Introduction: Although platelet reactivity on clopidogrel is related to outcomes in patients with acute coronary syndromes, few studies have investigated its relation to clinical outcomes in acute ischemic stroke. Hypothesis: This study evaluated the association between clopidogrel resistance and early neurological outcomes in patients diagnosed with acute large artery atherosclerotic stroke. Methods: 1067 consecutive patients with onset within 7 days and stroke classification of large artery atherosclerosis were included. Platelet reactivity on clopidogrel was assessed using VeryfyNow P2Y12 assay at least 72 hours after the time of first clopidogrel dosage. Optimal cutoff value of clopidogrel resistance was obtained by using receiver-operating characteristic curve. Early neurological deterioration was defined as an increment of motor NIHSS score ≥1 before P2Y12 assay. We assessed any hemorrhagic transformation on 5-day MRI. Results: A total of 235 patients who met inclusion criteria were analyzed. The median initial dose of clopidogrel was 300 mg, and their median P2Y12 % inhibition was 26.3. P2Y12 % inhibition <29 was the significant discriminator of clopidogrel resistance with an AUC of 0.632 (95% CI 0.48-0.67; p=0.048). A multivariate analysis revealed that clopidogrel resistance is an independent risk factor even after adjustment for the variables that may affect the outcome (OR 2.75; 95% CI 1.11 to 6.83; p=0.029). Hemorrhagic transformation was not influenced by clopidogrel resistance (OR 0.60, 95% CI 0.14 to 2.540; P=0.484). Conclusion: In conclusion, high platelet reactivity with clopidogrel is an independent risk factor of early neurological worsening in acute large artery atherosclerotic stroke. Evaluation of ischemic stroke patients regarding antiplatelet resistance might be of clinical importance and alternative pharmacological strategies could be investigated in patients with high platelet reactivity.
Introduction: Although white matter hyperintensities (WMH) on brain MRIs are associated with common vascular risk factors, the mechanisms underlying progression of WMH are still poorly understood. Hypothesis: We aim to investigate the association between common vascular risk factors and the severity of WMH according to the subtypes of ischemic stroke. Methods: Consecutive patients admitted due to ischemic stroke or TIA were included (n=841). Large artery disease (LAD) and small vessel occlusion (SVO) were defined according to the SSS-TOAST classification. WMH were categorized into two groups: no/mild and moderate/severe using Fazekas scale. Demographics, vascular risk factors and laboratory results were compared between the two groups (LAD vs SVO) in total and separately. Results: A total of 228 patients who underwent brain MRI within seven days after onset were eligible (n=170 in LAD, n=58 in SVO). Patients with LAD were older than those with SVO (mean age 67 years vs. 60 years, p<0.001), but the proportion of patients with moderate/severe WMH did not significantly differ between the two groups (28.2% vs 29.3%, p=0.876). Older age and hypertension were independent risk factors of moderate/severe WMH (OR=3.94 [2.46-6.30] with an increased age of 10 years; OR=5.14 [1.70-15.56], P=0.004 for hypertension) after adjustment of common cardiovascular risk factors. In patients with LAD, independent risk factors of moderate/severe WMH were age (OR=3.86 [1.83-8.12] for every ten-year increase, P<0.001) and hypertension (OR=5.64 [1.51-21.1], P=0.01). On the other hand, age was the only independent risk factor in patients with SVO (OR=3.03 [1.28-7.19] for every ten-year increase, P=0.012). Conclusion: In conclusion, this study showed that there is a different association between hypertension and severity of WMH in each stroke subtype. Other potential mechanisms of WMH, those not associated with traditional vascular risk factors, may be associated with progression of WMH.
Introduction: Imaging findings for the improvement of prognosis are not well established in patients with cervicocerebral artery dissection. Hypothesis: We aim to identify the imaging outcomes of cervicocerebral artery dissection and prognostic factors which influence improving the imaging outcomes. Methods: We included 162 consecutive patients diagnosed with cervicocerebral artery dissection on baseline vascular images. Imaging findings on the baseline were obtained within 7 days after symptoms onset, and follow-up vascular images were performed 6 months or 1 year. We compared the radiological features and the degrees of recovery (complete or partial recovery) between baseline and follow-up vascular images. Results: A total of 70 patients who underwent baseline and 6-month or a year vascular imaging were compared for these analyses. The patient mean age was 48 (SD 11), and the number of females was 21 (30%). The site of a dissection was more common in the posterior circulation (71.4%) and presence of infarction on baseline MRI was 84%. Regarding the lesion sites, a dissection was more common in the intracranial (83%). The baseline vascular images identified an aneurysm in 40% and stenosis or occlusion in 77%. Follow-up images showed complete improvement of the dissected vessels in 78% at 3 months and 83% at 6 months. Patients (n=15) who had an occlusion on the baseline images had partial or complete resolution in 38%. There were no significant differences in efficacy for the partial or complete improvement of vascular lesion on the follow-up images in patients who were treated with antiplatelet (OR=0.68 [0.15-3.10], p=0.72) or anticoagulation treatment (OR=1.38 [0.48-3.97], p=0.60). In the multivariate analysis, the odds ratio for complete or partial improvement on the follow-up vascular images from vertebral artery was 0.16 (0.48-0.52) (p=0.002) after adjustment for age, gender, and eGFR. Conclusions: In patients who diagnosed with cervicocerebral artery dissection on baseline vascular images, the rate of complete or partial recanalization was over 80% on the 6-month or 1-year follow-up images. Vertebral artery dissection are poor prognostic factors for the recovery of the vascular lesion after cervicocerebral artery dissection.
