The role of biomarkers and neuroimaging in ischemic/hemorrhagic risk assessment for cardiovascular/cerebrovascular disease prevention

Gökçal, Elif; Horn, Mitchell J; Gurol, M. Edip

doi:10.1016/b978-0-12-819814-8.00021-4

Cited by 5 publications

(3 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…74 In addition to these hemorrhagic markers, ischemic MRI lesions related to cerebral microangiopathies such as moderate-to-severe leukoaraiosis, extensive perivascular spaces, and lacunes have been confirmed as markers of high ICH risk in multiple studies. [75][76][77][78] Patients with these high baseline ICH risk features and concomitant NVAF could be helped by LAAC if RCTs confirm data obtained from observational studies. Overall, appropriate stratification of ICH risk along with the risk of IS/SE and appropriate shared decision-making discussions of risks/ benefits of different preventive approaches with patients is key to optimal management.…”

Section: Intracerebral Hemorrhage Risk In Patients With Nvaf and Requ...mentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research

Gurol,

Wright,

Janis

et al. 2024

Stroke

Self Cite

View full text Add to dashboard Cite

Nonvalvular atrial fibrillation is a common rhythm disorder of middle-aged to older adults that can cause ischemic strokes and systemic embolism. Lifelong use of oral anticoagulants reduces the risk of these ischemic events but increases the risk of major and clinically relevant hemorrhages. These medications also require strict compliance for efficacy, and they have nontrivial failure rates in higher-risk patients. Left atrial appendage closure is a nonpharmacological method to prevent ischemic strokes in atrial fibrillation without the need for lifelong anticoagulant use, but this procedure has the potential for complications and residual embolic events. This workshop of the Roundtable of Academia and Industry for Stroke Prevention discussed future research needed to further decrease the ischemic and hemorrhagic risks among patients with atrial fibrillation. A direct thrombin inhibitor, factor Xa inhibitors, and left atrial appendage closure are FDA-approved approaches whereas factor XIa inhibitors are currently being studied in phase 3 randomized controlled trials for stroke prevention. The benefits, risks, and shortcomings of these treatments and future research required in different high-risk patient populations are reviewed in this consensus statement.

show abstract

Section: Intracerebral Hemorrhage Risk In Patients With Nvaf and Requ...mentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research

Gurol,

Wright,

Janis

et al. 2024

Stroke

Self Cite

View full text Add to dashboard Cite

show abstract

“…To evaluate the clinical application that may effectively predict the functional results of stroke survivors, substantially enhancing the effectiveness of stroke patients' rehabilitation To improve the predictive ability of stroke prognostic models, a bloodderived multibiomarker is suggested as a suitable method in addition to neuroimaging and neurophysiological biomarkers 5 [ 32] Observational study To assess the relationship between severe upper limb impairment following a stroke and imaging biomarkers beyond the corticospinal tract by analyzing the white matter microstructure in the corpus callosum The microstructure of the corpus callosum could be a useful biomarker for the fate of severe upper limb loss following a stroke, which could improve our capacity to forecast recovery in patients with severe motor impairment 6 [ 33] Research article Examine the function of neuroimaging and biomarkers in stroke risk assessment for the prevention of cardiovascular disease It has been confirmed that neuroimaging and other biomarkers can be used to stratify an older person's risk of a brain hemorrhage. Choosing the right anticoagulant or closing the left atrial appendage to avoid stroke in atrial fibrillation patients requires a detailed understanding of these indicators.…”

