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1.
Medicine (Baltimore) ; 99(9): e19252, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118731

RESUMEN

Stroke is a serious disease that can lead to disability and death in adults, and the prediction of functional outcome is important in the management of acute ischemic stroke (AIS). Blood biomarker is a promising technique, for the measurement is fast, cheap and convenient. Visinin-like protein-1 (VILIP-1) is a classic stroke biomarker, thus we tried to investigate the predictive value of VILIP-1 for early functional outcomes of AIS.A total of 70 AIS patients were enrolled in our study. Venous blood samples of all patients were taken at day 3 after admission to the stroke unit, and levels of serum VILIP-1 were analyzed by the use of the enzyme-linked immunosorbent assay. All subjects underwent diffusion weighted imaging (DWI) of the brain MRI scanning at 72 hours after stroke onset, and infarct volumes were calculated. Initial neurological status was evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission. The short-term functional outcome was graded by the modified Rankin Scale (mRS) at discharge from the hospital. Baseline data between the favorable outcome group and poor outcome group were compared, and univariate and multivariable logistic regression analysis were used to identify risk factors of early functional outcome of AIS.The multivariate logistic regression analysis showed age, initial NIHSS scores and levels of VILIP had a strong association with poor clinical outcomes.Levels of serum VILIP-1 are associated with short-term functional outcomes in patients with AIS.


Asunto(s)
Neurocalcina/sangre , Accidente Cerebrovascular/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/mortalidad , Adulto Joven
2.
J Rehabil Med ; 52(2)2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-31960066

RESUMEN

Repetitive, task-specific practice increases functioning of the paretic upper extremity and decreases upper extremity motor impairment. One method to increase participation in repetitive, task-specific practice is an upper extremity myoelectric device, called the "Myomo", which uses surface electromyography signals to assist with active movement of the moderately impaired hemiplegic upper extremity. To determine the efficacy of regimens comprised of: () Myomo + repetitive, task-specific practice; () repetitive, task-specific practice only; and () Myomo only on outcomes for hemiplegic arm. Using a randomized, controlled, single-blinded design, 34 subjects (20 males; mean age 55.8 years), exhibiting chronic, moderate, stable, post-stroke, upper extremity hemiparesis, were included. Participants were randomized to one of the above conditions, and administered treatment for 1 h/day on 3 days/week over an 8-week period. The primary outcome measure was the upper extremity section of the Fugl-Meyer Impairment Scale (FM); the secondary measurement was the Arm Motor Activity Test (AMAT). The groups exhibited similar score increases of approximately +2 points, resulting in no differences in the amount of change on the FM (H= 0.376, = 0.83) and AMAT (H= 0.978 = 0.61). The results suggest that a therapeutic approach integrating myoelectric bracing yields highly comparable outcomes to those derived from repetitive, task-specific practice-only. Myoelectric bracing could be used as alternative for labour-intensive upper extremity training due to its equivalent efficacy to hands-on manual therapy with moderately impaired stroke survivors.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/mortalidad , Análisis de Supervivencia
3.
Khirurgiia (Mosk) ; (1): 67-73, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-31994502

RESUMEN

OBJECTIVE: To compare long-term outcomes in patients after carotid endarterectomy and those who refused surgical correction and received only conservative treatment. MATERIAL AND METHODS: There were 1035 carotid endarterectomies performed at the Kemerovo Regional Clinical Hospital and Kemerovo Regional Clinical Cardiology Dispensary for the period 2014-2017. Surgery was refused by 136 patients for the same time. Thus, two groups of patients were formed: 1 - carotid endarterectomy group; 2 - conservative treatment group. INCLUSION CRITERIA: significant carotid stenosis, absence of severe neurological deficit (over 25 scores by the National Institutes of Health Stroke Scale), absence of concomitant diseases limiting long-term follow-up. RESULTS: Lethal outcome (p=0.0038) and fatal acute cerebrovascular accident (p=0.0005) were significantly more common in the 2nd group in long-term follow-up period. Thus, combined endpoint took the greatest values in patients who refused surgery compared with patients who received surgical treatment (p=0.0001). It should be noted that ischemic stroke de novo occurred in 9 (6.6%) patients of the 2nd group after 10.8 ± 2.5 months. This complication required subsequent hospitalization for carotid endarterectomy. CONCLUSION: Preventive role of carotid endarterectomy was convincingly proved in comparison with drug therapy regarding mortality and fatal ischemic stroke in patients with significant carotid stenoses within 2.5 years of follow-up period.


