scholarly journals Small Vessel Disease and Ischemic Stroke Risk During Anticoagulation for Atrial Fibrillation After Cerebral Ischemia

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 91-99
Author(s):  
Houwei Du ◽  
Duncan Wilson ◽  
Gareth Ambler ◽  
Gargi Banerjee ◽  
Clare Shakeshaft ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Ischemic Attack

Background and Purpose: The causes of recurrent ischemic stroke despite anticoagulation for atrial fibrillation are uncertain but might include small vessel occlusion. We investigated whether magnetic resonance imaging markers of cerebral small vessel disease (SVD) are associated with ischemic stroke risk during follow-up in patients anticoagulated for atrial fibrillation after recent ischemic stroke or transient ischemic attack. Methods: We analyzed data from a prospective multicenter inception cohort study of ischemic stroke or transient ischemic attack anticoagulated for atrial fibrillation (CROMIS-2 [Clinical Relevance of Microbleeds in Stroke Study]). We rated markers of SVD on baseline brain magnetic resonance imaging: basal ganglia perivascular spaces (number ≥11); cerebral microbleeds (number ≥1); lacunes (number ≥1); and white matter hyperintensities (periventricular Fazekas grade 3 or deep white matter Fazekas grade ≥2). We investigated the associations of SVD presence (defined as presence of ≥1 SVD marker) and severity (composite SVD score) with the risk of ischemic stroke during follow-up using a Cox proportional hazards model adjusted for congestive heart failure, hypertension, age >75, diabetes, stroke, vascular disease, age 65–74, female score. Results: We included 1419 patients (mean age: 75.8 years [SD, 10.4]; 42.1% female). The ischemic stroke rate during follow-up in patients with any SVD was 2.20 per 100-patient years (95% CI, 1.60–3.02), compared with 0.98 per 100 patient-years (95% CI, 0.59–1.62) in those without SVD ( P =0.008). After adjusting for congestive heart failure, hypertension, age >75, diabetes, stroke, vascular disease, age 65–74, female score, SVD presence remained significantly associated with ischemic stroke during follow-up (hazard ratio, 1.89 [95% CI, 1.01–3.53]; P =0.046); the risk of recurrent ischemic stroke increased with SVD score (hazard ratio per point increase, 1.33 [95% CI, 1.04–1.70]; P =0.023). Conclusions: In patients anticoagulated for atrial fibrillation after ischemic stroke or transient ischemic attack, magnetic resonance imaging markers of SVD are associated with an increased risk of ischemic stroke during follow-up; improved stroke prevention treatments are required in this population. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02513316.

scholarly journals Dabigatran following acute transient ischemic attack and minor stroke II (DATAS II)

2017 ◽  
Vol 12 (8) ◽  
pp. 910-914 ◽  
Author(s):  
Kuan H Ng ◽  
Mukul Sharma ◽  
Oscar Benavente ◽  
Laura Gioia ◽  
Thalia S Field ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Transformation ◽  
Phase Iii ◽  
Minor Stroke ◽  
Resonance Imaging ◽  
Repeat Magnetic Resonance Imaging ◽  
Ischemic Attack

Rationale Patients with transient ischemic attack or minor stroke are at high risk of early recurrent cerebrovascular events. Anticoagulation with heparin or warfarin acutely after ischemic stroke is at least as efficacious as aspirin for preventing recurrent events but is associated with an increased risk of clinical worsening due to hemorrhagic transformation. Aim and hypothesis We aim to demonstrate the safety of early anticoagulation with dabigatran, an oral direct thrombin inhibitor, in acute cerebrovascular syndrome patients. The primary hypothesis is that symptomatic hemorrhagic transformation rates in dabigatran and aspirin-treated patients will be similar. Sample size estimates At least 136 participants in two groups required to demonstrate an absolute between-group difference in the rate of hemorrhagic transformation of 5.6% with 80% power, assuming alpha = 5%. Methods and design A randomized, multicenter open-label clinical trial (NCT02295826). Three-hundred participants with a transient ischemic attack/ischemic stroke (National Institutes of Health Stroke Scale ≤ 9) will undergo magnetic resonance imaging within 72 h of symptom onset and will be randomized to aspirin 81 mg daily or dabigatran 150 mg twice daily for 30 days. Participants undergo repeat magnetic resonance imaging at 30 days and clinical assessment to 90 days. Study outcomes The primary outcome is the symptomatic hemorrhagic transformation rate. Secondary outcomes include recurrent stroke and new ischemic lesions on repeat magnetic resonance imaging. Discussion This study will determine the safety of early anticoagulation with dabigatran in patients with acute transient ischemic attack/ischemic stroke and will inform the design of a phase III randomized trial aimed at demonstrating reduced recurrent early ischemic events after acute transient ischemic attack/stroke.

