, for primary stroke prevention in patients with asymptomatic ICAS.

Stroke, Volume 56, Issue Suppl_1, Page ADP13-ADP13, February 1, 2025. Background:People with stroke are at high risk of dementia. There have been reductions in stroke case fatality and disability but temporal trends in the incidence and absolute burden of post-stroke dementia have not been described.Methods:We did a population-wide analysis of over 15 million people in Ontario, Canada between 2002-2022. Using linked administrative databases, we identified all 90-day dementia-free survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH). We evaluated dementia incidence from 90-days after stroke onwards using a validated definition which included hospitalization, physician claims, and dementia medications. We calculated 1-year and 5-year incidence of dementia as percentages and per 100 person-years for each fiscal year, age-/sex-standardized by the 2002 population and with follow-up until March 2022. We stratified incidence trends by sex, stroke type, and severity (90-day home time of

Stroke, Volume 56, Issue Suppl_1, Page A105-A105, February 1, 2025. Introduction:Ambient air pollution is linked to increased stroke risk, but it is unclear if associations apply to long-term exposures, equally to different stroke subtypes (ischemic versus hemorrhagic) and differ by pollutants. Of particular interest is exposure to ultrafine particles (PM0.1) for which there is sparse literature on its association with stroke.Hypothesis:Long-term exposures to particulate matter (PM0 2.5, PM10, PM0.1), ozone (O3), and nitrogen dioxide (NO2) are associated with stroke risk.Methods:In a prospective cohort study of 133,477 women enrolled in the California Teachers Study in 1995-96, we assessed 110,120 participants who resided in California from 2000-2018 for residential exposure to 5 air pollutants (O3, NO2, PM2.5, PM10, and PM0.1) based on a chemical transport model (4-km grid) applied to geocoded residential histories across follow-up (median follow-up=19 years). Strokes were identified with ICD-9 and ICD-10 codes via linkage of cohort participants to California state hospitalization records (Department of Health Care Access and Information). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for associations between the air pollutants (average exposure across follow-up) with total stroke (n=4,348) and stroke subtypes (ischemic stroke n=3,596; hemorrhagic stroke n=752), adjusted for stroke risk factors.Results:Consistent with state-wide trends, median levels of NO2and PM masses assessed among participants declined and plateaued in recent years (2000-2018), whereas median annual O3levels increased. The exposures observed among study participants also reflected that of the State; annual median PM2.5=8.23 ug/m3(range: 0.84-85.6). We observed increased risks for total, ischemic, and hemorrhagic strokes per ug/m3 increase of PM2.5, PM10.0, and PM0.1 (overall stroke: HRPM0.1=1.43, 95% CI=1.29-1.58; HRPM2.5=1.45, 95% CI=1.30-1.63; HRPM10=1.36, 95% CI=1.23-1.51); the risk magnitudes were higher for hemorrhagic stroke (HRPM0.1=1.57, 95% CI=1.22-2.02; HRPM2.5=1.84, 95% CI=1.40-2.42; HRPM10=1.62, 95% CI=1.27-2.08). Associations observed between NO2and stroke were also elevated (HR=1.12 per ppm, 95% CI=1.07-1.18).Conclusion:All PM masses, including ultrafine particles, were associated with overall stroke risk and for both ischemic and hemorrhagic stroke. Further delineation of independent versus combined effect of pollutants is warranted and will be presented.

Stroke, Volume 56, Issue Suppl_1, Page ATP291-ATP291, February 1, 2025. Introduction:In patients with severe COVID-19 infection there is an increased risk of cerebrovascular events, including acute ischemic stroke (AIS). In patients who present with COVID-19 infection and AIS, certain stroke subtypes have been reported with greater frequency. The objective of this study was to determine differences in patient demographics and stroke sub-type by COVID status at a US comprehensive stroke center.Methods:We retrospectively evaluated adults (≥18) with AIS admitted during the first year of the COVID pandemic (3/1/2020 – 3/1/2021). Demographics (age, sex, race, comorbidities with ≥5% incidence), stroke subtype (TOAST classification), severity (NIHSS), management (intravenous and intraarterial therapy [IVT and IAT]), and outcomes (in-hospital mortality and discharge modified Rankin scale [mRS]) were compared for patients who were COVID+ vs COVID– using Pearson chi-square tests.Results:Among 1,086 AIS patients, 475 (44%) were evaluated for COVID-19 infection during their inpatient stay. Most patients (94%) had PCR testing. Thirty-five (7%) patients were COVID+ and 441 (93%) were COVID–. There were significant differences in study covariates by COVID status, table 1. COVID+ patients had a greater proportion of cryptogenic strokes (62% vs. 32%, p