Asunto(s)
Estenosis Carotídea/tratamiento farmacológico , Estenosis Carotídea/cirugía , Tratamiento Conservador/mortalidad , Endarterectomía Carotidea/mortalidad , Estenosis Carotídea/complicaciones , Estenosis Carotídea/mortalidad , Tratamiento Conservador/efectos adversos , Estudios de Seguimiento , Humanos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Resultado del Tratamiento
4.
J Stroke Cerebrovasc Dis ; 29(1): 104465, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704123

RESUMEN

BACKGROUND: The Kingdom of Saudi Arabia has a young but ageing population, leading to concerns for planning for future growth in the number of strokes to provide necessary care. An understanding of the expected evolution of stroke incidence is therefore necessary to plan infrastructure changes. Our aim was to predict the number of first strokes occurring in Saudi Arabia over a 10-year period. METHODS: An epidemiological model was developed, using local mortality and population data to model changes in the population. Gender- and age-specific stroke rates were then applied to the population projections to estimate the number of first strokes occurring over a 10-year period. Stroke incidence data from a range of sources were applied to obtain a plausible range for the change in expected number of first strokes. RESULTS: The model predicted population growth of 12.8% over the 10-year period. Depending on the stroke incidence data applied, the number of first strokes occurring during this time was predicted to increase within the range 57%-67%. CONCLUSIONS: A growing and ageing population is expected to lead to a substantial increase in the number of first strokes occurring in Saudi Arabia in the coming decade. Our results suggest that stroke care services will need to be expanded to continue to ensure high quality care, and that strategies for stroke prevention will play an important role in reducing the overall burden. This type of analysis can be applied to other countries' stroke policy planning.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Distribución por Edad , Femenino , Predicción , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Incidencia , Masculino , Cadenas de Markov , Evaluación de Necesidades/tendencias , Formulación de Políticas , Dinámica Poblacional , Arabia Saudita/epidemiología , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo
5.
J Stroke Cerebrovasc Dis ; 29(2): 104528, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806451

RESUMEN

BACKGROUND: Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels have been related to clinical outcome in stroke patients. However, the role of hs-cTnT and its potential as a biomarker in ischaemic stroke (IS) has not been well established. This study aims to determine whether basal hs-cTnT determination in the hyperacute phase of undetermined IS and transient ischaemic attack (TIA) can predict the cardioembolic aetiology and clinical outcome. METHODS: We prospectively studied 110 consecutive patients with undetermined acute IS and TIA. hs-cTnT levels were determined at hospital arrival. Large vessel stenosis/occlusion and previously known aetiologies at admission were exclusion criteria for this study. All patients were subjected to a complete aetiological evaluation. A 12-month follow-up was performed in all patients. The subtype of IS was evaluated following the SSS-TOAST criteria. We established two groups at admission: cardioembolic aetiology (group A) and noncardioembolic aetiologies (group B). RESULTS: The number of patients in each group was similar (group A: 52, 47.27%; group B, 58, 52.73%). Patients in group A had elevated hs-cTnT more frequently (61.54% versus 17.24%; P < .001). Group A patients had significantly higher mortality at 3 months (14.29% versus 1.82%, P = .025). In the multivariate analysis, elevated hs-cTnT was the only independent predictor of cardioembolic aetiology (odds ratio: 14.821; 95% confidence interval: 3.717-59.102, P < .001). CONCLUSION: Baseline hs-cTnT assessment in undetermined strokes and TIA during the hyperacute phase is independently associated with cardioembolic aetiology.