scholarly journals Redefinition of Transient Ischemic Attack Improves Prognosis of Transient Ischemic Attack and Ischemic Stroke

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3612-3613 ◽  
Author(s):  
Michael T. Mullen ◽  
Brett L. Cucchiara
Keyword(s):  
Magnetic Resonance Imaging ◽  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Resonance Imaging ◽  
Acute Infarction ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose— The recent redefinition of transient ischemic attack (TIA) reclassifies patients with acute infarction on magnetic resonance imaging as ischemic stroke. Redefinition will improve the prognosis of both TIA and ischemic stroke, an epidemiological paradox known as the Will Rogers phenomenon. We sought to quantify the impact of this phenomenon. Methods— Incidence of TIA, risk of death/disability after stroke, rate of acute infarction on magnetic resonance imaging after TIA, and 90-day stroke risk after TIA with and without infarction on magnetic resonance imaging were determined based on published data. The impact on poststroke disability in the redefined cohort of patients with ischemic stroke was computed. A sensitivity analysis was performed to account for uncertainty in input variables. Results— Using the new TIA definition, the 90-day risk of stroke following TIA is 1%. In the United States, redefinition will increase annual ischemic stroke incidence from 691 650 to 747 755 and result in a 3.4% absolute reduction in poststroke disability. In a sensitivity analysis, this risk reduction varies from 1.5 to 6.5%, and is most dependent on the incidence of TIA. Conclusions— Redefinition of TIA reduces stroke risk after TIA to approximately 1% at 90 days, and reduces the rate of poststroke disability by approximately 3.4%.

Total small vessel disease score and cerebro-cardiovascular events in healthy adults: The Kashima scan study

2020 ◽  
Vol 15 (9) ◽  
pp. 973-979 ◽  
Author(s):  
Kohei Suzuyama ◽  
Yusuke Yakushiji ◽  
Atsushi Ogata ◽  
Masashi Nishihara ◽  
Makoto Eriguchi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Disease ◽  
Magnetic Resonance ◽  
Cardiovascular Events ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Disease Score ◽  
Resonance Imaging ◽  
Vessel Disease

Background and aims We explored the association between the total small vessel disease score obtained from baseline magnetic resonance imaging and subsequent cerebro-cardiovascular events in neurologically healthy Japanese adults. Methods The presence of small vessel disease features, including lacunae, cerebral microbleeds, white matter changes, and basal ganglia perivascular spaces on magnetic resonance imaging, was summed to obtain a “total small vessel disease score” (range, 0–4). After excluding participants with previous stroke or ischemic heart disease, intracranial artery stenosis (≥50%), or cerebral aneurysm (≥4 mm), a total of 1349 participants (mean age, 57.7 years; range, 22.8–85.0 years; 46.9% male) were classified into three groups by total small vessel disease score: 0 ( n = 984), 1 ( n = 269), and ≥2 ( n = 96). Cerebro-cardiovascular events (i.e., any stroke, transient ischemic attack, ischemic heart disease, acute heart failure, and aortic dissection) were defined as the primary end point. The hazard ratio (HR) of events during follow-up was calculated using Cox proportional hazards modeling with adjustments for age, sex, hypertension, diabetes mellitus, and smoking. Cumulative event-free rates were estimated using the Kaplan–Meier method. Results During follow-up (mean, 6.7 years), 35 cerebro-cardiovascular (16 cerebrovascular) events were identified. Higher small vessel disease score was associated with increased risk of cerebro-cardiovascular events (HR per unit increase, 2.17; 95% confidence interval, 1.36–3.46; P = 0.001). Events were more frequent among participants with higher score ( P < 0.001, log-rank test). Conclusions This study offered additional evidence for the clinical relevance of total small vessel disease score, suggesting the score as a promising tool to predict the risk of subsequent vascular events even in healthy populations.

