Displaying One Session

Rapid Communications
Session Type
Rapid Communications
Room
Product Theatre
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM

PAST USE OF ORAL ANTICOAGULATION AMONG PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION ADMITTED FOR ISCHAEMIC STROKE: A DESCRIPTIVE STUDY IN THE UNITED KINGDOM AND DENMARK

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:30 PM - 02:35 PM

Abstract

Background And Aims

Discontinuation of oral anticoagulant therapy (OAC) in patients with non-valvular atrial fibrillation (NVAF) increases the risk of ischaemic stroke (IS). We conducted a population-based study in the United Kingdom (UK) and Denmark to describe the frequency of previous OAC non-use/discontinuation in patients with NVAF hospitalised for IS.

Methods

Patients with NVAF were identified from primary care electronic health records in the UK (N=76,882) and registries from Southern Denmark (N=41,526). Among these patients, we identified those admitted for an IS (2016– 2018) and described their previous patterns of OAC use. We calculated the percentage of patient with IS who discontinued an OAC, defined as end of use >1 month before the date of IS admission.

Results

44.7% of UK patients (245/548) and 52.7% (339/643) of Danish patients used an OAC at the time of their IS, while 27.2% and 22%, respectively had no record of OAC use before their IS. The percentage of IS patients who discontinued an OAC before their hospitalisation was similar in the UK (22.6%, 124/548) and Denmark 131/643 (20.4%, 131/643). Among UK patients, 8.4% discontinued a non-vitamin K oral anticoagulant and 14.2% discontinued a vitamin K antagonist; corresponding numbers among patients in Denmark were 8.7% and 11.7%, respectively.

Conclusions

Among patients with NVAF and IS, previous non-use/discontinuation of an OAC was high, with discontinuation rates similar in the UK and Denmark. Further studies are warranted to explore whether persistence with OAC therapy can be improved among patients with NVAF to ensure they are adequately protected against IS.

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DISCONTINUATION OF ORAL ANTICOAGULATION AMONG PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION INCREASES RISK OF ISCHAEMIC STROKE: A POPULATION-BASED STUDY IN THE UNITED KINGDOM AND DENMARK

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:35 PM - 02:40 PM

Abstract

Background And Aims

The majority of patients with non-valvular atrial fibrillation (NVAF) require oral anticoagulant (OAC) therapy to reduce their risk of ischaemic stroke (IS), and persistence with therapy is needed to maintain adequate thromboembolic protection. We conducted a population-based cohort study using primary care data from the UK and registry data from Denmark to evaluate associations between OAC discontinuation and risk of hospitalised IS.

Methods

From 2016–2018, patients with NVAF (UK, N=76,882; Denmark, N=41,526) were followed-up and incident cases of hospitalised IS were identified. Nested case–control analyses were conducted using logistic regression to calculate odds ratios (ORs) for OAC discontinuation (vs. current OAC use) and IS risk, adjusted for confounders. OAC discontinuation was defined as end of use >1 month before the index date (IS date for cases; random date during follow-up for controls).

Results

There were 548 incident IS cases in the UK and 643 in Denmark. Adjusted ORs (95% CIs) for OAC discontinuation were 2.88 (2.20–3.79; UK) and 2.31 (1.81–2.97; Denmark). ORs for OAC discontinuation occurring >365 days previously were 3.33 (2.34–4.74; UK) and 2.51 (1.82–3.44; Denmark), and for 30–365 days previously were 2.45 (1.70–3.53; UK) and 2.41 (1.68–3.44; Denmark). ORs for OAC discontinuation after ≤1 year use were 2.87 (2.07–3.96; UK) and 2.48 (1.59–3.89; Denmark); and after use of >1 year 2.87 (1.92–4.30; UK); 1.55 (0.69–3.44; Denmark).

Conclusions

Patients with NVAF who discontinue OAC therapy have a substantially increased risk of IS than those who maintain therapy irrespective of previous treatment duration or whether discontinuation occurred ≤1 year or >1 year previously.

Trial Registration Number

Not applicable

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ENDOVASCULAR TREATMENT PROTOCOL OF BILATERAL INTRACRANIAL VERTEBRAL ARTERY ANEURYSMS

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:40 PM - 02:45 PM

Abstract

Background And Aims

The management of bilateral IVADAs is controversial, and requires the development of endovascular treatment modalities and principles. We aim to define the endovascular treatment protocol for bilateral intracranial vertebral artery dissecting aneurysms (IVADAs).

Methods

We identified all bilateral IVADAs at a high-volume neurointerventional center over a 10-year period (from January 2009 to December 2018). Radiographic and clinical data were recorded, and a treatment algorithm was derived.

