American Heart Association

Monthly Archives: October 2021

Article Commentary: “Peanut Consumption and Risk of Stroke and Ischemic Heart Disease in Japanese Men and Women”

Hannah Roeder, MD, MPH

Ikehara S, Iso H, Kokubo Y, Yamagishi K, Saito I, Yatsuya H, Kimura T, Sawada N, Iwasaki M, Tsugane S, and the JPHC Study Group. Peanut Consumption and Risk of Stroke and Ischemic Heart Disease in Japanese Men and Women: The JPHC Study. Stroke. 2021.

In the health care community, we continuously search for the best diet to prevent vascular disease. The authors investigated whether greater peanut consumption, as recorded in a food frequency questionnaire in the Japan Public Health Center-based Prospective Study, was correlated with lower rates of stroke and heart disease among middle-aged Japanese men and women. More than 70,000 participants aged 45 to 74 years completed food frequency questionnaires, and the participants were monitored for a median follow-up of 14.8 years. The authors calculated multivariable hazard ratios for the highest versus lowest quartiles of peanut consumption (after adjusting for some demographic features, medical co-morbidities, and dietary factors). Hazard ratios were 0.84 (95% CI: 0.77-0.93) for total stroke, 0.80 (0.71-0.90) for ischemic stroke, 0.93 (0.79-1.08) for hemorrhagic stroke, 0.97 (0.80-1.17) for ischemic heart disease, and 0.87 (0.80-0.94) for cardiovascular disease (defined as stroke and heart disease). The authors concluded that higher peanut consumption was associated with reduced risk of stroke, particularly ischemic stroke, but not ischemic heart disease. The authors proposed that the high level of unsaturated fatty acids improving lipid profiles and lowering blood pressure contributes to the beneficial effects.

By |October 8th, 2021|clinical|Comments Off on Article Commentary: “Peanut Consumption and Risk of Stroke and Ischemic Heart Disease in Japanese Men and Women”

DOACs Can Safely Be Administered in Dependent Patients With Recent Stroke

Ayush Agarwal, DM
@drayushagarwal

Meya L, Polymeris AA, Schaedelin S, Schaub F, Altersberger VL, Traenka C, Thilemann S, Wagner B, Fladt J, Hert L, et al. Oral Anticoagulants in Atrial Fibrillation Patients With Recent Stroke Who Are Dependent on the Daily Help of Others. Stroke. 2021.

Cardio-embolic strokes comprise one third of all acute ischemic strokes.1 Trials have proven direct oral anticoagulants (DOACs) to be as effective as vitamin K antagonists (VKAs) with lesser intracranial bleeding risk.2 The added absence of dietary interactions and routine blood level monitoring makes DOACs the preferred alternative over VKAs.3

However, all major DOAC trials recruited patients with only minor strokes and transient ischemic attacks, and patients with disabling strokes were excluded.4-7 This excluded population forms a significant proportion of stroke burden as approximately 40% of strokes attributable to atrial fibrillation (AF) are dependent on caregivers for their daily living.8

By |October 7th, 2021|clinical|Comments Off on DOACs Can Safely Be Administered in Dependent Patients With Recent Stroke

Choosing Amongst Different Revascularization Techniques for Recurrent Carotid Stenosis After Carotid Endarterectomy

Muhammad Rizwan Husain, MD
@RIZWANHUSAINMD

Elsayed N, Ramakrishnan G, Naazie I, Sheth S, Malas MB. Outcomes of Carotid Revascularization in the Treatment of Restenosis After Prior Carotid Endarterectomy. Stroke. 2021;52:3199–3208.

The incidence of restenosis after carotid endarterectomy (CEA) varies from 6 to 16%, and these patients were historically treated with redo-CEA. However, redo-CEA is associated with a risk of increased mortality and cranial nerve injury while transfemoral carotid stenting (TFCAS) has a higher 30-day rate of perioperative strokes. TCAR (transcarotid artery revascularization) is a newer technique that helps with reducing risk of distal embolization and is reported to be associated with a 65% reduction in stroke or death compared with TFCAS. In treatment of primary carotid disease, TCAR has been seen to perform as well as CEA and better than TFCAS. The authors here evaluate the outcomes of TCAR, TFCAS and redo-CEA in patients who develop restenosis after CEA.

A retrospective analysis was conducted of the VQI (Vascular quality initiative) database for patients who after ipsilateral CEA underwent TCAR, TFCAS or redo-CEA. Patients with prior carotid stenting, trauma or dissections were excluded. In this cohort, 21.8% underwent redo-CEA, 37.8% underwent TCAR and 40.4% underwent TFCAS.

