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February 2021 Stroke Highlights
Nicole B. Sur
doi : 10.1161/STROKEAHA.120.033941
Stroke. 2021 | Volume 52, Issue 2: 395
Sex, Age, and Socioeconomic Differences in Nonfatal Stroke Incidence and Subsequent Major Adverse Outcomes
Ralph K. Akyea, Yana Vinogradova, Nadeem Qureshi, Riyaz S. Patel, Evangelos Kontopantelis, George Ntaios, Folkert W. Asselbergs, Joe Kai, Stephen F. Weng
doi : 10.1161/STROKEAHA.120.031659
Stroke. 2021 | Volume 52, Issue 2: 396–405
Data about variations in stroke incidence and subsequent major adverse outcomes are essential to inform secondary prevention and prioritizing resources to those at the greatest risk of major adverse end points. We aimed to describe the age, sex, and socioeconomic differences in the rates of first nonfatal stroke and subsequent major adverse outcomes.
Sex Differences in Acute Treatment and Early Outcomes of Acute Ischemic Stroke
Anna K. Bonkhoff, André Karch, Ralph Weber, Jürgen Wellmann, Klaus Berger
doi : 10.1161/STROKEAHA.120.032850
Stroke. 2021 | Volume 52, Issue 2: 406–415
Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry.
Absence of Consistent Sex Differences in Outcomes From Symptomatic Carotid Endarterectomy and Stenting Randomized Trials
Virginia J. Howard, Ale Algra, George Howard, Leo H. Bonati, Gert J. de Borst, Richard Bulbulia, David Calvet, Hans-Henning Eckstein, Gustav Fraedrich, Jacoba P. Greving, Alison Halliday, Jeroen Hendrikse, Olav Jansen, Martin M. Brown, Jean-Louis Mas, Peter A. Ringleb, Thomas G. Brott and on behalf of the Carotid Stenosis Trialists’ Collaboration
doi : 10.1161/STROKEAHA.120.030184
Stroke. 2021 | Volume 52, Issue 2: 416–423
CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) reported a higher periprocedural risk for any stroke, death, or myocardial infarction for women randomized to carotid artery stenting (CAS) compared with women randomized to carotid endarterectomy (CEA). No difference in risk by treatment was detected for women relative to men in the 4-year primary outcome. We aimed to conduct a pooled analysis among symptomatic patients in large randomized trials to provide more precise estimates of sex differences in the CAS-to-CEA risk for any stroke or death during the 120-day periprocedural period and ipsilateral stroke thereafter.
Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack
Francisco Purroy, Mikel Vicente-Pascual, Gloria Arque, Mariona Baraldes-Rovira, Robert Begue, Yhovany Gallego, M. Isabel Gil, M. Pilar Gil-Villar, Gerard Mauri, Alejandro Quilez, Jordi Sanahuja, Daniel Vazquez-Justes
doi : 10.1161/STROKEAHA.120.032814
Stroke. 2021 | Volume 52, Issue 2: 424–433
Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA.
Influence of Pregnancy on Hemorrhage Risk in Women With Cerebral and Spinal Cavernous Malformations
Nycole K. Joseph, Shivram Kumar, Robert D. Brown Jr, Giuseppe Lanzino, Kelly D. Flemming
doi : 10.1161/STROKEAHA.120.031761
Stroke. 2021 | Volume 52, Issue 2: 434–441
Pregnancy as a hemorrhage risk factor in women with cavernous malformations (CMs) is controversial. We describe prospective hemorrhage risk in women who become pregnant after an established CM diagnosis.
Why Are Women Less Represented in Intracerebral Hemorrhage Trials?
Tatiana Greige, Casey Norton, Lydia D. Foster, Sharon D. Yeatts, Andre Thornhill, Jessica Griffin, Jeffrey Wang, Courtney M. Hrdlicka, Magdy Selim,
doi : 10.1161/STROKEAHA.120.032166
Stroke. 2021 | Volume 52, Issue 2: 442–446
Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine).
Stroke Incidence by Sex Across the Lifespan
Manav V. Vyas, Frank L. Silver, Peter C. Austin, Amy Y.X. Yu, Priscila Pequeno, Jiming Fang, Andreas Laupacis, Moira K. Kapral
doi : 10.1161/STROKEAHA.120.032898
Stroke. 2021 | Volume 52, Issue 2: 447–451
We evaluated the influence of age on the association between sex and the incidence of stroke or transient ischemic attack (TIA) using a population-based cohort from Ontario, Canada.
