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October 2021 Stroke Highlights
Nicole B. Sur
doi : 10.1161/STROKEAHA.121.037103
Stroke. 2021;52:3081
Effects of Fluoxetine on Outcomes at 12 Months After Acute Stroke
Erik Lundström, Eva Isaksson, Nina Greilert Norin, Per Näsman, Per Wester, Björn Mårtensson, Bo Norrving, Håkan Wallén, Jörgen Borg, Graeme J. Hankey, Maree L. Hackett, Gillian E. Mead, Martin S. Dennis, Katharina S. Sunnerhagen, on the behalf of the EFFECTS Writing Committee
doi : 10.1161/STROKEAHA.121.034705
Stroke. 2021;52:3082–3087
The EFFECTS (Efficacy of Fluoxetine—a Randomised Controlled Trial in Stroke) recently reported that 20 mg fluoxetine once daily for 6 months after acute stroke did not improve functional outcome but reduced depression and increased fractures and hyponatremia at 6 months. The purpose of this predefined secondary analysis was to identify if any effects of fluoxetine were maintained or delayed over 12 months.
Long-Term Incidence of Stroke and Dementia in ASCOT
William N. Whiteley, Ajay K. Gupta, Thomas Godec, Somayeh Rostamian, Andrew Whitehouse, Judy Mackay, Peter S. Sever
doi : 10.1161/STROKEAHA.120.033489
Stroke. 2021;52:3088–3096
Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels.
Endovascular Therapy of Anterior Circulation Tandem Occlusions
Mohammad Anadani, Gaultier Marnat, Arturo Consoli, Panagiotis Papanagiotou, Raul G. Nogueira, Adnan Siddiqui, Marc Ribo, Alejandro M. Spiotta, Romain Bourcier, Maeva Kyheng, Julien Labreuche, Adam de Havenon, Igor Sibon, Cyril Dargazanli, Caroline Arquizan, Christophe Cognard, Jean-Marc Olivot, René Anxionnat, Gérard Audibert, Mikaël Mazighi, Raphaël Blanc, Bertrand Lapergue, Sébastien Richard, Benjamin Gory
doi : 10.1161/STROKEAHA.120.033032
Stroke. 2021;52:3097–3105
Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice.
Tandem Occlusions
Luciana Catanese, Ashkan Shoamanesh, Alexandre Y. Poppe
doi : 10.1161/STROKEAHA.121.036219
Stroke. 2021;52:3106–3108
Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage
Lukas Meyer, Matthias Bechstein, Maxim Bester, Uta Hanning, Caspar Brekenfeld, Fabian Flottmann, Helge Kniep, Noel van Horn, Milani Deb-Chatterji, Götz Thomalla, Peter Sporns, Leonard Leong-Litt Yeo, Benjamin Yong-Qiang Tan, Anil Gopinathan, Andreas Kastrup, Maria Politi, Panagiotis Papanagiotou, André Kemmling, Jens Fiehler, Gabriel Broocks,
doi : 10.1161/STROKEAHA.120.033101
Stroke. 2021;52:3109–3117
This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment.
Thrombectomy for Patients With Large Infarct Core in Practice
Thabele M. Leslie-Mazwi, Dorothea Altschul, Claus Z. Simonsen
doi : 10.1161/STROKEAHA.121.034754
Stroke. 2021;52:3118–3120
Stroke Prevention by Anticoagulants in Daily Practice Depending on Atrial Fibrillation Pattern and Clinical Risk Factors
Lamiae Grimaldi-Bensouda, Jean-Yves Le Heuzey, Jean Ferrières, Didier Leys, Jean-Marc Davy, Mikel Martinez, Olivia Dialla, Didier Smadja, Norbert Nighoghossian, Jacques Benichou, Clementine Nordon, Emmanuel Touzé, Lucien Abenhaim, on behalf of the PGRx-Stroke and PGRx-Atrial Fibrillation Study Groups
doi : 10.1161/STROKEAHA.120.032704
Stroke. 2021;52:3121–3131
The objective of the study was to assess the effectiveness of individual direct oral anticoagulants versus vitamin K antagonists for primary prevention of stroke (ischemic and hemorrhagic) in routine clinical practice in patients with various clinical risk factors depending on their atrial fibrillation (AF) patterns.
Clinical Outcomes in Atrial Fibrillation Patients With a History of Cancer Treated With Non-Vitamin K Antagonist Oral Anticoagulants
Yi-Hsin Chan, Tze-Fan Chao, Hsin-Fu Lee, Shao-Wei Chen, Pei-Ru Li, Jia-Rou Liu, Lung-Sheng Wu, Shang-Hung Chang, Yung-Hsin Yeh, Chi-Tai Kuo, Lai-Chu See, Gregory Y.H. Lip
doi : 10.1161/STROKEAHA.120.033470
Stroke. 2021;52:3132–3141
Data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation and cancer are limited, and patients with active cancer were excluded from randomized trials. We investigated the effectiveness and safety for NOACs versus warfarin among patients with atrial fibrillation with cancer.
