scholarly journals Association of Plasma Metabolic Biomarker Sphingosine-1-Phosphate With Cerebral Collateral Circulation in Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Fang Yu ◽  
Xianjing Feng ◽  
Xi Li ◽  
Zeyu Liu ◽  
Di Liao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Sphingolipid Metabolism ◽  
Healthy Controls ◽  
Control Groups ◽  
Sphingosine 1 Phosphate ◽  
Discovery Stage ◽  
Significant Pathway ◽  
And Control

Background: The contribution of metabolic profile to the cerebral collateral circulation in acute ischemic stroke (AIS) has not been fully outlined. In this study, we conducted a metabolomic study to assess the relationship between the metabolic biomarkers and the collateral status of AIS.Methods: A two-stage study was conducted from September 2019 to June 2021 in our hospital. There were 96 subjects including 66 patients with AIS and 30 healthy controls in the discovery stage and 80 subjects including 53 patients with AIS and 27 healthy controls in the validation stage. Collateral circulation was assessed by the Tan score based on computed tomographic angiography (CTA). Liquid chromatography-tandem mass spectrometry was used to identify differential metabolic markers. Then, an ELISA was employed to detect the plasma levels of sphingosine-1-phosphate (S1P).Results:There were 114 differential metabolites between patients with AIS and control groups and 37 differential metabolites between good collateral circulation (GCC) and poor collateral circulation (PCC) groups. The pathway enrichment analysis revealed that arginine biosynthesis was the only statistically significant pathway between AIS and control groups and sphingolipid metabolism was the only statistically significant pathway between GCC and PCC groups. The differential metabolites sphinganine-1-phosphate (SA1P) and S1P belong to the sphingolipid metabolism. In the discovery stage, when the GCC group was compared with the PCC group, the receiver operating characteristic (ROC) analysis showed that plasma SA1P relative levels demonstrated an area under the curve (AUC) of 0.719 (95% CI: 0.582–0.834), and S1P levels demonstrated an AUC of 0.701 (95% CI: 0.567–0.819). In addition, both plasma SA1P and S1P relative levels showed significant negative correlations with the 90-day modified Rankin Scale (mRS) score. In the validation sample, higher plasma S1P levels were independent predictors of GCC (p = 0.014), and plasma S1P levels demonstrated an AUC of 0.738 (95% CI: 0.599–0.849) to differentiate patients with GCC from patients with PCC. In addition, plasma S1P levels also showed significant negative correlations with the 90-day mRS score.Conclusion: We first illustrated the association between plasma metabolic profiles and cerebral collateral circulation in patients with AIS. Plasma S1P levels might be a potential diagnostic biomarker for predicting collateral circulation status in patients with AIS.

scholarly journals Clinical Impact of Estradiol/Testosterone Ratio in Patients with Acute Ischemic Stroke

2020 ◽  
Author(s):  
Jung-Won Choi ◽  
In Woo Ryoo ◽  
Jun Yeong Hong ◽  
Kyung-Yul Lee ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sex Hormones ◽  
Control Group ◽  
Control Groups ◽  
Sexual Hormones ◽  
Stroke Group ◽  
Male Patients ◽  
And Control

Abstract Background: Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS).Methods: Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.Results: The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).Conclusions: These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

scholarly journals Clinical Impact of Estradiol/Testosterone Ratio in Patients with Acute Ischemic Stroke

2020 ◽  
Author(s):  
Jung-Won Choi ◽  
In Woo Ryoo ◽  
Jun Yeong Hong ◽  
Kyung-Yul Lee ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sex Hormones ◽  
Control Group ◽  
Control Groups ◽  
Sexual Hormones ◽  
Stroke Group ◽  
Male Patients ◽  
And Control

Abstract Background: Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). Methods: Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.Results: The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).Conclusions: These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

scholarly journals Clinical Impact of Estradiol/Testosterone Ratio in Patients with Acute Ischemic Stroke

2020 ◽  
Author(s):  
Jung-Won Choi ◽  
In Woo Ryoo ◽  
Jun Yeong Hong ◽  
Kyung-Yul Lee ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sex Hormones ◽  
Control Group ◽  
Control Groups ◽  
Sexual Hormones ◽  
Stroke Group ◽  
Male Patients ◽  
And Control

Abstract Background: Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). Methods: Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.Results: The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).Conclusions: These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

scholarly journals Clinical impact of estradiol/testosterone ratio in patients with acute ischemic stroke