Under-Enrollment of Women in Stroke Clinical Trials
Cheryl Carcel, Mathew Reeves
doi : 10.1161/STROKEAHA.120.033227
Stroke. 2021 | Volume 52, Issue 2: 452–457
The under-representation of women in clinical trials is a commonly recognized and seemingly intractable problem in many different areas of clinical medicine. Discrepancies in the enrollment of women in clinical trials raises concerns about the generalizability of trial evidence, as well as the potential for reduced access and utilization of new therapies in women. Recent studies confirm that the problem of under-enrollment of women continues to exist in stroke clinical trials, even after accounting for the sex ratio of stroke cases in the underlying population. The origins of these disparities are complex, and there remains a relative dearth of stroke studies that have examined the causes in detail. Although caution should be used when generalizing research findings from studies conducted in other medical conditions including cardiology trials, factors that contribute to lower enrollment in women include the use of specific trial eligibility criteria (eg, older age, presence of specific comorbidities), patient attitudes and beliefs (resulting in less interest and more refusals in women), and potentially implicit biases among study personnel. Beyond a general call to prioritize stroke research in this area, we also recommend the greater use of trial screening logs, the use of qualitative studies to understand patient attitudes and beliefs towards stroke research, avoiding the use of age-based exclusion criteria (eg, >80 years), and increasing the number of women who lead stroke clinical trials.
Goal Setting Improves Cognitive Performance in a Randomized Trial of Chronic Stroke Survivors
Keera N. Fishman, Andrea R. Ashbaugh, Richard H. Swartz
doi : 10.1161/STROKEAHA.120.032131
Stroke. 2021 | Volume 52, Issue 2: 458–470
Cognitive impairment after stroke, especially executive and attention dysfunction, is common, negatively affects daily functioning, and has limited treatment options. A single-blind, parallel-design, randomized controlled trial was used to examine the impact of goal setting on poststroke cognitive performance.
Course and Recognition of Poststroke Delirium
Robert Fleischmann, Sina Warwas, Tina Andrasch, Rhina Kunz, Carl Witt, Annerose Mengel, Bettina von Sarnowski
doi : 10.1161/STROKEAHA.120.031019
Stroke. 2021 | Volume 52, Issue 2: 471–478
Poststroke delirium (PSD) is an independent predictor of unfavorable outcome. Despite its individual and socioeconomic burden, its frequency, clinical course, and routine detection remain unresolved. This study aimed to assess psychometric properties of established delirium screening tools and investigate the natural course of PSD.
Screening for Delirium in Acute Stroke
Sarah T. Pendlebury
doi : 10.1161/STROKEAHA.120.033192
Stroke. 2021 | Volume 52, Issue 2: 479–481
Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy
Fabian Flottmann, Caspar Brekenfeld, Gabriel Broocks, Hannes Leischner, Rosalie McDonough, Tobias D. Faizy, Milani Deb-Chatterji, Anna Alegiani, G?tz Thomalla, Anastasios Mpotsaris, Christian H. Nolte, Jens Fiehler, M?té E. Maros,
doi : 10.1161/STROKEAHA.120.029830
Stroke. 2021 | Volume 52, Issue 2: 482–490
Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. Often, more than one retrieval attempt is needed to achieve reperfusion. We aimed to quantify the influence of endovascular therapy on clinical outcome depending on the number of retrievals needed for successful reperfusion in a large multi-center cohort.
Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows
Raul G. Nogueira, Diogo C. Haussen, David Liebeskind, Tudor G. Jovin, Rishi Gupta, Ashutov Jadhav, Ron F. Budzik, Blaise Baxter, Antonin Krajina, Alain Bonafe, Ali Malek, Ana Paula Narata, Ryan Shields, Yanchang Zhang, Patricia Morgan, Bruno Bartolini, Joey English, Michael R. Frankel, Erol Veznedaroglu and for the Trevo Registry and DAWN Trial Investigators
doi : 10.1161/STROKEAHA.120.031685
Stroke. 2021 | Volume 52, Issue 2: 491–497
Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients.
Correlation of Alberta Stroke Program Early Computed Tomography Score With Computed Tomography Perfusion Core in Large Vessel Occlusion in Delayed Time Windows
Sriharsha Voleti, Johnathan Vidovich, Brendan Corcoran, Bin Zhang, Vivek Khandwala, Eva A. Mistry, Pooja Khatri, Thomas Tomsick, Achala Vagal
doi : 10.1161/STROKEAHA.120.030353
Stroke. 2021 | Volume 52, Issue 2: 498–504
The Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and CT perfusion (CTP) are commonly used to predict the ischemic core in acute ischemic strokes. CT angiography source images (CTA-SI) can also provide additional information to identify the extent of ischemia. Our objective was to investigate the correlation of noncontrast CT (NCCT) ASPECTS and CTA-SI ASPECTS with CTP core volumes.
Defining a Target Population to Effectively Test a Neuroprotective Drug
Marta Olivé-Gadea, Manuel Requena, Daniel Campos, Alvaro Garcia-Tornel, Mat?as Deck, Marian Muchada, Sandra Boned, Noelia Rodr?guez, Jes?s Juega, David Rodr?guez-Luna, Jorge Pagola, Marta Rubiera, Macarena Hern?ndez-Jiménez, Carlos A. Molina, Marc Ribo
doi : 10.1161/STROKEAHA.120.032025
Stroke. 2021 | Volume 52, Issue 2: 505–510
We aim to identify the subgroup of acute ischemic stroke patients with higher probabilities of benefiting from a potential neuroprotective drug using baseline outcome predictors and test whether different selection criteria strategies can improve detected treatment effect.
Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding
Soonil Kwon, So-Ryoung Lee, Eue-Keun Choi, Euijae Lee, Jin-Hyung Jung, Kyung-Do Han, Myung-Jin Cha, Seil Oh, Gregory Y.H. Lip
doi : 10.1161/STROKEAHA.120.030761
Stroke. 2021 | Volume 52, Issue 2: 511–520
Limited data support the benefits of non–vitamin K oral anticoagulants (NOACs) among atrial fibrillation patients with prior gastrointestinal bleeding (GIB). We aimed to evaluate the effectiveness and safety of NOACs compared with those of warfarin among atrial fibrillation patients with prior GIB.
Body Mass Index and Clinical Outcomes in Asian Patients With Atrial Fibrillation Receiving Oral Anticoagulation
So-Ryoung Lee, Eue-Keun Choi, Jin-Hyung Jung, Sang-Hyun Park, Kyung-Do Han, Seil Oh, Gregory Y.H. Lip
doi : 10.1161/STROKEAHA.120.030356
Stroke. 2021 | Volume 52, Issue 2: 521–530
The influence of body mass index (BMI) on clinical outcomes in patients with atrial fibrillation remains controversial, especially among Asians. We aimed to evaluate the association between BMI and clinical outcomes in Asian patients with atrial fibrillation receiving oral anticoagulants.
Risk Factors for Severe Residual Headache in Cerebral Venous Thrombosis
Kangxiang Ji, Chen Zhou, Longfei Wu, Weili Li, Milan Jia, Min Chu, Di Wu, Chengbei Hou, Jiangang Duan, Ran Meng, Xunming Ji
doi : 10.1161/STROKEAHA.120.029820
Stroke. 2021 | Volume 52, Issue 2: 531–536
Which factors will influence the presence of severe residual headache after cerebral venous thrombosis (CVT) is unclear. The purpose of this study was to identify risk factors for severe residual headache in a large single-center cohort of patients with CVT.
Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients
Xuting Zhang, Shenqiang Yan, Wansi Zhong, Yannan Yu, Min Lou
doi : 10.1161/STROKEAHA.120.029593
Stroke. 2021 | Volume 52, Issue 2: 537–542
We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT).
Role of Blood-Based Biomarkers in Ischemic Stroke Prognosis
Felipe A. Montellano, Kathrin Ungethüm, Laura Ramiro, Aliona Nacu, Simon Hellwig, Felix Fluri, William N. Whiteley, Alejandro Bustamante, Joan Montaner, Peter U. Heuschmann
doi : 10.1161/STROKEAHA.120.029232
Stroke. 2021 | Volume 52, Issue 2: 543–551
Outcome prognostication in ischemic stroke patients remains challenging due to limited predictive properties of existing models. Blood-based biomarkers might provide additional information to established prognostic factors. We intended to identify the most promising prognostic biomarkers in ischemic stroke, their incremental prognostic value, and whether their predictive value differs among etiologies.
Stroke Acute Management and Outcomes During the COVID-19 Outbreak
Blanca Fuentes, Mar?a Alonso de Leci?ana, Sebasti?n Garc?a-Madrona, Fernando D?az-Otero, Clara Aguirre, Patricia Calleja, José A. Egido, Joaqu?n Carneado-Ruiz, Gerardo Ruiz-Ares, Jorge Rodr?guez-Pardo, ?ngela Rodr?guez-L?pez, ?lvaro Ximénez-Carrillo, Alicia de Felipe, Fernando Ostos, Guillermo Gonz?lez-Ortega, Patricia Simal, Carlos I. G?mez Escalonilla, Pablo G?mez-Porro-S?nchez, Zayrho Desanvicente, Gemma Reig, Antonio Gil-N??ez, Jaime Masju?n, Exuperio D?ez-Tejedor
doi : 10.1161/STROKEAHA.120.031769
Stroke. 2021 | Volume 52, Issue 2: 552–562
The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non–COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19.
Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic
Richa Sharma, Lindsey R. Kuohn, Daniel M. Weinberger, Joshua L. Warren, Lauren H. Sansing, Adam Jasne, Guido Falcone, Amar Dhand, Kevin N. Sheth
doi : 10.1161/STROKEAHA.120.031975
Stroke. 2021 | Volume 52, Issue 2: 563–572
The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19–related vascular pathology.