Lipid-Lowering Therapy and Hemorrhagic Stroke Risk
Borja E. Sanz-Cuesta, Jeffrey L. Saver
doi : 10.1161/STROKEAHA.121.034576
Stroke. 2021;52:3142–3150
Statins were shown to increase hemorrhagic stroke (HS) in patients with a first cerebrovascular event in 2006 (SPARCL), likely due to off-target antithrombotic effects, but continued to sometimes be used in patients with elevated HS risk due to absence of alternative medications. Recently, the PCSK9Is (proprotein convertase subtilisin kexin 9 inhibitors) have become available as a potent lipid-lowering class with potentially less hemorrhagic propensity.
Association of Oral Anticoagulation With Stroke in Atrial Fibrillation or Heart Failure
Catriona Reddin, Conor Judge, Elaine Loughlin, Robert Murphy, Maria Costello, Alberto Alvarez, John Ferguson, Andrew Smyth, Michelle Canavan, Martin J. O’Donnell
doi : 10.1161/STROKEAHA.120.033910
Stroke. 2021;52:3151–3162
Atrial fibrillation and heart failure with reduced ejection fraction (HFrEF) are common sources of cardioembolism. While oral anticoagulation is strongly recommended for atrial fibrillation, there are marked variations in guideline recommendations for HFrEF due to uncertainty about net clinical benefit. This systematic review and meta-analysis evaluates the comparative association of oral anticoagulation with stroke and other cardiovascular risk in populations with atrial fibrillation or HFrEF in sinus rhythm and identify factors mediating different estimates of net clinical benefit.
Mobile Stroke Units Facilitate Prehospital Management of Intracerebral Hemorrhage
S. Regan Cooley, Henry Zhao, Bruce C.V. Campbell, Leonid Churilov, Skye Coote, Damien Easton, Francesca Langenberg, Michael Stephenson, Bernard Yan, Patricia M. Desmond, Peter J. Mitchell, Mark W. Parsons, Geoffrey A. Donnan, Stephen M. Davis, Nawaf Yassi,
doi : 10.1161/STROKEAHA.121.034592
Stroke. 2021;52:3163–3166
Mobile stroke units (MSUs) improve reperfusion therapy times in acute ischemic stroke (AIS). However, prehospital management options for intracerebral hemorrhage (ICH) are less established. We describe the initial Melbourne MSU experience in ICH.
Revisiting the Proportional Recovery Model in View of the Ceiling Effect of Fugl-Meyer Assessment
Hyun Haeng Lee, Deog Young Kim, Min Kyun Sohn, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Junhee Han, Jeonghoon Ahn, Won Hyuk Chang, Ilyoel Kim, Soo Mi Choi, Jongmin Lee, Yun-Hee Kim
doi : 10.1161/STROKEAHA.120.032409
Stroke. 2021;52:3167–3175
The aim of this study was to verify the validity of the proportional recovery model in view of the ceiling effect of the Fugl-Meyer Assessment.
Overnight Rostral Fluid Shifts Exacerbate Obstructive Sleep Apnea After Stroke
Devin L. Brown, Azadeh Yadollahi, Kevin He, Yuliang Xu, Bryan Piper, Erin Case, Ronald D. Chervin, Lynda D. Lisabeth
doi : 10.1161/STROKEAHA.120.032688
Stroke. 2021;52:3176–3183
Overnight shifts of fluid from lower to upper compartments exacerbate obstructive sleep apnea (OSA) in some OSA populations. Given the high prevalence of OSA after stroke, decreased mobility and use of IV fluids among hospitalized patients with stroke, and improvement in OSA in the months after stroke, we hypothesized that overnight fluid shifts occur and are associated with OSA among patients with subacute ischemic stroke.
Marijuana Use and the Risk of Early Ischemic Stroke
Tara Dutta, Kathleen A. Ryan, Oluwatosin Thompson, Haley Lopez, Natalie Fecteau, Mary J. Sparks, Seemant Chaturvedi, Carolyn Cronin, Prachi Mehndiratta, Joel R. Nunez Gonzalez, Michael Phipps, Marcella Wozniak, Patrick F. McArdle, Steven J. Kittner, John W. Cole
doi : 10.1161/STROKEAHA.120.032811
Stroke. 2021;52:3184–3190
Few studies have examined the dose-response and temporal relationships between marijuana use and ischemic stroke while controlling for important confounders, including the amount of tobacco smoking. The purpose of our study was to address these knowledge gaps.