Asunto(s)
Isquemia Encefálica/etiología , Cardiopatías/sangre , Embolia Intracraneal/etiología , Ataque Isquémico Transitorio/etiología , Accidente Cerebrovascular/etiología , Troponina T/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Humanos , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/mortalidad , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/mortalidad , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Regulación hacia Arriba
6.
J Stroke Cerebrovasc Dis ; 29(2): 104537, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806454

RESUMEN

BACKGROUND AND PURPOSE: The safety and efficacy of intravenous thrombolytic therapy (IVT) for posterior circulation stroke (PCS) in the real world are rarely studied. This study was designed to evaluate the prestroke and baseline characteristics, stroke sub-types, complications, and outcomes of PCS patients and compare them with anterior circulation stroke (ACS) after intravenous thrombolysis. METHODS: Data of consecutive patients with PCS and ACS treated with alteplase in a standard dose of 0.9 mg/kg in our stroke center were collected and analyzed retrospectively. Presenting characteristics, hemorrhage transformation, mortality, and favorable outcomes (modified Rankin scale 0 or 1) at 90 days were compared between PCS and ACS patients. RESULTS: A total of 462 patients were included in this study, including 350 (75.8%) in ACS group and 112 (24.2%) in PCS group. A history of coronary artery disease was significantly more common in ACS patients than that in PCS patients (15.1% versus 6.3%, P = .015). There was no significant difference in fast glucose and baseline NIHSS scores between PCS and ACS groups. In PCS group, 7 patients (6.3%) had hemorrhage transformation after IVT and 5 patients (4.5%) were symptomatic versus 32 (9.1%) and 22 (6.3%) in ACS group (P > .05). 75.5% PCS patients versus 72.2% ACS patients had excellent recovery outcomes (mRS 0-1) at 90 days (P = .507). For PCS patients, logistic regression analysis after adjusting the covariates identified age (P = .047, OR .920, 95% CI = .847-.999) and atrial fibrillation (P = .007, OR 12.149, 95% CI = 1.966-75.093) as independent significant predictors of hemorrhage transformation. In addition, atrial fibrillation was also an independent predictor of symptomatic intracranial hemorrhage (P = .008, OR 21.176, 95% CI = 2.228-201.273). Multivariate logistic analysis identified hemorrhage transformation (P = .012; OR .131, 95% CI = .027-.644) and onset to drug time (P = .026, OR 1.006, 95% CI = 1.001-1.011) as independent predictors of functional independence (mRS 0-2). Symptomatic intracranial hemorrhage (P = .007, OR 15.094, 95% CI = 2.097-108.661) and baseline NIHSS score (P = .050; OR 1.070, 95% CI = 1.000-1.145) were independent predictors of mortality. CONCLUSION: Our results suggest that IVT in PCS patients is safe and effective as that in ACS patients. In PCS patients, long onset to needle time and hemorrhage transformation were identified as independent predictors of unfavorable outcomes.


Asunto(s)
Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Factores de Edad , Anciano , Circulación Cerebrovascular , Evaluación de la Discapacidad , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Hemorragias Intracraneales/inducido químicamente , Masculino , Persona de Mediana Edad , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento
7.
J Stroke Cerebrovasc Dis ; 29(2): 104529, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806455

RESUMEN

BACKGROUND: Controversial evidence suggests that right insular stroke may be associated with worse outcomes compared to the left insular ischemic lesion. OBJECTIVES: We investigated whether lateralization of insular stroke is associated with early and late outcome in terms of in-hospital complications, stroke recurrence, cardiovascular events, and death. METHODS: Data were prospectively collected from the Athens Stroke Registry. Insular cortex involvement was identified based on brain CT scans or MRI images. Patients were followed up prospectively at 1, 3, 6 months after hospital discharge and yearly thereafter up to 5-years or until death. The assessed outcomes were in-hospital complications, functional outcome assessed by the modified Rankin Scale, stroke recurrence, cardiovascular events, and death. Cox-regression analysis was performed to estimate the cumulative probability of each outcome according to the lateralization of insular strokes. RESULTS: Among the 1212 patients, 650 had left insular stroke involvement and 562 had right. New onset of in-hospital atrial fibrillation was similar between right and left insular strokes (11.6% versus 12.9%, P = .484). During the 5-year follow-up sudden death occurred in 21 (3.7%) patients with right insular compared to 30 (4.6%) with left insular stroke (P = .476). There was no difference between left and right insular strokes regarding mortality (adjusted odds ratio [OR]: .92, 95% confidence interval [CI]: .80-1.06), stroke recurrence (4.3% versus 4.9%; adjusted OR: .81 95% CI: .58-1.13), cardiovascular events, and sudden death (adjusted OR: .99, 95% CI: .76-1.29) and on death and dependency (adjusted OR: .88, 95% CI: .75-1.02) during a 5-year follow up. CONCLUSIONS: Lateralization of insular ischemic stroke involvement is not associated with stroke outcomes.


