Increased Arterial Stiffness is Associated with Poor Collaterals in Acute Ischemic Stroke from Large Vessel Occlusion

Acampa, Maurizio; Romano, Daniele Giuseppe; Lazzerini, Pietro Enea; Leonini, Sara; Guideri, Francesca; Tassi, Rossana; Casseri, Tommaso; Bracco, Sandra; Martini, Giuseppe

doi:10.2174/1567202615666180326100347

Cited by 24 publications

(18 citation statements)

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“…Moreover, we did not take into account the possible role of arterial stiffness that may be an important predictor for HT after (intravenous, mechanical or both). 47 , 48 Finally, this study did not exclude patients without recanalization success because this study aimed to explore the impact of anatomical factors on HT and identify biomarkers of blood samples in AIS patients treated by MT.…”

Section: Limitationmentioning

confidence: 99%

<p>Identification of Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke After Endovascular Therapy Using the Decision Tree Model</p>

Feng¹,

Ye²,

Cao³

et al. 2020

CIA

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Purpose This study aimed to identify independent predictors for the risk of hemorrhagic transformation (HT) in arterial ischemic stroke (AIS) patients. Methods Consecutive patients with AIS due to large artery occlusion in the anterior circulation treated with mechanical thrombectomy (MT) were enrolled in a tertiary stroke center. Demographic and medical history data, admission lab results, and Circle of Willis (CoW) variations were collected from all patients. Results Altogether, 90 patients were included in this study; among them, 34 (37.8%) had HT after MT. The final pruned decision tree (DT) model consisted of collateral score and platelet to lymphocyte ratios (PLR) as predictors. Confusion matrix analysis showed that 82.2% (74/90) were correctly classified by the model (sensitivity, 79.4%; specificity, 83.9%). The area under the ROC curve (AUC) was 81.7%. The DT model demonstrated that participants with collateral scores of 2–4 had a 75.0% probability of HT. For participants with collateral scores of 0–1, if PLR at admission was <302, participants had a 13.0% probability of HT; otherwise, participants had an 75.0% probability of HT. The final adjusted multivariate logistic regression analysis indicated that collateral score 0–1 (OR, 10.186; 95% CI, 3.029–34.248; p < 0.001), PLR (OR, 1.005; 95% CI, 1.001–1.010; p = 0.040), and NIHSS at admission (OR, 1.106; 95% CI, 1.014–1.205; p = 0.022) could be used to predict HT. The AUC for the model was 0.855, with 83.3% (75/90) were correctly classified (sensitivity, 79.4%; specificity, 87.3%). Less patients with HT achieved independent outcomes (mRS, 0–2) in 90 days (20.6% vs. 64.3%, p < 0.001). Rate of poor outcomes (mRS, 4–6) was significantly higher in patients with HT (73.5% vs. 19.6%; p < 0.001). Conclusion Both the DT model and multivariate logistic regression model confirmed that the lower collateral status and the higher PLR were significantly associated with an increased risk for HT in AIS patients after MT. PLR may be one of the cost-effective and practical predictors for HT. Further prospective multicenter studies are needed to validate our findings.

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Section: Limitationmentioning

confidence: 99%

<p>Identification of Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke After Endovascular Therapy Using the Decision Tree Model</p>

Feng¹,

Ye²,

Cao³

et al. 2020

CIA

View full text Add to dashboard Cite

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“…In a recent study, higher values of arterial stiffness index and PP were associated with poor intracranial collaterals in AIS patients with LVO 26, 27. Collateral scoring was not performed in the present study but further studies are needed to address the PP and arterial stiffness markers relevance for collateral functionality prediction and assessment in the setting of the acute phase.…”

Section: Discussionmentioning

confidence: 82%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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BackgroundStudies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT.Methods and ResultsAcute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders.Conclusions PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.

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“…Homocysteine may represent an important pathogenic factor in some types of stroke, and homocysteine causes inflammation and increases carotid artery atherosclerosis and formation of plaque, which is involved in multiple mechanisms, including effects on atrial ionic channels and the thrombotic state . Homocysteine levels, as an independent risk factor, may favor an ischemic stroke by promoting arterial stiffness, and may determine more subsequent and severe complications . Hypertension is a major risk factor for ischemic stroke, which, combined with hyperhomocysteine, may increase the incidence of ischemic stroke .…”

Section: Discussionmentioning

confidence: 99%

Comparison of serum Lp‐PLA2 levels in ischemic stroke patients with H‐type hypertension or non‐H‐type hypertension

Qiao

Zhou

Huang

et al. 2019

Clinical Laboratory Analysis

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Background Increased serum Lp‐PLA2 levels have been reported in patients who experienced an ischemic stroke; however, the relationship between Lp‐PLA2 and H‐type hypertension in patients with ischemic stroke remains unclear. Methods In the present study, we investigated the correlation between serum Lp‐PLA2 and H‐type hypertension in patients with ischemic stroke. A total of 135 patients who experienced acute ischemic stroke were enrolled in Tianjin Huanhu Hospital during October 2015 to May 2016. The demographic characteristics of the patients were collected, and biochemical parameters were detected. Results Among the 135 patients, 111 patients had essential hypertension, including 41 patients with H‐type hypertension and 70 with non‐H‐type hypertension. There were higher proportions of males and patients with diabetes mellitus in the H‐type hypertension group compared with the non‐H‐type hypertension group (P < .05). Lp‐PLA2, glucose, and LDL‐C levels were higher in the H‐type hypertension group than in the non‐H‐type hypertension group (P < .05). Multivariate logistic regression showed that Lp‐PLA2 levels >208.46 mg/L were independently associated with H‐type hypertension in patients with ischemic stroke (OR: 2.560, 95% CI: 1.085‐6.040, P = .032). The area under the ROC curve of Lp‐PAL2 levels in the H‐type hypertension group was 0.665 (95% CI: 0.561‐0.768, P = .004). Conclusion Synergetic effects of H‐type hypertension and Lp‐PLA2 levels were noted in the pathogenesis of ischemic stroke.

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Increased Arterial Stiffness is Associated with Poor Collaterals in Acute Ischemic Stroke from Large Vessel Occlusion

Abstract: Our results suggest that, in patients with ischemic stroke from LAA, arterial stiffness may contribute to the impairment of collateral circulation and, therefore, it could reduce the beneficial effects of acute treatments.

Cited by 24 publications

References 0 publications

<p>Identification of Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke After Endovascular Therapy Using the Decision Tree Model</p>

<p>Identification of Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke After Endovascular Therapy Using the Decision Tree Model</p>

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Comparison of serum Lp‐PLA2 levels in ischemic stroke patients with H‐type hypertension or non‐H‐type hypertension

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