INSTRuCT
Jeyaraj Durai Pandian, Shweta Jain Verma, Deepti Arora, Meenakshi Sharma, Rupinder Dhaliwal, Himani Khatter, Rahul Huilgol, P.N. Sylaja, Aneesh Dhasan, Vishnu Renjith, Abhishek Pathak, Aparna Pai, Arvind Sharma, Anand Vaishnav, Biman Ray, Dheeraj Khurana, Gaurav Mittal, Girish Kulkarni, Ivy Sebastian, Jayanta Roy, Somasundaram Kumaravelu, Lydia John, Mahesh Kate, M.V. Srivastava, Madhusudhan Byadarahalli Kempegowda, Nomal Borah, Neetu Ramrakhiani, Nirendra Rai, Pawan Ojha, Rohit Bhatia, Rupjyoti Das, Sachin Sureshbabu, Shaikh Afshan Jabeen, Sanjeev Bhoi, Sanjith Aaron, Prabhakaran Sarma, Aralikatte Onkarappa Saroja, Sherly Abraham, Sudhir Sharma, Sulena Sulena, Sankar Gorthi, Sundarachary Nagarjunakonda, Sunil Narayan, Thomas Mathew, Tina George, Pamidimukkala Vijaya, Vikram Huded, Vivek Nambiar, Y. Muralidhar Reddy
doi : 10.1161/STROKEAHA.120.033149
Stroke. 2021;52:e574–e580
Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India.
Different Predictive Factors for Early Neurological Deterioration Based on the Location of Single Subcortical Infarction
Ki-Woong Nam, Hyung-Min Kwon, Yong-Seok Lee
doi : 10.1161/STROKEAHA.120.032966
Stroke. 2021;52:3191–3198
Patients with single subcortical infarctions (SSIs) have relatively a favorable prognosis, but they often experience early neurological deterioration (END). In this study, we compared the predictors for END in patients with SSI according to the location of the lesion.
Outcomes of Carotid Revascularization in the Treatment of Restenosis After Prior Carotid Endarterectomy
Nadin Elsayed, Ganesh Ramakrishnan, Isaac Naazie, Sharvil Sheth, Mahmoud B. Malas
doi : 10.1161/STROKEAHA.120.033667
Stroke. 2021;52:3199–3208
Restenosis after carotid endarterectomy (CEA) is associated with an increased risk of ipsilateral stroke. The optimal procedural modality for this indication has yet to be determined. Here, we evaluate the in-hospital outcomes of transcarotid artery revascularization (TCAR), redo-CEA, and transfemoral carotid artery stenting (TFCAS) in a large contemporary cohort of patients who underwent treatment for restenosis after CEA.
Rescue of Neglect and Language Impairment After Stroke Thrombectomy
Shashvat M. Desai, Konark Malhotra, Guru Ramaiah, Daniel A. Tonetti, Waqas Haq, Tudor G. Jovin, Ashutosh P. Jadhav
doi : 10.1161/STROKEAHA.121.034243
Stroke. 2021;52:3209–3216
Although National Institutes of Health Stroke Scale scores provide an objective measure of clinical deficits, data regarding the impact of neglect or language impairment on outcomes after mechanical thrombectomy (MT) is lacking. We assessed the frequency of neglect and language impairment, rate of their rescue by MT, and impact of rescue on clinical outcomes.
Prediction of Independent Walking in People Who Are Nonambulatory Early After Stroke
Elisabeth Preston, Louise Ada, Rosalyn Stanton, Niruthikha Mahendran, Catherine M. Dean
doi : 10.1161/STROKEAHA.120.032345
Stroke. 2021;52:3217–3224
One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months.
Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19
Pratyaksh K. Srivastava, Shuaiqi Zhang, Ying Xian, Hanzhang Xu, Christine Rutan, Heather M. Alger, Jason G. Walchok, Joseph H. Williams, James A. de Lemos, Marquita R. Decker-Palmer, Brooke Alhanti, Mitchell S.V. Elkind, Steve R. Messé, Eric E. Smith, Lee H. Schwamm, Gregg C. Fonarow
doi : 10.1161/STROKEAHA.120.034414
Stroke. 2021;52:3225–3232
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19.
Sex Differences in Stroke Care and Outcome 2005–2018
Marie Eriksson, Signild Åsberg, Katharina Stibrant Sunnerhagen, Mia von Euler, on behalf of the Riksstroke Collaboration
doi : 10.1161/STROKEAHA.120.033893
Stroke. 2021;52:3233–3242
Previous studies of stroke management and outcome in Sweden have revealed differences between men and women. We aimed to analyze if differences in stroke incidence, care, and outcome have altered over time.
Blood Pressure Control and Recurrent Stroke After Intracerebral Hemorrhage in 2002 to 2018 Versus 1981 to 1986
Linxin Li, Susanna M. Zuurbier, Wilhelm Kuker, Charles P. Warlow, Peter M. Rothwell
doi : 10.1161/STROKEAHA.121.034432
Stroke. 2021;52:3243–3248
The PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study) conducted in the early 1990s showed that blood pressure (BP) lowering therapy reduced the risks of recurrent stroke by about 50% after spontaneous intracerebral hemorrhage (ICH). However, the ICH subgroup was a minority, and trial cohorts are invariably selective. Therefore, it is unclear whether the impact of BP control on risk of recurrent stroke in ICH observed in PROGRESS would be as great in real-world practice.
