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1.
Jung-Soo Park Hyo-Sung Kwak Gyung Ho Chung Seungbae Hwang 《Journal of stroke and cerebrovascular diseases》2018,27(10):2797-2803
Background
The objective of this study was to investigate the prognostic value of computed tomographic angiography (CTA) based on leptomeningeal collateral (LMC) status and other parameters in acute ischemic stroke (AIS) patients with internal carotid artery (ICA) terminus occlusion treated with endovascular treatment (EVT).Methods
All eligible patients from January 2013 to December 2017 undergoing EVT were retrospectively reviewed. The regional leptomeningeal score was used to assess the LMCs on baseline CTA. The collateral status measured by the LMC score (0-20) was trichotomized into 3 groups: good (17-20), intermediate (11-16), and poor (0-10).Results
Our sample included a total of 119 eligible patients (60 males; mean age, 73 years) with a median baseline National Institute of Health Stroke Scale (NIHSS) score of 14. Patients with a good LMC score had a lower baseline mean NIHSS score, a higher mean Alberta Stroke Program Early CT score, and a higher mean clot burden score (CBS). Baseline NIHSS score <15 (odds ratio [OR] 3.69 95% confidence ratio [CI]: 1.32-10.29, P?=?.013), CBS ≥ 6 (OR 3.97 95%CI: 1.05-14.99, P?=?.042), good LMC score (OR 5.14 95%CI: 1.62-16.26, P?=?.005) and successful recanalization (OR 11.55 95%CI: 2.72-48.99 P?=?.001) were independent predictors of good clinical outcomes.Conclusions
CTA-based LMC status and CBS are powerful predictors of clinical outcomes in patients with an acute ICA terminus occlusion treated with EVT. 相似文献2.
Wen-Yi Huang Wei-Chieh Weng Feng-Chieh Su Shun-Wen Lin 《Journal of stroke and cerebrovascular diseases》2018,27(11):3365-3372
Background
The clinical presentations and outcomes of patients with high-grade stenosis of internal carotid artery (ICA) are highly variable. We investigate the influence of different stroke severity on outcomes of ischemic stroke patients with high-grade stenosis of ipsilateral ICA.Methods
372 acute first-ever ischemic stroke patients with high-grade stenosis (70%-99%) or occlusion of ipsilateral ICA were enrolled and followed up for 5years. Stroke severities of the enrolled patients were grouped according to the Oxfordshire Community Stroke Project classification system as total anterior circulation infarcts (TACI) or non-TACI. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between the 2 groups.Results
A total of 71 patients (19.1%) were presented with TACI. Of laboratory data, the values of white blood cell count and high-sensitivity C-reactive protein were significantly higher in patients with TACI (P?=?.008 and P?=?.003, respectively). Of clinical course, the occurrence of initial impaired conscious, stroke-in-evolution, pneumonia, gastrointestinal bleeding, and urinary tract infection were significantly higher in patients with TACI. The prevalence of dependent functional status was higher in patients with TACI. Multivariate Cox regression revealed that TACI is a significant predictor of 5-year all-cause mortality in first-ever ischemic stroke patients with high-grade stenosis of ipsilateral ICA (HR [hazard ratio] = 3.66, 95% confidence interval = 2.23-6.00, P < .001).Conclusions
TACI is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade stenosis of ipsilateral ICA. Intensive medical treatment for stroke prevention in patients with severe carotid artery stenosis is warranted. 相似文献3.