Asunto(s)
Isquemia Encefálica/fisiopatología , Corteza Cerebral/irrigación sanguínea , Lateralidad Funcional , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Causas de Muerte , Circulación Cerebrovascular , Progresión de la Enfermedad , Femenino , Grecia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Recurrencia , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo
8.
J Stroke Cerebrovasc Dis ; 29(2): 104556, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31818682

RESUMEN

BACKGROUND: Ischemic stroke is an emergency with elevated risk for morbidity and mortality. Hypoxia is harmful in acute ischemic stroke. Recent evidence raises concerns regarding hyperoxia as well in acute illness, and for supplemental oxygen therapy when SpO2greater than 92%. Current AHA/ASA guidelines recommend maintaining SpO2greater than 94%. In this study, we aimed to assess the relationship between the oxygenation levels within the first 6-hour of ischemic stroke admission and mortality. METHODS: With the approval of the Human Studies Committee (IRB #: 13.0396), we performed a retrospective cohort study of ischemic stroke patients consecutively admitted to our hospital in the years 2013-14 and 2017-18 (n = 1479). Relationship between the first 6 hours oxygenation status and in-house mortality was assessed. SpO2/FiO2 ratio was used as the oxygenation outcome parameter. Patients who were intubated at admission were excluded. Additionally, demographics, baseline confounding factors, neurological status, and laboratory values on admission were examined for their association with mortality in a multivariate logistic regression analysis. RESULTS: Mean age of patients was 64 ± 15 years. Time interval from last seen normal to hospital admission was 7 ± 5 hours (mean ± standard deviation). NIHSS on arrival was 41-9 (median-IQR). Fourteen percent of patients received IV alteplase and 6% were treated with mechanical thrombectomy. Baseline SpO2 was 97 ± 2%, and 47% of the patients required supplemental oxygen treatment per AHA/ASA guidelines. In hospital mortality rate of this cohort was 5.7%. Lower mean SpO2 /FiO2 levels were strongly correlated with increasing mortality rates (R2 = .973). Age (1.048 [1.028-1.068]), NIHSS (1.120 [1.088-1.154]), WBC (1.116 [1.061-1.175]) and Mean SpO2/FiO2 (.995 [.992-.999]) independently risk associated with mortality. CONCLUSIONS: Baseline oxygenation varies within the acute ischemic stroke patient population. In this retrospective cohort study, we are reporting a strong association between lower SpO2/FiO2 levels in the first few hours of admission and mortality. In the light of these results, we plan to prospectively assess the role of oxygenation further in the context of recanalization status of stroke.


Asunto(s)
Isquemia Encefálica/sangre , Hiperoxia/sangre , Oxígeno/sangre , Accidente Cerebrovascular/sangre , Anciano , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Femenino , Mortalidad Hospitalaria , Humanos , Hiperoxia/diagnóstico , Hiperoxia/mortalidad , Hiperoxia/terapia , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Trombectomía , Terapia Trombolítica , Factores de Tiempo , Resultado del Tratamiento
9.
J Stroke Cerebrovasc Dis ; 29(2): 104490, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31839547

RESUMEN

BACKGROUND: Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected. OBJECTIVE: We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF. METHODS: We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios. RESULTS: We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death. CONCLUSIONS: In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death.


Asunto(s)
Fibrilación Atrial/mortalidad , Complejos Atriales Prematuros/mortalidad , Isquemia Encefálica/mortalidad , Ataque Isquémico Transitorio/mortalidad , Accidente Cerebrovascular/mortalidad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/fisiopatología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Dinamarca/epidemiología , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Pronóstico , Estudios Prospectivos , Recurrencia , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo
10.
J Stroke Cerebrovasc Dis ; 29(2): 104480, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31780246

