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Peter M Rothwell - One of the best experts on this subject based on the ideXlab platform.
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long term risk of myocardial infarction compared to recurrent stroke after Transient Ischemic Attack and Ischemic stroke systematic review and meta analysis
Journal of the American Heart Association, 2018Co-Authors: Marion Boulanger, Peter M Rothwell, Yannick Bejot, Emmanuel TouzeAbstract:BackgroundUncertainties remain about the current risk of myocardial infarction (MI) after Ischemic stroke or Transient Ischemic Attack. Methods and ResultsWe undertook a systematic review to estima...
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white matter imaging correlates of early cognitive impairment detected by the montreal cognitive assessment after Transient Ischemic Attack and minor stroke
Stroke, 2017Co-Authors: Giovanna Zamboni, Sarah T Pendlebury, Ludovica Griffanti, Mark Jenkinson, Sara Mazzucco, Wilhelm Kuker, Peter M RothwellAbstract:Background and Purpose— Among screening tools for cognitive impairment in large cohorts, the Montreal Cognitive Assessment (MoCA) seems to be more sensitive to early cognitive impairment than the Mini-Mental State Examination (MMSE), particularly after Transient Ischemic Attack or minor stroke. We reasoned that if MoCA-detected early cognitive impairment is pathologically significant, then it should be specifically associated with the presence of white matter hyperintensities (WMHs) and reduced fractional anisotropy (FA) on magnetic resonance imaging. Methods— Consecutive eligible patients with Transient Ischemic Attack or minor stroke (Oxford Vascular Study) underwent magnetic resonance imaging and cognitive assessment. We correlated MoCA and MMSE scores with WMH and FA, then specifically studied patients with low MoCA and normal MMSE. Results— Among 400 patients, MoCA and MMSE scores were significantly correlated (all P <0.001) with WMH volumes ( r MoCA=−0.336; r MMSE=−0.297) and FA ( r MoCA=0.409; r MMSE=0.369) and—on voxel-wise analyses—with WMH in frontal white matter and reduced FA in almost all white matter tracts. However, only the MoCA was independently correlated with WMH volumes ( r =−0.183; P <0.001), average FA values ( r =0.218; P <0.001), and voxel-wise reduced FA in anterior tracts after controlling for the MMSE. In addition, patients with low MoCA but normal MMSE (n=57) had higher WMH volumes ( t =3.1; P =0.002), lower average FA ( t =−4.0; P <0.001), and lower voxel-wise FA in almost all white matter tracts than those with normal MoCA and MMSE (n=238). Conclusions— In patients with Transient Ischemic Attack or minor stroke, early cognitive impairment detected with the MoCA but not with the MMSE was independently associated with white matter damage on magnetic resonance imaging, particularly reduced FA.
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validation of the montreal cognitive assessment versus mini mental state examination against hypertension and hypertensive arteriopathy after Transient Ischemic Attack or minor stroke
Stroke, 2014Co-Authors: Alastair J S Webb, Sarah T Pendlebury, Z Mehta, Michela Simoni, Nicola Lovett, Peter M RothwellAbstract:Background and Purpose—Lack of reduced cognitive impairment with blood pressure (BP) lowering in trials may reflect use of the Mini-Mental State Examination (MMSE), which is insensitive to mild cognitive impairment after cerebrovascular events compared with the Montreal Cognitive Assessment. We determined relationships between impairment on MMSE versus Montreal Cognitive Assessment (MoCA) with the major physiological determinant of vascular cognitive impairment: hypertension and hypertensive arteriopathy. Methods—Cognitive impairment in consecutive patients 6 months after Transient Ischemic Attack or minor stroke was defined as significant, mild, or none (MMSE<23, 23–26, ≥27; MoCA<20, 20–24, ≥25) and related to 20 premorbid systolic BP readings, home BP measurement (3 measurements, 3×daily for 1 month), and hypertensive arteriopathy (creatinine, stroke versus Transient Ischemic Attack, leukoaraiosis) by ordinal regression. Results—Of 463 patients, 45% versus 28% had at least mild cognitive impairment on t...
