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  • 1
    Online Resource
    Online Resource
    Jugular Venous Reflux as an Indicator of Innominate Vein Occlusion Responsible for Superior Ophthalmic Vein Thrombosis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 4 ( 2023-04)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 4 ( 2023-04)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.042062
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Online Resource
    Characteristics and Clinical Implication of White Matter Lesions in Patients With Adult Moyamoya Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology Vol. 100, No. 18 ( 2023-05-2), p. e1912-e1921
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 18 ( 2023-05-2), p. e1912-e1921
    Abstract: White matter hyperintensities (WMHs) are reportedly increased in moyamoya disease (MMD); however, their clinical importance is not well-established owing to their pathophysiologic heterogeneity by distribution. This study aimed to evaluate the burden and pattern of WMHs and its clinical implications in the MMD trajectory. Methods Adult patients with MMD without significant structural lesions were 1:1 propensity score-matched with healthy controls for sex and vascular risk factors. The total, periventricular, and subcortical WMH volumes were segmented and quantified fully automatically. WMH volumes were detrended by age and compared between the 2 groups. MMD severity based on Suzuki stage and future ischemic events were assessed for their association with WMH volumes. Results A total of 161 pairs of patients with MMD and controls were analyzed. MMD significantly correlated with increased total WMH volume (B [standard error], 0.126 [0.030] ; p 〈 0.001), periventricular WMH volume (0.114 [0.027]; p 〈 0.001), and periventricular-to-subcortical ratio (0.090 [0.034]; p = 0.009). In the MMD subgroup (n = 187), advanced MMD had an independent association with the total WMH volume (0.120 [0.035]; p 〈 0.001), periventricular WMH volume (0.110 [0.031]; p 〈 0.001), and periventricular-to-subcortical ratio (0.139 [0.038]; p 〈 0.001). Periventricular WMH volume (adjusted hazard ratio [95% confidence interval], 5.12 [1.26–20.79] ) and periventricular-to-subcortical ratio (3.80 [1.51–9.56]) were associated with future ischemic events in patients with medically followed up MMD. However, no demonstrable association was found between subcortical WMH volume and MMD, MMD severity, or future ischemi c events. Discussion Periventricular WMHs, but not subcortical WMHs, may represent the main pathophysiology of MMD. Periventricular WMHs may be used as a marker for ischemic vulnerability in patients with MMD.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000207130
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 3
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    Online Resource
    Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Neurology Vol. 101, No. 13 ( 2023-09-26), p. e1364-e1369
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 101, No. 13 ( 2023-09-26), p. e1364-e1369
    Abstract: The etiology of central retinal artery occlusion (CRAO) is unclear in approximately 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO. Methods CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E + and CRAO-E − ). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month. Results A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E + independently predicted visual improvement (odds ratio 3.00, 95% CI 1.15–7.81, p = 0.025). Discussion CRAO-E + was found to be associated with a better outcome. CRAO-E + may be more prone to recanalization than that CRAO-E − .
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000207445
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 4
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    Online Resource
    Abstract WP234: Intracranial Vasculopathy Patterns of RNF213 R4810K Carriers: Does Anatomical Difference Make a Clinical Difference?
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
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    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: The 2021 revised diagnostic criteria of Moyamoya’s disease (MMD) of Japan more emphasize terminal ICA involvement than 2012 version. Accordingly, there is still ambiguity about whether MCA steno-occlusion with intact ICA qualifies as MMD. Also, basal collateral is mandated in both versions, while its specificity and sensitivity for MMD remain uncertain. Although the discovery of RNF 213 R4810K variant gave hope for further insight into MMD, its diagnostic role is limited by scarce data on associated vasculopathy pattern. Methods: Patients with intracranial vasculopathy tested for RNF213 genotype between September 2017 and 2022 and positive for R4810K were included. They were classified by two anatomical features of vasculopathy in the latest angiographic image: 1) steno-occlusive degree of ICA and MCA, 2) laterality. The resulting classification composes 3 main and 6 subgroups: A) No involvement. B) MCA involvement and intact ICA, bilaterally (B1) or unilaterally (B2). C) ICA involvement, bilaterally (C1), unilaterally (C2), or unilaterally with contralateral MCA involvement (C3). Their demographic and clinical factors were compared, and fulfillment for MMD by 2012 and 2021 criteria was assessed. Results: Among 240 eligible patients, 84 (35.9%) and 33 (14.1%) did not meet 2021 and 2012 criteria. Notably, though group B showed high basal collateral prevalence of over 80%, all (100%) and 25 (36.8%) of them did not fulfill 2021 and 2012 criteria by ICA and MCA parameters. This group showed no significant contrast in demographic, conventional stroke risk factors and hemorrhagic or ischemic stroke prevalence from those with ICA involvement. Conclusions: Despite their clinical and demographic similarities, a notable number of RNF213 R4810K carriers do not meet MMD criteria due to anatomical features, mainly when ICA involvement is absent. Revising the criteria of MMD to incorporate RNF213 R4810K positivity should be considered to address its weakness.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.WP234
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Abstract 50: Sodium-Glucose Cotransporter 2 Inhibitors Use in Diabetic Patients With Acute Ischemic Stroke is Linked to Favorable Neurological Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