Differential characteristics, stroke recurrence, and predictors of covert atrial fibrillation of embolic strokes of undetermined source

2017 ◽  
Vol 13 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Maximiliano A Hawkes ◽  
Mauricio F Farez ◽  
Lucia Pertierra ◽  
Maia M Gomez-Schneider ◽  
José M Pastor-Rueda ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Stroke Recurrence ◽  
Resonance Imaging ◽  
Erythrocyte Sedimentation

Background and purpose Identifying embolic strokes of undetermined source (ESUS) patients likely to harbor atrial fibrillation may have diagnostic and therapeutic implications. Our aim was to examine differences between ESUS and cardioembolic strokes, to evaluate stroke recurrence rate among ESUS and to identify baseline characteristics of ESUS patients who were later diagnosed with atrial fibrillation. Materials and methods We assessed all ischemic stroke patients admitted between June 2012 and November 2013. ESUS were compared to cardioembolic strokes at discharge. After at least 12-month follow-up, ESUS patients diagnosed with atrial fibrillation were compared to those who remained as ESUS. Results There were 236 ischemic strokes, 32.6% were ESUS. Compared to cardioembolic strokes, ESUS were younger (p < 0.0001), had milder strokes (p < 0.05), less prevalence of hypertension (p < 0.05), peripheral vascular disease (p < 0.05), and previous ischemic stroke (p < 0.05). After follow-up, 15% of ESUS patients had stroke recurrences and 12% evidenced paroxysmal atrial fibrillation. ESUS patients diagnosed with atrial fibrillation in the follow-up were older (p < 0.0001), had higher erythrocyte sedimentation rate (p < 0.05), and were more likely to have ≥2 infarcts in the same arterial territory in the initial magnetic resonance imaging (p < 0.05). Conclusions Older age, small-scattered infarcts on initial magnetic resonance imaging and high erythrocyte sedimentation rate levels appear to identify ESUS patients more likely to be diagnosed of atrial fibrillation during follow-up.

scholarly journals Characteristics and clinical significance of magnetic resonance imaging manifestations of cerebral small vessel disease in acute period of ischemic stroke

2018 ◽  
Vol 99 (4) ◽  
pp. 562-568
Author(s):  
N A Kayleva ◽  
A A Kulesh ◽  
N Kh Gorst ◽  
A Yu Bykova ◽  
V E Drobakha ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Integral Scale ◽  
Acute Period ◽  
Vessel Disease

Aim. To characterize magnetic-resonance imaging manifestations of cerebral small vessel disease in patients in acute period of ischemic stroke and to study their clinical significance. Methods. 56 patients in acute period of ischemic stroke and 10 subjects without stroke and cognitive impairment were examined. Magnetic-resonance tomography of the brain was performed to all patients and healthy subjects to assess the quantity of lacunes, perivascular spaces, leukoaraiosis and cerebral microbleeds. Based on analysis of 4 neurovisual markers of cerebral small vessel disease, an integral scale was developed. The obtained results were evaluated in association with a wide spectrum of clinical data. Results. Patients in acute period of ischemic stroke are characterized by higher quantitative expression of certain markers of cerebral small vessel disease in comparison with healthy age-matched subjects. A correlation between neuroimaging markers of cerebral small vessel disease and patients` age, severity and etiology of the stroke was observed. Total expression of cerebral small vessel disease, assessed using the integral score turned out to be higher in the group of stroke than in healthy elderly persons. High rates of certain markers of cerebral small vessel disease and integral scale score are associated with low mobility of patients, neurological deficiency and dependence in daily activities on discharge. Conclusion. In patients in acute period of ischemic stroke, higher expression of certain markers of cerebral small vessel disease and their total evidence were revealed in comparison with healthy people; total indicator of cerebral small vessel disease expression is associated with neurological and functional outcome of acute period of stroke.

scholarly journals Risk factors for small-vessel disease revealed by magnetic resonance imaging of the brain.

Nosotchu ◽  
1996 ◽  
Vol 18 (1) ◽  
pp. 10-18
Author(s):  
Tatsuo Kohriyama ◽  
Shinya Yamaguchi ◽  
Eiji Tanaka ◽  
Yasuhiro Yamamura ◽  
Shigenobu Nakamura
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Vessel Disease ◽  
The Brain
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