RESUMEN

OBJECTIVES: Acute ischemic stroke is one of the leading causes of death. Patient outcomes, such as in-patient mortality, may be impacted by the time of arrival to the hospital. Telestroke networks have been found to be effective and safe at treating acute ischemic strokes. This paper investigated the association between mortality and time of arrival and hospital's participation in a telestroke network. METHODS: Data were collected on ischemic stroke patients who arrived at 15 nonteaching hospitals in Georgia's Paul Coverdell Acute stroke registry from 2009 to 2016. After controlling for patient and hospital characteristics, multivariate logistic regression was conducted to assess whether time of arrival and telestroke participation was associated with in-hospital mortality. Subgroup analysis was conducted based on hospital bed size. RESULTS: Overall, a total of 19,759 admissions for acute ischemic stroke were included in this analysis. The odds of dying in the hospital when arriving during the nighttime are 1.22 times the odds of dying when arriving during the day (95% CI: 1.04-1.45) and the odds of dying at a telestroke hospital are 53% lower than at a nontelestroke hospital (OR .47, 95% CI .31-.71). The associations were more prominent in large hospitals. CONCLUSIONS: Our study found that the hour of arrival for acute ischemic stroke is linked with in-hospital mortality in large hospitals, with patients more likely to die if they arrive during the nighttime hours as compared to the daytime hours. Telestroke participation is linked with lower odds of hospital mortality in all hospitals.


Asunto(s)
Atención Posterior , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Mortalidad Hospitalaria , Admisión del Paciente , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Telemedicina/organización & administración , Adolescente , Adulto , Anciano , Isquemia Encefálica/diagnóstico , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Georgia/epidemiología , Capacidad de Camas en Hospitales , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
11.
J Stroke Cerebrovasc Dis ; 29(2): 104559, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31836360

RESUMEN

OBJECTIVES: This study aimed to examine the temporal trend of 30-day and 1-year mortality among U.S. Medicare beneficiaries who were hospitalized for ischemic stroke, with special focus on the mortality among subgroup of patients in relation to acute reperfusion therapies including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). METHODS: We evaluated Medicare fee-for-service beneficiaries age 65 years or older who were hospitalized for ischemic stroke between 2009 and 2013. Multivariable Cox proportional hazards models were generated to analyze the trend of adjusted mortality. RESULTS: A total of 1,070,574 patients were included in the study. The 30-day mortality did not change among patients who were not treated with IVT or EVT. It decreased by 13% among patients treated with IVT but not EVT (HR = .87, 95% CI .82-.92), 25% among patients treated with EVT but not IVT (HR = .75, 95% CI .59-.95), and 37% among patients treated with both IVT and EVT (HR = .63, 95% CI .52-.77). One-year mortality decreased by 19% among patients who were not treated with IVT nor EVT (HR = .81, 95% CI .80-.83), 22% among those treated with IVT but not EVT (HR = .78, 95% CI .75-.81), 33% among those treated with EVT but not IVT (HR = .67, 95% CI .55-.81), and 38% among those treated with both IVT and EVT (HR = .62, 95% CI .53-.73). CONCLUSIONS: From 2009 to 2013, the 30-day stroke case fatality decreased only among the patients received reperfusion therapy. The 1-year mortality declined among all the stroke patients, with the greatest decline among those treated with both IVT and EVT.


Asunto(s)
Isquemia Encefálica/mortalidad , Beneficios del Seguro/tendencias , Medicare/tendencias , Accidente Cerebrovascular/mortalidad , Trombectomía/mortalidad , Terapia Trombolítica/mortalidad , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Terapia Combinada , Femenino , Humanos , Masculino , Mortalidad/tendencias , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Trombectomía/efectos adversos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología
12.
Ann Vasc Surg ; 62: 166-172, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30763710

RESUMEN

BACKGROUND: Primary closure (PC) and patch angioplasty (PA) during carotid endarterectomy (CEA) have been disputed in many studies. Some studies announced that PC is associated with a higher restenosis rate. The aim of this study was to evaluate the outcomes of PC and PA using propensity score matching (PSM). METHODS: Between November 1994 and October 2016, 1,044 patients underwent primary CEA procedures at our institution and were retrospectively analyzed. The study endpoints included rates of ipsilateral stroke, any clinical stroke, cranial nerve palsy, hematoma, bleeding warranting repeat surgery within 30 postoperative days. We also investigated the restenosis rates, overall survival, stenosis-free survival, and stroke-free survival during follow-up (median follow-up 37.1 months). RESULTS: This study includes 435 cases of PC and 476 cases of PA. After PSM analysis, baseline characteristics (age, gender, hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, previous percutaneous coronary intervention or coronary artery bypass grafting, contralateral carotid occlusion, degree of carotid stenosis, and symptomatic status within 6 months) were balanced. Finally, 377 pairs of matched cases were analyzed. Statistical analysis showed no significant differences between the 2 groups in ipsilateral stroke (P = 0.45), clinical stroke (P = 0.75), cranial nerve palsy (P = 1), hematoma (P = 0.18), bleeding which required reoperation (P = 0.12) within 30 postoperative days, and restenosis rates during follow-up (P = 0.16). In addition, there were no differences between the 2 groups during follow-up in overall, stroke-free, and restenosis-free survival with P values of 0.136, 0.07, and 0.06, respectively. CONCLUSIONS: According to the analysis using PSM, there were no significant differences between PC and PA closure during CEA in perioperative and long-term outcomes.