Dose-Response Relationship Between Long-Term Blood Pressure Variability and Cognitive Decline
Chenglong Li, Yanjun Ma, Rong Hua, Zhenchun Yang, Baoliang Zhong, Hongyu Wang, Wuxiang Xie
doi : 10.1161/STROKEAHA.120.033697
Stroke. 2021;52:3249–3257
We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship.
Balancing Benefits and Risks of Long-Term Antiplatelet Therapy in Noncardioembolic Transient Ischemic Attack or Stroke
Nina A. Hilkens, Ale Algra, Hans Christoph Diener, Philip M. Bath, László Csiba, Werner Hacke, L. Jaap Kappelle, Peter J. Koudstaal, Didier Leys, Jean-Louis Mas, Ralph L. Sacco, Jacoba P. Greving, on behalf of the Cerebrovascular Antiplatelet Trialists’ Collaborative Group
doi : 10.1161/STROKEAHA.120.031755
Stroke. 2021;52:3258–3265
Lifelong treatment with antiplatelet drugs is recommended following a transient ischemic attack or ischemic stroke. Bleeding complications may offset the benefit of antiplatelet drugs in patients at increased risk of bleeding and low risk of recurrent ischemic events. We aimed to investigate the net benefit of antiplatelet treatment according to an individuals’ bleeding risk.
Neutrophil Counts as Promising Marker for Predicting In-Hospital Mortality in Aneurysmal Subarachnoid Hemorrhage
Yu Zhang, Linjie Li, Lu Jia, Tiangui Li, Yuanyuan Di, Peng Wang, Haidong Deng, Huaqian Fan, Ying Li, Xin Cheng, Younian Chen, Xing Wang, Weelic Chong, Yang Hai, Chao You, Yongzhong Cheng, Fang Fang
doi : 10.1161/STROKEAHA.120.034024
Stroke. 2021;52:3266–3275
Systemic inflammation is recognized as a hallmark of stroke. We aimed to evaluate the prognostic value of various inflammatory factors using blood at admission in patients with aneurysmal subarachnoid hemorrhage.
CRP (C-Reactive Protein) in Outcome Prediction After Subarachnoid Hemorrhage and the Role of Machine Learning
Ben Gaastra, Peter Barron, Laura Newitt, Simran Chhugani, Carole Turner, Peter Kirkpatrick, Ben MacArthur, Ian Galea, Diederik Bulters
doi : 10.1161/STROKEAHA.120.030950
Stroke. 2021;52:3276–3285
Outcome prediction after aneurysmal subarachnoid hemorrhage (aSAH) is challenging. CRP (C-reactive protein) has been reported to be associated with outcome, but it is unclear if this is independent of other predictors and applies to aSAH of all grades. Therefore, the role of CRP in aSAH outcome prediction models is unknown. The purpose of this study is to assess if CRP is an independent predictor of outcome after aSAH, develop new prognostic models incorporating CRP, and test whether these can be improved by application of machine learning.
Fatigue Following Pediatric Arterial Ischemic Stroke
Mardee Greenham, Anne L. Gordon, Anna Cooper, Stephen Hearps, Michael Ditchfield, Lee Coleman, Rod W. Hunt, Mark T. Mackay, Paul Monagle, Vicki Anderson
doi : 10.1161/STROKEAHA.120.033000
Stroke. 2021;52:3286–3295
The aims of this study were to assess the prevalence of multidimensional fatigue symptoms 5 years after pediatric arterial ischemic stroke and identify factors associated with fatigue.
Automated Perfusion-Diffusion Magnetic Resonance Imaging in Childhood Arterial Ischemic Stroke
Melissa J. Visser, Joseph Yuan-Mou Yang, Fernando Calamante, Michael Kean, Christopher L. Adamson, Gagan Sharma, Vicki Anderson, Bruce C.V. Campbell, Mark T. Mackay
doi : 10.1161/STROKEAHA.120.032822
Stroke. 2021;52:3296–3304
Recent studies using automated perfusion imaging software have identified adults most likely to benefit from reperfusion therapies in extended time windows. The time course of penumbral tissue is poorly characterized in childhood arterial ischemic stroke (AIS). We explore the feasibility of using automated perfusion-diffusion imaging software to characterize penumbra in childhood AIS.
Target Practice
Sarah Lee, Catherine M. Amlie-Lefond
doi : 10.1161/STROKEAHA.121.036218
Stroke. 2021;52:3305–3307
Distal Medium Vessel Occlusions Can Be Accurately and Rapidly Detected Using Tmax Maps
Shalini A. Amukotuwa, Angel Wu, Kevin Zhou, Inna Page, Peter Brotchie, Roland Bammer
doi : 10.1161/STROKEAHA.120.032941
Stroke. 2021;52:3308–3317
Distal medium vessel occlusions (DMVOs) are increasingly considered for endovascular thrombectomy but are difficult to detect on computed tomography angiography (CTA). We aimed to determine whether time-to-maximum of tissue residue function (Tmax) maps, derived from CT perfusion, can be used as a triage screening tool to accurately and rapidly identify patients with DMVOs.