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    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: The benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in acute ischemic stroke (AIS) have been demonstrated preclinically. Here, we evaluated the neurological effects of SGLT2i use after stroke in patients with diabetes and AIS. Methods: Using a prospective stroke registry, we reviewed consecutive diabetic patients with AIS. Patients with and without SGLT2i use were 1:4 propensity score-matched for clinical variables. Clinical outcomes, including early neurological deterioration (END) during admission, National Institutes of Health Stroke Scale (NIHSS) score at discharge, and modified Rankin Scale (mRS) scores at discharge and at 3 months, were compared. The impact of SGLT2i on metabolic activity of various organs was examined in another cohort using 18 F-fluorodeoxyglucose positron emission tomography post-stroke. Results: Among the 820 eligible patients, 90 (11.0%) were prescribed SGLT2i on admission, and 76 continued the prescription at discharge. Seventy-four patients with and 266 patients without SGLT2i use were propensity score-matched and analyzed. SGLT2i did not increase the END risk (adjusted odds ratio [aOR] 0.48, 95% confidence interval [CI] 0.20-1.19). There was no significant difference in clinical outcomes at discharge between the two groups (NIHSS: B [standard error] -1.321 [0.952] , p=0.17; mRS: aOR for favorable mRS 1.47, 95% CI 0.93-2.32). SGLT2i demonstrated significant improvement in the 3-month mRS (aOR 1.73, 95% CI 1.10-2.74). The positron emission tomography cohort showed that SGLT2i prescription was associated with elevated brown and subcutaneous adipose tissue metabolism. Conclusions: SGLT2i may be a priority for diabetic patients with AIS because of its potential benefits on long-term outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.50
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Online Resource
    Abstract 84: Impact Of Gastrointestinal Surgery On Efficacy Of Oral Anticoagulants In Patients With Nonvalvular Atrial Fibrillation: A Nationwide Population-based Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Alteration of the gastrointestinal (GI) tract by resection or bypass surgery might affect the absorption of both warfarin and direct oral anticoagulants (DOACs). The clinical trials of DOACs excluded individuals with altered GI tract, hence there are limited pharmacokinetic data for them. Only several cases have been reported suggesting atrial fibrillation-related stroke due to reduced absorption of DOACs after GI surgery. We aimed to investigate the efficacy of warfarin and DOACs who underwent GI surgery using nationwide population-based data. Methods: This was a retrospective cohort study using claim-based national data from 2013 to 2020 from Korean Health Insurance Review and Assessment Service (HIRA). Patients with nonvalvular AF (NVAF) taking oral anticoagulants (OACs) were included. The patients taking OACs due to other indications than NVAF were excluded. Cox proportional hazard models with time-varying covariates were used to investigate the impact of GI surgery in patients taking warfarin and DOACs. Results: Of the 311,782 patients (mean age 72, male 56.7%) with NVAF, 3,807 underwent GI surgery. Warfarin and DOACs were prescribed in 14.3% and 85.7% of the patients, respectively. Overall, warfarin was associated with a higher risk of ischemic stroke compared with DOACs (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.44-1.59). In the GI surgery group, the hazard ratio for ischemic stroke for warfarin compared with DOACs was 2.70 (95% CI, 1.63-4.45, Figure). In the no GI surgery group, warfarin also had a higher risk of ischemic stroke compared with DOACs (HR 1.51, 95% CI 1.44-1.59). Among DOAC-treated patients, GI surgery was not associated with a risk of ischemic stroke (HR 0.87, 95% CI 0.67-1.12). Conclusions: DOACs were more effective for stroke prevention than warfarin in patients with NVAF whose GI tracts were altered due to previous surgery. GI surgery did not affect the risk of stroke in patients with NVAF taking DOAC.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.84
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Online Resource
    Abstract WMP83: Arterial Dissection: A Still Underestimated Cause Of Lateral Medullary Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Although the association between vertebral artery or posterior inferior cerebellar artery dissection and lateral medullary infarction (LMI) has been established, the actual prevalence of dissection among patients with LMI may still be underestimated. Methods: Consecutive patients with acute pure LMI admitted between 2010 and 2021 were included. High-resolution vessel wall MRI (VWMRI) and/or transfemoral cerebral angiography (TFCA) were performed in a part of patients and were regarded as gold standard tests for diagnosis of dissection. Factors associated with definite dissection based on VWMRI or TFCA findings were assessed. Risk scoring for dissection was created based on multivariate logistic regression and applied to estimate the number of possible dissection. Results: Eighty-seven LMI patients were eligible and 47 (54.0%) of them underwent VWMRI (n=43) and/or TFCA (n=7). Among these 47 cases, 24 were definite dissection. Three out of 40 patients without gold standard tests were diagnosed with definite dissection based on conventional MRI findings. Preceding headache and normal body weight were independently associated with dissection in LMI patients. A risk scoring which includes age, body mass index, and headache predicted dissection with 91.7% sensitivity and 69.6% specificity (area under the receiver operating characteristic curve, 0.889; 95% confidence intervals, 0.802-0.977) in our population. Additional nine out of 37 patients without gold standard tests nor diagnosis of definite dissection in conventional MRI could be considered as possible dissection based on the scoring. Definite and possible dissections together comprised 41.4% (n=36) of LMI in our study. Conclusions: Arterial dissection may be more prevalent among LMI patients than reported before. Thorough diagnostic effort for dissection is necessary based on scrutinizing risk stratification.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.WMP83
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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