Cerebrovascular Diseases Extra最新文献

{"title":"Women and Stroke: Different, yet Similar.","authors":"Nandini Mitta,&nbsp;Sapna Erat Sreedharan,&nbsp;Sankara P Sarma,&nbsp;Padmavathy N Sylaja","doi":"10.1159/000519540","DOIUrl":"https://doi.org/10.1159/000519540","url":null,"abstract":"<p><strong>Background: </strong>The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India.</p><p><strong>Methods: </strong>Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2.</p><p><strong>Results: </strong>Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, p = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, p = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, p = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, p = 0.04), but was not statistically significant after adjusting for confounders.</p><p><strong>Conclusion: </strong>Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"106-111"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/58/cee-0011-0106.PMC8543327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39502101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy.","authors":"Luís Duarte-Gamas, António Pereira-Neves, Filipa Jácome, Mariana Fragão-Marques, Ricardo P Vaz, Jose Paulo Andrade, João P Rocha-Neves","doi":"10.1159/000512587","DOIUrl":"10.1159/000512587","url":null,"abstract":"<p><strong>Objective: </strong>Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6-9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA.</p><p><strong>Methods: </strong>From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE).</p><p><strong>Results: </strong>At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588-0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037-15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231-4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202-3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e-8, 95% CI 9.049e-15 to 0.078, p = 0.019) was also associated with all-cause mortality.</p><p><strong>Conclusion: </strong>RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"181-192"},"PeriodicalIF":1.9,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/9f/cee-0010-0181.PMC7841742.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38719116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Deep Venous Thrombosis in Non-Severe COVID-19 Patients Hospitalized for a Neurovascular Disease.","authors":"Olivier Rouyer, Irène Nora Pierre-Paul, Amadou Talibe Balde, Damaris Jupiter, Daniela Bindila, Bernard Geny, Valérie Wolff","doi":"10.1159/000513295","DOIUrl":"10.1159/000513295","url":null,"abstract":"<p><strong>Introduction: </strong>Severe SARS-CoV-2 infection induces COVID-19 along with venous thromboembolic occurrences particularly in intensive care units. For non-severe COVID-19 patients affected by neurovascular diseases, the prevalence of deep venous thrombosis (DVT) is unknown. The aim of our study was to report data obtained after systematic Doppler ultrasound scanning (DUS) of lower limbs in such patients.</p><p><strong>Methods: </strong>Between March 20 and May 2, 2020, the deep venous system of 13 consecutive patients diagnosed with neurovascular diseases and non-severe COVID-19 was investigated with a systematic bedside DUS.</p><p><strong>Results: </strong>Thirteen patients were enrolled in the study including 9 acute ischaemic strokes, 1 occlusion of the ophthalmic artery, 1 transient ischaemic attack, 1 cerebral venous thrombosis and 1 haemorrhagic stroke. On admission, the median National Institute of Health Stroke Scale (NIHSS) score was of 6 (IQR, 0-20). During the first week after admission, and despite thromboprophylaxis, we found a prevalence of 38.5% of asymptomatic calves' DVT (n = 5). One patient developed a symptomatic pulmonary embolism and 2 other patients died during hospitalization. The outcome was positive for the other patients with a discharge median NIHSS score of 1 (IQR, 0-11).</p><p><strong>Discussion/conclusion: </strong>Despite thromboprophylaxis, systematic bedside DUS showed a high prevalence (38.5%) of asymptomatic DVT in non-severe COVID-19 patients suffering from a neurovascular disease. In the absence of a reliable marker of DVT, we suggest that this non-invasive investigation could be an interesting tool to monitor peripheral venous thrombotic complications in such patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"174-180"},"PeriodicalIF":1.9,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/c6/cee-0010-0174.PMC7772891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38683206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Impairment Correlates Linearly with Mean Flow Velocity by Transcranial Doppler below a Definable Threshold.","authors":"Randolph S Marshall,&nbsp;Marykay A Pavol,&nbsp;Ying Kuen Cheung,&nbsp;Iris Asllani,&nbsp;Ronald M Lazar","doi":"10.1159/000506924","DOIUrl":"https://doi.org/10.1159/000506924","url":null,"abstract":"<p><strong>Introduction: </strong>Low cerebral blood flow can affect cognition in patients with high-grade asymptomatic internal carotid artery stenosis. Current clinical algorithms use stroke risk to determine which patients should undergo revascularization without considering cognitive decline. Although correlations between low-flow and cognitive impairment have been reported, it is not known whether a threshold exists below which such a correlation expresses itself. Such information would be critical in treatment decisions about whether to intervene in patients with high-grade carotid artery stenosis who are at risk for cognitive decline.