Impact of sex in stroke in the young Schwarzwald, Anina; Fischer, Urs; Seiffge, David ...
PloS one,
03/2023, Letnik:
18, Številka:
3
Journal Article
Recenzirano
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Limited data is available on sex differences in young stroke patients describing discrepant findings. This study aims to investigate the sex differences in young stroke patients.
Prospective cohort ...study comparing risk factors, etiology, stroke localization, severity on admission, management and outcome in patients aged 16-55 years with acute ischemic stroke consecutively included in the Bernese stroke database between 01/2015 to 12/2018 with subgroup analyses for very young (16-35y) and young patients (36-55y).
689 patients (39% female) were included. Stroke in women dominated in the very young (53.8%, p<0.001) and in men in the young (63.9%, p<0.001). As risk factors only sleep-disordered breathing was more predominant in men in the very young, whereas arterial hypertension, diabetes and atrial fibrillation did not differ in women and men older than 35y. The higher frequency of stroke in women in the very young may be explained by the sex specific risk factors such as pregnancy, puerperium, the use of oral contraceptives, and hormonal replacement therapy. Stroke severity at presentation, etiology, stroke localization, management, and outcome did not differ between women and men.
The main finding of this study is that sex specific risk factors in women may contribute to a large extent to the higher incidence of stroke in the very young in women. Important modifiable stroke risk factors, such as arterial hypertension, diabetes mellitus and atrial fibrillation did not differ in women and men, either in the young as well as in the very young. These findings have major implications for primary preventive strategies of stroke in young people.
BACKGROUND AND PURPOSE—We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs).
METHODS—In a ...multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic.
RESULTS—Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62–82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio aOR, 2.55 95% CI, 1.35–4.84 and 1.64 95% CI, 1.09–2.47) as compared with the control group, whereas no association with DOAC intake was observed (aOR, 0.98 95% CI, 0.29–3.35 and 1.35 95% CI, 0.72–2.53). Sensitivity analyses considering only patients within the confirmed therapeutic anticoagulation range did not alter the findings. A study-level meta-analysis incorporating data from 7462 patients (855 VKAs, 318 DOACs, and 6289 controls) from 15 observational cohorts corroborated these observations, yielding an increased rate of sICH in VKA patients (aOR, 1.62 95% CI, 1.22–2.17) but not in DOAC patients (aOR, 1.03 95% CI, 0.60–1.80).
CONCLUSIONS—Patients taking VKA have an increased risk of sICH and mortality after mechanical thrombectomy. The lower risk of sICH associated with DOAC may also be noticeable in the acute setting. Improved selection might be advisable in VKA-treated patients.
REGISTRATION—URLhttps://www.clinicaltrials.gov. Unique identifierNCT03496064. Systematic Review and Meta-AnalysisCRD42019127464.
Anemia is associated with worse outcome in stroke, but the impact of anemia with intravenous thrombolysis or endovascular therapy has hardly been delineated. The aim of this study was to analyze the ...role of anemia on infarct evolution and outcome after acute stroke treatment.
1158 patients from Bern and 321 from Los Angeles were included. Baseline data and 3 months outcome assessed with the modified Rankin Scale were recorded prospectively. Baseline DWI lesion volumes were measured in 345 patients and both baseline and final infarct volumes in 180 patients using CT or MRI. Multivariable and linear regression analysis were used to determine predictors of outcome and infarct growth.
712 patients underwent endovascular treatment and 446 intravenous thrombolysis. Lower hemoglobin at baseline, at 24h, and nadir until day 5 predicted poor outcome (OR 1.150-1.279) and higher mortality (OR 1.131-1.237) independently of treatment. Decrease of hemoglobin after hospital arrival, mainly induced by hemodilution, predicted poor outcome and had a linear association with final infarct volumes and the amount and velocity of infarct growth. Infarcts of patients with newly observed anemia were twice as large as infarcts with normal hemoglobin levels.
Anemia at hospital admission and any hemoglobin decrease during acute stroke treatment affect outcome negatively, probably by enlarging and accelerating infarct growth. Our results indicate that hemodilution has an adverse effect on penumbral evolution. Whether hemoglobin decrease in acute stroke could be avoided and whether this would improve outcome would need to be studied prospectively.
Background and Purpose
Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim ...of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment.
Materials and Methods
A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Underlying intracranial atherosclerotic stenosis (ICAS) was present in 10 patients (1.9%), whereas 523 patients (98.1%) had an embolic occlusion without stenosis.
Results
There was no difference in age, admission National Institutes of Health Stroke Scale, risk factors, Alberta stroke program early CT score or collaterals between the groups. Procedure time (155 vs 40 min,
P
= 0.001) was significantly longer in the ICAS group where rescue stent-angioplasty was performed in all patients. There was no statistical difference in final modified thrombolysis in cerebral infarction score between both groups (70 vs 88%,
P
= 0.115). Favorable outcome (modified Rankin Scale ≤ 2) at 90 days was less frequent in patients with ICAS than in the embolic group (0 vs 49.4%,
P
= 0.004). The mortality rate tended to be higher in the ICAS group (44.4 vs 19.4%,
P
= 0.082).
Conclusion
In patients with AIS, rescue therapy with stent placement to treat underlying ICAS of the M1 segment is technically feasible; however, in our study, a significantly lower rate of favorable outcome was observed in these patients compared to those with thromboembolic M1 occlusions.