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population based study of disability and institutionalization after Transient Ischemic Attack and stroke 10 year results of the oxford vascular study
Stroke, 2013Co-Authors: Ramon Luengofernandez, Sarah T Pendlebury, Alastair Gray, Nicola L M Paul, Linda M Bull, Sarah J V Welch, Fiona C Cuthbertson, Peter M RothwellAbstract:Background and Purpose—Long-term outcome information after Transient Ischemic Attack (TIA) and stroke is required to help plan and allocate care services. We evaluated the impact of TIA and stroke ...
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stroke risk after posterior circulation stroke Transient Ischemic Attack and its relationship to site of vertebrobasilar stenosis pooled data analysis from prospective studies
Stroke, 2013Co-Authors: Giosue Gulli, L Marquardt, Peter M Rothwell, Hugh S MarkusAbstract:Background and Purpose—Recent prospective studies have shown vertebrobasilar (VB) stenosis predicts stroke risk in posterior circulation stroke and Transient Ischemic Attack. It is unclear whether this association is independent of other risk factors, and whether intracranial or extracranial stenosis confers different risks. Methods—A pooled individual patient analysis of data from 2 prospective studies was performed in 359 patients presenting with VB Transient Ischemic Attack or stroke. Contrast-enhanced magnetic resonance angiography, or computed tomography angiogram, and clinical follow-up were available in 323 patients. Risk of stroke was calculated from any VB Transient Ischemic Attack/stroke in the month before the presenting episode (first event) and from the presenting event. A systematic review of similar prospective studies was performed. Results—Ninety-day risk of stroke from the first event was 24.6% in patients with VB stenosis versus 7.2% in those without (odds ratio, 4.2; 95% confidence int...
Pierre Amarenco - One of the best experts on this subject based on the ideXlab platform.
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risk for major bleeding in patients receiving ticagrelor compared with aspirin after Transient Ischemic Attack or acute Ischemic stroke in the socrates study acute stroke or Transient Ischemic Attack treated with aspirin or ticagrelor and patient out
Circulation, 2017Co-Authors: Donald J Easton, Pierre Amarenco, Gregory W Albers, Hans Denison, Scott R Evans, Peter Held, Maria Aunes, Sara Bokelundsingh, Marianne Jahreskog, Jenny JonassonAbstract:Background: Patients with minor acute Ischemic stroke or Transient Ischemic Attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute Ischemic stroke or Transient Ischemic Attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute Ischemic stroke or Transient Ischemic Attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.
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ticagrelor in acute stroke or Transient Ischemic Attack in asian patients
Stroke, 2017Co-Authors: Yongjun Wang, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Scott R Evans, Peter Held, Kazuo Minematsu, Ka Sing Lawrence Wong, Jenny JonassonAbstract:Background and Purpose—In the SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes), ticagrelor was not superior to aspirin. Because of ...
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ticagrelor versus aspirin in acute stroke or Transient Ischemic Attack
The New England Journal of Medicine, 2016Co-Authors: Claiborne S Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A MolinaAbstract:BackgroundTicagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. MethodsWe conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere Ischemic stroke or high-risk Transient Ischemic Attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90). The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. ResultsDuring the 90 days of treatment, a primary end-point event occurred in 442 of the 6589 patients (6.7%) treated with ticagrelor, ver...
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one year risk of stroke after Transient Ischemic Attack or minor stroke
The New England Journal of Medicine, 2016Co-Authors: Pierre Amarenco, Julien Labreuche, Philippa C Lavallee, Gregory W Albers, Geoffrey A Donnan, Louis R Caplan, Natan M Bornstein, Patricia Canhao, Jose M Ferro, Michael G HennericiAbstract:BackgroundPrevious studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a Transient Ischemic Attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor Ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. MethodsWe recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a ...