</p><p><strong>Objective: </strong>To determine how reduced blood flow correlates with lower cognitive scores.</p><p><strong>Methods: </strong>Patients with ≥80% unilateral internal carotid artery stenosis with no history of stroke were recruited from inpatient and outpatient practices at a single, large, comprehensive stroke center. Patients underwent bilateral insonation of middle cerebral arteries with standard 2-Hz probes over the temporal windows with transcranial Doppler. Cognitive assessments were performed by an experienced neuropsychologist using a cognitive battery comprising 14 standardized tests with normative samples grouped by age. Z-scores were generated for each test and averaged to obtain a composite Z-score for each patient. Multivariable linear regression examined associations between mean flow velocity (MFV) and composite Z-score, adjusting for age, education, and depression. The Davies test was used to determine if there was a breakpoint for a non-zero difference in slope of a segmented relationship over the range of composite Z-score values.</p><p><strong>Results: </strong>Forty-two patients with unilateral high-grade internal carotid artery stenosis without stroke were enrolled (26 males, age = 74 ± 9 years, education = 16 ± 3 years). Average composite Z-score was -0.31 SD below the age-specific normative mean (range -2.8 to +1.2 SD). In linear regression adjusted for age, education, and depression, MFV correlated with cognitive Z-score (β = 0.308, p = 0.043). A single breakpoint in the range of composite Z-scores was identified at 45 cm/s. For MFV <45 cm/s, Z-score decreased 0.05 SD per cm/s MFV (95% CI: 0.01-0.10). For MFV >45 cm/s, Z-score change was nonsignificant (95% CI: -0.07 to 0.05).</p><p><strong>Conclusions: </strong>In high-grade, asymptomatic carotid artery stenosis, cognitive impairment correlated linearly with lower flow in the hemisphere fed by the occluded internal carotid artery, but only below a threshold of MFV = 45 cm/s. Identifying a hemodynamic threshold for cognitive decline using a simple, noninvasive method may influence revascularization decision-making in otherwise \"asymptomatic\" carotid disease.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 1","pages":"21-27"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000506924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37832632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Stay-at-Home Order on Stroke Admission, Subtype, and Metrics during the COVID-19 Pandemic.","authors":"Fnu Rameez,&nbsp;Philip McCarthy,&nbsp;Yao Cheng,&nbsp;Laurel M Packard,&nbsp;Alan T Davis,&nbsp;Nabil Wees,&nbsp;Nadeem Khan,&nbsp;Justin Singer,&nbsp;Muhib Khan,&nbsp;Jiangyong Min","doi":"10.1159/000512742","DOIUrl":"https://doi.org/10.1159/000512742","url":null,"abstract":"<p><strong>Objective: </strong>Our study aims to evaluate the impact of a stay-at-home order on stroke metrics during the 2019-novel coronavirus (COVID-19) pandemic.</p><p><strong>Methods: </strong>Data on baseline characteristics, stroke subtype, initial National Institutes of Health Stroke Scale (NIHSS) score, the time between last known well (LKW) to emergency department (ED) arrival, tissue plasminogen activator (tPA) administration, the involvement of large vessel occlusion (LVO), and whether mechanical thrombectomy (MT) was pursued in patients with acute stroke were extracted from 24 March to 23 April 2020 (the time period of a stay-at-home order was placed due to the COVID-19 pandemic as the study group) at a tertiary care hospital in West Michigan, USA, compared with data from 24 March to 23 April 2019 (control group).</p><p><strong>Results: </strong>Our study demonstrated a reduction in cases of acute ischemic stroke (AIS), although this did not reach statistical significance. However, there was an increase in hemorrhagic stroke (7.5% controls vs. 19.2% study group). The age of stroke patients was significantly younger during the period of the stay-at-home order compared to the control group. We identified a significant overall delay of ED arrivals from LKW in the study group. Additionally, an increased number of AIS patients with LVO in the study group (34.8%) was found compared to the control group (17.5%). A significantly increased number of patients received MT in the study group. Additionally, 11 patients were COVID-19 PCR-positive in the study group, 10 with AIS and only 1 with hemorrhagic stroke. Patients with COVID-19 had a high incidence of atrial fibrillation and hyperlipidemia. One AIS patient with COVID-19 rapidly developed cytotoxic edema with corresponding elevated inflammatory biomarkers. No statistical significance was noted when stroke subtype, LVO, and MT groups were compared.</p><p><strong>Conclusions: </strong>There was a trend of decreasing AIS admissions during the COVID-19 pandemic. There was also a significantly increased number of AIS patients with LVO who received MT, especially those with COVID-19. We conclude that cytokine storm resulting from SARS-CoV-2 infection might play a role in AIS patients with COVID-19.