Average Lifespan Shortened due to Stroke in Canada
Truong-Minh Pham, Nguyen Xuan Thanh, Tracy Wasylak, Michael D. Hill, Thomas Jeerakathil, Khokan C. Sikdar, Bethany Kaposhi, Lorraine Shack, Winson Y. Cheung
doi : 10.1161/STROKEAHA.120.032028
Stroke. 2021 | Volume 52, Issue 2: 573–581
There are challenges in comparability when using existing life lost measures to examine long-term trends in premature mortality. To address this important issue, we have developed a novel measure termed average lifespan shortened (ALSS). In the present study, we used the ALSS measure to describe temporal changes in premature mortality due to stroke in the Canadian population from 1990 to 2015.
Genetically Determined Smoking Behavior and Risk of Nontraumatic Subarachnoid Hemorrhage
Juli?n N. Acosta, Natalia Szejko, Cameron P. Both, Kevin Vanent, Rommell B. Noche, Thomas M. Gill, Charles C. Matouk, Kevin N. Sheth, Murat Gunel, Guido J. Falcone
doi : 10.1161/STROKEAHA.120.031622
Stroke. 2021 | Volume 52, Issue 2: 582–587
Animal and observational studies indicate that smoking is a risk factor for aneurysm formation and rupture, leading to nontraumatic subarachnoid hemorrhage (SAH). However, a definitive causal relationship between smoking and the risk of SAH has not been established. Using Mendelian randomization (MR) analyses, we tested the hypothesis that smoking is causally linked to the risk of SAH.
Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage
Gregoire Boulouis, Jean-François Hak, Basile Kerleroux, Sandro Benichi, Sarah Stricker, Florent Gariel, Quentin Alias, Marie Bourgeois, Philippe Meyer, Manoelle Kossorotoff, Lorenzo Garzelli, Nicolas Garcelon, Nathalie Boddaert, Andrea Morotti, Thomas Blauwblomme, Olivier Naggara
doi : 10.1161/STROKEAHA.120.030592
Stroke. 2021 | Volume 52, Issue 2: 588–594
Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children.
Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage and Risk of Stroke
Santosh B. Murthy, Cenai Zhang, Ajay Gupta, Sung-Min Cho, Lucia Rivera-Lara, Radhika Avadhani, Joshua Gruber, Costantino Iadecola, Guido J. Falcone, Kevin N. Sheth, Adnan I. Qureshi, Joshua N. Goldstein, Daniel F. Hanley, Hooman Kamel, Wendy C. Ziai
doi : 10.1161/STROKEAHA.120.031628
Stroke. 2021 | Volume 52, Issue 2: 595–602
Punctate ischemic lesions noted on diffusion-weighted imaging (DWI) are associated with poor functional outcomes after intracerebral hemorrhage (ICH). Whether these lesions increase long-term risk of stroke is poorly understood.
Impact of Preexisting Cognitive Impairment and Race/Ethnicity on Functional Outcomes Following Intracerebral Hemorrhage
Russell P. Sawyer, Eunji Yim, Elisheva Coleman, Stacie L. Demel, Padmini Sekar, Daniel Woo
doi : 10.1161/STROKEAHA.120.030084
Stroke. 2021 | Volume 52, Issue 2: 603–610
In intracerebral hemorrhage (ICH), preexisting cognitive impairment has been identified as a risk factor for increased mortality and morbidity. However, previous studies examined predominantly White populations; therefore, the prevalence and effect of preICH cognitive impairment has not been studied in a multiethnic cohort. This limits the generalizability of previous findings. We sought to investigate the role of preexisting cognitive impairment in a multiethnic population on short-term mortality and functional outcomes after ICH.
Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage
Anne Mrochen, Maximilian I. Sprügel, Stefan T. Gerner, Jochen A. Sembill, Stefan Lang, Hannes Lücking, Joji B. Kuramatsu, Hagen B. Huttner
doi : 10.1161/STROKEAHA.120.031478
Stroke. 2021 | Volume 52, Issue 2: 611–619
The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT).
Heterogeneity of Cerebral White Matter Lesions and Clinical Correlates in Older Adults
Keun-Hwa Jung, Kimberly A. Stephens, Kathryn M. Yochim, Joost M. Riphagen, Chan Mi Kim, Randy L. Buckner, David H. Salat
doi : 10.1161/STROKEAHA.120.031641
Stroke. 2021 | Volume 52, Issue 2: 620–630
Cerebral white matter signal abnormalities (WMSAs) are a significant radiological marker associated with brain and vascular aging. However, understanding their clinical impact is limited because of their pathobiological heterogeneity. We determined whether use of robust reliable automated procedures can distinguish WMSA classes with different clinical consequences.