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acute stroke or Transient Ischemic Attack treated with aspirin or ticagrelor and patient outcomes socrates trial rationale and design
International Journal of Stroke, 2015Co-Authors: Claiborne S Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A Molina, Lawrence K S WongAbstract:RationaleThe risk of recurrent ischemia is high in the acute period after Ischemic stroke and Transient Ischemic Attack. Aspirin is recommended by guidelines for this indication, but more intensive...
Claiborne S Johnston - One of the best experts on this subject based on the ideXlab platform.
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genetic polymorphisms and clopidogrel efficacy for acute Ischemic stroke or Transient Ischemic Attack a systematic review and meta analysis
Circulation, 2017Co-Authors: Yuesong Pan, Claiborne S Johnston, Weiqi Chen, Yan Han, Qingwu Yang, Lian Huang, Xingquan Zhao, Liping Liu, Qi Zhang, Guangyao WangAbstract:Background:The association of genetic polymorphisms and clopidogrel efficacy in patients with Ischemic stroke or Transient Ischemic Attack (TIA) remains controversial. We performed a systematic rev...
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ticagrelor versus aspirin in acute stroke or Transient Ischemic Attack
The New England Journal of Medicine, 2016Co-Authors: Claiborne S Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A MolinaAbstract:BackgroundTicagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. MethodsWe conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere Ischemic stroke or high-risk Transient Ischemic Attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90). The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. ResultsDuring the 90 days of treatment, a primary end-point event occurred in 442 of the 6589 patients (6.7%) treated with ticagrelor, ver...
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acute stroke or Transient Ischemic Attack treated with aspirin or ticagrelor and patient outcomes socrates trial rationale and design
International Journal of Stroke, 2015Co-Authors: Claiborne S Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A Molina, Lawrence K S WongAbstract:RationaleThe risk of recurrent ischemia is high in the acute period after Ischemic stroke and Transient Ischemic Attack. Aspirin is recommended by guidelines for this indication, but more intensive...
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cost effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or Transient Ischemic Attack
Stroke, 2012Co-Authors: Hooman Kamel, Donald J Easton, Claiborne S Johnston, Anthony S KimAbstract:Background and Purpose—The cost-effectiveness of dabigatran for stroke prevention in patients with atrial fibrillation and prior stroke or Transient Ischemic Attack has not been directly assessed. Methods—A Markov decision model was constructed using data from the Randomized Evaluation of Long-Term Therapy (RE-LY) trial, other trials of warfarin therapy for atrial fibrillation, and the published cost of dabigatran. We compared the cost and quality-adjusted life expectancy associated with 150 mg dabigatran twice daily versus warfarin therapy targeted to an international normalized ratio of 2 to 3. The target population was a cohort of patients aged ≥70 years with nonvalvular atrial fibrillation, prior stroke or Transient Ischemic Attack, and no contraindication to anticoagulation. Results—In the base case, dabigatran was associated with 4.27 quality-adjusted life-years compared with 3.91 quality-adjusted life-years with warfarin. Dabigatran provided 0.36 additional quality-adjusted life-years at a cost of ...
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guidelines for the prevention of stroke in patients with stroke or Transient Ischemic Attack
Stroke, 2011Co-Authors: Karen L Furie, Gregory W Albers, Claiborne S Johnston, Irene L Katzan, Scott E Kasner, Robert J Adams, Ruth L Bush, Susan C Fagan, Jonathan L Halperin, Walter N KernanAbstract:The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of Ischemic stroke among survivors of Ischemic stroke or Transient Ischemic Attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations.
Gregory W Albers - One of the best experts on this subject based on the ideXlab platform.
