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Progress-Defining Risk Factors for Stroke Prevention
Anderson C.S.
doi : 10.1159/000516996
Cerebrovasc Dis 2021;50:615–616
PROGRESS in Blood Pressure Control for the Prevention of Secondary Stroke
Chalmers J.a · MacMahon S.b
doi : 10.1159/000518181
Cerebrovasc Dis 2021;50:617–621
Stroke Prevention: Little-Known and Neglected Aspects
Azarpazhooh M.R.a · Bogiatzi C.b · Spence J.D.c
doi : 10.1159/000515829
Cerebrovasc Dis 2021;50:622–635
Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.
The Stroke Unit Story: Where Have We Been and Where Are We Going?
Langhorne P.
doi : 10.1159/000518934
Cerebrovasc Dis 2021;50:636–643
The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions.
Evolution of Evidence-Based Medicine in Stroke
Hankey G.J.
doi : 10.1159/000517679
Cerebrovasc Dis 2021;50:644–655
The introduction and evolution of evidence-based stroke medicine has realized major advances in our knowledge about stroke, methods of medical research, and patient outcomes that continue to complement traditional individual patient care. It is humbling to recall the state of knowledge and scientific endeavour of our forebears who were unaware of what we know now and yet pursued the highest standards for evaluating and delivering effective stroke care. The science of stroke medicine has evolved from pathophysiological theory to empirical testing. Progress has been steady, despite inevitable disappointments and cul-de-sacs, and has occasionally been punctuated by sensational breakthroughs, such as the advent of reperfusion therapies guided by imaging.
Ischemic Penumbra: A Personal View
Davis S.M. · Donnan G.A.
doi : 10.1159/000519730
Cerebrovasc Dis 2021;50:656–665
The concept of the ischemic penumbra was defined over 40 years ago by Lindsay Symon and his group and is now an established principle of all acute ischemic stroke therapies. These reperfusion treatments rescue threatened, critically hypoperfused brain tissue and have been proven to improve clinical outcomes. We have been fortunate to have observed and played a small part in the penumbral story from its beginnings in the 1970s to its pivotal position today. Over this period, we have witnessed penumbral imaging evolve from positron emission tomography through to magnetic resonance imaging and now predominantly computed tomography perfusion, with the advent of automated imaging facilitating case selection for reperfusion therapies. We and others have conducted clinical trials using penumbral imaging to extend the time window for intravenous thrombolysis and select patients for thrombectomy. Together with the concept of fast- and slow-growing ischemic infarct patterns, this embeds the penumbral principle in everyday clinical management. The opportunity now exists to make penumbral imaging even more portable, affordable, and more widely available using mobile platforms, novel imaging techniques, digital linkage, and artificial intelligence.
Fifty Years of Acute Ischemic Stroke Treatment: A Personal History
Grotta J.C.
doi : 10.1159/000519843
Cerebrovasc Dis 2021;50:666–680
It has been 50 years since the first explorations of the physiology of cerebral ischemia by measuring cerebral blood flow (CBF), and 25 years since the approval of tissue plasminogen activator for treating acute ischemic stroke. My personal career began and matured during those eras. Here, I provide my perspective on the evolution of acute stroke research and treatment from 1971 to the present, with some in-depth discussion of the National Institutes of Neurologic Disease and Stroke (NINDS) tissue-type plasminogen activator (tPA) stroke trial and development of mobile stroke units.
p53 Inhibition Provides a Pivotal Protective Effect against Cerebral Ischemia-Reperfusion Injury via the Wnt Signaling Pathway
Liu Y.a · Wu X.b · Du D.c · Liu J.d · Zhang W.c · Gao Y.c · Zhang H.c
doi : 10.1159/000516889
Cerebrovasc Dis 2021;50:682–690
Cerebral ischemia-reperfusion injury enhances brain injury and increases its morbidity and mortality. The purpose of our study was to further explore the specific pathogenesis of cerebral ischemia disease by studying the role of p53 in cerebral ischemia-reperfusion injury and its mechanism to provide a new target for the treatment of cerebral ischemia.
High Triglyceride Glucose Index Is Associated with Poor Outcomes in Ischemic Stroke Patients after Reperfusion Therapy
Lee M.a · Kim C.-H.b · Kim Y.c · Jang M.U.d · Mo H.J.d · Lee S.-H.b · Lim J.-S.e · Yu K.-H.a · Lee B.-C.a · Oh M.S.a
doi : 10.1159/000516950
Cerebrovasc Dis 2021;50:691–699
The triglyceride glucose index (TyG index) is a simple and reliable surrogate marker of insulin resistance (IR) that can predict functional outcomes and mortality after acute ischemic stroke (AIS). However, it is unclear whether the TyG index is associated with functional outcomes in patients with stroke who receive reperfusion therapy. Thus, we aimed to explore the prognostic value of the TyG index for the clinical outcomes of patients with AIS who underwent reperfusion therapy.