Show Me Your White Matter, I Will Tell You Who You Are …
Gregory Kuchcinski, Clinton B. Wright
doi : 10.1161/STROKEAHA.120.033225
Stroke. 2021 | Volume 52, Issue 2: 631–633
no abstract
Noncontrast Computed Tomography e-Stroke Infarct Volume Is Similar to RAPID Computed Tomography Perfusion in Estimating Postreperfusion Infarct Volumes
Mehdi Bouslama, Krishnan Ravindran, George Harston, Gabriel M. Rodrigues, Leonardo Pisani, Diogo C. Haussen, Michael R. Frankel, Raul G. Nogueira
doi : 10.1161/STROKEAHA.120.031651
Stroke. 2021 | Volume 52, Issue 2: 634–641
The e-Stroke Suite software (Brainomix, Oxford, United Kingdom) is a tool designed for the automated quantification of The Alberta Stroke Program Early CT Score and ischemic core volumes on noncontrast computed tomography (NCCT). We sought to compare the prediction of postreperfusion infarct volumes and the clinical outcomes across NCCT e-Stroke software versus RAPID (IschemaView, Menlo Park, CA) computed tomography perfusion measurements.
Automated Measurement of Computed Tomography Acute Ischemic Core in Stroke
Mark W. Parsons
doi : 10.1161/STROKEAHA.120.032998
Stroke. 2021 | Volume 52, Issue 2: 642–644
no abstract
Serum Neurofilament to Magnetic Resonance Imaging Lesion Area Ratio Differentiates Spinal Cord Infarction From Acute Myelitis
Elia Sechi, Sara Mariotto, Andrew McKeon, Karl N. Krecke, Sean J. Pittock, Sergio Ferrari, Salvatore Monaco, Eoin P. Flanagan, Serena Zanzoni, Alejandro A. Rabinstein, Dean M. Wingerchuk, Deena M. Nasr, Nicholas L. Zalewski
doi : 10.1161/STROKEAHA.120.031482
Stroke. 2021 | Volume 52, Issue 2: 645–654
The diagnosis of spontaneous spinal cord infarction (SCI) is limited by the lack of diagnostic biomarkers and MRI features that often overlap with those of other myelopathies, especially acute myelitis. We investigated whether the ratio between serum neurofilament light chain levels and MRI T2-lesion area (neurofilament light chain/area ratio—NAR) differentiates SCI from acute myelitis of similar severity.
Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack
Faizul Hasan, Christopher Gordon, Dean Wu, Hui-Chuan Huang, Lia Taurussia Yuliana, Budi Susatia, Ollyvia Freeska Dwi Marta, Hsiao-Yean Chiu
doi : 10.1161/STROKEAHA.120.029847
Stroke. 2021 | Volume 52, Issue 2: 655–663
The exact prevalence of sleep disorders following stroke or transient ischemic attack (TIA) remains unclear. We aimed to determine the prevalence of sleep-disordered breathing, insomnia, periodic leg movement during sleep, and restless leg syndrome following stroke or TIA in acute, subacute, and chronic phases and examine the moderating effects of patient characteristics (eg, age) and methodological features (eg, study quality) on the prevalence.
Cost-Effectiveness of Mechanical Thrombectomy for Treatment of Nonminor Ischemic Stroke Across Europe
Paolo Candio, Mara Violato, Jose Leal, Ramon Luengo-Fernandez
doi : 10.1161/STROKEAHA.120.031027
Stroke. 2021 | Volume 52, Issue 2: 664–673
Mechanical thrombectomy (MT) has been recommended for the treatment of nonminor ischemic stroke by national and international guidelines, but cost-effectiveness evidence has been generated for only a few countries using heterogeneous evaluation methods. We estimate the cost-effectiveness of MT across 32 European countries.
Cost-Effectiveness of Mechanical Thrombectomy for Treatment of Stroke
Greg Arling, Mikael Mazighi
doi : 10.1161/STROKEAHA.120.032112
Stroke. 2021 | Volume 52, Issue 2: 674–676
CD31 Mimetic Coating Enhances Flow Diverting Stent Integration into the Arterial Wall Promoting Aneurysm Healing
Jonathan Cortese, Charlotte Rasser, Guillaume Even, Sylvia M. Bardet, Christine Choqueux, Jules Mesnier, Marie-Laure Perrin, Kevin Janot, Jildaz Caroff, Antonino Nicoletti, Jean-Baptiste Michel, Laurent Spelle, Giuseppina Caligiuri, Aymeric Rouchaud
doi : 10.1161/STROKEAHA.120.030624
Stroke. 2021 | Volume 52, Issue 2: 677–686
Beyond aneurysmal occlusion, metallic flow diverters (FDs) can induce an adverse endovascular reaction due to the foreignness of metal devices, hampering FD endothelialization across the aneurysm neck, and arterial healing of intracranial aneurysms. Here, we evaluated the potential benefits of an FD coating mimicking CD31, a coreceptor critically involved in endothelial function and endovascular homeostasis, on the endothelialization of FDs implanted in vivo.