Stroke, Volume 56, Issue Suppl_1, Page A137-A137, February 1, 2025. Introduction:Stroke is the fifth leading cause of death and long-term disability in the United States with an estimated prevalence of 7 million individuals affected as of 2019. Protocols for stroke management established by the American Heart Association (AHA) and American Stroke Association (ASA) include a 25-minute timeframe from door to CT time (DTCT). Adapting to challenges during the COVID-19 pandemic likely increased the DTCT in acute stroke patients from various sociodemographic backgrounds.Methods:We aimed to identify factors affecting the DTCT time for a cohort of over 23,000 patients between January 2018 and August 2022. The primary endpoint was DTCT ≤25 minutes upon arrival to hospital for all patients suspected of acute ischemic stroke. Race and ethnicity were self-reported.Results:We have identified patient race and post-COVID timing of care as two factors with statistically significant effects on DTCT time. 4,468 patients (19.1%) had DTCT times less than or equals to 25 minutes, and 16,464 patients (70.5%) had DTCT times more than 25 minutes. Patients in the pre-COVID, COVID, and post-COVID phases were 6,852 (29.3%), 13,593 (58.2%) and 2,919 (12.5%), respectively. In our cohort, Black (OR 1.35; 95% CI 1.23-1.49) and Asian patients (OR 1.33; 95% CI 1.01-1.74) were more likely to have DTCT >25 minutes compared to White patients. Hispanic patients (OR 1.20; 95% C1 1.07-1.34) were more likely to have DTCT >25 minutes compared to non-Hispanics. Patients presenting during COVID (OR 1.45; 95% CI 1.34-1.57) and post-COVID period (OR 1.46; 95% CI 1.30-1.65) were more likely to have DTCT >25 minutes compared to the pre-COVID period.Conclusion:Therefore, we demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population. We also observed an increase in DTCT time after the start of COVID-19 which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time. Identifying disparities can help address inequities and ensure that all patients, regardless of background, receive timely care.

Stroke, Volume 56, Issue Suppl_1, Page A118-A118, February 1, 2025. Introduction:The phase III CHARM trial evaluated the safety and efficacy of intravenous glyburide as a treatment for large hemispheric infarction (LHI) patients at high risk for cerebral edema.Hypothesis:We aimed to determine whether subjects who were treated with IV glyburide would have better 12-month outcomes than those who received placebo in the CHARM trial.Methods:The source population included all CHARM subjects who were enrolled and treated with IV glyburide or placebo and had a recorded 12-month outcome. For those subjects missing a 12-month outcome, multiple imputation including baseline covariates and the 90-day modified Rankin Scale (mRS) was used. Shift analysis was performed on the 12-month mRS using 5 categories, where 0-1 and 5-6 were each collapsed into a single category. Independent variables included age, sex, baseline NIHSS, world region, tPA, and thrombectomy. Based on prior analysis, we also examined subjects with a baseline stroke volume ≤125 mL.Results:The cohort included a total of 431 subjects (mean age 58±9 years, 33% female, baseline NIHSS 19 (16-22), 40% received thrombolysis), the median 90-day mRS was 5 (4-6) and the median 12-month mRS was 5 (3-6). A total of 90 subjects (21%) had missing 12-month outcomes (n=38 in glyburide and n=52 in placebo). The correlation between 90d and 12mo mRS was r=0.93, p

Stroke, Volume 56, Issue Suppl_1, Page AWP209-AWP209, February 1, 2025. Background:COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients.Methods:Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, with a significance threshold of p

Stroke, Volume 56, Issue Suppl_1, Page ATP98-ATP98, February 1, 2025. Objectives:We evaluate the potential link between post-acute care, particularly care provided at inpatient rehabilitation facilities (IRF) (vs. home discharge or discharge to a skilled nursing facility [SNF]), and major adverse cardiovascular events (MACE) among ICH survivors.Methods:Using inpatient and emergency department data from Florida, New York, Maryland, Washington, and Georgia, we identified adult (≥18 years) spontaneous ICH survivors discharged to home (with or without home health), IRF, or SNF between April 2016 and December 2018. We fit multivariable logistic regression models and report the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the independent association of discharge disposition (IRF versus home, and IRF versus SNF) with MACE (a composite outcome of stroke, acute myocardial infarction [AMI], systemic embolism, or vascular death), recurrent primary ICH [rICH], acute ischemic stroke (AIS), AMI, and all-cause mortality within 1-year of initial ICH admission. We assessed for interaction between age and discharge disposition and performed stratified analysis among patients aged < 65 years and older patients ≥ 65 years.Results:A total of 17 647 ICH patients alive at discharge (median age [IQR]: 69[57-79]; 45.2% female; 55.5% non-Hispanic White; 23.2% non-Hispanic Black; 10.4% Hispanic; 4.9% Asian) were included, of which 8 194(46.4%), 4 506 (25.5%), and 4 947(28%) were discharged to home, IRF, and SNF, respectively. Within 1-year of follow-up, 7.4% of ICH survivors experienced MACE, while 2.5%, 3.2%, 0.6%, and 3.5%, respectively, experienced rICH, AIS, AMI, and mortality. Overall, patients discharged to IRF had lower odds of MACE (vs. home [aOR, CI: 0.79, 0.68-0.92]; vs. SNF [0.82, 0.70-0.97]; Table 1), rICH (vs. home [0.68, 0.52-0.89]; and vs. SNF [0.66, 0.49-0.88]), AMI (vs. home [0.57, 0.35-0.94]) and mortality (vs. SNF [0.57, 0.45-0.72]). A significant interaction between age and discharge destination was observed (P