Serial ASPECTS in the DAWN Trial
David S. Liebeskind, Hamidreza Saber, Parita Bhuva, Bin Xiang, Albert J. Yoo, Ashutosh P. Jadhav, Diogo C. Haussen, Ronald F. Budzik, Alain Bonafe, Dileep R. Yavagal, Ricardo A. Hanel, Marc Ribo, Christophe Cognard, Cathy Sila, Ameer E. Hassan, Wade S. Smith, Jeffrey L. Saver, Raul G. Nogueira, Tudor G. Jovin, for DAWN Investigators
doi : 10.1161/STROKEAHA.120.033477
Stroke. 2021;52:3318–3324
The impact of baseline ischemia on Alberta Stroke Program Early CT Score (ASPECTS) and evolution over 24 hours may be distinct in late thrombectomy. We analyzed predictors of serial ASPECTS and clinical outcomes in the DAWN trial (Diffusion-Weighted Imaging or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo).
Economic Impact of Poststroke Delirium and Associated Risk Factors
Carl Moritz Zipser, Jeremy Werner Deuel, Jeremia Philipp Oskar Held, Jutta Ernst, Maria Schubert, Michael Weller, Andreas Rüdiger Luft, Roland von Känel, Soenke Boettger
doi : 10.1161/STROKEAHA.120.033005
Stroke. 2021;52:3325–3334
Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD).
Extracellular Vesicle Surface Markers as a Diagnostic Tool in Transient Ischemic Attacks
Jacopo Burrello, Giovanni Bianco, Alessio Burrello, Concetta Manno, Francesco Maulucci, Marco Pileggi, Stefania Nannoni, Patrik Michel, Sara Bolis, Giorgia Melli, Giuseppe Vassalli, Gregory W. Albers, Alessandro Cianfoni, Lucio Barile, Carlo W. Cereda
doi : 10.1161/STROKEAHA.120.033170
Stroke. 2021;52:3335–3347
Extracellular vesicles (EVs) are promising biomarkers for cerebral ischemic diseases, but not systematically tested in patients with transient ischemic attacks (TIAs). We aimed at (1) investigating the profile of EV-surface antigens in patients with symptoms suspicious for TIA; (2) developing and validating a predictive model for TIA diagnosis based on a specific EV-surface antigen profile.
New Light on the Horizon
Dirk M. Hermann, Thorsten R. Doeppner, Bernd Giebel
doi : 10.1161/STROKEAHA.121.036150
Stroke. 2021;52:3348–3350
Proteomic Profiling of Exosomes From Hemorrhagic Moyamoya Disease and Dysfunction of Mitochondria in Endothelial Cells
Xia Wang, Cong Han, Yangjie Jia, Jiayu Wang, Wei Ge, Lian Duan
doi : 10.1161/STROKEAHA.120.032297
Stroke. 2021;52:3351–3361
Moyamoya disease (MMD) is a rare steno-occlusive and slowly progressing cerebrovascular disorder. The detailed mechanism of the underlying pathogenesis is still blurry.
Neuronal CD200 Signaling Is Protective in the Acute Phase of Ischemic Stroke
Abdullah Al Mamun, Conelius Ngwa, Shaohua Qi, Pedram Honarpisheh, Saumil Datar, Romana Sharmeen, Yan Xu, Louise D. McCullough, Fudong Liu
doi : 10.1161/STROKEAHA.120.032374
Stroke. 2021;52:3362–3373
CD200 (cluster of differentiation 200), a highly glycosylated protein primarily expressed on neurons in the central nervous system, binds with its receptor CD200R to form an endogenous inhibitory signal against immune responses. However, little is known about the effect of neuronal CD200 signaling in cerebral ischemia. The aim of this study was to investigate how neuronal CD200 signaling impacts poststroke inflammation and the ischemic injury.
Neutrophil Enzyme Myeloperoxidase Modulates Neuronal Response in a Model of Subarachnoid Hemorrhage by Venous Injury
Aminata P. Coulibaly, Pinar Pezuk, Paul Varghese, William Gartman, Danielle Triebwasser, Joshua A. Kulas, Lei Liu, Mariam Syed, Petr Tvrdik, Heather Ferris, J. Javier Provencio
doi : 10.1161/STROKEAHA.120.033513
Stroke. 2021;52:3374–3384
Aneurysmal subarachnoid hemorrhage (SAH) is associated with the development of delayed cognitive deficits. Neutrophil infiltration into the central nervous system is linked to the development of these deficits after SAH. It is however unclear how neutrophil activity influences central nervous system function in SAH. The present project aims to elucidate which neutrophil factors mediate central nervous system injury and cognitive deficits after SAH.
