scholarly journals Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

2015 ◽  
Vol 23 (1) ◽  
pp. 127-132 ◽  
Author(s):  
D. Damania ◽  
N. T.‐M. Kung ◽  
M. Jain ◽  
A. R. Jain ◽  
J. A. Liew ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Symptomatic Carotid ◽  
Factors Associated

Internal Borderzone Infarction is Associated with Hemodynamic Compromise in Patients with Carotid Occlusion but Not with Recurrent Stroke

2014 ◽  
Vol 9 (5) ◽  
pp. E24-E24 ◽  
Author(s):  
Suzanne Persoon ◽  
L. Jaap Kappelle ◽  
Jeroen Hendrikse ◽  
Gert Jan de Borst ◽  
Albert van der Zwan ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Hemodynamic Compromise

Abstract 17130: Variables Associated With Uncontrolled Blood Pressure Early After Stroke

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Saviour Achilike ◽  
Austin Wang ◽  
Gabretta Cooksey ◽  
Evelyn Hinojosa ◽  
Munachi Okpala ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Uncontrolled Blood Pressure ◽  
Factors Associated ◽  
Multivariable Analyses ◽  
Medication Complexity ◽  
Ischemic Attack

Introduction: Uncontrolled blood pressure (BP) is a major risk factor for recurrent stroke; however, up to 50% of stroke survivors have uncontrolled BP 6 months after stroke. Characterization of factors associated with uncontrolled BP early after stroke discharge (DC) may help to identify patients for BP interventions. Hypothesis: We sought to identify factors associated with uncontrolled BP in the first month after stroke discharge. We hypothesized that African American (AA) race, insurance status, medication complexity, and hospital BP prior to discharge would be associated with uncontrolled BP. Methods: We identified hypertensive patients with ischemic or hemorrhagic stroke or transient ischemic attack scheduled to follow-up in the stroke clinic 2 to 4 weeks after hospital DC. Office BP was obtained using BpTRU, an automated machine that averages five unattended BP measures. Uncontrolled BP was defined using 2017 American College of Cardiology Guidelines as BP ≥ 130/80 mmHg. We used univariate logistic regression to assess relationships between uncontrolled BP and selected variables. Variables with statistically significant associations in the univariate models and variables associated with uncontrolled BP in the literature were included in the multiple logistic regression model. Results: Of the 230 patients identified, 55.7% had uncontrolled BP at clinic follow-up. In univariate and multivariable analyses, AA race, young stroke (age < 50), and systolic BP (SBP) 24-hours prior to DC were significantly associated with uncontrolled BP early after stroke DC. BP medication complexity was not associated with uncontrolled BP in this study. Conclusions: AA race, young age, and elevate SBP in the 24 hours prior to of stroke DC were associated with uncontrolled BP early after stroke. These variables can be used to identify patients who may benefit from early interventions aimed at reducing the risk of uncontrolled BP after stroke and stroke recurrence.

Abstract WP33: Reperfusion Therapy in Carotid Artery Occlusion with Collaterals Through the Circle of Willis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong Hwan Ahn ◽  
In Sung Choo ◽  
Hyun Gu Kang ◽  
Ji Yeon Jung ◽  
Sang Woo Ha
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Carotid Occlusion ◽  
Large Artery ◽  
Clinical Worsening

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

Abstract W P291: Long-term Stroke Awareness Among Stroke Survivors is Suboptimal

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Carlos Corado ◽  
Deborah Bergman ◽  
Ilana Ruff ◽  
Yvonne Curran ◽  
Richard A Bernstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariate Regression ◽  
Recurrent Stroke ◽  
Cognitive Status ◽  
Warning Signs ◽  
Stroke Survivors ◽  
Index Hospitalization ◽  
Factors Associated ◽  
Stroke Awareness

Background/Objective: Stroke survivors are at high-risk for recurrent stroke. Stroke education attempts to reduce this risk by emphasizing stroke warning signs and need to call 911. Long-term stroke awareness has been under-studied in stroke survivors. We aimed to assess stroke awareness at 1 year among stroke survivors and identify factors associated with poor performance. Methods: From a single center prospective cohort study of consecutive patients diagnosed with acute ischemic stroke or transient ischemic stroke (TIA), we identified stroke survivors able to complete telephone interviews at 1 year. All patients were provided standardized educational materials during index hospitalization. We used the validated Stroke Action Test (STAT) to assess stroke knowledge at 1 year. The STAT is a 28-item questionnaire that asks respondents to choose 1 of 4 answers to each scenario (call 911, call doctor, wait 1 hour, or wait 1 day). We also assessed cognitive status at 1 year using the validated telephone interview for Cognitive Status (TICS). We identified factors associated with STAT score (number of correct responses) using univariate and multivariate regression. Results: Among 254 patients who completed 1 year follow-up (65.8 years; 55.5% male; 68.5% white; 94.1% modified Rankin 0-1 at 1 year), the median STAT score was 57.1% (range 2.1-75.0%). In multivariate regression, TICS score (B=0.533; p<0.001) and ethnicity (B=-2.357, p=0.006) were independently associated with STAT score. Age, race, insurance, arrival by ambulance at time of index hospitalization, stroke unit admission, length of stay, discharge to rehabilitation, post-stroke hospital/clinic visits were not associated with STAT score. Conclusion: Despite hospitalization and standardized education at time of index event, most stroke survivors are unaware of stroke warning signs at 1 year. Besides cognitive status and Hispanic ethnicity, no other factors were identified that predicted STAT score performance. Future studies should focus on improving hospital-based stroke educational programs and consider novel strategies in patients with cognitive impairment and differing language/cultural backgrounds.

Abstract TP135: Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Tonetti ◽  
Brian Jankowitz ◽  
Kenmuir Cynthia ◽  
Benjamin Zussman ◽  
Rahul Rao ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Clinical Equipoise ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Recorded Data ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. The aim of this report is to analyze prospectively-recorded data from an institutional protocol that standardized the urgent (<48 hours) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 months to a comprehensive stroke center with symptomatic carotid stenosis within 48 hours of index event were screened for inclusion. All patients were given dual antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if DSA demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 days. Results: 178 patients with a diagnosis of recently symptomatic carotid stenosis were included; 120 patients (67%) met criteria. 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.

scholarly journals Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
Soo Joo Lee ◽  
Jae-Kwan Cha ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Predictive Risk ◽  
Multicenter Registry

Abstract Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

scholarly journals Factors associated with time delay to carotid stenting in patients with a symptomatic carotid artery stenosis

2011 ◽  
Vol 258 (7) ◽  
pp. 1228-1233 ◽  
Author(s):  
Klaus Gröschel ◽  
Sonja Schnaudigel ◽  
Katrin Wasser ◽  
Sara M. Pilgram-Pastor ◽  
Ulrike Ernemann ◽  
...  
Keyword(s):  
Time Delay ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Stenting ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Factors Associated

The risk of recurrent stroke at 24 months in patients with symptomatic carotid near‐occlusion: results from CAOS, a multicentre registry study

2019 ◽  
Vol 26 (11) ◽  
pp. 1391-1398 ◽  
Author(s):  
A. García‐Pastor ◽  
A. Gil-Núñez ◽  
J. M. Ramírez‐Moreno ◽  
N. González‐Nafría ◽  
J. Tejada ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Registry Study ◽  
Symptomatic Carotid ◽  
Near Occlusion
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