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jung-Won Choi ◽  
In Woo Ryoo ◽  
Jun Yeong Hong ◽  
Kyung-Yul Lee ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sex Hormones ◽  
Control Group ◽  
Control Groups ◽  
Sexual Hormones ◽  
Stroke Group ◽  
Male Patients ◽  
And Control

Abstract Background Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). Methods Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients. Results The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003). Conclusions These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

Abstract P221: Effects of Immediate Antihypertensive Treatment in Men and Women with Acute Ischemic Stroke: The CATIS Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Qi Zhao ◽  
Yonghong Zhang ◽  
Jing Chen ◽  
Tan Xu ◽  
Chung-Shiuan Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Primary Outcome ◽  
Control Groups ◽  
Men And Women ◽  
Comparison Groups ◽  
Event Rates ◽  
And Control

Gender difference in the risk and prognosis of ischemic stroke has been reported. We examined the effects of immediate antihypertensive treatment on clinical outcomes among acute ischemic stroke by gender in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). CATIS was a randomized, single-blind, and blinded end-point trial conducted in 4,071 acute ischemic stroke patients (2,604 men and 1,467 women). Eligible stroke patients with elevated systolic blood pressure (SBP) were randomly assigned to receive antihypertensive treatment (lowering SBP by 10-25% within the first 24 hours after randomization and BP < 140/90 mm Hg within 7 days) or control (discontinuing all antihypertensive medications). The primary outcome was a combination of death and major disability (defined by a modified Rankin score ≥ 3) at day 14 (or at discharge if earlier than 14 days) and 3-month post-treatment follow-up. The primary outcome was not significantly different between the treatment and control groups in either men or women. The primary outcome event rates for the two comparison groups were 31.6% and 32.1% in men ( P = 0.79) and 37.3% and 36.1% in women ( P = 0.65) at day 14; and were 23.6% and 24.5% in men ( P = 0.60) and 28.0% and 26.6% in women ( P = 0.56) at 3-month follow-up. The secondary outcomes were not different between treatment and control groups among men and women at 14 days or hospital discharge and at 3 months. The median modified Rankin scores (interquartile range) for the comparison groups were 2.0 (1.0-3.0) and 2.0 (1.0-3.0) in both men and women at day 14 or hospital discharge. The modified Rankin score, recurrent stroke, vascular event, and all-cause mortality at 3-month follow-up were similar between the treatment and control groups for both men and women. For example, the vascular event rates for the comparison groups were 2.4% and 3.0% in men ( P = 0.34) and 2.4% and 2.9% in women ( P = 0.58). There were no significant treatment and sex interactions for any of the primary and secondary outcomes. In conclusion, these data suggest that immediate antihypertensive treatment within the first 48 hours after stroke onset has no gender-specific effect on short-term outcomes of patients with acute ischemic stroke.

scholarly journals Early Blood Pressure Reduction in Acute Ischemic Stroke with Various Severities: A Subgroup Analysis of the CATIS Trial

2016 ◽  
Vol 42 (3-4) ◽  
pp. 186-195 ◽  
Author(s):  
Xiaoqing Bu ◽  
Changwei Li ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Dali Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Subgroup Analysis ◽  
Recurrent Stroke ◽  
Control Groups ◽  
Vascular Events ◽  
Nihss Score ◽  
Comparison Groups ◽  
And Control

Background: Clinical trials have generally showed a neutral effect of blood pressure (BP) reduction on clinical outcomes among acute ischemic stroke patients. We conducted a prespecified subgroup analysis to assess whether disease severity modifies the effect of early antihypertensive treatment on death and disability among patients with acute ischemic stroke. Methods: In the China Antihypertensive Trial in Acute Ischemic Stroke, 4,071 patients with acute ischemic stroke and elevated BP were randomly assigned to receive antihypertensive treatment or to discontinue all hypertension medications within 48 h of symptom onset. The primary outcome was a combination of death and major disability at 14 days or hospital discharge. In this subgroup analysis, participants were categorized into 3 groups according to their baseline NIH Stroke Scale (NIHSS) scores (0-4, 5-15, or ≥16). Results: At 24 h after randomization, mean systolic BP differences (95% CIs) were -8.5 (-10.0 to -7.1), -9.8 (-11.4 to -8.3), and -9.1 (-14.4 to -3.8) mm Hg between the treatment and control groups (all p values <0.001) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. At day 7 after randomization, the corresponding mean systolic BP differences were -9.3 (-10.5 to -8.2), -9.1 (-10.3 to -7.8), and -10.1 (-15.1 to -5.1) mm Hg between the treatment and control groups (all p values <0.001). The primary outcome was not significantly different between the treatment and control groups at day 14 or hospital discharge among all NIHSS subgroups (p value for homogeneity = 0.66). ORs (95% CI) associated with treatment were 1.14 (0.87-1.49, p = 0.33), 1.04 (0.86-1.25, p = 0.70), and 0.67 (0.18-2.44, p = 0.54) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. The composite outcome of death and major disability at 3-month follow-up did not differ between the 2 comparison groups for all NIHSS subgroups. In addition, vascular events and recurrent stroke were not significantly different between the 2 comparison groups at the 3-month follow-up visit among all NIHSS subgroups except that there was a suggestive risk reduction for recurrent stroke among those with an NIHSS score of 5-15 (OR 0.45, 95% CI 0.20-0.99, p = 0.05). Conclusion: Early BP reduction with antihypertensive medications did not reduce or increase the risk of death, major disabilities, recurrent instances of stroke, and vascular events in acute ischemic stroke patients with a variety of disease severities.