Stroke, Volume 56, Issue Suppl_1, Page AWP268-AWP268, February 1, 2025. Introduction:The overall composition of stroke subtype is typically stable within biogeographical groups. Whether the COVID-19 pandemic impacted stroke etiology is still being investigated, but most studies have been performed outside the United States. This study sought to determine the composition of acute ischemic strokes (AIS) before and during the pandemic.Methods:This retrospective cohort study was conducted at a comprehensive stroke center in Colorado (USA). Adults (≥18) with AIS were compared based on admission date: Pre-COVID period (1/1/2019 – 12/31/2019) vs. COVID period (3/1/2020 – 3/1/2021). Stroke subtype was examined using TOAST classification: 1) large artery atherosclerosis; 2) cardioembolic; 3) small vessel occlusion; 4) other known etiology (e.g., hematologic disorders or arterial dissection); 5) cryptogenic stroke. Comparisons were made with Pearson chi-square tests.Results:There were 2,130 patients with AIS during the study period: Pre-COVID (n=1,034) and COVID (n=1,096). There were significant differences in stroke subtype by time period (Table 1). Compared to the pre-COVID period, the COVID period had a lower proportion of strokes from large artery atherosclerosis (17.6% vs. 12.1%, p

Stroke, Volume 56, Issue Suppl_1, Page AWP288-AWP288, February 1, 2025. Background:The COVID-19 pandemic disrupted healthcare systems and altered patient behaviors, potentially affecting stroke prevalence and outcomes. This study examines trends in stroke-related hospitalizations by age and sex in California from 2016 to 2022, focusing on the pandemic years (2020-2022).Methods:A retrospective analysis of patient discharge data from the California Department of Health Care Access and Information was conducted, screening nearly 25 million inpatient events for stroke-related ICD-10-CM codes (I60-I63) among individuals aged 20 and older. Age-and-sex-standardized hospitalization rates per 100,000 population were calculated. Multivariate logistic regression (MLR) assessed the impact of pre- and post-COVID-19 periods on stroke-related admissions, adjusting for age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). From 2016 to 2019, stroke-related hospitalization rates were stable (257.7 to 259.2 per 100,000). A significant decrease to 242.6 occurred in 2020, followed by an increase to 253.7 in 2021, coinciding with peak COVID-19 cases. By 2022, the rate slightly declined to 251.0, indicating stabilization but not a return to pre-pandemic levels. While the overall trend from 2016 to 2022 was not statistically significant (p=0.400), fluctuations reflect the pandemic’s impact, particularly in 2021.Age and gender analyses showed distinct trends. The age-adjusted rate for males remained stable (p=0.774), while females faced a notable decrease (p=0.018). Among those aged 20-44, stroke-related hospitalizations increased by 19% (RR=1.19, p