Asunto(s)
Angioplastia , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Pericardio/trasplante , Técnicas de Sutura , Anciano , Anciano de 80 o más Años , Angioplastia/efectos adversos , Angioplastia/mortalidad , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/mortalidad , Investigación sobre la Eficacia Comparativa , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Técnicas de Sutura/efectos adversos , Técnicas de Sutura/mortalidad , Factores de Tiempo
13.
Ann Vasc Surg ; 62: 15-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31201981

RESUMEN

BACKGROUND: Guidelines recommend that patients with carotid artery stenosis ≥50% (Sx-CAS) undergo carotid endarterectomy (CEA) within 14 days of symptoms. However, perioperative risks, especially stroke, may be increased when CEA is performed within 48 hours. This study seeks to more fully evaluate the effect of timing of surgery on outcomes for Sx-CAS. METHODS: All CEAs in the Southern California Vascular Outcomes Improvement Collaborative (SoCal VOICe) from 2012 to 18 were reviewed. Ipsilateral cortical or visual symptoms within 6 months defined Sx-CAS. Timing from symptom occurrence to CEA was classified as immediate (0-2 days), early (3-14 days), or delayed (>14 days). Perioperative stroke, myocardial infarction (MI), and 30-day mortality rates were compared by time to surgery. RESULTS: Of 2203 CEAs, 436 (20%) were for Sx-CAS (52% stroke, 48% transient ischemic attack). Mean time from symptoms to CEA was 28.3 days (range, 0-172; median, 14 days). Sixty-one cases (14%) were immediate, 166 (38%) early, and 209 (48%) delayed. Perioperative stroke occurred in 2.8% and stroke/MI/30-day mortality in 5.7%. Stroke rate was significantly higher in the immediate group (vs. early and delayed): 8.2%, versus 3.0%, and 0.96%, respectively (P = 0.009). Stroke/MI/30-day mortality was also higher in the immediate group: 13.1%, versus 6.0%, and 3.3%, respectively (P = 0.001). Immediate surgery was associated with greater postoperative events (P = 0.009), and logistic regression confirmed decreased risk of postoperative stroke and stroke/MI/30-day mortality in delayed surgery using immediate surgery as a reference. Wide variability existed among centers in the timing of CEA (immediate-range, 0-50%; delayed-range, 41-83%; P = 0.01). CONCLUSIONS: In the SoCal VOICe, 52% of patients undergo CEA within 2 weeks of symptoms. Increased stroke rates occur when CEA is performed within 2 days, whereas stroke and death rates are decreased at 3-14 days and beyond. These data support avoidance of immediate CEA. Opportunity exists to standardize timing of CEA for Sx-CAS among SoCal VOICe participants. Further study is required to define the role of immediate CEA.


Asunto(s)
Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Infarto del Miocardio/etiología , Accidente Cerebrovascular/etiología , Tiempo de Tratamiento , Anciano , California , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/mortalidad , Bases de Datos Factuales , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento
14.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190013.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800852