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"159-165"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000512742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38582960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study.","authors":"Anna Tancin Lambert,&nbsp;Xiang Y Kong,&nbsp;Barbara Ratajczak-Tretel,&nbsp;Dan Atar,&nbsp;David Russell,&nbsp;Mona Skjelland,&nbsp;Vigdis Bjerkeli,&nbsp;Karolina Skagen,&nbsp;Matthieu Coq,&nbsp;Eric Schordan,&nbsp;Huseyin Firat,&nbsp;Bente Halvorsen,&nbsp;Anne H Aamodt","doi":"10.1159/000504529","DOIUrl":"https://doi.org/10.1159/000504529","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cardioembolic stroke due to paroxysmal atrial fibrillation (AF) may account for 1 out of 4 cryptogenic strokes (CS) and transient ischemic attacks (TIAs). The purpose of this pilot study was to search for biomarkers potentially predicting incident AF in patients with ischemic stroke or TIA.</p><p><strong>Methods: </strong>Plasma samples were collected from patients aged 18 years and older with ischemic stroke or TIA due to AF (n = 9) and large artery atherosclerosis (LAA) with ipsilateral carotid stenosis (n = 8) and age- and sex-matched controls (n = 10). Analyses were performed with the Olink technology simultaneously measuring 184 biomarkers of cardiovascular disease. For bioinformatics, acquired data were analyzed using gene set enrichment analysis (GSEA). Selected proteins were validated using ELISA. Individual receiver operating characteristic (ROC) curves and odds ratios from logistic regression were calculated. A randomForest (RF) model with out-of-bag estimate was applied for predictive modeling.</p><p><strong>Results: </strong>GSEA indicated enrichment of proteins related to inflammatory response in the AF group. Interleukin (IL)-6, growth differentiation factor (GDF)-15, and pentraxin-related protein PTX3 were the top biomarkers on the ranked list for the AF group compared to the LAA group and the control group. ELISA validated increased expression of all tested proteins (GDF-15, PTX3, and urokinase plasminogen activator surface receptor [U-PAR]), except for IL-6. 19 proteins had the area under the ROC curve (AUC) over 0.85 including all of the proteins with significant evolution in the logistic regression. AUCs were very discriminant in distinguishing patients with and without AF (LAA and control group together). GDF-15 alone reached AUC of 0.95. Based on RF model, all selected participants in the tested group were classified correctly, and the most important protein in the model was GDF-15.</p><p><strong>Conclusions: </strong>Our results demonstrate an association between inflammation and AF and that multiple proteins alone and in combination may potentially be used as indicators of AF in CS and TIA patients. However, further studies including larger samples sizes are needed to support these findings. In the ongoing NOR-FIB study, we plan further biomarker assessments in patients with CS and TIA undergoing long-term cardiac rhythm monitoring with insertable cardiac monitors.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 1","pages":"11-20"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000504529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37618541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates and Determinants for the Use of Anticoagulation Treatment before Stroke in Patients with Known Atrial Fibrillation.","authors":"Michela Giustozzi,&nbsp;Giancarlo Agnelli,&nbsp;Silvia Quattrocchi,&nbsp;Monica Acciarresi,&nbsp;Andrea Alberti,&nbsp;Valeria Caso,&nbsp;Maria Cristina Vedovati,&nbsp;Michele Venti,&nbsp;Maurizio Paciaroni","doi":"10.1159/000506923","DOIUrl":"https://doi.org/10.1159/000506923","url":null,"abstract":"Introduction and Objective: Even though the introduction of less cumbersome anticoagulant agents has improved, the rates ofoverall anticoagulant treatment in eligible patients with atrial fibrillation (AF) remain to be defined. We aimed to assess the rates of and determinants for the use of anticoagulation treatment before stroke in patients with known AF since the introduction of direct oral anticoagulants (DOAC) in clinical practice. Methods: Consecutive patients admitted to an individual stroke unit, from September 2013 through July 2019, for acute ischemic stroke or transient ischemic attack (TIA) with known AF before the event were included in the study. Logistic regression analysis was used to identify independent predictors of the use of anticoagulant treatment. Results: Overall, 155 patients with ischemic stroke/TIA and known AF were included in this study. Among 152 patients with a CHA2DS2-VASc score >1, 43 patients were not receiving any treatment, 47 patients were receiving antiplatelet agents, and the remaining 62 patients were on oral anticoagulants. Among 34 patients on DOAC, 13 were receiving a nonlabeled reduced dose and 18 out of 34 patients on vitamin K antagonists had an INR value <2 at the time of admission. Before stroke, only 34 out of 155 patients (21.9%) were adequately treated according to current guidelines. Previous stroke/TIA was the only independent predictor of the use of anticoagulant therapy. Conclusions: Only 21.9% of the patients hospitalized for a stroke or TIA with known AF before the event were adequately treated according to recent treatment guidelines. It is important to improve medical information about the risk of AF and the efficacy of anticoagulants in stroke prevention.