Unique Subtype of Microglia in Degenerative Thalamus After Cortical Stroke
Zhijuan Cao, Sean S. Harvey, Terrance Chiang, Aulden G. Foltz, Alex G. Lee, Michelle Y. Cheng, Gary K. Steinberg
doi : 10.1161/STROKEAHA.120.032402
Stroke. 2021 | Volume 52, Issue 2: 687–698
Stroke disrupts neuronal functions in both local and remotely connected regions, leading to network-wide deficits that can hinder recovery. The thalamus is particularly affected, with progressive development of neurodegeneration accompanied by inflammatory responses. However, the complexity of the involved inflammatory responses is poorly understood. Herein we investigated the spatiotemporal changes in the secondary degenerative thalamus after cortical stroke, using targeted transcriptome approach in conjunction with histology and flow cytometry.
Intended Bridging Therapy or Intravenous Thrombolysis Alone in Minor Stroke With Basilar Artery Occlusion
Pierre Seners, Cyril Dargazanli, Michel Piotin, Denis Sablot, Serge Bracard, Philippe Niclot, Jean-Claude Baron, Guillaume Turc,and on behalf of the MINOR-STROKE Collaborators
doi : 10.1161/STROKEAHA.120.030992
Stroke. 2021 | Volume 52, Issue 2: 699–702,
Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with basilar artery occlusion remains uncertain.
Linoleic Acid Status in Cell Membranes Inversely Relates to the Prevalence of Symptomatic Carotid Artery Disease
Iolanda L?zaro, Montserrat Cof?n, Antonio J. Amor, Emilio Ortega, Tania-Marisa Freitas-Simoes, Laura Llull, Sergio Amaro, Gaspar Mestres, Xavier Yugueros, William S. Harris, Vicente Riambau, Aleix Sala-Vila
doi : 10.1161/STROKEAHA.120.030477
Stroke. 2021 | Volume 52, Issue 2: 703–706
The red blood cell fatty acid composition objectively reflects the long-term dietary intake of several fatty acids. In patients undergoing carotid endarterectomy, we explored whether red blood cell status of selected fatty acids related to symptomatic carotid artery disease.
Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke
Silvia Hern?ndez-Dur?n, Leonie Meinen, Veit Rohde, Christian von der Brelie
doi : 10.1161/STROKEAHA.120.032390
Stroke. 2021 | Volume 52, Issue 2: 707–711
The role of decompressive hemicraniectomy (DC) in malignant cerebral infarction (MCI) has clearly been established, but little is known about the course of intracranial pressure (ICP) in patients undergoing this surgical measure. In this study, we investigated the role of invasive ICP monitoring in patients after DC for MCI, postulating that postoperative ICP predicts mortality.
Impact of Sleep Apnea on Cardioembolic Risk in Patients With Atrial Fibrillation
Martino F. Pengo, Andrea Faini, Ludger Grote, Ondrej Ludka, Pavol Joppa, Athanasia Pataka, Zoran Dogas, Stefan Mihaicuta, Holger Hein, Ulla Anttalainen, Silke Ryan, Carolina Lombardi, Gianfranco Parati and on behalf of the ESADA Working Group
doi : 10.1161/STROKEAHA.120.030285
Stroke. 2021 | Volume 52, Issue 2: 712–715
An accurate determination of the cardioembolic risk in patients with atrial fibrillation (AF) is crucial to prevent consequences like stroke. Obstructive sleep apnea (OSA) is a known risk factor for both AF and stroke. We aim to explore a possible association between OSA and an increased cardioembolic risk in patients with AF.
Analysis of Nationwide Stroke Patient Care in Times of COVID-19 Pandemic in Germany
Daniel Richter, Jens Eyding, Ralph Weber, Dirk Bartig, Armin Grau, Werner Hacke, Christos Krogias
doi : 10.1161/STROKEAHA.120.033160
Stroke. 2021 | Volume 52, Issue 2: 716–721
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many countries have introduced strict hygiene measures of social distancing to prevent further spreading of the disease. This may have led to a decreased presentation to hospital of patients with acute medical conditions and time-dependent management, such as stroke.
Associations of an Abnormal Physiological Score With Outcomes in Acute Intracerebral Hemorrhage
Lili Song, Xia Wang, Menglu Ouyang, Lingli Sun, Xiaoying Chen, Hisatomi Arima, Else C. Sandset, Candice Delcourt, Jiguang Wang, Guofang Chen, Thompson Robinson, Richard I. Lindley, John Chalmers, Craig S. Anderson and for the INTERACT2 Investigators
doi : 10.1161/STROKEAHA.120.030435
Stroke. 2021 | Volume 52, Issue 2: 722–725
We determined associations of physiological abnormalities (systolic blood pressure, glucose, and body temperature) and warfarin use with outcomes in spontaneous intracerebral hemorrhage.
Effect of Premorbid Anxiolytic Medications on Ischemic Stroke Functional Outcome
Cecilia Peterson, Ka-Ho Wong, Eric L. Stulberg, Kirby Taylor, Steven C. Cramer, Adam H. de Havenon
doi : 10.1161/STROKEAHA.120.032812
Stroke. 2021 | Volume 52, Issue 2: e51–e52
Stroke in Women
Moira K. Kapral, Cheryl Bushnell
doi : 10.1161/STROKEAHA.120.033233
Stroke. 2021 | Volume 52, Issue 2: 726–728
Sex differences exist in the epidemiology, care, and outcomes of stroke. This article highlights recent advances in our understanding of sex and gender differences in the benefits of endovascular therapy, outcomes after stroke and transient neurological events, and the potential to prevent stroke in women with a history of hypertensive disorders of pregnancy.
