scholarly journals A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2872-2876 ◽  
Author(s):  
Andrew J. Zhang ◽  
Parth Dhruv ◽  
Philip Choi ◽  
Caitlin Bakker ◽  
Jonathan Koffel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Carotid Revascularization ◽  
Stroke Risk Factors ◽  
Patient Level

Background and Purpose— Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods— Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results— Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16–85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0–97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions— CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

Abstract 207: A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Parth Dhruv ◽  
Jae Kim ◽  
Jonathan Koffel ◽  
David Anderson ◽  
Christopher Streib
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Recurrent Stroke ◽  
Fibrous Tissue ◽  
Definitive Treatment ◽  
Stroke Recurrence ◽  
Prevention Measures ◽  
Carotid Revascularization

Introduction: Carotid Web (CW) is a rare form of focal fibromuscular dysplasia that results in an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. There is uncertainty in diagnosis, prognosis, and optimal management of this uncommon entity. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods: Our literature search for CW and related terms yielded 1017 results. After a preliminary assessment of all 1017 retrieved manuscripts; 72 manuscripts were reviewed in detail. A total of 31 manuscripts met entry criteria and were included in our SLR. We present the demographics, cardiovascular (CV) risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality of CW patients. Results: Our SLR resulted in 104 patients with CW, (median age at presentation: 45.7 [IQR 45-57], 52.3% female). The majority (68.3%) of CW patients did not have CV risk factors, however, 22.2% of patients were smokers. 47.8% of patients suffered recurrent stroke. The majority of patients were ultimately treated with antiplatelet therapy (94.4%) and 21.2% underwent carotid revascularization (4.8% carotid stenting, 16.3% carotid endarterectomy). None of the patients who underwent revascularization had a reported stroke recurrence. See Table. Conclusions: CW is a rare disease leading to ischemic stroke in younger patients without typical CV risk factors. CW patients in our SLR were at extremely high risk for recurrent stroke (47.8%). Aggressive secondary stroke prevention measures are indicated in this patient population, however, the optimal treatment strategies remain unclear. Carotid revascularization may be the definitive treatment for certain patients with CW, but further studies are needed as incomplete reporting and potential publication bias limit our findings.

scholarly journals Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

2021 ◽  
pp. 239698732110585
Author(s):  
Elora Basu ◽  
Setareh Salehi Omran ◽  
Hooman Kamel ◽  
Neal S Parikh
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Stroke Risk Factors ◽  
Minor Ischemic Stroke ◽  
Using Data

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

Abstract 1122‐000169: The Carotid Web and Ischemic Stroke ‐ A Case Report

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Aravind Reddy ◽  
Neil Suryadevara ◽  
Hesham Masoud ◽  
Palma Shaw ◽  
Karen Albright
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Literature Review ◽  
Medical Therapy ◽  
Systematic Literature Review ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Patient Case

Introduction : Case report: 63 year old African American woman with history of hypertension presented with acute onset of expressive aphasia. Her neurologic exam and NIHSS was significant for moderate aphasia with paraphasic errors and impairment of repetition. She was outside the treatment window for IV thrombolytic therapy. CT angiography of the head and neck in the ED showed moderate 60–70% stenosis of the left internal carotid artery secondary to a carotid web. She was admitted to the stroke service and started on DAPT with ASA and clopidogrel. MRI brain was obtained, which confirmed a small acute infarct in the posterior margin of the left sylvian fissure. Methods : Intervention and Follow‐up: Vascular surgery and interventional neurology were consulted to discuss the treatment options for the patient’s carotid web. Give the unique nature of the patient’s web with its triple lumen appearance, carotid endarterectomy (CEA) was favored over stenting, and the patient underwent left CEA. There were no immediate complications, and she was continued on DAPT for 21 days, then ASA monotherapy. One month follow‐up carotid dopplers of the left ICA showed patent flow without significant stenosis. On follow‐up evaluations at 3 and 12 months, the patient’s speech deficits had improved significantly and she reported no new stroke‐like symptoms. Results : Literature Review: Carotid webs (CaW) may be a potentially underrecognized cause of ischemic strokes. CaW are thin, fibrous tissue that extends from the wall of the carotid artery into the lumen in a shelf‐like projection. It is believed to be a variant of fibromuscular dysplasia. It is hypothesized that blood stasis on the downstream surface of the web may result in thrombus formation and thromboembolic stroke. The optimal treatment for CaW remains unclear, however there is some evidence to suggest that antiplatelet therapy alone may be insufficient to prevent recurrent stroke, with rates of recurrent stroke of 30–50% from a systematic literature review. Furthermore, there have been no reports of CaW positive remodeling over time, so patients likely remain at elevated risk for ischemic stroke without intervention. Conclusions : Discussion: Case series as well as systematic literature review have shown high rates of stroke recurrence in CaW patients treated with medical therapy alone. Data is still limited, however, CEA and carotid artery stenting (CAS) appear to be safe and effective revascularization procedures for CaW, with potentially significant reduction in recurrent stroke risk. CEA was preferred in our patient case due to the triple‐lumen appearance of the carotid web (Figure). CaW is a relatively underappreciated cause of ischemic strokes and the optimal management is not well‐established, however medical therapy alone appears to be sub‐optimal with high rates of stroke recurrence. Our patient case shows that carotid revascularization can be safe may be effective in preventing stroke recurrence.

scholarly journals Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack

2014 ◽  
Vol 36 (1) ◽  
pp. E10 ◽  
Author(s):  
Brian S. Katz ◽  
Kelly D. Flemming
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Management Options ◽  
Risk Factor Management ◽  
Stroke Risk Factors ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack ◽  
Selection Of

In addition to appropriate antithrombotic therapy, the identification and treatment of modifiable ischemic stroke risk factors can reduce the likelihood of recurrent stroke. Neurosurgeons should be knowledgeable of the specific risk factors and general recommendations for ischemic stroke, as they may play a significant role in the management options for patients with intracranial and extracranial atherosclerotic disease. The authors of this article review the indications for and selection of antithrombotics in patients with cerebral ischemia. In addition, the identification and secondary prevention of select risk factors are discussed.

Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Urvish K Patel ◽  
Priti Poojary ◽  
Vishal Jani ◽  
Mandip S Dhamoon
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Stroke Risk ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

scholarly journals Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1563-1569 ◽  
Author(s):  
Adam Richards ◽  
Nicholas J. Jackson ◽  
Eric M. Cheng ◽  
Robert J. Bryg ◽  
Arleen Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Reduction ◽  
Stroke Risk ◽  
Care Delivery ◽  
Recurrent Stroke ◽  
Individual Risk ◽  
Stroke Risk Factors ◽  
Multiple Stroke ◽  
Individual Risk Factors ◽  
Delivery Models

Background and Purpose— Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods— We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results— The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions— A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00861081.

scholarly journals What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review

PLoS ONE ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. e0217981
Author(s):  
Paul Mackie ◽  
Ishanka Weerasekara ◽  
Gary Crowfoot ◽  
Heidi Janssen ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Scoping Review ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Stroke Risk Factors ◽  
Prolonged Sitting

scholarly journals Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

2016 ◽  
Vol 47 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Wesley T. O'Neal ◽  
Hooman Kamel ◽  
Dawn Kleindorfer ◽  
Suzanne E. Judd ◽  
George Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Cox Regression ◽  
Stroke Risk Factors ◽  
Stroke Study ◽  
Increased Risk ◽  
Study Participants ◽  
The Relationship

Background: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. Methods: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. Results: PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). Conclusion: PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.

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