Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease (original) (raw)
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Recurrence of Ischemic Stroke Patients with Common Risk Factors
Bangladesh Journal of Neuroscience, 2019
Background: Mortality and morbidity due to recurrent ischemic stroke is gradually increasing in Bangladesh due to gradual increase of life expectancy. Previously many studies were done to identify the risk factors of ischemic stroke. But there was scanty data about risk factors of recurrent ischemic stroke. So,it is time demanding to find out those risk factors for ischemic stroke recurrence to reduce the mortality and morbidity from recurrent ischemic stroke. The objective of the study was to determine the frequency of recurrence ischemic stroke events within one year of follow up after discharge from hospital admitted due to first ever stroke. Methods: This is a prospective cohort study. This study was conducted on 150 patients admitted in Neurology ward of BSMMU, presenting with first ever ischemic stroke. Patients mRS were evaluated three monthly interval for one year. Sudden onset mRS deterioration than previous one during this one year period was categorized as recurrence. Res...
Recurrent ischemic stroke is associated with the burden of risk factors
Acta Neurologica Scandinavica, 2015
Aim-To determine the characteristics of acute ischemic stroke patients admitted to hospital with history of prior ischemic stroke(s). We hypothesized that there is an association between the number of risk factors and prior ischemic stroke irrespective of age. Methods-All patients with acute ischemic stroke admitted to Haukeland University Hospital between 2006 and 2013 were registered in the NORSTROKE database. Variables included prior ischemic stroke(s) (based on self-report and patient records), risk factors, TOAST classification, and CT and MRI findings. Comparison was made between patients with prior ischemic stroke and first-ever ischemic stroke. Multivariate analyses were performed. Results-In total, 2697 patients were included and 461 (17.1%) had a history of prior ischemic stroke(s). Logistic regression analyses showed that prior ischemic stroke was associated with the number of risk factors, leukoaraiosis, hypertension, atrial fibrillation, and atherosclerosis. Conclusion-History of prior ischemic stroke in patients with acute ischemic stroke was associated with the burden of risk factors, atherosclerosis, and atrial fibrillation compared to first-ever ischemic stroke. This has important implications for secondary preventive treatment.
Recurrent stroke risk in intracranial atherosclerotic disease
Frontiers in Neurology
Recurrent stroke risk secondary to intracranial atherosclerotic disease remains high despite aggressive medical treatment. This risk is further amplified in subgroups possessing biomarkers of hemodynamic insufficiency and potential for embolization, which have been shown to be independently and synergistically predictive of recurrent stroke. Luminal stenosis was predominantly used as entry criteria in major treatment trials, discounting the potential role of hemodynamics from primary analyses, limiting the strength of evidence and conclusions of these biomarkers to post-hoc analyses and other natural history studies. Future treatment trials should consider stratifying patients using a combination of these high-risk biomarkers. In the absence of trials, risk stratifying patients based on the presence of these markers may lend to more individualized clinical decisions. We aimed to summarize the studies that have investigated the relationship between biomarkers and their role in predic...
Background and Purpose-The goal of this study was to document the long-term outcome of ischemic stroke patients in a population with predominant intracranial atherosclerosis and risk factors for a recurrent event. Methods-Intracranial and extracranial arteries of consecutive patients with acute ischemic stroke were studied prospectively with transcranial Doppler and duplex ultrasound. All patients were followed up regularly for the development of recurrent stroke, cardiac event, or death. Results-We included 705 patients with acute ischemic stroke, of whom 345 were documented ultrasonographically as having large-artery lesions. The follow-up period was up to 42 months (mean, 28Ϯ5 months). One hundred seventeen patients (17%) died of any cause, and 199 (28%) suffered further cerebrovascular cardiac events. The 3.5-year cumulative mortality rate was 20.8%; for cerebrovascular event, it was 29.5%. The annual recurrent stroke rates during the first year were 10.9% for patients without vascular lesion, 17.1% for intracranial atherosclerosis only, and 24.3% for both intracranial and extracranial atherosclerosis; for the second year, the rates were 7.5%, 8.6%, and 7.7%, respectively. More occurrence of death (log rank, 5.19; Pϭ0.02) or cerebrovascular event (log rank, 9.68; Pϭ0.002) was found among patients with than those without vascular lesions. Patients with both intracranial and extracranial arterial lesions were at highest risk of death (log rank, 9.64; Pϭ0.008) and cerebrovascular event (log rank, 11.56; Pϭ0.003).
Clinical risk factors associated with recurrence of ischemic stroke within two years
Medicine, 2020
To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke. From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated. The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726-0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability. Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction. The clinical trial registration number: ChiCTR1800019647 Abbreviations: AUC = area under the curve, CI = confidence interval, CV DBP = diastolic pressure variation coefficient, CV SBP = systolic pressure variation coefficient, DBP = diastolic blood pressure, ESRS = Essen Stroke Risk Score, HAMD = Hamilton Depression, Hg = hydrargyrum, MAX DBP = maximum diastolic pressure, MAX SBP = maximum systolic pressure, MEAN DBP = mean diastolic pressure, MEAN SBP = mean systolic pressure, MIN DBP = minimum diastolic pressure, MIN SBP = minimum systolic pressure, MR = magnetic resonance , MRA = magnetic resonance angiography, NIHSS = National Institutes of Health Stroke Scale, OR = odds ratio, ROC = receiver operating characteristic, SBP = systolic blood pressure, SD = standard deviations.
Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study
Neurology Research International, 2021
Introduction. Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods. We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors’ institution as of January 15, 2019. Wilcoxon signed-rank and Fisher’s exact tests were used. Also, a Cox regression model was used to identify confounders.Results. We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out ...
Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study
Arquivos de Neuro-Psiquiatria, 2015
Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of athe...
BMC Neurology, 2013
Background: Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. Methods: We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from "The Study of Stroke Mortality and Morbidity" (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level). Results: We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype. Conclusions: For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.