Results

Twenty-seven patients with bilateral IVADAs (54 IVADAs in total) were diagnosed. Four patients received single-stage endovascular treatment. One IVADA in patient with subarachnoid hemorrhage recanalized at follow-up and re-coiling. Two unruptured patient has infarction, and had unfavorable clinical outcome at follow-up. Twelve patients received staged endovascular treatment, and had favorable clinical outcome at follow-up. One ruptured IVADA recanalized and re-coiling. The other IVADAs were completely obliterated or stable at follow-up. One patient had parent artery occlusion after treatment, but no clinical symptoms were found. Eleven patients received reconstructive endovascular treatment for only one side of their bilateral IVADAs. The treated IVADAs were completely obliterated, and untreated IVADAs were stable at follow-up. Among all patients, all 13 IVADAs with a flow diverter showed complete obliteration at follow-up. Only half of IVADAs with stent alone showed complete obliteration at follow-up.

Conclusions

The endovascular treatment protocol for bilateral IVADAs was helpful in clinical management. Staged reconstructive endovascular methods are safe and effective for treating bilateral IVADAs. The use of flow diverters is a novel endovascular approach, while the parent artery occlusion should be considered.

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SEVERITY OF NONALCOHOLIC FATTY LIVER DISEASE AND RISK OF FUTURE ISCHEMIC STROKE EVENTS: A COHORT STUDY.

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:45 PM - 02:50 PM
Presenter

Abstract

Background And Aims

We assessed prospectively whether nonalcoholic fatty liver disease (NAFLD) and its severity predicts future ischemic stroke (IS) events in a community-based cohort.

Methods

From the Kailuan study, a total of 79,905 participants free of history of stroke, cancer, or myocardial infarction were enrolled after excluding alcohol abuse and other liver diseases. NAFLD was evaluated through ultrasonography and histories of alcohol consumption or other liver disease. Participants with NAFLD were further stratified into slight, moderate and severe groups. The outcome was the first occurrence of IS. The secondary outcomes included myocardial infarction and combined vascular events. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident ischemic stroke according to presence and severity of NAFLD, adjusting for age, sex, physical activity, body mass index (BMI), smoker, history of hypertension, diabetes mellitus, hypercholesterolemia, lipid-lowering medication, high-density lipoprotein (HDL), triglyceride (TG), high sensitivity C-reactive protein (hsCRP) and fasting blood glucose (FBG).

Results

During a median of 10.34 years of follow-up, we documented 3490 incident stroke cases. NAFLD was found in 24,874 (31.18%) participants. Relative to participants without NAFLD at the baseline, those with NAFLD had a 16% higher risk (95% CI 1.08-1.26) of developing ischemic stroke, after adjusted for confounding variables. The HRs for patients with slight, moderate and severe NAFLD were 1.28 (95% CI 1.18–1.40), 1.39 (95% CI 1.24–1.55), and 1.49 (95% CI 1.21–1.84), respectively.

Conclusions

NAFLD is significantly associated with a higher risk of future ischemic stroke events by a dose-dependent pattern.

Trial Registration Number

Not applicable

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INCREASE IN AMBIENT TEMPERATURE PARAMETERS IS ASSOCIATED WITH LOWER INCIDENCE OF STROKE IN A JAPANESE POPULATION: TAKASHIMA STROKE REGISTRY, JAPAN, 1988-2010.

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:50 PM - 02:55 PM
Presenter

Abstract

Background And Aims

Using a population based stroke registry system, our objective was to evaluate the relationship between ambient temperature parameters and stroke incidence in a geographically defined semi-urban and rural Japanese population.

Methods

We analyzed data from the Takashima Stroke Registry, which has been capturing all stroke occurrences in a population of approximately 55,000 in Takashima County in central Japan. Using Poisson regression model we examined the age-gender adjusted effect temperature parameters (average, minimum, and maximum) on the incidence of stroke. The study period of 8,401 days were divided into quintile of daily weather parameters and the middle-quintile was used as the reference category. The analysis was repeated across warmer and colder days.

Results

There were 2407 first-ever strokes (1295 men, 1112 women) during 1988-2010 with 1627 ischemic, 545 hemorrhagic, 213 SAH, and 22 unclassified strokes. The temperature parameters were; average 14.0°C (range: −2.5 to 30.1), minimum 10.3°C (range: −8.5 to 26.8), and maximum 17.9°C (range: −1.4 to 36.9). For all strokes, the incidence rate ratio (IRR) associated with highest quintile (Q5: IRR 0.82, 95%CI 0.73-0.93) and second-highest quintile (Q4: IRR 0.80, 95%CI 0.71-0.91) was lower than the middle-quintile (Q3: Reference). Similar association was observed for all subtypes of stroke and across warmer as well as colder weather.

Conclusions

Our analysis shows that higher the temperature, whatever way the parameter is measured (average, minimum, or maximum), has shown to have a protective effect against stroke occurrence.

Trial Registration Number

Not applicable.

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LONG-TERM TRENDS IN SURVIVAL AFTER HAEMORRHAGIC STROKES: THE SOUTH LONDON STROKE REGISTER

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
02:55 PM - 03:00 PM

Abstract

Background And Aims

There have been reductions in stroke mortality over the past decades but estimates by subtypes are limited. This study estimates time-trends in mortality by haemorrhagic stroke (HS) subtypes over a 16-year period.

