Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis.

PURPOSE: To obtain normal ranges for the inner diameters of the carotid arteries. METHODS: This retrospective analysis included consecutive patients with disease-free carotid arteries who had undergone 3D-DSA at two hospitals in Nanning, Guangxi, between March 2013 and March 2018. Demographic and clinical characteristics, including Essen Stroke Risk Score (ESRS), were extracted from the medical records. The 3D-DSA data were used to calculate the inner diameters of the carotid arteries. RESULTS: The analysis included 1182 patients (837 males) aged 58.81 ± 11.02 years. The inner diameters of the proximal carotid sinus (CS), CS bulge, distal CS, and common carotid artery (CCA) were larger on the right than on the left (P < 0.05). The inner diameters of the proximal CS, CS bulge, distal CS, and CCA on both sides were larger for males than females (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients aged > 65 years than for patients aged ≤ 55 years (P < 0.05). Right CCA inner diameter did not vary with age, whereas left CCA inner diameter was larger for patients aged > 55 years than for patients aged ≤ 45 years (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients with ESRS ≥ 3 than those with ESRS < 3 (P < 0.05). CONCLUSION: This study provides reference values for the internal diameters of normal carotid arteries. Carotid artery diameters varied with side, sex, and age.

Comparison of Risk Scores for the Prediction of the Overall Cardiovascular Risk in Patients with Ischemic Stroke: The Athens Stroke Registry.

BACKGROUND: Stratification of overall vascular risk in patients with ischemic stroke is important as it may guide management decisions. Currently available schemes have only modest prognostic accuracy. The TRA2°P score aids in vascular risk stratification in patients with previous myocardial infarction (MI). AIM: We investigated whether the prognostic performance of TRA2°P can be extended in patients with ischemic stroke and whether it can improve the risk stratification made by CHA2DS2VASc and Essen-Stroke-Risk-Score (ESRS). METHODS: We analyzed the Athens Stroke Registry using Kaplan-Meier survival and Cox-regression analyses to assess if TRA2°P (in different categorizations) predicts the composite endpoint of stroke recurrence, MI or cardiovascular death. We compared its incremental predictive value over CHA2DS2-VASc and ESRS and calculated continuous net reclassification indices (cNRI). RESULTS: In 2833 patients (followed for 9278 patient-years) and 776 events, there was decreased survival probability for TRA2°P-based high-risk patients compared to low-risk (log-rank-test P < .001), but the discriminatory power for the occurrence of the composite endpoint was only modest (Harrell's-C:.566, 95% CI:.545-.587). Combined with ESRS, TRA2°P conferred incremental discrimination (Harrell's-C:.544, 95% CI:.513-.574 versus .574, 95% CI:.543-.605 respectively, P = .049) and reclassification value (cNRI = 9.8%, P = .02). Combined with CHA2DS2-VASc, TRA2°P did not improve discrimination (Harell's-C:.578, 95% CI: .547-.608 versus .585, 95% CI:.554-.616, P = .738). CONCLUSION: The currently available prognostic scores have generally low performance to predict the overall cardiovascular risk in ischemic stroke patients. Further research is needed to improve vascular risk stratification in ischemic stroke patients.

A Validation of the Essen Stroke Risk Score in Outpatients with Ischemic Stroke.

BACKGROUND: Little is known about the predictive accuracy of the Essen Stroke Risk Score (ESRS) for Chinese stroke outpatients. Our goal was to perform an external validation of the ESRS using a large multicenter cohort of outpatients with ischemic stroke (IS). METHODS: We estimated the 1-year cumulative event rates for both recurrent stroke and combined vascular events for patients in different ESRS categories using data from a prospective cohort of 3316 outpatients with IS admitted to 18 hospitals in China. In addition, we evaluated the predictive accuracy of the ESRS for both recurrent stroke and combined vascular events using C statistic. RESULTS: In the nonatrial fibrillation IS outpatients, the cumulative 1-year event rate was 2.47% (95% confidence interval [CI], 1.97%-3.06%) for recurrent stroke and 4.32% (95% CI, 3.65%-5.06%) for combined vascular events. The event rates were significantly higher in patients in higher ESRS categories. The ESRS had a predictive accuracy of .63 (.57-.69) for recurrent stroke and .63 (.58-.68) for combined vascular events. CONCLUSION: Among the Chinese outpatients with IS, the ESRS was able to stratify the risk of both recurrent stroke and combined vascular events equally well. A prediction model suitable for Chinese IS populations is needed.

Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort.

BACKGROUND AND PURPOSE: The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. METHODS: We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. RESULTS: 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. CONCLUSIONS: In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application.

The Predictive Value of Essen and SPI-II on the Risk of 5-Year Recurrence in Chinese Patients with Acute Ischemic Stroke.