By |October 6th, 2021|clinical|Comments Off on Choosing Amongst Different Revascularization Techniques for Recurrent Carotid Stenosis After Carotid Endarterectomy

Assessing MR Perfusion-Diffusion Mismatch in Pediatric Acute Ischemic Stroke

Kevin O’Connor, MD

Visser MJ, Yang JYM, Calamante F, Kean M, Adamson CL, Sharma G, Anderson V, Campbell BCV, Mackay MT. Automated Perfusion-Diffusion Magnetic Resonance Imaging in Childhood Arterial Ischemic Stroke. Stroke. 2021.

Visser et al. explore the feasibility of automated software to evaluate MRI perfusion-diffusion mismatch in children with acute ischemic stroke. Their retrospective study examined 29 children with acute ischemic stroke and MR perfusion imaging obtained within 72 hours of symptom onset at a single center. They excluded 158 children, predominantly for lack of perfusion imaging, among other reasons.

Perfusion-diffusion mismatch assessment was automated with RAPID software. The software detected an ischemic core in 19 children (66%). The remaining children (n=10, 34%) tended to present later (undetected onset-to-imaging time median 21.8 hours, IQR, 14.3–27 versus detected onset-to-imaging time median 11 hours, IQR, 7.2–23.5) and have smaller ischemic lesions (undetected core volume median 2.7 mL, IQR, 1.1–6.2 versus detected core volume median 17.3 mL, IQR, 12.4–49.6) that limited the software’s effectiveness. Eighteen of the 29 children required sedation, and they tended to be younger (median age 4.4, IQR, 2.8–7.3 versus median age 14.8, IQR, 10.7–15.7).

By |October 5th, 2021|clinical|Comments Off on Assessing MR Perfusion-Diffusion Mismatch in Pediatric Acute Ischemic Stroke

Obstructive Sleep Apnea: Further Evidence on its Impact in Cardiovascular Disease

Wern Yew Ding, MBChB

Dalmar A, Singh M, Heis Z, Cumpian TL, Ceretto C, Mortada ME, Bhatia A, Niazi I, Chua TY, Sra J, Jahangir A. Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea. Stroke. 2021;52:2266-2274.

Obstructive sleep apnea (OSA) is common in morbidly obese patients and has been linked to the initiation and maintenance of atrial fibrillation (AF), which in turn predisposes patients to an increased risk of ischemic stroke. The benefits of gastric banding in patients with and without AF have previously been demonstrated. However, there is a lack of studies examining the effects of OSA in such patients.

In this study by Dalmar and colleagues, the authors sought to determine whether incident AF and stroke rates after gastric banding are influenced by OSA using a single-centre retrospective analysis of 853 morbidly obese patients (defined as body mass index ≥35 kg/m2 with obesity-associated comorbidity or body mass index ≥40 kg/m2) who failed conservative treatment for weight loss and were selected for laparoscopic adjustable gastric banding by a multidisciplinary team approach. Most patients were females (84%) with a mean age of 44 years old, body weight of 136kg and body mass index of 48.6 kg/m2. OSA was present in 27% of this cohort. Over a follow-up period of 6 years, it was reported that new-onset AF and incident stroke were significantly higher in the OSA group than in the non-OSA group (new-onset AF: 1.7% vs 0.5%, incident stroke: 2.1% vs. 0.5%). The findings persisted after propensity score matched analysis to account for differences in baseline characteristics between the groups. Furthermore, OSA was found to be an independent risk factor for new-onset AF and incident stroke after adjustment for other risk factors.

By |October 4th, 2021|clinical|Comments Off on Obstructive Sleep Apnea: Further Evidence on its Impact in Cardiovascular Disease

Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease: Importance of Diagnostic Biomarkers

Meghana Srinivas, MD
@SrinivasMeghana

Prabhakaran S, Liebeskind DS, Cotsonis G, Nizam A, Feldmann E, Sangha RS, Campo-Bustillo I, Romano JG, and on behalf of the MYRIAD Investigators. Predictors of Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease. Stroke. 2021;52:1961–1966.

Intracranial atherosclerotic disease (ICAD) is a progressive pathological process of the cerebral vasculature which can lead to symptomatic stenosis of the blood vessels, causing occurrence and/or recurrence of strokes. Intracranial stenosis accounts for 10% of ischemic strokes in the United States with 12 to 20% experiencing recurrent strokes within one year of index stroke.

Shyam Prabhakaran et al. performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of ICAD patients with recent (less than 21 days) stroke/transient ischemic attack, 50-99% stenosis and those who had 6–8 weeks MRI Brain per protocol.  The study reported the risk of clinical stroke recurrence in the territory of the symptomatic artery at 1 year was 8.8%, with nearly 25% of patients having recurrent infarcts on 6- to 8-week brain magnetic resonance imaging (MRI). 

By |October 1st, 2021|clinical|Comments Off on Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease: Importance of Diagnostic Biomarkers