Advances in Acute Stroke Treatment 2020
Joseph P. Broderick, Michael D. Hill
doi : 10.1161/STROKEAHA.120.033744
Stroke. 2021 | Volume 52, Issue 2: 729–734
Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease
Janine Gronewold, Miriam Engels, Sarah van de Velde, Thomas Kofi Mensah Cudjoe, Ela-Emsal Duman, Martha Jokisch, Christoph Kleinschnitz, Karl Lauterbach, Raimund Erbel, Karl-Heinz J?ckel, Dirk M. Hermann
doi : 10.1161/STROKEAHA.120.032070
Stroke. 2021 | Volume 52, Issue 2: 735–747
The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.
Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes
Renerus J. Stolwyk, Tijana Mihaljcic, Dana K. Wong, Jodie E. Chapman, Jeffrey M. Rogers
doi : 10.1161/STROKEAHA.120.032215
Stroke. 2021 | Volume 52, Issue 2: 748–760
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18–96 years). Median length of follow-up was 12 months (range: 3 months–11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33–0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose
Kathryn S. Hayward, Leonid Churilov, Emily J. Dalton, Amy Brodtmann, Bruce C.V. Campbell, David Copland, Numa Dancause, Erin Godecke, Tammy C. Hoffmann, Natasha A. Lannin, Matthew W. McDonald, Dale Corbett, Julie Bernhardt
doi : 10.1161/STROKEAHA.120.032496
Stroke. 2021 | Volume 52, Issue 2: 761–769
Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines; (2) inadequate conceptualization of dose, which is multidimensional; and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain individual sessions and episodes that can be active (time on task) or inactive (time off task), and each individual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.
Endovascular Therapy Versus Medical Treatment for Symptomatic Intracranial Artery Stenosis
Tao Wang, Jichang Luo, Xue Wang, Kun Yang, Vikram Jadhav, Peng Gao, Yan Ma, Na Zhao, Liqun Jiao
doi : 10.1161/STROKEAHA.120.032988
Stroke. 2021 | Volume 52, Issue 2: e53–e54
Atrial Fibrillation and Prevention of Embolic Stroke
Robert G. Hart
doi : 10.1161/STROKEAHA.120.030420
Stroke. 2021 | Volume 52, Issue 2: e55–e57
Cases of Stroke Presenting With an Isolated Third Nerve Palsy
Fransisca Indraswari, Loulwah Mukharesh, Kathleen M. Burger, Christopher R. Leon Guerrero
doi : 10.1161/STROKEAHA.120.030568
Stroke. 2021 | Volume 52, Issue 2: e58–e60
Letter by Amukotuwa and Dehkharghani Regarding Article, “Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography”
Shalini A. Amukotuwa, Seena Dehkharghani
doi : 10.1161/STROKEAHA.120.032604
Stroke. 2021 | Volume 52, Issue 2: e61–e62
Response by Olivé Gadea and Ribo to Letter Regarding Article, “Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography”
Marta Olivé Gadea, Marc Ribo
doi : 10.1161/STROKEAHA.120.033116
Stroke. 2021 | Volume 52, Issue 2: e63
Letter by Kamtchum-Tatuene and Jickling Regarding Article, “Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy”
Joseph Kamtchum-Tatuene, Glen C. Jickling
doi : 10.1161/STROKEAHA.120.032698
Stroke. 2021 | Volume 52, Issue 2: e64–e65
Response by Waissi et al Regarding Article, “Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy”
Farahnaz Waissi, Dominique P.V. de Kleijn, Jeffrey Kroon
doi : 10.1161/STROKEAHA.120.033240
Stroke. 2021 | Volume 52, Issue 2: e66–e67
Letter by Almallouhi and Al Kasab Regarding Article, “Antiphospholipid Antibody and Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis”
Eyad Almallouhi, Sami Al Kasab
doi : 10.1161/STROKEAHA.120.033073
Stroke. 2021 | Volume 52, Issue 2: e68
Response by Kim and Kim to Letter Regarding Article, “Antiphospholipid Antibody and Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis”
Yerim Kim, Soo Young Kim
doi : 10.1161/STROKEAHA.120.033364
Stroke. 2021 | Volume 52, Issue 2: e69
Letter by Rose et al Regarding Article, “Acute Cerebrovascular Events in Hospitalized COVID-19 Patients”
David Z. Rose, Swetha Renati, W. Scott Burgin
doi : 10.1161/STROKEAHA.120.032363