RESUMEN

INTRODUCTION: Unspecified stroke (UnST) is of great importance in mortality statistics, as it is the fourth leading cause of death in Brazil. The objective of this study was to identify the profile of reclassified causes of death after investigation of deaths caused by UnST in Brazil. METHODS: All deaths registered as UnST in 2017 in the Mortality Information System (SIM) were considered as garbage codes. The specific causes, detected after investigation in 60 selected cities, were analyzed by age and sex. RESULTS: Of the total deaths due to UnST identified in these 60 cities (n = 11,289), 25.8% were investigated. Of these, 56.3% were reclassified to ischemic stroke, 12.7% to hemorrhagic stroke, and 23.3% to other specific causes, such as diabetes and chronic kidney disease, in both sexes. DISCUSSION: The higher proportion of deaths due to ischemic stroke in comparison to hemorrhagic stroke was expected. However, the detection of other specific causes outside the stroke group indicates possible quality problems in the filling of death certificate (DC). CONCLUSION: The investigations allowed the identification of subgroups of deaths due to stroke. In addition to the research, however, it is important to conduct physician training in the adequate filling in of the DC, in order to improve estimates of specific stroke mortality, and to enable appropriate targeting of health actions and services.


Asunto(s)
Causas de Muerte , Accidente Cerebrovascular/mortalidad , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Ciudades/epidemiología , Estudios Transversales , Certificado de Defunción , Femenino , Geografía , Humanos , Sistemas de Información , Masculino , Persona de Mediana Edad , Distribución por Sexo , Accidente Cerebrovascular/etiología
15.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(8. Vyp. 2): 5-12, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31825357

RESUMEN

AIM: To analyze epidemiological data and predict the morbidity and mortality of stroke for a 5-year period in different age groups. MATERIAL AND METHODS: The study of indicators of morbidity and mortality of stroke was conducted on the basis of data on the population aged 25 years and older from the territorial population register for 2009-2016 and covered 8 study areas. A total of 25.504 cases of primary stroke were analyzed in four age groups: young age, middle age, old age, oldest age. The prognosis of indicators of morbidity and mortality was made using the ARIMA (autoregressive integrated moving average) method. RESULTS AND CONCLUSION: The study revealed positive dynamics for 2009-2016 to reduce the incidence of stroke in middle age and old age. The morbidity in the group of young people in 2016 was lower than in 2009, though the difference was not significant. In the group of oldest age, there was a tendency to increase the incidence rate since 2012, the growth rate reached 10% per year. Prediction of stroke incidence for 5 years was impossible in all age groups due to the lack of significant autocorrelations. Positive dynamics of reduction of mortality of stroke was observed among middle, old and oldest age. The highest rate of decline in mortality was observed in middle aged and old people amounting to about 30% in 2012. Among the oldest age, the dynamics of the reduction of mortality rate was less pronounced. Among young people, the death rate has not changed since 2009 by 2016 and amounted to 0.05 per 1000 people. Prediction of the mortality rate for middle age assumes a decrease in mortality by 2019 inclusive with further stabilization of the indicator until 2021. The prognosis of mortality in old age suggests a gradual slight increase (about 1.5%) over the entire forecast horizon. Taking into account the progress in the 8-year decline by 81%, the projected growth does not change the burden of stroke in the old age.


Asunto(s)
Morbilidad , Sistema de Registros , Accidente Cerebrovascular , Adolescente , Adulto , Humanos , Incidencia , Persona de Mediana Edad , Pronóstico , Accidente Cerebrovascular/mortalidad
16.
Cardiovasc Ther ; 2019: 1607181, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31867054

RESUMEN

Aim: Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to compare clopidogrel versus aspirin monotherapy in this population. Methods: PubMed, Embase, and CENTRAL databases were searched from inception to May 2018 to identify clinical trials and observational studies comparing clopidogrel versus aspirin for secondary prevention in patients with recent ischemic stroke within 12 months. Pooled effect estimates were calculated using a random effects model and were reported as risk ratios with 95% confidence intervals. Results: Five studies meeting eligibility criteria were included in the analysis. A total of 29,357 adult patients who had recent ischemic stroke received either clopidogrel (n = 14, 293) or aspirin (n = 15, 064) for secondary prevention. Pairwise meta-analysis showed a statistically significant risk reduction in the occurrence of major adverse cardiovascular and cerebrovascular events (risk ratio 0.72 [95% CI, 0.53-0.97]), any ischemic or hemorrhagic stroke (0.76 [0.58, 0.99), and recurrent ischemic stroke (0.72 [0.55, 0.94]) in patients who received clopidogrel versus aspirin. The risk of bleeding was also lower for clopidogrel versus aspirin (0.57 [0.45, 0.74]). There was no difference in the rate of all-cause mortality between the two groups. Conclusions: The analysis showed lower risks of major adverse cardiovascular or cerebrovascular events, recurrent stroke, and bleeding events for clopidogrel monotherapy compared to aspirin. These findings support clinical benefit for single antiplatelet therapy with clopidogrel over aspirin for secondary prevention in patients with recent ischemic stroke.