Chunmei Cheng Xin Liu Wenjun Fan Xue Bai Zhaojun Liu 《Journal of stroke and cerebrovascular diseases》2018,27(10):2613-2622
Background
To explore the effect of comprehensive rehabilitation training (CRT) on cognitive impairment, anxiety, and depression in poststroke patients.Methods
168 poststroke patients were consecutively recruited in this randomized controlled study. Patients were randomly assigned to CRT group (CRT plus conventional treatment) and control group (conventional treatment) as 1:1 ratio. The specific interventions of CRT included patient and family member education, cognitive training, rehabilitation training, and regular check.Results
Both montreal cognitive assessment score change (Month12 [M12]-baseline; P?=?.001) and minimum mental state examination score change (M12-baseline) were higher in CRT group than that in control group (P?=?.004), and the percentage of cognitive impairment by montreal cognitive assessment score ≤26 was lower (P?=?.003) in CRT group compared to control group at month 12. Anxiety assessments were performed by hospital anxiety and depression scale (HADS) and Zung self-rating anxiety scale (SAS). The HADS anxiety score change (M12-baseline; P?=?.002) and the SAS score change (M12-baseline; P?=?.006) were decreased in CRT group compared to control group. Lower occurrence rate of anxiety assessed by SAS was observed in CRT group compared to control group (P?=?.033). Depression assessments were performed by HADS and Zung self-rating depression scale (SDS). HADS depression score change (M12-baseline; P < .001) and the SDS score change (M12-baseline; P?=?.002) were reduced in CRT group compared to control group. Decreased occurrence rate of depression assessed by SDS was found in CRT group compared to control group (P?=?.022).Conclusions
CRT contributes to the recovery of cognitive impairment, and decreases anxiety and depression in poststroke patients. 相似文献4.
Jianting Huang Xuanwei Liu Xun Luo Chunzhi Tang Mingzhu Xu Lisa Wood Yulong Wang Qing Mei Wang 《Journal of stroke and cerebrovascular diseases》2018,27(11):3320-3327
Background
To investigate whether fluoxetine improves poststroke dysphagia and to detect the potential relationship between serum brain-derived neurotrophic factor (BDNF) levels and fluoxetine effects.Methods
In this retrospective study, 159 stroke patients who met our study criteria were included. In total, 110 patients were placed in the control group, and 49 patients were placed in the fluoxetine group. Demographic and clinical characteristics of the patients were collected for the baseline assessment. Functional independence measure scores and American speech-language-hearing association/functional communication measures scores for swallowing were collected to evaluate the patients’ swallowing function. Patients’ serums were collected at weeks 1 and 3 after admission, and serum BDNF levels were measured by enzyme-linked immunosorbent assay. T test, chi-squared test, and general linear model analysis were performed to determine the differences between the two groups.Results
A significantly higher improvement of swallowing function was observed in the fluoxetine group compared with that of the control group (P?=?.023). In addition, a general linear model analysis showed that the treatment of fluoxetine has a statistically significant effect on swallowing improvement after adjustment of swallowing score on admission, stroke types, and interval between the onset of stroke and admission (P?=?.022, R2?=?.46, adjusted R2?=?.446). There is no significant difference in the change of serum BDNF levels in the two groups (P?=?.269).Conclusions
This study suggests that treatment with fluoxetine in stroke patients with dysphagia may improve swallowing function. A placebo-controlled, randomized clinical trial is warranted to confirm this finding. 相似文献5.
Claudia-Alexandrina Irimie Mihai Vârciu Marius Irimie Petru-Iulian Ifteni Dan-Ioan Minea 《Journal of stroke and cerebrovascular diseases》2018,27(10):2731-2737
Background
Several studies have shown that high level of plasma C-reactive protein (CRP) is associated with stroke outcomes and future vascular events, and a decrease in serum triiodothyronine (T3) was reported to be associated with stroke severity and poor prognosis.Objective
The goal of this study is to evaluate CRP and T3 as independent predictors of poor functional and cognitive outcomes in patients with acute ischemic stroke at hospital discharge.Methods
This study evaluated 120 patients who were admitted to the Clinical Hospital of Neurology and Psychiatry Brasov, between July 2016 and January 2017. The patients were evaluated for clinical stroke severity (National Institutes of Health Stroke Scale) and serum CRP and total T3 were evaluated on admission. Functional outcome and cognitive outcome were evaluated at discharge.Results
The severity of NIHHS scores were associated with higher CRP levels (β?=?.583, P = .000) and lower T3 concentration (β = ?.185, P?=?.043). Poor cognitive prognosis was associated with CRP levels (β?=?.441, P?=?.000) but not with T3 concentrations (P?=?.142). Poor functional outcome was associated with higher CRP levels (β?=?.457, P?=?.000), but not with T3 concentrations (P?=?.100). Using CRP and T3 as prognostic factors resulted in a probability of 53.5% to predict a poor functional outcome and of 80.42% to predict a poor cognitive outcome in stroke patients at discharge.Conclusions
The study showed that higher CRP and lower T3 levels were associated with stroke severity on admission. Functional outcome is likely secondary to stroke severity but functional outcome at discharge was associated with higher CRP levels and not with T3 concentration. Cognitive outcome was associated with higher CRP levels and not with T3 concentration. 相似文献6.