Introduction: Imaging characteristics and prognosis on the follow-up imaging in patients with acute cervicocerebral artery dissection are not well established. Hypothesis: Initial lesion patterns on early vascular imaging would predict vascular imaging outcomes in acute cervicocerebral artery dissection. Methods: Individual clinical data and imaging features were obtained from 167 consecutive patients who presented with acute ischemic symptoms or headache due to cervicocerebral artery dissection. Patients were categorized according to their baseline vascular imaging features as either Stenosis Only, Aneurysm Only, or Both Stenosis and Aneurysm. The angiographic characteristics and improvements of early vascular lesions between baseline (within 7 days after symptoms onset) and follow-up vascular images (6-month or 1-year after symptom onset) were compared. Results: A total of 76 patients who underwent baseline and 6-month or 1-year vascular imaging were included. Patients in the Stenosis Only group (n=36) were younger (mean age, 45±11) than those in the Aneurysm Only (n=9, 55±7) and Both Stenosis and Aneurysm (n=31, 48±12) groups (p=0.044). The most common sites of lesions were the distal vertebral artery and posterior inferior cerebellar artery (n=43, 57%). All patients in Aneurysm Only group had their lesions in the posterior circulation (61% in Stenosis Only, 77% in Both Stenosis and Aneurysm; p=0.047). A total of 43 patients (57%) showed improvement of initial lesions on follow-up vascular images (58% in Stenosis Only vs. 22% in Aneurysm Only vs. 65% in Both Stenosis and Aneurysm; p=0.076). The proportion of patients who obtained improvements on follow-up vascular images on baseline images was lower in Aneurysm Only compared with groups with stenosis (Stenosis Only and Both Stenosis and Aneurysm) (Odds ratio 0.18, 95% CI 0.03 to 0.94; p=0.035). Conclusions: Complete or partial improvements on follow-up images are obtained in over half of the patients with acute cervicocerebral artery dissection. Patients with only aneurysm on early images showed poor imaging prognosis compared to patients with stenosis.
Introduction: The features of vascular images and risk factors might be different according to the location of the cervicocerebral artery dissection. Hypothesis: We investigate whether the risk factors, neuroimaging features, and imaging outcomes differ according to the dissection site (anterior vs. posterior circulation). Methods: Consecutive patients who presented with ischemic symptoms and underwent brain vascular imaging within seven days after the onset of symptoms were enrolled. Demographic characteristics, putative risk factors, imaging findings, and types of antithrombotic medication were assessed between anterior circulation dissection (ACD) and posterior circulation dissection (PCD). The baseline and follow-up vascular images (6 months or 1 year after the onset of symptoms) were compared to determine the prognostic difference in the reverse of the lesion. Results: A total of 117 patients (n=32 with ACD and n=85 with PCD) were eligible for these analysis. The median delay from symptom onset to baseline vascular imaging was a day (IQR 1, 2). Patients with PCD were older (OR=1.5 by increasing 10 years old [1.02-2.03], p=0.038) and had a dissection associated with exercise or neck manipulation more frequently (OR=4.8 [1.2-18.1], p=0.019) compared to patients with ACD. Arterial stenosis or occlusion was the most common imaging feature (94% in ACD vs. 86% in PCD, p= 0.345). Aneurysm or pseudoaneurysm was identified in 9.4% of ACD and 24.7% of PCD (p=0.067). Among patients with PCD, vertebral artery was the most common lesion site (65% [53-74%]). The complete reverse on the follow-up images at the 6 months or 1 year was identified in 9 patients with ACD and 11 patients with PCD (45% vs. 22%, p=0.054). Neither anticoagulation nor antiplatelet demonstrated significant differences between the frequency of the complete reverse on the follow-up vascular images in patients with ACD and PCD (33% vs. 21%, p=0.613 for anticoagulation; 44% vs. 23%, p=0.087 for antiplatelet). Conclusions: These results substantiate the difference in the risk factors and radiologic features according to the dissection site. There was no difference in efficacy of antiplatelet and anticoagulant drugs at complete reverse of the lesion after cervicocerebral artery dissection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.