Asunto(s)
Aspirina/uso terapéutico , Isquemia Encefálica/tratamiento farmacológico , Clopidogrel/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prevención Secundaria/métodos , Accidente Cerebrovascular/tratamiento farmacológico , Aspirina/efectos adversos , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Clopidogrel/efectos adversos , Hemorragia/inducido químicamente , Humanos , Inhibidores de Agregación Plaquetaria/efectos adversos , Recurrencia , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento
17.
J Stroke Cerebrovasc Dis ; 28(12): 104415, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31669071

RESUMEN

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.


Asunto(s)
Isquemia Encefálica/diagnóstico , Enfermedades Cardiovasculares/diagnóstico , Técnicas de Apoyo para la Decisión , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Causas de Muerte , Femenino , Grecia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Sistema de Registros , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo
18.
J Stroke Cerebrovasc Dis ; 28(12): 104450, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31676160

RESUMEN

BACKGROUND: Stroke is a leading cause of death and disability in the developed world. The major factor affecting long term survival (other than age) is known to be the severity of disability. Yet to our knowledge there are no studies reporting life expectancies stratified by both age and severity. Remaining life expectancy is a key measure of health. METHODS: We identified 11 long-term follow-up studies of stroke patients that reported the multivariate effects of age, sex, the modified Rankin Scale (mRS) grade of disability, and other factors. From these we computed the composite effects of these factors on survival, then used these to calculate age-, sex-, and mRS-specific mortality rates. Finally we used the rates to construct life tables, and hence obtain life expectancies. RESULTS: Life expectancy varies by age, sex, and mRS. The life expectancies of males age 70, for example, were 13, 13, 11, 8, 6, and 5 years for Rankin Grades 0-5, respectively, representing reductions of 1, 1, 3, 6, 8, and 9 years from the corresponding general population figure. CONCLUSIONS: These figures demonstrate the importance of rehabilitation following stroke, and can be used in discussion of public policy and benchmarking of future results.


Asunto(s)
Esperanza de Vida , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Rehabilitación de Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento
19.
Neurology ; 93(24): e2170-e2180, 2019 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-31719135

RESUMEN

OBJECTIVE: To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data. METHODS: Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. RESULTS: There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94). CONCLUSIONS: This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.


Asunto(s)
Factores Sexuales , Accidente Cerebrovascular , Resultado del Tratamiento , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia
20.
Behav Neurol ; 2019: 5406923, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565095

RESUMEN

Objectives: Unknown onset stroke (UOS) is usually excluded from intravenous thrombolysis concerning the unclear symptom onset time. Attempts have been done to use thrombolytic therapy in these patients. The current meta-analysis was done to examine the efficacy and safety of intravenous thrombolysis in UOS. Methods: PubMed, Web of Science, and Cochrane Library were searched for studies comparing thrombolysis with conservative therapy among UOSs. Data of good outcome (mRS, 0-2), mortality, and intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) were extracted and analyzed using the Revman 5.2 software. Results: In total, 8 studies with 1271 subjects (542 with thrombolysis and 729 with conservative therapy) were included in this meta-analysis. The data showed that patients receiving thrombolysis had a higher incidence of 90-day good outcome (P = 0.0005) than conservative therapy. The comparison of discharge (P = 0.89) and 90-day mortality (P = 0.10) in both groups did not find any significances. The incidences of ICH (P = 0.42) and sICH (P = 0.06) were relatively comparable between the two therapies. Conclusions: Intravenous thrombolysis is a better choice for UOS patients for its efficacy and safety. In addition, pretreatment imaging assessment is beneficial for improving the efficacy of thrombolytic therapy. However, it needs more supporting evidences for clinical use in the future.


Asunto(s)
Accidente Cerebrovascular/terapia , Terapia Trombolítica/mortalidad , Terapia Trombolítica/métodos , Administración Intravenosa/métodos , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/tratamiento farmacológico , Hemorragia Cerebral/tratamiento farmacológico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/mortalidad , Resultado del Tratamiento
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