Yang Liu Xue Liang Xiaomin Xu Meixue Dong Shiyu Jia Changqi Lu Youdong Wei 《Journal of stroke and cerebrovascular diseases》2019,28(1):21-25
Background
Stroke is one of the most common causes of disability and death. Higher alkaline phosphatase (ALP) levels have been associated with poor functional outcomes and mortality in previous studies. We investigated alterations in serum ALP concentrations and functional outcomes in patients with acute ischemic stroke (AIS).Methods
Patients with first-ever AIS were recruited to participate in the study. Serum ALP levels were measured using a Cobas Integra 400 Plus automatic biochemical analyzer, and severity of stroke was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Functional outcome was measured using the modified Rankin scale 1 year after admission.Results
Serum ALP concentration was increased in patients with AIS (81.75 ± 20.49 versus 69.93 ± 16.12 U/L, P?=?.000) and the optimal ALP cutoff point for diagnosing patients with AIS was 81.50 U/L, with a sensitivity of 49.5% and specificity of 78.9%. However, there was no significant correlation between ALP and NIHSS scores (r?=?.170, P?=?.085) and ALP was not significantly different between favorable and unfavorable functional outcomes (81.76 ± .60 versus 81.70 ± 20.54 U/L, P?=?.802).Conclusions
Serum ALP concentration, which was increased in patients with AIS, might represent a low-potency biomarker for the diagnosis of AIS. However, this was not significantly correlated with NIHSS scores or the functional outcome after 1 year. 相似文献7.
Mohsen Saleh ElAlfy Fatma Soliman Elsayed Ebeid Tarek Mostafa Kamal Deena Samir Eissa Eman Abdel Rahman Ismail Samar Hassan Mohamed 《Journal of stroke and cerebrovascular diseases》2019,28(2):441-449
Background
Cerebrovascular stroke is a common critical complication of sickle cell disease (SCD). Angiotensinogen (AGT) M235T gene polymorphism is associated with risk of ischemic stroke and cardiovascular disease.Aim
We investigated the potential association between angiotensinogen M235T gene polymorphism and susceptibility to cerebrovascular and cardiopulmonary complications in adolescents with SCD.Methods
Forty-six patients with SCD in steady state were studied stressing on history of stroke, hydroxyurea/chelation therapy, hematological profile, and echocardiographic findings. Polymerase chain reaction-based restriction fragment length polymorphism analysis was used to detect AGT M235T gene polymorphism. Fifty sex- and age-matched healthy controls were enrolled for assessment of M235T gene polymorphism pattern.Results
The distribution of AGT M235T gene polymorphism was similar between SCD patients and healthy controls. The frequency of T allele of AGT M235T gene polymorphism (TT and MT genotypes) was significantly higher among patients with history of manifest stroke (P < .001). Patients with TT and MT genotypes had higher incidence of cardiopulmonary complications (P?=?.041) as well as higher percentage of HbS (P < .001) and lower hemoglobin level (P?=?.008) compared with those with MM genotype. Serum ferritin, liver iron concentration, and cardiac T2* were not related to T alleles or genotypes. Logistic regression analysis revealed that M235T genotype was a significant independent factor related to the occurrence of stroke among patients with SCD (Odds Ratio 14.05, 95% confidence interval 3.82-28.91; P?=?.001).Conclusion
AGT M235T gene polymorphism may represent a genetic modifier to vascular morbidities in Egyptian patients with SCD. 相似文献8.
Charlotte Lützhøft Rath Niklas Rye Jørgensen Troels Wienecke 《Journal of stroke and cerebrovascular diseases》2018,27(10):2683-2690
Background
Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS.Methods
We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period.Results
A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis.Conclusions
Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients. 相似文献9.