Level of Evidence
Level 3, non-randomized controlled study.
BACKGROUND AND PURPOSE:Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with ...reduced reperfusion rates. Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals.
METHODS:Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov; Unique identifierNCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction TICI 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders.
RESULTS:Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 95% CI, +9.1 to +29.1 minutes), general anesthesia (+12.1 95% CI, +3.7 to +20.4 minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 95% CI, +6.1 to +21.6 minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio aOR, 0.87 95% CI, 0.79–0.96) and TICI 2c/3 (aOR, 0.87 95% CI, 0.79–0.95) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 95% CI, 0.94–0.99) and inconsistent regarding TICI 2c/3 (aOR, 0.99 95% CI, 0.97–1.02). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 95% CI, 0.76–0.99).
CONCLUSIONS:There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research.
REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT03496064.
Bis(4‐methoxybenzoyl)diethylgermane (BMDG) is used for the photopolymerization of six 1,1‐disubstituted 2‐vinylcyclopropanes (VCPs). A significantly higher photopolymerization reactivity compared to ...the conventional camphorquinone (CQ)/amine or CQ/amine/iodonium salt photoinitiator systems is observed. Furthermore, the influence of the electron‐withdrawing substituents on the monomer reactivity is investigated. 1‐Ethoxycarbonyl‐1‐ethylcarbamoyl‐2‐vinylcyclopropane 5 and 1‐ethoxycarbonyl‐2‐vinylcyclopropanecarboxylic acid 2 are found to be the most reactive monomers. 1,1‐Disubstituted VCP‐based dental composites containing BMDG are formulated. Those materials exhibit good mechanical properties as well as a low polymerization shrinkage.
Bis(4‐methoxybenzoyl)diethylgermane (BMDG) is shown to be an excellent photoinitiator for the photopolymerization of 1,1‐disubstituted 2‐vinylcyclopropanes. Vinylcyclopropane‐based dental composites containing BMDG are formulated. These materials exhibit good mechanical properties and low polymerization shrinkage.
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•Synthesis of seven vinylcyclopropanes bearing urethane groups.•Determination of polymerization rates using Photo-DSC.•Evaluation of the rheological behavior using real ...time-NIR-photorheology.•Formulation and characterization of innovative low-shrinkage dental composites.•Influence of the urethane group on the mechanical properties of the tested composites.
Polymerization shrinkage of methacrylate-based dental composites remains a major concern in restorative dentistry. Cyclic monomers, such as 1,1-disubstituted 2-vinylcyclopropanes, might represent an interesting alternative to dimethacrylates in order to reduce shrinkage. In this contribution, the synthesis of seven crosslinking vinylcyclopropanes bearing urethane groups is described. These monomers were synthesized by esterification of 1-ethoxycarbonyl-2-vinylcyclopropane-1-carboxylic acid with either ethylene glycol or diethylene glycol, followed by a reaction with selected diisocyanates. In order to evaluate the reactivity of the synthesized vinylcyclopropanes, their photopolymerization behavior was investigated by photo-differential scanning calorimetry. Real-time (RT)-NIR-photorheology measurements were performed to evaluate rheological behavior (i.e. time of gelation, polymerization induced shrinkage force) and chemical conversion (i.e. double bond conversion at the gel point, final double bond conversion) of the vinylcyclopropanes in situ. Composites based on these monomers show good to excellent mechanical properties and exhibit low shrinkage. The presence of urethane groups provides a significant improvement of the mechanical properties. The replacement of methacrylates by urethane vinylcyclopropanes appears to be a promising approach to develop low-shrinkage dental composites without sacrificing the mechanical properties.
Introduction Susceptibility weighted imaging (SWI) is a very sensitive technique that often depicts prominent focal veins (PFV) in patients with acute migraine with aura (MwA). Interpretation of ...visual venous asymmetry (VVA) between brain hemispheres on SWI may help support the clinical diagnosis of MwA. Our goal was to develop an automated algorithm for segmentation and quantification of cerebral veins using SWI. Materials and methods Expert readers visually evaluated SWI of patients with acute MwA for VVA. Subsequently a fully automated algorithm based on 3D normalization and 2D imaging processing using SPM and MATLAB image processing software including top-hat transform was used to quantify cerebral veins and to calculate volumetric differences between hemispheres. Results Fifty patients with MwA were examined with SWI. VVA was present in 20 of 50 patients (40%). In 95% of patients with VVA, the fully automated calculation agreed with the side that visually harboured more PFV. Our algorithm showed a sensitivity of 95%, specificity of 90% and accuracy of 92% for detecting VVA. Patients with VVA had significantly larger vein volume on the hemisphere with more PFV compared to patients without (15.90 ± 5.38 ml vs 11.93 ± 5.31 ml; p = 0.013). The mean difference in venous volume between hemispheres in patients with VVA was larger compared to patients without VVA (16.34 ± 7.76% vs 4.31 ± 3.26% p < 1E-10). The average time between aura onset and SWI correlated negatively with venous volume of the dominant brain hemisphere (r = -0.348; p = 0.038). Conclusion A fully automated algorithm can accurately identify and quantify cerebral venous distribution on SWI. Absolute quantification may be useful for the future assessment of patients with suspected diseases, which may be associated with a unilateral abnormal degree of venous oxygenation.
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