Stroke, Volume 56, Issue Suppl_1, Page AWP270-AWP270, February 1, 2025. Introduction:Patients experiencing a transient ischemic attack (TIA) or minor stroke have a high long-term risk of subsequent stroke that persists for over one year following presentation. While risk stratification tools like the ABCD2score have been used to identify patients at high risk of stroke in the short-term (within the first 90 days), less is known about factors that determine long-term risk. Some studies suggest that traditional predictors of early stroke risk may not be associated with long-term risk, while others have reported conflicting results. We aimed to summarize the association between clinical, demographic, imaging factors and the long-term risk of stroke in patients experiencing TIA or minor stroke.Methods:We searched MEDLINE, Embase, and the Web of Science from inception to June 2024, for observational studies that examined factors associated with subsequent stroke in patients experiencing TIA or minor stroke during a minimum follow-up of one year. Two reviewers independently performed study screening and data extraction. For the primary analysis, we included prognostic factors if they were derived from a multivariable Cox proportional hazards model and reported in at least 2 studies. We contacted the corresponding authors of the studies to obtain adjusted effect estimates when these values could not be extracted from the reported data. We conducted random effects meta-analyses of adjusted hazard ratios and report pooled effect estimates with 95% confidence intervals.Results:Of 13051 citations identified, we included 28 studies examining 85,328 patients including unpublished data from 8 studies that we directly obtained from study authors. Factors associated with an increased risk of stroke at one year or beyond included male sex, older age, hypertension, diabetes mellitus, atrial fibrillation, history of stroke or TIA before the qualifying event, history of coronary artery disease, presence of hemiparesis, aphasia, baseline ABCD2score of 4 or greater, acute infarct on brain imaging, large-artery atherosclerosis, and cardioembolism (Figure 1).Conclusion:We have identified important prognostic factors associated with long-term risk of stroke after a TIA or minor stroke. These findings provide a framework for evidence-based risk stratification of patients who may require extended treatment and vigorous monitoring.

Background
This qualitative evaluation was embedded in the Rehabilitation Exercise and psycholoGical support After COVID-19 InfectioN (REGAIN) study, a randomised controlled trial (RCT) for those with post-COVID-19 condition (‘long COVID’) after hospital admission for COVID-19, comparing weekly home-based, live online supervised group exercise and psychological support sessions with ‘best practice usual care’ (a single session of advice).

Objective
To increase our understanding of how and why the REGAIN programme might have worked and what helped or hindered this intervention.

Design
A qualitative evaluation which utilised interviews with participants and practitioners delivering the intervention. Framework and thematic analysis were used to analyse the findings.

Setting
England and Wales, UK.

Participants
Adults discharged from National Health Service (NHS) hospitals at least 3 months previously after COVID-19, with ongoing physical and/or mental health sequelae.

Results
Twenty intervention participants, 20 control participants and five practitioners were interviewed.
The themes from the group support sessions were: (1) you are not alone; (2) sharing experiences and addressing worries; (3) gaining new perspectives; (4) hope for progression; (5) peer support and bonding; (6) integration of facilitation skills; (7) modified activity pacing and goal setting, and (8) giving participants structure. The themes from group exercise were: (1) monitoring and modification of the online exercise; (2) catering for differing abilities; (3) feeling safe and confident to exercise; (4) progression of fitness; (5) optimal timing in the recovery trajectory; (6) group effect; (7) initial apprehension about exercise group; (8) gauging exercise capabilities; (9) translating exercises into life; and (10) on-demand supplementary videos. The 1:1 consultation sessions revealed patients needed to tell their stories.

Conclusion
Being listened to and being understood by someone ‘who got it’ was very important to people with post-COVID-19 condition. The group sessions of both exercise and psychological support were valued by participants, working together, and learning from each other in the face of a new disease within a global pandemic.

Objective
To examine the prevalence rate of social anxiety disorder (SAD) among university students in Jordan after the COVID-19 pandemic and its associated predictors.

Design
A cross-sectional online survey study that was conducted in Jordan between January and December 2023.
Setting: Universities in Jordan.

Participants
Healthy university students from any specialty currently enrolled at a Jordanian university.

Primary outcome measure
The prevalence rate of SAD, which was assessed using the Social Phobia Inventory.

Results
A total of 851 university students participated in this study. More than half of them (65%) were women. The mean age of the study participants was 21.9 (2.7) years. The majority of them (70.6%) were studying medical fields. The median number of times the study participants got infected with COVID-19 was 1.0 (IQR: 0.0–2.0). The median number of viewing hours spent on social networking sites was 4.0 (IQR: 3.0–6.0). The median SAD score was 19 (IQR: 10–32) out of 68, which represents 27.9% of the maximum attainable score. Up to 45.4% of the study participants were susceptible to SAD, with 12.5% of the study participants reporting severe to very severe SAD symptoms. Students older than 21.9 years were 32% less likely to report SAD symptoms compared with younger students (p

Objectives
During the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This study aimed to describe the impact of the pandemic on rehabilitation care indicators for poststroke users with (COV+) and without (COV–) COVID-19 infection in designated rehabilitation centres compared with those admitted in the previous year (pre-COV).

Method
A retrospective analysis of 292 medical files was performed in 3 rehabilitation centres. Demographic characteristics were collected, as well as indicators routinely collected in acute care and rehabilitation such as length of stay (LOS), the Functional Independence Measure and a number of physical/occupational therapy (PT/OT) sessions. Non-parametric statistical tests were used to compare variables among the three groups.

Results
COV+ users were older than COV– and pre-COV ones (p

I dati del progetto Pascnet coordinato dalla Cattolica di Milano