Endovascular Treatment for Acute Stroke in Cerebral Amyloid Angiopathy
Johannes M. Weller, Simon Jonas Enkirch, Christopher Bogs, Tim Bastian Braemswig, Milani Deb-Chatterji, Fee Keil, Christine Kindler, Sarah Maywald, Markus D. Schirmer, Sebastian Stösser, Laszlo Solymosi, Christian H. Nolte, Felix J. Bode, Gabor C. Petzold,
doi : 10.1161/STROKEAHA.120.033014
Stroke. 2021;52:e581–e585
We aimed to compare outcome of endovascular thrombectomy in acute ischemic stroke in patients with and without cerebral amyloid angiopathy (CAA).
Thrombolysis in Mild Stroke
Negar Asdaghi, Jose G. Romano, Hannah Gardener, Iszet Campo-Bustillo, Barbara Purdon, Yosef M. Khan, Deepak Gulati, Joseph P. Broderick, Lee H. Schwamm, Eric E. Smith, Jeffrey L. Saver, Ralph Sacco, Pooja Khatri, on behalf of MaRISS and PRISMS Collaborators and Investigators†
doi : 10.1161/STROKEAHA.120.033466
Stroke. 2021;52:e586–e589
Mild ischemic stroke patients enrolled in randomized controlled trials of thrombolysis may have a different symptom severity distribution than those treated in routine clinical practice.
Switching to Tenecteplase for Stroke Thrombolysis
Karim Mahawish, John Gommans, Timothy Kleinig, Bhavesh Lallu, Alicia Tyson, Annemarei Ranta
doi : 10.1161/STROKEAHA.121.035931
Stroke. 2021;52:e590–e593
Due to practical advantages, increasing trial safety data, recent Australian Guideline endorsement and local population needs we switched to tenecteplase for stroke thrombolysis from alteplase. We describe our change process and real-world outcome data.
Clinical Effectiveness of the Queen Square Intensive Comprehensive Aphasia Service for Patients With Poststroke Aphasia
Alexander P. Leff, Sarah Nightingale, Beth Gooding, Jean Rutter, Nicola Craven, Makena Peart, Alice Dunstan, Amy Sherman, Andrew Paget, Morvwen Duncan, Jonathan Davidson, Naveen Kumar, Claire Farrington-Douglas, Camille Julien, Jennifer T. Crinion
doi : 10.1161/STROKEAHA.120.033837
Stroke. 2021;52:e594–e598
Poststroke aphasia has a major impact on peoples’ quality of life. Speech and language therapy interventions work, especially in high doses, but these doses are rarely achieved outside of research studies. Intensive Comprehensive Aphasia Programs (ICAPs) are an option to deliver high doses of therapy to people with aphasia over a short period of time.
Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population
Lars Wessels, Nils Hecht, Peter Vajkoczy
doi : 10.1161/STROKEAHA.120.033991
Stroke. 2021;52:e599–e604
Despite the findings reported in the COSS (Carotid Occlusion Surgery Study), patients with atherosclerotic cerebrovascular disease continue to be referred for superficial temporal artery to middle cerebral artery bypass surgery. Here, we determined how today’s patients differ from the population reported in COSS.
FIP1L1-PDGFRA-Associated Hypereosinophilic Syndrome as a Treatable Cause of Watershed Infarction
Juliette Tennenbaum, Matthieu Groh, Laura Venditti, France Campos-Gazeau, Emilie Chalayer, Thomas De Broucker, Mohamed Hamidou, Mathilde Hunault, Aicha Lyoubi, Raphaëlle Meunier, Thierry Muron, Damien Sène, Borhane Slama, Céline Guidoux, Guillaume Lefèvre, Jean-Emmanuel Kahn, Christian Denier, Julien Rohmer
doi : 10.1161/STROKEAHA.121.034191
Stroke. 2021;52:e605–e609
Ischemic stroke has been reported in various conditions associated with eosinophilia. FIP1L1-PDGFRA fusion ([Fip1-like 1-platelet-derived growth factor receptor alpha]; F/P) leads to the proliferation of the eosinophilic lineage and thus to a clonal hypereosinophilic syndrome that is highly responsive to imatinib.
Outcome Following Hemorrhage From Cranial Dural Arteriovenous Fistulae
Matthew J. Koch, Christopher J. Stapleton, Ridhima Guniganti, Giuseppe Lanzino, Jason Sheehan, Ali Alaraj, Diederik Bulters, Louis Kim, W. Christopher Fox, Bradley A. Gross, Minako Hayakawa, J. Marc C. van DijK, Robert M. Starke, Junichiro Satomi, Adam J. Polifka, Gregory J. Zipfel, Sepideh Amin-Hanjani, for the CONDOR Consortium*
doi : 10.1161/STROKEAHA.121.034707
Stroke. 2021;52:e610–e613
Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–related hemorrhage.