scholarly journals PENGARUH BACAAN MUROTTAL AL-QUR’AN YANG DIPERDENGARKAN PADA PASIEN STROKE ISKEMIK AKUT TERHADAP LUARAN KLINIS

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Susi Ifati ◽  
Dodik Tugasworo ◽  
Dwi Pudjonarko
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Hospital Anxiety ◽  
Control Groups ◽  
Chi Square ◽  
Control Group Design ◽  
And Control

    THE EFFECT OF HOLY QUR’AN HEARING ON CLINICAL OUTCOMES IN ACUTE ISCHEMIC STROKEABSTRACTIntroduction: Qur’an recitation has a high spiritual and religious value and effect to Islam believer, and also has beautiful and regular tone, so that it is believed to be useful to cure various diseases. Depression and anxiety are common, and add to worsening outcomes of stroke. There was spiritual correlation between decreased emotional distress and depression associated with poor outcome of stroke. Qur’an recitation could be used as spiritual relaxation technique, thus improve the effect of mental health.Aims: To determine effect of Qur’an recitation audio on anxiety, depression and National Institute of Health Stroke Scale (NIHSS) in acute ischemic stroke in Medical Faculty of Diponegoro University/dr. Kariadi Hospital, Semarang, Central Java Indonesia.Method: This was an intended to treat research with randomized pretest-posttest with control group design. Subjects were acute ischemic stroke patients with onset less than 72 hours, divided into treatment and control groups. Treatment was carried out for 7 days by playing Juz ‘Amma Qur’an recitation through headphone twice a day for 30 minutes at 06.00 am and 06.00 pm. Demographic data, risk factors, and Hospital Anxiety and Depression Scale (HADS) and NIHSS before and after treatment were assessed. The correlation of HADS and NIHSS between treatment and control were analyzed with Chi-square/Fisher test. Multivariate analysis was used to analyzed other factors affecting clinical outcomes.Result: Forty subjects were randomized into treatment or control groups. There was significant correlation between listening Juz ‘Amma Qur’an recitation with improvement of anxiety HADS and NIHSS. There was no correlation with improvement of depression HADS. Logistic regression analysis showed improvement of NIHSS after listening Juz ‘Amma Qur’an recitation.Discussion: Listening to the Qur’an recitation improved anxiety symptoms, improved clinical outcomes by 9.025 times compared to controls in acute ischemic stroke, thus can be considered to support the recovery of stroke patients.Keywords: Acute ischemic stroke, HADS, NIHSS, Qur’an recitationABSTRAKPendahuluan: Bacaan Al-Qur’an memiliki nilai spiritualitas dan religiositas yang tinggi serta memberikan efek ketenangan selain nadanya indah dan teratur, sehingga dapat digunakan untuk penyembuhan berbagai penyakit. Depresi maupun ansietas sering terjadi pada stroke yang menambah perburukan luaran. Terdapat hubungan spiritual pada penurunan ansietas dan depresi yang dihubungkan dengan luaran stroke yang buruk. Bacaan Al-Qur’an dapat digunakan sebagai teknik relaksasi spiritual sehingga didapatkan efek meningkatkan kesehatan mental.Tujuan: Untuk mengetahui pengaruh murottal Al-Qur’an yang diperdengarkan pada pasien stroke iskemik akut terhadap luaran klinis neurologis menggunakan skor National Institute of Health Stroke Scale (NIHSS), gangguan depresi dan ansietas di Fakultas Kedokteran Universitas Diponegoro/RSUP dr. Kariadi, Semarang, Jawa Tengah, Indonesia.Metode: Penelitian ini merupakan penelitian perlakuan randomized pretest-posttest control group design. Subjek adalah pasien stroke iskemik akut awitan kurang 72 jam, dibagi menjadi kelompok perlakuan dan kontrol. Perlakuan dilaksanakan 7 hari dengan memperdengarkan murottal Al-Qur’an Juz ‘Amma melalui headphone sehari 2 kali, durasi30 menit pukul 06.00 dan 16.00. Data yang diambil meliputi data demografi, faktor risiko stroke serta penilaian Hospital Anxiety and Depression Scale (HADS), dan NIHSS sebelum dan setelah perlakuan. Pengaruh perlakuan terhadap HADS, NIHSS menggunakan uji Chi-square/Fisher. Faktor-faktor lain yang berpengaruh pada luaran klinis juga dianalisis secara multivariat.Hasil: Sebanyak 40 subjek dilakukan random alokasi sebagai kelompok perlakuan berjumlah 20 subjek dan kelompok kontrol berjumlah 20 subjek. Terdapat hubungan bermakna antara memperdengarkan murottal Al-Qur’an dengan perbaikan HADS ansietas, dan perbaikan NIHSS. Tidak terdapat hubungan antara memperdengarkan murottal Al-Qur’an dan perbaikan HADS depresi. Analisis logistik regresi menunjukkan, memperdengarkan murottal Al-Qur’an berpengaruh pada perbaikan NIHSS pasien stroke iskemik akut.Diskusi: Memperdengarkan murottal Al-Qur’an memperbaiki gejala ansietas, memperbaiki luaran klinis sebesar 9,025 kali dibanding kontrol pada stroke iskemik akut sehingga dapat dipertimbangkan untuk menunjang pemulihan pasien stroke.Kata kunci: Murottal Al-Qur’an, NIHSS, skor HADS, stroke iskemik akut 