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risk for major bleeding in patients receiving ticagrelor compared with aspirin after Transient Ischemic Attack or acute Ischemic stroke in the socrates study acute stroke or Transient Ischemic Attack treated with aspirin or ticagrelor and patient out
Circulation, 2017Co-Authors: Donald J Easton, Pierre Amarenco, Gregory W Albers, Hans Denison, Scott R Evans, Peter Held, Maria Aunes, Sara Bokelundsingh, Marianne Jahreskog, Jenny JonassonAbstract:Background: Patients with minor acute Ischemic stroke or Transient Ischemic Attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute Ischemic stroke or Transient Ischemic Attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute Ischemic stroke or Transient Ischemic Attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.
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ticagrelor in acute stroke or Transient Ischemic Attack in asian patients
Stroke, 2017Co-Authors: Yongjun Wang, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Scott R Evans, Peter Held, Kazuo Minematsu, Ka Sing Lawrence Wong, Jenny JonassonAbstract:Background and Purpose—In the SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes), ticagrelor was not superior to aspirin. Because of ...
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ticagrelor versus aspirin in acute stroke or Transient Ischemic Attack
The New England Journal of Medicine, 2016Co-Authors: Claiborne S Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, Donald J Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A MolinaAbstract:BackgroundTicagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. MethodsWe conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere Ischemic stroke or high-risk Transient Ischemic Attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90). The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. ResultsDuring the 90 days of treatment, a primary end-point event occurred in 442 of the 6589 patients (6.7%) treated with ticagrelor, ver...
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one year risk of stroke after Transient Ischemic Attack or minor stroke
The New England Journal of Medicine, 2016Co-Authors: Pierre Amarenco, Julien Labreuche, Philippa C Lavallee, Gregory W Albers, Geoffrey A Donnan, Louis R Caplan, Natan M Bornstein, Patricia Canhao, Jose M Ferro, Michael G HennericiAbstract:BackgroundPrevious studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a Transient Ischemic Attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor Ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. MethodsWe recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a ...
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inter rater agreement analysis of the precise diagnostic score for suspected Transient Ischemic Attack
International Journal of Stroke, 2016Co-Authors: Carlo W Cereda, Jeanmarc Olivot, Michael Mlynash, Maarten G Lansberg, Neil E Schwartz, Stephanie Kemp, Paul M George, Manabu Inoue, Nirali Vora, Gregory W AlbersAbstract:BackgroundNo definitive criteria are available to confirm the diagnosis of Transient Ischemic Attack. Inter-rater agreement between physicians regarding the diagnosis of Transient Ischemic Attack is low, even among vascular neurologists. We developed the Precise Diagnostic Score, a diagnostic score that consists of discrete and well-defined clinical and imaging parameters, and investigated inter-rater agreement in patients with suspected Transient Ischemic Attack.MethodsFellowship-trained vascular neurologists, blinded to final diagnosis, independently reviewed retrospectively identical history, physical examination, routine diagnostic studies, and brain magnetic resonance imaging (diffusion and perfusion images) from consecutive patients with suspected Transient Ischemic Attack. Each patient was rated using the 8-point Precise Diagnostic Score score, composed of a clinical score (0–4 points) and an imaging score (0–4 points). The composite Precise Diagnostic Score determines a Precise Diagnostic Score Li...
Vincent Thijs - One of the best experts on this subject based on the ideXlab platform.
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dolichoectasia and small vessel disease in young patients with Transient Ischemic Attack and stroke
Stroke, 2017Co-Authors: Vincent Thijs, Ulrike Grittner, Franz Fazekas, Dominick J H Mccabe, Annekatrin Giese, Christof Kessler, Peter Martus, Bo NorrvingAbstract:Background and Purpose— We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger Transient Ischemic Attack and Ischemic stroke patients. Methods— We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young ( Results— Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09–1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59–2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13–1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P =0.065; 29.1% versus 16.5% for old lesions, P P P =0.001). Microbleeds (16.3% versus 4.7%, P =0.001), higher grades of white matter hyperintensities ( P P for differences in TOAST ( P =0.018) were more often present in patients with dolichoectasia. Conclusions— Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with Transient Ischemic Attack and Ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.