Cortical Neuronal Damage in Atherosclerotic Large Artery Disease
Yamauchi H, Kagawa S, Kishibe Y, Takahashi M, Higashi T. Progressive Cortical Neuronal Damage and Chronic Hemodynamic Impairment in Atherosclerotic Major Cerebral Artery Disease. Stroke. 2016
Bone Marrow Derived Mononuclear Cells Improve Functional Outcomes in Animal Models of Ischemic Stroke
High BP at time of Stroke Associated with Increased Risk of Recurrent Stroke in the Young
Alexander E. Merkler, MD
Mustanoja S, Putaala J, Gordin D, Tulkki L, Aarnio K, Pirinen J, et al. Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke. Stroke. 2016
Hypertension is one of the most important stroke risk factors and one in four adults has hypertension. Lowering blood pressure is associated with a decreased risk of cardiovascular mortality and recurrent strokes in the elderly. Although risk factors for stroke in the young are different, the prevalence of hypertension in young adults has already doubled in the past two decades, making it a significant risk factor for cardiovascular mortality even in young patients. In this study, Dr Mustanoja et al. evaluate whether acute blood pressure recordings during an ischemic stroke are associated with recurrent stroke.
Certain limitations apply; for example, although the authors state that the their findings were unchanged irrespective of whether patients used anti-hypertensive treatment post-stroke, it’s unclear which agent, the duration of the agent, and most importantly, the efficacy of the agent. In addition, the findings may not be entirely generalizable as the study was conducted on only Caucasians at a single center in Scandanavia.
Despite these limitations, the results emphasize the importance of hypertension in stroke in the young and the necessity to aggressively control elevated blood pressure in adults of any age.
Perfusion MRI in Perinatal Stroke
Watson CG, Dehaes M, Gagoski BA, Grant PE, Rivkin MJ. Arterial Spin Labeling Perfusion Magnetic Resonance Imaging Performed in Acute Perinatal Stroke Reveals Hyperperfusion Associated With Ischemic Injury. Stroke. 2016
FLAIR Vascular Hyperintensities in Bordezone Strokes
Eighty-seven consecutive patients with acute borderzone strokes were identified, 62 with CBZ and 55 with IBZ. Thirty of all included stroke patients were considered FLAIR-positive. The authors found that FLAIR vascular hyperintensities were associated with a more severe clinical presentation and a poorer clinical prognosis in patients with CBZ strokes, but not in patients with IBZ strokes. They concluded the presence of FLAIR vascular hyperintensities, “may help to identify CBZ-infarcted patients who require close observation and hemodynamic control.”
Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients with Stroke
Kim D, Shim CY, Hong G-R, Kim M-H, Seo J, Cho IJ, et al. Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients With Stroke. Stroke. 2016
Cardiovascular evaluation is an important part of the evaluation of the stroke patient, in part due to its use to diagnose cardioembolic etiologies of stroke, but also to assess for risk of future events. Left atrial enlargement has been associated with recurrent and first episodes of stroke, even in cases where dysrhythmias are not present; however, the mechanism by which this occurs is not well understood. Here, the authors use TTE with speckle tracking imaging to (1) assess enlargement and impaired mechanical function of the left atrium to define the risk of cardioembolism in stroke patients and (2) define the major determinants of left atrial mechanical dysfunction in these patients.
Validating Functional Outcome Prediction Models in Acute Ischemic Stroke: Testing the ASTRAL and DRAGON Scores
Given that functional outcome is one of the most commonly used parameters in studying acute stroke treatment, developing accurate prognostication scores would greatly facilitate treatment decisions and improve communicating expectations to patients and families. Cooray et al. sought to validate the two most recently developed scores designed to predict functional outcome at three months, one studied in unselected acute stroke patients (ASTRAL) and the other in acute stroke patients treated with iv-tPA (DRAGON) using the SITS-International Stroke Thrombolysis Register (ISTR), a global stroke thrombolysis database. Outcomes were dichotomized into modified Rankin Scale (mRS) 0-2 and 3-6 as were done in both of the initial studies, and the area under the curve (AUC) of the receiver operating characteristic (ROC) was used in both scores to assess the overall predictive and discriminative performance.
The DRAGON score was developed in a single center cohort of acute ischemic stroke patients treated with iv-tPA using similar statistical design to the ASTRAL score. It is a 10 point scale and the included parameters are hyperdense cerebral artery sign (1 point) and early infarct signs (1 point) on baseline CT, pre-stroke mRS score >1 (1 point), age (<65 years = 0 points, 65-79 years = 1 point, >80 years ≥ 2 points), acute blood glucose >8 mmol/L (1 point), time from symptom onset to treatment >90 min (1 point) and NIHSS score (0-4 = 0 points, 5-9 = 1 point, 10-15 = 2 points and >15 = 3 points). A total of 33,716 iv-tPA treated patients with complete data for the DRAGON score were registered in the SITS-ISTR database. The main differences between the SITS and DRAGON cohorts were higher median baseline stroke severity (NIHSS 12 vs 9), lower proportion of early infarct signs (16.5% vs 30.6%) and higher onset-to-treatment time in the SITS cohort. The AUC-ROC value for functionally dependent outcome on the DRAGON score using the SITS-ISTR cohort was 0.77 (95% CI 0.769-0.779). The largest discrepancy between observed and predicted outcome was close to 17%.
Predicting Large Vessel Occlusions in Ischemic Stroke Patients: Search for the Holy Scale
Turc G, Maïer B, Naggara O, Seners P, Isabel C, Tisserand M, et al. Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large–Artery Occlusion. Stroke. 2016
Structured Nurse Practitioner Transitional Stroke Program Reduced 30-day Readmissions after Stroke