Michele Torrisi Maria Cristina De Cola Antonio Buda Luigi Carioti Maria Valentina Scaltrito Placido Bramanti Alfredo Manuli Rosaria De Luca Rocco Salvatore Calabrò 《Journal of stroke and cerebrovascular diseases》2018,27(11):3208-3211
Background
The sudden live changes of stroke survivors may lead to negative psychological and behavioral outcomes, including anxiety and depressive mood, which may compromise the rehabilitation process. Some personality features, such as self-efficacy, could play an important role in mediating the degree of post-stroke depression. Aim of this study is to investigate the possible correlation between specific psychological dimensions, such as poststroke depression and self-efficacy, and rehabilitation outcomes.Materials and Methods
Thirty-eight patients, affected by stroke, completed a four-hour-daily training lasting up to 8 weeks, including traditional and robotic-assisted physiotherapy. Patients were assessed at admission (T0) and at the end (T1) of the motor training, by means of the Montgomery-Asberg Depression Scale, the General Self-Efficacy Scale, and the Functional Independent Measure.Results
We observed a significant T0-T1 difference in MADRS scores in patients with a better functional recovery (t?=?5.76; P < .0001) and higher self-efficacy (t?=?4.74; P < .001), but no significant T0-T1 difference in individuals without functional recovery (t?=?1.21; P?=?.239) and low self-efficacy (t?=?1.72; P?=?.103).Conclusions
Our study shows that rehabilitation outcomes and self-efficacy may influence mood, but not vice versa. Thus, to potentiate self-efficacy in the rehabilitation setting may help clinicians in obtaining better functional outcomes, including depression reduction. 相似文献10.
Xian Fu Qi Liu Xianfan Zeng Shiyan Huang Ruxun Huang Qingchun Gao 《Journal of stroke and cerebrovascular diseases》2018,27(11):2993-3000
Background and Purpose
Carotid–cerebral pulse wave velocity (ccPWV) reflects the segment (C-M segment) stiffness between common carotid artery and ipsilateral middle cerebral artery. The C-M segment atherosclerosis (CMSA) is regarded as a most frequent cause of anterior circulation ischemic stroke. We therefore, attempted to investigate the relationship between cerebral arterial stiffness and CMSA, and provide reliable data for the early diagnosis of CMSA.Methods
Between June 2012 and August 2016, 81 acute ischemic stroke (AIS) patients with 154 C-M segments successfully evaluated with digital subtraction angiography and ccPWV were enrolled into this study. Patient demographics and clinical data were retrieved from our AIS databases.Results
Multivariate analyses showed that ccPWV was independently associated with CMSA (β?=?39.6, P?=?.009) and Systolic blood pressure (β?=?7.1, P < .001) in AIS patients. The values of ccPWV had a trend to be higher in the groups with more lesions (F?=?45.9, P < .01) and severer stenosis (F?=?102.6, P?=?.000), and was positively correlated with the number of lesions (r?=?.662, P?=?.000), and degree of stenosis (r?=?.858, P?=?.000) of CMSA. The fractional polynomial plots with 95% CIs also describe the close relationship between ccPWV and the number of lesions and degree of stenosis in CMSA.Conclusions
Cerebral arterial stiffness is independently associated with the presence of CMSA, closely related to the vascular damage of C-M segment and reflects the vascular structure change of C-M segment in AIS patients. It may have the potential for assessment of CMSA in its initial stage. 相似文献11.
Mi Shen Peiyi Gao Qian Zhang Lina Jing Hongyi Yan Hao Li 《Journal of stroke and cerebrovascular diseases》2018,27(11):3387-3392
Background
Deep subcortical infarction is a major subtype of stroke in middle cerebral artery (MCA) territory. This study aims to evaluate the relationship between characteristics of MCA plaque and features of deep subcortical infarction.Methods
Patients with recent acute ischemic stroke and deep subcortical infarction were prospectively enrolled. Both multicontrast brain sequences and 3D high-resolution vessel wall imaging (VWI) sequences were scanned for all patients. MCA plaque characteristics, including plaque presence, location, maximum vessel wall thickness (Max WT), signal intensity and luminal stenosis, and deep subcortical infarction features, including lowest infarct layer index (LILI), area, volume, maximum area, and infarct quantity were evaluated. Infarct feature differences were compared between MCA plaque+ group and MCA plaque? group. The correlations between MCA plaque characteristics and deep subcortical infarction features were analyzed.Results
Of all 50 patients included in this study, 30 (60%) had MCA plaques. All deep subcortical infarction was single lesion for patients without MCA plaque. The average number of deep subcortical infarction for patients with MCA plaque was 3.10 ± 4.44. The LILI (P?=?.036) and infarct quantity (P?=?.030) showed significant differences between 2 groups. Max WT (P?=?.025) and stenosis degree (P?=?.023) were negatively correlated with LILI. Intraplaque hemorrhage was positively correlated with maximum area (P?=?.029) and infarct volume (P?=?.030).Conclusions
MCA plaque characteristics were correlated with deep subcortical infarct features. Magnetic resonance VWI may provide more information for etiological evidence of deep subcortical infarction. 相似文献12.