Section: Reviewmentioning

confidence: 99%

Neuroimaging biomarkers for predicting stroke outcomes: A systematic review

Gaviria,

Eltayeb Hamid

2024

Health Science Reports

View full text Add to dashboard Cite

Background and AimsStroke is a prominent cause of long‐term adult impairment globally and a significant global health issue. Only 14% of stroke survivors achieve full recovery, while 25% to 50% require varying degrees of support, and over half become dependent. The aftermath of a stroke brings profound changes to an individual's life, with early choices significantly impacting their quality of life. This review aims to establish the efficacy of neuroimaging data in predicting long‐term outcomes and recovery rates following a stroke.MethodsA scientific literature search was conducted using the Centre of Reviews and Dissemination (CRD) criteria and PRISMA guidelines for a combined meta‐narrative and systematic quantitative review. The methodology involved a structured search in databases like PubMed and The Cochrane Library, following inclusion and exclusion criteria to identify relevant studies on neuroimaging biomarkers for stroke outcome prediction. Data collection utilized the Microsoft Edge Zotero plugin, with quality appraisal conducted via the CASP checklist. Studies published from 2010 to 2024, including observational, randomized control trials, case reports, and clinical trials. Non‐English and incomplete studies were excluded, resulting in the identification of 11 pertinent articles. Data extraction emphasized study methodologies, stroke conditions, clinical parameters, and biomarkers, aiming to provide a thorough literature overview and evaluate the significance of neuroimaging biomarkers in predicting stroke recovery outcomes.ResultsThe results of this systematic review indicate that integrating advanced neuroimaging methods with highly successful reperfusion therapies following a stroke facilitates the diagnosis of the condition and assists in improving neurological impairments resulting from stroke. These measures reduce the possibility of death and improve the treatment provided to stroke patients.ConclusionThese findings highlight the crucial role of neuroimaging in advancing our understanding of post‐stroke outcomes and improving patient care.

show abstract

“…[3][4][5][6][7] A clinical dilemma arises when these high ICH risk patients concurrently have non-valvular atrial fibrillation (NVAF), as ischaemic stroke prevention in this context has classically relied on life-long OAC based on risk score. 8 Two recent randomised controlled trials (RCTs) attempted to investigate the outcomes of using OAC versus permanently avoiding them in patients who experienced ICH. However, these studies failed to establish noninferiority of OAC use compared with avoidance, as OAC arms showed higher ICH recurrence rates and very high OAC-related ICH mortality.…”

Section: Introductionmentioning

confidence: 99%

Left atrial appendage closure for patients with atrial fibrillation at high intracranial haemorrhagic risk

Abramovitz Fouks,

Yaghi,

Gokcal

et al. 2024

Stroke Vasc Neurol

Self Cite

View full text Add to dashboard Cite

Background and objectivesAlthough left atrial appendage closure (LAAC) is performed in patients with non-valvular atrial fibrillation (NVAF) at increased risk of intracranial haemorrhage (ICH), outcome data are scarce. We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients.MethodsStudy population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI (cerebral microbleeds (CMBs)). Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events, respectively, after LAAC.ResultsAmong 146 patients with NVAF who underwent LAAC for high ICH risk, 122 had a history of ICH, while 24 presented with high ICH risk imaging markers only. Mean age was 75.7±7.61, 42 (28.8%) were women. Mean CHA2DS2-VASc score was 5.23±1.52. Of 122 patients with ICH history, 58 (47.5%) had intraparenchymal haemorrhage (IPH), 40 (32.8%) had traumatic ICH (T-ICH) and 18 (14.7%) had non-traumatic subdural haemorrhage. Of 85 patients with brain MRIs including necessary sequences, 43 (50.6%) were related to cerebral amyloid angiopathy and 37 (43.5%) to hypertensive microangiopathy. While 70% of patients were discharged on oral anticoagulants (OAC), 92% were not taking OAC at 1 year. Over 2.12 years mean follow-up, one patient had recurrent non-traumatic IPH (incidence rate (IR) 0.32 per 100 patient-years), five had T-ICH (IR 1.61 per 100 patient-years) and six had an ischaemic stroke (IR 1.94 per 100 patient-years).ConclusionsAmong patients with NVAF at high ICH risk, LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data. LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.

show abstract

The role of biomarkers and neuroimaging in ischemic/hemorrhagic risk assessment for cardiovascular/cerebrovascular disease prevention

Cited by 5 publications

References 73 publications

Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research

Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research

Neuroimaging biomarkers for predicting stroke outcomes: A systematic review

Left atrial appendage closure for patients with atrial fibrillation at high intracranial haemorrhagic risk

Contact Info

Product

Resources

About