scholarly journals Clinical Impact of Estradiol/Testosterone Ratio in Patients with Acute Ischemic Stroke

2020 ◽  
Author(s):  
Jung-Won Choi ◽  
In Woo Ryoo ◽  
Jun Yeong Hong ◽  
Kyung-Yul Lee ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sex Hormones ◽  
Control Group ◽  
Control Groups ◽  
Sexual Hormones ◽  
Stroke Group ◽  
Male Patients ◽  
And Control

Abstract Background: Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). Methods: Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.Results: The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).Conclusions: These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

Intensive Statin Therapy for Acute Ischemic Stroke to Reduce the Number of Microemboli: A Preliminary, Randomized Controlled Study

2018 ◽  
Vol 80 (3-4) ◽  
pp. 163-170 ◽  
Author(s):  
Xingyu Chen ◽  
Xiaorong Zhuang ◽  
Zhongwei Peng ◽  
Huili Yang ◽  
Liangyi Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
High Sensitivity ◽  
Controlled Study ◽  
Statin Group ◽  
Pre Treatment ◽  
Hs Crp ◽  
And Control ◽  
Intensive Statin Therapy

Background: To assess whether intensive statin therapy reduces the occurrence of microemboli in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke within 72 h of onset were randomized to the intensive statin (atorvastatin 60 mg/day, adjusted to 20 mg/day after 7 days) and control (atorvastatin 20 mg/day) groups. Combined aspirin and clopidogrel were used for antiplatelet therapy. Microemboli were monitored by transcranial Doppler on days 1 (pre-treatment), 3, and 7. Metalloproteinase-9 (MMP-9), high-sensitivity C-reactive protein (hs-CRP), and National Institutes of Health Stroke Scale (NIHSS) score were assessed on days 1 and 7. The modified Rankin scale (mRS) was used on day 90. The primary outcome was the proportion of patients with microemboli on day 3. Results: There were 35 (58.3%) and 30 (52.6%) patients with microemboli in the intensive statin (n = 60) and control (n = 57) groups, respectively, on day 1 (p = 0.342). On day 3, there were significantly less microemboli in the intensive statin group (n = 9; 15.0%) compared with controls (n = 16; 28.1%; p = 0.002). No difference was observed in MMP-9 and hs-CRP levels on day 1, but on day 7, MMP-9 (median 79.3 vs. 95.9 μg/L; p = 0.004) and hs-CRP (median 2.01 vs. 3.60 mg/L; p = 0.020) levels were lower in the intensive statin group compared with controls. There were no differences in NIHSS scores on days 1 and 7. There was no difference in mRS on day 90. Conclusion: Intensive atorvastatin therapy in patients with acute ischemic stroke reduces the occurrence of microemboli and inflammation, with no overt adverse events.

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