strokeblog

Praveen Hariharan, MD

Buckley BJR, Harrison SL, Hill A, Underhill P, Lane DA, Lip GYH. Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. Stroke. 2022.

Over the last two decades, an increasing body of evidence has recognized various cardiovascular complications following ischemic stroke collectively known as the stroke-heart syndrome. Ischemic stroke can cause impaired autonomic cardiac reflexes, repolarization abnormalities, myocardial injury and cardiomyopathy resulting in myocardial infarction, cardiac arrhythmias including atrial fibrillation, new-onset or exacerbation of heart failure, recurrent stroke, poor functional outcomes, and increased mortality. Many studies have explored the short-term consequences, but there is a paucity of data on long-term clinical outcomes.

In this study, the authors have utilized retrospective observational data obtained from a global federated health research network called TriNetX. Patients with an incident acute ischemic stroke from 2002-2021 with at least 5 years follow up were included. Ischemic stroke patients with newly diagnosed cardiovascular complications within 4 weeks post-stroke were 1:1 propensity score-matched (for baseline demographics and comorbidities) with ischemic stroke patients without cardiovascular complications for comparison of 5-year MACE (major adverse cardiovascular events) outcomes.

Dixon Yang, MD

Dicpinigaitis AJ, Gandhi CD, Pisapia J, Muh CR, Cooper JB, Tobias M, Mohan A, Nuoman R, Overby P, Santarelli J, et al. Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke. Stroke. 2022.

Pediatric acute ischemic stroke (AIS) is an uncommon and poorly understood clinical entity, but its absolute incidence has been increasing and may represent significant cause of disability. In 2019, the American Heart Association Stroke Council and Council of Cardiovascular and Stroke Nursing issued a statement suggesting emergent therapies and endovascular therapies be limited to consideration of children with persistent neurologic deficits (pediatric NIHSS >/= 6), radiographically confirmed large vessel occlusion, and those with a large body habitus due to technical considerations and risks with exposure to radiation and contrast.

In absence of high-quality data and trials, optimal management for pediatric acute ischemic stroke remains unclear. Therefore, Dicpinigaitis and authors performed a large cross-sectional analysis using an administrative inpatient care registry in the United States from the Healthcare Cost and Utilization Project to characterize patient profiles and clinical course of endovascular therapy (EVT) in pediatric patients for AIS.

Vignan Yogendrakumar, MD MSc
@VYogendrakumar

Wei C, Wang J, Foster LD, Yeatts SD, Moy C, Mocco J, Selim M. Effect of Deferoxamine on Outcome According to Baseline Hematoma Volume: A Post Hoc Analysis of the i-DEF Trial. Stroke. 2021.

Intracerebral hemorrhage is a complex disease because, truly, no two bleeds are ever the same. Hemorrhages can differ in size, location, or compartment, and the varying combinations of these elements can lead to dramatic differences in clinical severity and long-term outcome. A small but well-placed hemorrhage in the internal capsule can lead to contralateral hemiplegia, whilst a moderately sized lobar hemorrhage can sometimes present with minimal clinical symptoms. This heterogeneity has been a point of frustration in treatment trials that aim to improve clinical outcomes because a candidate therapy may have a significant effect on a portion of the trial population, but the treatment effect may be diluted when the whole population is assessed. Past trials have informed subsequent studies regarding patient selection, but even with the numerous lessons learned, identifying patients that are most likely to benefit from a candidate therapy remains a difficult task.