Association of Chronic Liver Disease and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage
Yu Zhang, Linjie Li, Lu Jia, Weelic Chong, Yang Hai, L. Dade Lunsford, Chao You, Yongzhong Cheng, Fang Fang
doi : 10.1161/STROKEAHA.121.034136
Stroke. 2021;52:e614–e617
Chronic liver disease (CLD) is a risk factor for increased morbidity and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between CLD and mortality remains unknown.
Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation
John Fournier, Hillel Finestone, Julia Lauzon, T. Mark Campbell
doi : 10.1161/STROKEAHA.121.034270
Stroke. 2021;52:e618–e621
Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options.
Mucormycosis Epidemic and Stroke in India During the COVID-19 Pandemic
M.V. Padma Srivastava, Venugopalan Y. Vishnu, Awadh Kishor Pandit
doi : 10.1161/STROKEAHA.121.036626
Stroke. 2021;52:e622–e623
COL4A1 and COL4A2 Duplication Causes Cerebral Small Vessel Disease With Recurrent Early Onset Ischemic Strokes
Liina Kuuluvainen, Saana Mönkäre, Hannaleena Kokkonen, Fang Zhao, Auli Verkkoniemi-Ahola, Johanna Schleutker, Anna H. Hakonen, Päivi Hartikainen, Minna Pöyhönen, Liisa Myllykangas
doi : 10.1161/STROKEAHA.120.033864
Stroke. 2021;52:e624–e625
Genetics, Genomics, and Precision Medicine
James F. Meschia, Martin Dichgans
doi : 10.1161/STROKEAHA.121.033966
Stroke. 2021;52:3385–3387
Stroke in Children
Jenny L. Wilson, Michael Dowling, Heather J. Fullerton
doi : 10.1161/STROKEAHA.121.033967
Stroke. 2021;52:3388–3390
Surgical Evacuation of Intracerebral Hemorrhage
Christopher P. Kellner, Alexander J. Schupper, J Mocco
doi : 10.1161/STROKEAHA.121.032238
Stroke. 2021;52:3391–3398
Hypertension Management in Stroke Prevention
Josephine McCarthy, Jun Yang, Ben Clissold, Morag J. Young, Peter J. Fuller, Thanh Phan
doi : 10.1161/STROKEAHA.120.033990
Stroke. 2021;52:e626–e634
Primary aldosteronism confers a higher risk of stroke, atrial fibrillation, and cardiovascular disease than blood pressure matched essential hypertension. It is the most common endocrine cause of secondary hypertension with prevalence estimates of up to 13% in primary care and 30% in referral centers around the world. Unlike essential hypertension, primary aldosteronism has targeted medical treatment and potentially curative surgical solutions which can ameliorate the associated cardiovascular risks. This narrative review highlights an evidence gap in the optimal diagnosis and targeted treatment of primary aldosteronism in secondary stroke prevention. Over half of the patients suffering a stroke have blood pressure in the hypertensive range and less than a third achieve optimal blood pressure control. There are no guideline recommendations to test for primary aldosteronism in these patients, although up to 30% of patients with resistant hypertension may have this disease. The accurate diagnosis of primary aldosteronism could significantly improve blood pressure, simplify the medication regimen and reduce the overall cardiovascular risk in these patients. The challenges associated with screening for primary aldosteronism following stroke may be overcome by novel blood tests which are less affected by antihypertensive medications routinely used in stroke care. Approximately one-quarter of all strokes occur in patients who have previously had a stroke. Modifying hypertension, the leading modifiable risk factor, would, therefore, have significant public health implications. As clinicians, we must increase our awareness of primary aldosteronism in patients with stroke, particularly in those with resistant hypertension, to enable targeted therapy and reduce the risk of stroke recurrence.
Cilostazol for Secondary Stroke Prevention
Adam de Havenon, Kevin N. Sheth, Tracy E. Madsen, Karen C. Johnston, Tanya N. Turan, Kazunori Toyoda, Jordan J. Elm, Joanna M. Wardlaw, S. Claiborne Johnston, Olajide A. Williams, Ashkan Shoamanesh, Maarten G. Lansberg
doi : 10.1161/STROKEAHA.121.035002
Stroke. 2021;52:e635–e645
Cilostazol is a PDE3 (phosphodiesterase III) inhibitor with a long track record of safety that is Food and Drug Administration and European Medicines Agency approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with noncardioembolic stroke. The onset of benefit appears after 60 to 90 days of treatment, which is consistent with cilostazol’s pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Cilostazol appears safe and does not increase the risk of major bleeding when given alone or in combination with aspirin or clopidogrel. Adverse effects such as headache, gastrointestinal symptoms, and palpitations, however, contributed to a 6% increase in drug discontinuation among patients randomized to cilostazol in a large secondary stroke prevention trial (CSPS.com [Cilostazol Stroke Prevention Study for Antiplatelet Combination]). Due to limitations of prior trials, such as open-label design, premature trial termination, large loss to follow-up, lack of functional or cognitive outcome data, and exclusive enrollment in Asia, the existing trials have not led to a change in clinical practice or guidelines in Western countries. These limitations could be addressed by a double-blind placebo-controlled randomized trial conducted in a broader population. If positive, it would increase the evidence in support of long-term treatment with cilostazol for secondary prevention in the millions of patients worldwide who have experienced a noncardioembolic ischemic stroke.