Bart M. Demaerschalk Erica L. Boyd Kevin M. Barrett Dale M. Gamble Sarah Sonchik Meghan M. Comer Judith Wieser Joseph G. Hentz Dennis Fitz-Patrick Yu-Hui H. Chang 《Journal of stroke and cerebrovascular diseases》2018,27(11):2940-2942
Purpose
To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care.Methods
Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics.Results
There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96% [95% confidence interval (CI): 94%-97%] versus 97% [95% CI: 95%-98%]; P?=?0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21% versus, 35%; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46% versus 63%; P < 0.01), were less likely to have received antithrombotic therapy (85% versus 90%; P?=?.02), were less likely to be discharged on anticoagulation when indicated (56% versus 64%; P?=?.01), and were less likely to be prescribed cholesterol reducing treatment (68% versus 72%; P < .001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P < .001).Conclusion
The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital. 相似文献13.
Isabelle Mourand Pauline Malissart Cyril Dargazanli Erika Nogue Stephane Bouly Nicolas Gaillard Yassine Boukriche Lucas Corti Marie-Christine Picot Olivier Beaufils Mohamed Chbicheb Denis Sablot Alain Bonafe Vincent Costalat Caroline Arquizan 《Journal of stroke and cerebrovascular diseases》2019,28(2):259-266
Background
Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship).Methods
We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH).Results
Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P?=?.562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P?=?.256), and sICH (7.0% versus 9.7%, P?=?.515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5points?=?1.59, P?=?.010), absence of diabetes (OR?=?3.35, P?=?.075), and the delay magnetic resonance imagining-puncture (OR -30min?=?1.16, P?=?.048).Conclusions
Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC. 相似文献14.
Haihua Yang Ning Ma Lian Liu Feng Gao Dapeng Mo Xuan Sun Zhongrong Miao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2822-2828
Background
The diffusion-weighted imaging (DWI) brain stem score (BSS) is an easy to use and can predict the clinical outcome of acute basilar artery occlusion (BAO) who underwent endovascular thrombectomy. The purpose of the current study was to validate its performance in Chinese acute BAO patients treated with mechanical thrombectomy.Methods
Fifty consecutive patients with acute BAO who received early magnetic resonance imaging and treated with mechanical thrombectomy in a single-center were included. Early ischemic damage on DWI was evaluated by applying BSS system. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the score system and multivariate logistic regression analysis was performed to identify predictor of clinical outcome.Results
Favorable outcomes were achieved in 38% patients (19 of 50 patients). Recanalization was successful in 92% patients (46 of 50 patients). Mortality rate was 26% (n?=?13/50). In ROC curve analysis, the area under ROC curve of BSS .864 (95% confidence interval [CI], .738-.945) to predict favorable and .769 (95% CI, .628-.877) to predictor mortality. In logistic regression adjusted for age, baseline National Institute of Health Stroke Scale and time to puncture, DWI BSS ≤2 (odds ratio [OR], 12.416; 95% CI, 2.520-61.179; P?=?.002) and DWI BSS >3 (OR, 7.871; 95% CI, 1.353-45.797; P?=?.022) were the independent predictor for favorable outcome and mortality at 3 months respectively.Conclusions
The results of this study suggest that the DWI BSS can be used to predict clinical outcome in patients with acute BAO treated with mechanical thrombectomy at 3 months. 相似文献15.