Association of Admission NIHSS Score with Infarct Core Volume and Target Mismatch of Infarct Core/Penumbra Volume on CT Perfusion in Acute Ischaemic Stroke
Cao W.a · Ling Y.a · Yang L.a · Wu F.a · Zhang H.a · Cheng X.a · Dong Q.a,b
doi : 10.1159/000515167
Cerebrovasc Dis 2021;50:700–706
Neurological impairment is associated with collateral status in acute ischaemic stroke (AIS). We aimed to validate the association between admission National Institutes of Health Stroke Scale (aNIHSS) score and infarct core volume (ICV) and target infarct core/penumbra volume mismatch (TMM) on CT perfusion (CTP) in AIS patients.
COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles
Padrick M.M.a · Sangha N.b · Paletz L.a · Mirocha J.c · Figueroa S.a · Manoukian V.a · Schlick K.a · Lyden P.D.d · Liebeskind D.S.e · Chatfield F.K.e · Tarpley J.W.f,g · Burgos A.h · Tenser M.i,j · Gaffney D.b · Pech M.A.k · Nazareth E.k · Jackson R.f · Kauffman H.f,g,k · Arnold L.f · Cox J.l · Joyce T.g · Nakamura C.g · Fitzgerald D.g · Ogami K.a · Steiner N.a · Wolber N.a · Robertson B.a · Izzo R.a · Gorski S.h · Manuel H.h · Valdez K.g,i · Reyes L.i · Sharma L.K.d · Song S.S.a
doi : 10.1159/000516908
Cerebrovasc Dis 2021;50:707–714
To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC).
Delayed Stroke Treatment during COVID-19 Pandemic in China
Gu S.a,b · Dai Z.c · Shen H.d · Bai Y.e · Zhang X.f · Liu X.a,f · Xu G.a,f
doi : 10.1159/000517075
Cerebrovasc Dis 2021;50:715–721
Social distance, quarantine, pathogen testing, and other preventive strategies implemented during COVID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS).
Renal Dysfunction Is Associated with Middle Cerebral Artery Pulsatility Index and Total Burden of Cerebral Small Vessel Disease
Lee E.-J.a · Jeong H.-B.b · Bae J.a · Guk H.S.c · Jeong H.-Y.a · Lee E.J.d · Yoon B.-W.a,e
doi : 10.1159/000517137
Cerebrovasc Dis 2021;50:722–728
Renal dysfunction is known to affect vasculature and lead to systemic arterial stiffness. It also independently increases the risk of cerebral small vessel disease (cSVD) and stroke. We aimed to examine the effect of renal dysfunction on cerebral hemodynamics and the burden of cSVD.
Beyond Functional Impairment: Redefining Favorable Outcome in Patients with Subarachnoid Hemorrhage
Custal C.a · Koehn J.b · Borutta M.b · Mrochen A.b · Brandner S.c · Eyüpoglu I.Y.c · Lücking H.d · Hoelter P.d · Kuramatsu J.B.b · Kornhuber J.a · Schwab S.b · Huttner H.B.b · Gerner S.T.b
doi : 10.1159/000517242
Cerebrovasc Dis 2021;50:729–737
For outcome assessment in patients surviving subarachnoid hemorrhage (SAH), the modified Rankin scale (mRS) represents the mostly established outcome tool, whereas other dimensions of outcome such as mood disorders and impairments in social life remain unattended so far.
Fluid-Attenuated Inversion Recovery Hyperintense Ischemic Stroke Predicts Less Favorable 90-Day Outcome after Intravenous Thrombolysis
Kim Y.a,b · Luby M.b · Burkett N.-S.c · Norato G.d · Leigh R.b,e · Wright C.B.b · Kern K.C.b · Hsia A.W.a,b · Lynch J.K.b · Adil M.M.b,e · Latour L.L.b
doi : 10.1159/000517241
Cerebrovasc Dis 2021;50:738–745
The absence of an ischemic lesion on MRI fluid-attenuated inversion recovery (FLAIR) is helpful in predicting stroke onset within 4.5 h. However, some ischemic strokes become visible on FLAIR within 4.5 h. We hypothesized that the early lesion visibility on FLAIR may predict stroke outcome 90 days after intravenous (IV) thrombolysis, independent of time.
Cerebral Microvascular Erdheim-Chester Disease: A Perivascular Hematopoietic Vasculopathy
Moussouttas M.a · Roemer S.b · Dickson D.W.b
doi : 10.1159/000516803
Cerebrovasc Dis 2021;50:746–751
Erdheim-Chester disease (ECD) is a rare and elusive hematopoietic malignancy that may involve the nervous system in various ways. Cerebrovascular ECD involves the perivascular infiltration and compromise of any cervicocranial vessel by transformed proliferating histiocytes. Presented is the novel case of a patient with pathologically proven perivascular microangiopathy, manifesting in multifaceted fashion with ischemia, hemorrhage, mass lesions, and edema.
Is Measuring Risk Marker Progression Useful for Cardiovascular Disease Prediction?
Fujiyoshi A.a · Zaid M.b · Barinas-Mitchell E.c
doi : 10.1159/000517869
Cerebrovasc Dis 2021;50:752–755