Stroke. 2021 | Volume 52, Issue 2: e70–e71
Response by Rothstein and Cucchiara to Letter Regarding Article, “Acute Cerebrovascular Events in Hospitalized COVID-19 Patients”
Aaron Rothstein, Brett L. Cucchiara
doi : 10.1161/STROKEAHA.120.032902
Stroke. 2021 | Volume 52, Issue 2: e72,
Letter by Wu and Yu Regarding Article, “Smoking Causes Fatal Subarachnoid Hemorrhage: A Case-Control Study of Finnish Twins”
Yuehui Wu, Xinyu Yu
doi : 10.1161/STROKEAHA.120.032874
Stroke. 2021 | Volume 52, Issue 2: e73
Response by Rautalin et al Letter Regarding Article, “Smoking Causes Fatal Subarachnoid Hemorrhage: A Case-Control Study of Finnish Twins”
Ilari Rautalin, Miikka Korja, Jaakko Kaprio
doi : 10.1161/STROKEAHA.120.033235
Stroke. 2021 | Volume 52, Issue 2: e74–e75
Letter by Broocks et al Regarding Article, “Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging”
Gabriel Broocks, Jens Minnerup, Rosalie McDonough, Fabian Flottmann, Andre Kemmling
doi : 10.1161/STROKEAHA.120.032707
Stroke. 2021 | Volume 52, Issue 2: e76–e77
Response by Ospel et al to Letter Regarding Article, “Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging”
Johanna M. Ospel, Marc Fisher, Mayank Goyal
doi : 10.1161/STROKEAHA.120.033573
Stroke. 2021 | Volume 52, Issue 2: e78
Letter by Reale et al Regarding Article, “Regional High Wall Shear Stress Associated With Stenosis Regression in Symptomatic Intracranial Atherosclerotic Disease”
Giuseppe Reale, Andrea Alexandre, Pietro Caliandro
doi : 10.1161/STROKEAHA.120.032934
Stroke. 2021 | Volume 52, Issue 2: e79
Response by Lan et al to Letter Regarding Article, “Regional High Wall Shear Stress Associated With Stenosis Regression in Symptomatic Intracranial Atherosclerotic Disease”
Linfang Lan, Haipeng Liu, Thomas W. Leung, Xinyi Leng
doi : 10.1161/STROKEAHA.120.033341
Stroke. 2021 | Volume 52, Issue 2: e80–e81
Letter by Acampa et al Regarding Article, “Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage in Patients With a History of Migraine”
Maurizio Acampa, Pietro Enea Lazzerini, Giuseppe Martini
doi : 10.1161/STROKEAHA.120.032632
Stroke. 2021 | Volume 52, Issue 2: e82
Letter by Goyal and Ospel Regarding Article, “Multimodal Predictive Modeling of Endovascular Treatment Outcome for Acute Ischemic Stroke Using Machine-Learning”
Mayank Goyal, Johanna M. Ospel
doi : 10.1161/STROKEAHA.120.033159
Stroke. 2021 | Volume 52, Issue 2: e83–e84
Response by Brugnara et al Regarding Article, “The Sense or Futility of Outcome Prediction in Acute Stroke for Endovascular Treatment Decision-Making”
Gianluca Brugnara, Ulf Neuberger, Philipp Vollmuth
doi : 10.1161/STROKEAHA.120.033453
Stroke. 2021 | Volume 52, Issue 2: e85–e86
Letter by Zheng et al Regarding Article, “Impact of Initial Imaging Protocol on Likelihood of Endovascular Stroke Therapy”
Feng Zheng, Jianfeng Zhou, Chubin Liu, Cui'e Wang, Yasong Li, Weipeng Hu, Boris Krischek
doi : 10.1161/STROKEAHA.120.032586
Stroke. 2021 | Volume 52, Issue 2: e87–e88
Response by Sheth to Letter Regarding Article, “Impact of Initial Imaging Protocol on Likelihood of Endovascular Stroke Therapy”
Sunil A. Sheth
doi : 10.1161/STROKEAHA.120.033238
Stroke. 2021 | Volume 52, Issue 2: e89
Correction to: Rivaroxaban for Prevention of Covert Brain Infarcts and Cognitive Decline: The COMPASS MRI Substudy
doi : 10.1161/STR.0000000000000360
Stroke. 2021 | Volume 52, Issue 2: e90
Correction to: Cysteine-Altering NOTCH3 Variants Are a Risk Factor for Stroke in the Elderly Population
doi : 10.1161/STR.0000000000000361
Stroke. 2021 | Volume 52, Issue 2: e91
Correction to: Early Recanalization With Alteplase in Stroke Because of Large Vessel Occlusion in the ESCAPE Trial
doi : 10.1161/STR.0000000000000363
Stroke. 2021 | Volume 52, Issue 2: e92
Correction to: Antiphospholipid Antibody and Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis
doi : 10.1161/STR.0000000000000364
Stroke. 2021 | Volume 52, Issue 2: e93