Yue Wang Qian Li Michael Mambiya Kaili Zhang Luping Yang Qian Zhang Shan Liu Mengwei Liu Jiali Yin Wanyang Liu 《Journal of stroke and cerebrovascular diseases》2018,27(11):3008-3019
Object
Single nucleotide polymorphisms (SNPs) of small non-coding RNAs (sncRNAs) that affect the sncRNA function and target gene expression to mediate the risk of certain diseases. The association between the miR-196a2 rs11614913 and ischemic stroke (IS) and coronary artery disease (CAD) is still conflicting and inconclusive. This meta-analysis aimed at analysing studies which have been done so far to get a more precise assessment of the association between the mutation and these two diseases.Methods
Electronic databases dated up to April 2018 were searched, retrieved and used. Revman 5.2 software and STATA version 12.0 were used for statistical analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to identify any potential associations. Heterogeneity, publication bias and sensitivity analysis were conducted to measure the robustness of our findings.Results
The overall meta-analysis results showed that miR-196a2 rs11614913 T > C polymorphism was significantly associated with CAD risk in certain genetic models, as well as in subgroup analysis (CC versus TT, OR?=?.43, 95%CI?=?.39-.47, P < .00001). However, no significant association was detected between the miR-196a2 rs11614913 T > C and IS risk in all genetic models.Conclusions
Our study suggests that miR-196a2 rs11614913 T > C may contribute to CAD susceptibility but further well-designed studies with larger sample size and comprehensive data are needed to confirm our findings and provide a profound conclusion. 相似文献16.
Han-Jin Cho Kyung-Hye Kim Eun-Joo Kim Tae Hong Lee Sang Min Sung Ji Hoe Heo Dae Soo Jung 《Journal of stroke and cerebrovascular diseases》2018,27(12):3591-3598
Background
Using high-resolution magnetic resonance imaging (HR-MRI), we investigated the impact of basilar artery plaques that were not detected by magnetic resonance angiography (MRA) on the functional outcomes of patients with acute pontine infarction.Methods
A total of 40 patients with acute pontine infarction and normal basilar findings on MRA prospectively underwent HR-MRI for detection of basilar artery plaques. A relevant plaque was defined as one on the dorsal side of basilar artery, the same side of the ischemic lesion, and the same axial slices of the ischemic lesion. We analyzed the relationship between the relevant basilar artery plaques and the functional outcomes at 3 months.Results
The initial National Institutes of Health Stroke Scale score (3.5 versus 2.0, P?=?.012), and the incidences of neurological deterioration (42.9% versus 6.3%, P?=?.031) and unfavorable functional outcome (71.4% versus 12.5%, P?=?.001) were higher in patients with relevant basilar artery plaques than in those without. On multiple regression analysis, the relevant basilar artery plaque was a significant and independent predictor of unfavorable functional outcome (odds ratio, 6.662; 95% confidence interval, 1.117-39.735; P?=?.037).Conclusions
The presence of a relevant basilar artery plaque was closely related with unfavorable functional outcome in patients with acute pontine infarction even if the patients’ MRA showed normal basilar findings. 相似文献17.
Claudia Rodríguez-López Federico Ballenilla Marco Jaime Díaz Guzmán 《Journal of stroke and cerebrovascular diseases》2018,27(12):3652-3656
Background
Both acute single intracranial and tandem occlusions are managed with intravascular thrombectomy with success, but little evidence exists about the differences in their mid-term outcome. We aim to compare the outcome at 3 months after tandem (extracranial internal carotid and/or middle cerebral artery) and single intracranial (M1 division) occlusions, and to identify the factors, which determine such prognosis.Methods
A total of 66 patients (33 with tandem and 33 with singleM1 occlusions) who underwent emergent intravascular therapy in our center between November of 2013 and November of 2016 were collected. Patients’ medical histories were reviewed for clinical and radiological variables. A modified Rankin Scale of 3 or more was considered as bad outcome. An interobserver concordance analysis evaluated the quality of collaterals in the initial computed tomography through the Maas, Miteff, and CGS (collateral grading scale) scales.Results
No differences were found in theprognosis of tandem versus single M1 occlusions (P?=?.30). The kappa index for the Maas scale was .77 (95% confidence interval [CI] .59-.94) and bad collaterals were defined by a score of 1 or 2. The factors independently associated with a worse prognosis were the presence of bad collaterals (adjusted odds ratio [OR] 6.03, 95% CI 1.01-35.9, P?=?.048) and an incomplete revascularization (adjusted OR 6.01, 95% CI 1.01-35.7, p?=?.049).Conclusions
The outcome of patients with acute stroke secondary to tandem or M1 occlusions has not been found to depend on their localization. The bad quality of collaterals is the main factor related to an unfavorable prognosis. 相似文献18.