Methods

The study area was 357,308 in 2011; 50.4% were males, 56% were white, and 25% of black ethnic backgrounds. People who had their first-ever HS during 2000-2015 were identified and classified according to the underlying mechanism into: intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH). Time-trends in survival were examined using proportional-hazards survival modelling, adjusted for demography, pre-stroke risk factors, case mix variables, and processes of care.

Results

A total of 715 patients with first-ever HSs were registered. The median age was 61.9 years; 45.7% were females, 55.5% were white, 30.1% were black, and 14.4% of other ethnic groups. Between 2000 and 2015, the adjusted overall mortality decreased by 38.9% (hazard ratio [HR] per year, 0.951; 95% confidence interval [CI], 0.923–0.981). Mortality reductions were noted in both types of HSs but were only significant in females (HR per year, 0.937; 95% CI, 0.892‒0.984), patients aged ˂65 years (HR per year, 0.927; 95% CI, 0.881‒0.975) and the white population (HR per year, 0.938; 95% CI, 0.902-0.975). Fewer number of events in certain subgroups (e.g., SAH) could have led to insufficient power to detect significant trends.

Conclusions

Mortality after HS has decreased by an annual average of around 4.9% during 2000‒2015. Such reductions were particularly evident in females, patients aged ˂65 years and the white population.

Trial Registration Number

Not applicable

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LEFT AURICULAR CARDIOPATHY IN EMBOLIC STROKE OF UNDETERMINED SOURCE

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
03:00 PM - 03:05 PM

Abstract

Background And Aims

Left atrial cardiopathy (LAC) is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding number of atrial premature complexes per hour (APC/h) to LAC criteria.

Methods

Retrospective analysis of 123 consecutive ESUS patients. LAC was defined according to two criteria (LAC2: left atrial diameter and p-wave terminal force in lead V1 [PTFV1]) or 3 criteria (LAC3: additionally APC/h). Survival analysis for the occurrence of atrial fibrillation (AF), stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves.

Results

Patients with LAC (35.0%) were older (p=0.007), more frequently had hypertension (p=0.004) and lower total cholesterol levels (p=0.044) than patients without LAC. The incidence of AF (median follow-up 21 months, IQR=9-35) was higher both in LAC2 (p=0.038) and LAC3 (p=0.001). There were no differences in stroke recurrence or death between patients with or without LAC. Among the three atrial dysfunction criteria, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC=0.822). Cox regression revealed that PTFV1>5000 µV·ms (HR=5.12, IC95%=1.28-20.56, p=0.021) and >30 APC/h (HR=13.02, IC95%=3.57-47.56) were independent predictors of AF.

Conclusions

The incidence of AF during follow-up is higher in ESUS patients with LAC. Frequent APC is also independently associated with AF and its inclusion as a diagnostic criteria for LAC should be considered.

Trial Registration Number

Not applicable

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HIGHER RATES OF PAROXYSMAL ATRIAL FIBRILLATION IN STROKE OF UNDETERMINED ETIOLOGY AFTER 12 MONTHS

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
02:30 PM - 03:10 PM
Room
Product Theatre
Lecture Time
03:05 PM - 03:10 PM

Abstract

Background And Aims

Detection of paroxysmal atrial fibrillation (pAF) results in oral anticoagulation for secondary stroke prevention. In a subgroup of stroke patients with unknown etiology, the ESUS-concept (“embolic stroke of undetermined stroke”) has been established. Two large randomized trials recently failed to show a benefit of oral anticoagulation among all ESUS-patients. To strengthen the concept of pAF as one major underlying cause for ESUS, detection rates of pAF between ESUS and No-ESUS patients were compared.

Methods

Within the open-label randomised multi-center prospective Find-AFrandomised-study (NCT01855035), assessing prolonged and enhanced Holter-monitoring in acute ischemic stroke patients ≥60 years without history of atrial fibrillation or significant extra- or intracranial artery stenosis, patients were screened for eligibility of adapted ESUS criteria. ESUS-patients were compared to No-ESUS-patients with respect to detection of pAF during follow-up.

Results

Of 393 patients, 251 (63.9%) fulfilled diagnostic workup to assess for ESUS (lesion depiction on imaging, TTE/TEE, ≥24h Holter-ECG-monitoring). Among these ESUS-eligible patients, 125 were classified as ESUS-patients. The two groups did not differ significantly with respect to baseline characteristics or intensified Holter-ECG-monitoring. pAF was detected in 11 after 6 and in 13 ESUS-patients after 12 months as opposed to 5 patients in the No-ESUS group after 6 and 12 months (p=0.177 and p=0.048, respectively).

Conclusions

ESUS patients were found to have a significantly higher rate of pAF after 12 months. This underlines the necessity for complete stroke work-up diagnostics to correctly identify ESUS-patients and initiate intensified rhythm monitoring to increase rates of pAF detection resulting in a shift of secondary stroke prevention.

Trial Registration Number

NCT01855035

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