Drugs Associated With Ischemic Stroke
João Pedro Marto, Davide Strambo, Francoise Livio, Patrik Michel
doi : 10.1161/STROKEAHA.120.033272
Stroke. 2021;52:e646–e659
Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities’ safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.
Deep Cerebral Perforators: Anatomical Distribution and Clinical Symptoms
Valerie Vogels, Ruben Dammers, Martine van Bilsen, Victor Volovici
doi : 10.1161/STROKEAHA.120.034096
Stroke. 2021;52:e660–e674
The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only report findings from a limited number of anatomic dissections, and no attempt has been made to date to provide a comprehensive overview of all published data. A comprehensive literature search was performed on MEDLINE, Embase, and Google Scholar with the help of an information specialist. Three types of studies were included: (1) articles that described the anatomy and distribution territories of perforator groups arising from the arteries of the circle of Willis; (2) studies that evaluated the anatomy of the deep cerebral perforators using imaging techniques; and (3) studies that evaluated either microsurgically or radiologically confirmed perforator occlusion and reported the (magnetic resonance imaging–confirmed) distribution territory of the infarction together with a description of the clinical symptoms associated as a result of the infarction. A total of 2715 articles were screened and 53 were included. Of these, 40 dealt with the anatomic and imaging anatomy of perforator groups (37 reported results of dissections and 3 results of imaging studies), with a total of 2421 hemispheres investigated. Another 13 articles with 680 patients were included that evaluated perforator infarction territories. The deep cerebral perforator distribution shows large variability with poor concordance rates among reported studies, with the exception of the posterior communicating and anterior choroidal artery perforators. Despite the assumption that cerebral perforator anatomy is a given, studies show large variability in the anatomic distribution of various perforator groups. Perforator anatomy and relationships between perforator groups, as well as potential collateral circulation in these territories should be prioritized as a research topic in cerebrovascular disease in the near future.
How to Establish the Outer Limits of Reperfusion Therapy
Lawrence R. Wechsler, Ashutosh P. Jadhav, Tudor G. Jovin,
doi : 10.1161/STROKEAHA.121.035022
Stroke. 2021;52:3399–3403
Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the “outer limits” of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy. The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.
The Outer Limits of Reperfusion Therapy
Mark W. Parsons, Ian H. Kerridge, Paul A. Komesaroff
doi : 10.1161/STROKEAHA.121.035815
Stroke. 2021;52:3404–3406
Vagus Nerve Stimulation for Upper Limb Function
Gert Kwakkel, Bruce H. Dobkin
doi : 10.1161/STROKEAHA.121.035648
Stroke. 2021;52:3407–3409
Endovascular Therapy for Stroke due to Basilar Artery Occlusion
Thanh N. Nguyen, Daniel Strbian
doi : 10.1161/STROKEAHA.121.035948
Stroke. 2021;52:3410–3413
Basilar artery occlusion stroke is known to have poor outcome with a high rate of morbidity and mortality despite best medical therapy. Since the original report of intra-arterial therapy for basilar artery occlusion in 1983, two recent randomized trials comparing endovascular therapy versus best medical management were completed on a large scale, BASICS (Basilar Artery International Cooperation Study) and the BEST trial (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment), both of which demonstrated equivocal benefit of the two modalities. In this commentary, we comment and highlight important lessons related to basilar occlusion stroke as learned from the BASICS and BEST randomized trials.
Clinical Performance Measures for Stroke Rehabilitation: Performance Measures From the American Heart Association/American Stroke Association
Joel Stein, Douglas I. Katz, Randie M. Black Schaffer, Steven C. Cramer, Anne F. Deutsch, Richard L. Harvey, Catherine E. Lang, Kenneth J. Ottenbacher, Janet Prvu-Bettger, Elliot J. Roth, David L. Tirschwell, George F. Wittenberg, Steven L. Wolf, T. Prashant Nedungadi, on behalf of the American Heart Association/American Stroke Association
doi : 10.1161/STR.0000000000000388
Stroke. 2021;52:e675–e700
The American Heart Association/American Stroke Association released the adult stroke rehabilitation and recovery guidelines in 2016. A working group of stroke rehabilitation experts reviewed these guidelines and identified a subset of recommendations that were deemed suitable for creating performance measures. These 13 performance measures are reported here and contain inclusion and exclusion criteria to allow calculation of rates of compliance in a variety of settings ranging from acute hospital care to postacute care and care in the home and outpatient setting.
Correction to: Blood Pressure After Endovascular Thrombectomy: Modeling for Outcomes Based on Recanalization Status
doi : 10.1161/STR.0000000000000391
Stroke. 2021;52:e701