Diana Baptista Pedro Abreu Elsa Azevedo Rui Magalhães Manuel Correia 《Journal of stroke and cerebrovascular diseases》2018,27(11):3115-3123
Background and Aim
Stroke is a major health problem. Several studies reported sex differences regarding stroke. We aim to study this issue in an incidence stroke study.Methods
Data were retrieved from a community-based prospective register of patients that had a first ever stroke in a life time between October 2009 and September 2011. We studied sex differences regarding demographic data, vascular risk factors, stroke type, stroke severity (NIHSS), disability at 28days (modified Rankin scale (mRS)), and case fatality at 30 and 90days.Results
From 720 stroke patients, 45.3% were men. Women were older (75.0 ± 13.6 versus 67.2 ± 14.9 years), had a worse premorbid mRS (39.3% versus 25.5%, P < .001), and a higher prevalence of hypertension (P?=?.004) and atrial fibrillation (P < .001). Previous myocardial infarction was more frequent in men (P?=?.001), as well as smoking habits (P < .001). Ischemic stroke was more common in women than men (87.6% versus 81.3%, P?=?.038). The 28 days’ outcome was worse in women (mRS ≥ 2, 77.2% versus 70.6%, P?=?.044). No differences were found in initial stroke severity (median NIHSS?=?4) and case fatality at 30 and 90days, after adjusting for age and premorbid mRS.Conclusion
No differences were found in stroke initial severity and mortality at 30 and 90days between men and women, despite the sex differences pertaining to the stroke profile—age, vascular risk factors, stroke type, and outcome. Our results are somewhat discrepant from those described in the literature; more research is needed to understand if this may be due to changes in stroke standard of care. 相似文献19.
Setareh Salehi Omran Srikanth Reddy Boddu Aaron M. Gusdon Benjamin Kummer Hediyeh Baradaran Praneil Patel Iván Díaz Babak B. Navi Ajay Gupta Hooman Kamel Athos Patsalides 《Journal of stroke and cerebrovascular diseases》2018,27(11):3124-3130
Background and Purpose
Risk factors for hemorrhagic transformation of ischemic stroke after mechanical thrombectomy (MT) are not well established. We conducted a study to determine if prominent angiographic cerebral vascularity following recanalization with thrombectomy (angiographic blush) is associated with hemorrhagic transformation.Methods
Using the Cornell AcutE Stroke Academic Registry, we identified stroke patients who had thrombectomy and achieved recanalization of anterior circulation large-vessel occlusion between 2012 and 2015. The exposure variable was presence of angiographic blush after recanalization, defined as capillary blush with or without early venous drainage. The primary outcome was volume of hemorrhagic transformation on brain imaging after thrombectomy, as determined by semiautomated volumetric analysis on computed tomography or magnetic resonance imaging among those adjudicated to have hemorrhagic conversion by neuroradiology investigators blinded to angiography results. Using a doubly robust estimator with propensity scores and outcome regression adjusting for demographics and known risk factors for hemorrhagic transformation, we evaluated whether angiographic blush after recanalization is associated with an increased volume of hemorrhagic transformation.Results
Among 48 eligible patients, 31 (64.6%) had angiographic blush and 26 (54.2%) had radiographic hemorrhagic transformation (mean volume, 7.6 ml). Patients with angiographic blush averaged lower thrombolysis in cerebral infarction scores and more often received intravenous thrombolysis. In adjusted analysis, angiographic blush was associated with an increased volume of hemorrhagic transformation: mean volume, 10.3ml (95% CI, 3.7-16.9 ml) with blush versus 1.8ml (95% Confidence Interval (CII = Confidence Interval), 0.1-3.4 ml) without (P?=?.01).Conclusions
Presence of angiographic blush after MT was independently associated with the volume of hemorrhagic transformation. 相似文献20.
Satoshi Suda Takashi Shimoyama Koichiro Nagai Masafumi Arakawa Junya Aoki Takuya Kanamaru Kentaro Suzuki Yuki Sakamoto Yuho Takeshi Noriko Matsumoto Yasuhiro Nishiyama Chikako Nito Masahiro Mishina Kazumi Kimura 《Journal of stroke and cerebrovascular diseases》2018,27(10):2804-2809