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 2","pages":"44-49"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000506923","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37907387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia Predicts Poor Clinical Outcome in Mechanical Thrombectomy Patients with Fair or Good Collateral Circulation.","authors":"Juha-Pekka Pienimäki,&nbsp;Sara Protto,&nbsp;Eetu Hakomäki,&nbsp;Pasi Jolma,&nbsp;Niko Sillanpää","doi":"10.1159/000510228","DOIUrl":"https://doi.org/10.1159/000510228","url":null,"abstract":"<p><strong>Background and purpose: </strong>Anemia predicts poor clinical outcome of ischemic stroke in the general stroke population. We studied whether this applies to those treated with mechanical thrombectomy for proximal anterior circulation occlusion in the setting of differing collateral circulation.</p><p><strong>Methods: </strong>We collected the data of 347 consecutive anterior circulation stroke patients who underwent mechanical thrombectomy after multimodal CT imaging in a single tertiary stroke care center. Patients with occlusion of the internal carotid artery and/or the first segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables, and the technical, imaging, and clinical outcomes. Differences between anemic and nonanemic patients were studied with appropriate statistical tests and binary logistic regression analysis.</p><p><strong>Results: </strong>Ninety-four out of the 285 patients eligible for analysis had anemia, and 243 had fair or good collateral circulation (collateral score, CS, >0). Fifty-four percent of the patients experienced good 3-month clinical outcome (modified Rankin Scale ≤2). In pooled analyses of the CS 1-4 and 2-4 ranges, nonanemic patients had good clinical outcome significantly more often (p < 0.001 for both). This effect was not seen in patients with poor collateral circulation (CS = 0). Nonanemic patients had significantly better odds of good clinical outcome (OR = 2.6, 95% CI 1.377-5.030, p = 0.004) in a binary regression model. A 0.1 g/dL increase in hemoglobin improved the odds of good clinical outcome by 2% (OR = 1.02, 95% CI 1.002-1.044, p = 0.03).</p><p><strong>Conclusions: </strong>Low hemoglobin on admission predicts poor clinical outcome in mechanical thrombectomy patients with fair or good collateral circulation.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"139-147"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000510228","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38524547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weather Fluctuations May Have an Impact on Stroke Occurrence in a Society: A Population-Based Cohort Study.","authors":"Naoki Matsumaru,&nbsp;Hideshi Okada,&nbsp;Kodai Suzuki,&nbsp;Sho Nachi,&nbsp;Takahiro Yoshida,&nbsp;Katsura Tsukamoto,&nbsp;Shinji Ogura","doi":"10.1159/000505122","DOIUrl":"https://doi.org/10.1159/000505122","url":null,"abstract":"<p><strong>Background: </strong>Stroke has been found to have a seasonally varying incidence; blood pressure, one of its risk factors, is influenced by humidity and temperature. The relationship between the incidence of stroke and meteorological parameters remains controversial.</p><p><strong>Objective: </strong>We investigated whether meteorological conditions are significant risk factors for stroke, focusing on the fluctuation of weather elements that triggers the onset of stroke.</p><p><strong>Methods: </strong>We collected ambulance transportation data recorded by emergency personnel from Gifu Prefecture. We included cases where the cause of the transportation was stroke and excluded cases of trauma. We combined these data with meteorological data as well as data on average temperature, average air pressure, and humidity provided publicly by the Japan Meteorological Agency. Our target period was from January 2012 to December 2016.</p><p><strong>Results: </strong>In the 5-year target period, there were 5,501 occurrences of ambulance transportation due to stroke. A seasonal tendency was confirmed, since ambulance transportation for stroke occurred more frequently at low temperatures (p < 0.001). Temperature (odds ratio: 0.91; p < 0.001) and humidity change (odds ratio: 1.50; p = 0.016) were identified as risk factors for ambulance transportation due to stroke. An increase in temperature incurs a lower risk than a decrease (odds ratio: 0.58; p = 0.09), although there is no statistically significant difference.</p><p><strong>Conclusions: </strong>Meteorological effects on the frequency of ambulance transportation due to stroke were studied. A lower temperature and radical humidity change were identified as risk factors for ambulance transportation due to stroke, and a decrease in temperature was also associated. We speculate on the possibilities of using meteorological data to optimize the assignment of limited medical resources in medical economics.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 1","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000505122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37614798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience.","authors":"Volker Maus,&nbsp;Finn Drescher,&nbsp;Lukas Goertz,&nbsp;Anushe Weber,&nbsp;Werner Weber,&nbsp;Sebastian Fischer","doi":"10.1159/000509455","DOIUrl":"https://doi.org/10.1159/000509455","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents.</p><p><strong>Methods: </strong>This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF.</p><p><strong>Results: </strong>Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%.</p><p><strong>Conclusion: </strong>Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 2","pages":"84-93"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000509455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38406025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}