Background: The risk prediction score for stroke recurrence is an important tool for stratifying patients based on the risk of cerebrovascular events and selecting potential preventive treatments. Objective: The study aimed to validate the Essen Stroke Risk Score (ESRS) and Stroke Prognosis Instrument II (SPI-II) for predicting long-term risk of stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke (AIS). Methods: A total of 876 consecutive patients with non-atrial fibrillation AIS were recruited. The Kaplan-Meier (KM) method was used to estimate the cumulative incidence of stroke recurrence and combined vascular events in different subgroups stratified by the ESRS and SPI-II scores. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of the two scores for stroke recurrence and combined vascular events. Results: The KM estimate for 5-year cumulative incidence of stroke recurrence and combined vascular events was 28.7% (95% confidence interval [CI], 25.4-32.0) and 35.6% (95% CI, 32.3-38.9), respectively, in Chinese AIS patients. The risk of stroke recurrence and combined vascular events were increased significantly with increasing ESRS and SPI-II scores. The ESRS and SPI-II scores had similar predictive accuracy for stroke recurrence (AUC 0.57 [95% CI 0.52-0.64] vs 0.59 [95% CI 0.55-0.64]) and combined vascular events (AUC 0.59 [95% CI 0.55-0.63] vs 0.62 [95% CI 0.58-0.66]) at 5 years. Conclusion: In Chinese patients with AIS, both ESRS and SPI-II scores were able to stratify the risk of 5-year recurrent stroke and combined vascular events. The predictive power of the two scores were modest and a prediction model suitable for Chinese IS populations is needed.

Evaluation of Risk Scores as Predictive Tools for Stroke in Patients with Retinal Artery Occlusion: A Danish Nationwide Cohort Study.

Purpose We investigated the 1-year risk of stroke in patients with retinal artery occlusion and evaluated the predictive and discriminating abilities of contemporary risk stratification models for embolic stroke. Methods This register-based cohort study included 7,906 patients with retinal artery occlusion from Danish nationwide patient registries between 1995 and 2018. The study population was stratified according to the number of points obtained in the stroke risk scores: the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score. The 1-year risk of stroke within strata was evaluated and compared using the cox proportional hazards model. Furthermore, the discrimination of the risk scores as predictive tools for stroke risk assessment was investigated using C-statistics, Brier score, and the index of prediction accuracy. Results The stroke event rate in patients with retinal artery occlusion increased as the score increased for both risk scores, ranging from 3.62 (95% confidence interval [CI]: 2.46-5.31) per 100 person-years to 13.25 (95% CI: 11.78--14.89) per 100-person-years for increasing levels of the CHA 2 DS 2 -VASc score and from 3.97 (95% CI: 2.97-5.32) per 100 person-years to 16.43 (95% CI: 14.01-19.27) per 100 person-years for increasing levels of the ESSEN Stroke Risk score. Using a risk score of 0 as a reference, the difference was statistically significant for retinal artery occlusion patients with a CHA 2 DS 2 -VASc score of 2 or above and for all levels of the ESSEN Stroke Risk score. The C-statistics for the risk scores was 61% (95% CI: 58%-63%) and 62% (95% CI: 59-64%) for the CHA 2 DS 2 -VASc score and ESSEN Stroke Risk score, respectively. Conclusion The results suggested that the use of the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score was applicable for risk stratification of stroke in patients with retinal artery occlusion, but discrimination was poor due to low specificity.

Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations.

BACKGROUND: Carotid atherosclerosis (CA) is closely related to stroke, and Framingham Risk Score (FRS) has been used for CA risk evaluation. However, FRS could only be used for subjects of up to 74 years old. The present study was to determine if Essen Stroke Risk Score (ESRS) could be used to estimate CA risk in community populations without age limits. METHODS: In the present prospective multi-community screening study, we evaluated the prevalence of CA using high-resolution ultrasound in 521 males and 1039 females (35 to 91 years old). Both FRS and ESRS were calculated for the subjects. Multivariate logistic regression analysis was used to determine the predictive values of FRS and ESRS for CA in these subjects. RESULTS: Ultrasound data showed that CA was present in 56.2% of the participants (total of 1560). Multivariate logistic regression analysis showed that ESRS was associated with CA with odds ratio (OR): 1.34 (95% confidence interval (CI), 1.12-1.60, p=0.001). Central obesity (OR: 1.40, CI: 1.07-1.83, p=0.015), female (OR: 0.55, CI: 0.39-0.77, p <0.001) and age (OR: 2.63, CI: 2.27-3.06, p <0.001) were also associated with CA. Based on the estimated area under curve (AUC), FRS (AUC 0.775) was better than ESRS (AUC 0.693) (z statistic 6.774, p <0.001) for CA prediction for individuals of ≤74 years old. However, receiver operating characteristic analysis showed ESRS was a good CA predictor for all subjects (AUC of 0.715). CONCLUSION: ESRS could be used as an alternative to FRS to predict CA in community population of all age.

An analysis of the risk of perioperative ischemic stroke in patients undergoing non-cardiovascular and non-neurological surgeries.

Objectives: This study aimed to assess the preoperative risk factor for perioperative ischemic stroke (PIS) in patients undergoing non-cardiovascular and non-neurological surgeries.Methods: Patients were retrospectively enrolled and grouped into two groups at a ratio of 1:2 according to their PIS status, i.e. patients with PIS in disease group, and patients without PIS in control group. Univariate analysis and multivariate logistic regression analysis were performed on admission laboratory test indices and preoperative risk factors for stroke. The pooled cohort equation (PCE), Essen Stroke Risk Score (ESRS), and Stroke Prognostic Instrument II (SPI-II) were used to separately assess the risk of stroke in patients with or without a history of stroke.Results: There were significant differences between the two groups in the levels of high-density lipoprotein cholesterol (HDL-C), prealbumin, renal insufficiency, dyslipidemia, coronary heart disease, anemia, and hemoglobin; the incidence of electrolyte disturbance; and previous histories of smoking, drinking, and stroke. Multivariate logistic regression analysis showed that renal insufficiency, histories of smoking and stroke, and decreased HDL-C can increase the risk of PIS. There were no significant differences between the disease group and the control group in ESRS or SPI-II score in patients with stroke history. There was a significant difference between the two groups in the risk of PIS evaluated by PCE in patients without stroke history.Conclusions: History of stroke and smoking, renal insufficiency, and low HDL-C are independent risk factors for PIS. It is feasible to assess the risk of stroke in preoperative patients using PCE in clinical practice.

A modified Essen Stroke Risk Score for predicting recurrent ischemic stroke at one year.

Objective The Essen Stroke Risk Score (ESRS) is widely used to predict the risk of recurrent ischemic stroke but may not have sufficient discriminatory ability for predicting early recurrence. In this study, we developed a modified ESRS for predicting recurrent ischemic stroke at one year based on Chinese population. Methods Eight hundred and three consecutive patients were included in the study. We performed a univariate analysis to investigate the effect of previously identified risk factors on recurrent stroke at one year. The candidate predictors were included in a forward stepwise logistic regression model. Prediction scores were assigned based on ß coefficient and a modified ESRS system was constructed. We used receiver operating characteristic (ROC) curves to compare the predictive ability of the modified and original ESRS. Results Recurrent ischemic stroke occurred in 85 (11.00%) patients and death occurred in 68 (8.80%) patients within one year. Hypertension over 15 years, diabetes over 10 years, large artery atherosclerosis cerebral infarction by TOAST criteria and a history of transient ischemic attack (TIA) or ischemic stroke (IS) were identified as independent risk factors for recurrent stroke (all P < 0.05). The areas under the ROC curves of ESRS and modified ESRS were 0.58 (P < 0.05, 95%CI: 0.51-0.64) and 0.70 (P < 0.05, 95% CI: 0.63-0.76), respectively. The modified ESRS appears to be superior to the original ESRS for predicting recurrent ischemic stroke at one year (P < 0.05). Conclusions The modified ESRS increased the ability of the original ESRS to predict recurrent stroke at one year among the Chinese population.

Antiplatelet Strategies and Outcomes in Patients with Noncardioembolic Ischemic Stroke from a Real-World Study with a Five-Year Follow-Up.

Aspirin and clopidogrel are both acceptable antiplatelet options for the secondary prevention of noncardioembolic ischemic stroke. Associations between Essen Stroke Risk Score (ESRS) and antiplatelet treatment in Chinese patients with noncardioembolic ischemic stroke were assessed. This retrospective study was taken in a tertiary care hospital located in eastern China. Patients with noncardioembolic ischemic stroke hospitalized during January 1, 2009, to December 31, 2011, were classified according to ESRS during index stroke hospitalization. Antiplatelet strategy at the time of discharge was categorized as aspirin (100 mg/day) vs. clopidogrel (75 mg/day). Patients received follow-up from July 1, 2014, to December 31, 2015, and the efficacy of clopidogrel and aspirin in different ESRS subgroups was assessed with respect to reducing the risk of a combined vascular event of recurrent stroke, myocardial infarction, or primary intracranial hemorrhage. Totally, 1175 non-cardiac stroke patients were included, among which 878 patients completed follow-up surveys. Of the patients who completed the follow-up, 458 (52.2%) had an ESRS > 3, and 621 (70.7%) received aspirin. Patients who received clopidogrel tended to be older, and more patients had hypertension, diabetes, and an ESRS > 3 than patients who received aspirin. Over a mean follow-up of 5.2 years, the rate of combined vascular events was 19.3% in the aspirin group and 16.7% in the clopidogrel group. Compared with clopidogrel-treated patients, a significant (P = 0.044) reduction in combined vascular events in aspirin-treated patients was observed in patients with an ESRS ≤ 3 (OR, odds ratio 0.5; 95% CI 0.3 to 0.9). However, a significant (P = 0.002) increase in combined vascular events was observed in patients with an ESRS > 3 (OR 2.2; 95% CI 1.3 to 3.8). More clopidogrel-treated patients with ESRS < 3 and ESRS = 3 discontinued treatment than their counterparts who took aspirin (P < 0.05). Adverse drug events, such as digestive discomfort and bleeding, were similar. In conclusion, clopidogrel is suggested for patients with an ESRS > 3 and aspirin for patients with an ESRS ≤ 3 for the secondary prevention of noncardioembolic ischemic stroke in Chinese patients.