Displaying One Session

Rapid Communications
Session Type
Rapid Communications
Room
Product Theatre
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM

PREVALENCE OF ATRIAL CARDIOPATHY IN EMBOLIC STROKE OF UNDETERMINED SOURCE AND LIKELY PATHOGENIC PATENT FORAMEN OVALE

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:20 PM - 03:25 PM

Abstract

Background And Aims

Patent foramen ovale (PFO) and atrial cardiopathy are important possible causes of embolic stroke of undetermined source (ESUS). We hypothesized that atrial cardiopathy would be less common in ESUS patients with likely pathogenic PFO compared to patients with likely incidental or without PFO.

Methods

The analysis was performed in the AF-ESUS (Prediction of AF in ESUS) dataset. The presence of PFO was assessed with transthoracic echocardiography with microbubble test and trans-oesophageal echocardiography, when necessary. Atrial cardiopathy was considered present if at least one of the following criteria was fulfilled: increased left atrial diameter index, increased left atrial volume index, prolonged PR interval and supraventricular extrasystoles presence in standard 12-lead ECGs during hospitalization. PFO presence was considered likely incidental if RoPE (Risk of Paradoxical Embolism) score was 0-6 and likely pathogenic if 7-10.

Results

Among 235 ESUS patients (median age: 59.5 years, 41.7% women), there were 42 (17.9%) with likely incidental PFO, 41 (17.4%) with likely pathogenic PFO and 118 (50.2%) with atrial cardiopathy. The prevalence of atrial cardiopathy was lower in patients with likely pathogenic PFO (12.2%) compared to patients with likely incidental (52.4%) or patients without PFO (59.9%) (p<0.001). After adjustment for multiple confounders, the prevalence remained lower in patients with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO (adjusted OR=0.162,95%CI 0.056-0.470, p=0.001).

Conclusions

Atrial cardiopathy was less prevalent in ESUS patients with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO. This may be useful during diagnostic work-up in ESUS patients.

Trial Registration Number

Not applicable

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EPIGENETIC BIOLOGICAL AGE MIGHT EXPLAIN AGE DIFFERENCES BETWEEN SEXES AT STROKE ONSET

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:25 PM - 03:30 PM

Abstract

Background And Aims

Stroke onset in women occur later in life relative to men. Biological age calculated by DNA methylation (DNAm) is an estimation of biological aging and is a better predictor of ischemic stroke (IS) risk compared to chronological age. Our aim was to determine if differences in biological age explain the delay of stroke occurrence in women.

Methods

In a two stages study, 386 samples were analyzed using Infinium 450K and EPIC BeadChip. Discovery: N=151 IS patients (29% female) and N=73 non-stroke controls (45% female); Replication: N=106 IS patients (50% female) and N=56 controls (76% female). Chronological age (Chrono_Age) described as time from birth, DNA methylation age (DNAm_age) calculated using Horvath’s DNAm age calculator. Proteomic analysis was performed using SOMAscan array in 46 IS and controls. Generalized linear model was used to identify age differences between man and women subjects.

Results

Sex differences in Chrono_Age in ISpatients were observed (p.value=1.37x10-3), women were over 7 years older than men, mean Chono_Age men=71,2±10, women=78,3±9. Whereas no DNAm_Age sex differences were observed (p.value=0.198). Same results were observed in the replication cohort, identifying statistically differences in Crono_age but not in DNAm_age. Control samples did not show sex differences neither in Chrono_Age nor in DNAm_Age. Protein levels of Apolipoprotein B, among others, were associated with DNAm_Age.

Conclusions

Men and women present the same Biological age at stroke onset compared to chronological age. Biological age could be the reason of sex differences observed in the time of stroke onset.

Trial Registration Number

Not applicable

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ASCOD PHENOTYPING OF ACUTE BRAIN INFARCTION WITH ANTERIOR LARGE VESSEL OCCLUSION TREATED BY MECHANICAL THROMBECTOMY.

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:30 PM - 03:35 PM

Abstract

Group Name

on behalf of the FRAME investigators

Toulouse University Hospital.

Acute Stroke Unit

Jean-Marc Olivot MD, Jean-François Albucher MD, Lionel Calviere MD, Alain Viguier MD, Nicolas Raposo MD, François Chollet MD, Marianne Barbieux MD

Diagnostic and Interventional Neuroradiology

Christophe Cognard, MD, Adrien Guenego MD, Fabrice Bonneville MD, Anne Christine Januel MD, Jean Darcourt MD, Caterina Michelozzi MD, Philippe Tall MD

Clinical Investigation Center

Claire Thalamas MD, Amel Drif RN, Agnes Sommet MD, Vanessa Rousseau BS, Brigitte Pouzet PhD, Fabienne Calvas MD, Monique Galitzki MD.

Bordeaux University Hospital

Acute Stroke Unit

Igor Sibon MD, Pauline Renou MD, François Rouanet MD, Ludovic Lucas MD, Cyrielle Coignon MD, Sabrina Debruxelles MD, Sharmila Sagnier MD, Sylvain Ledure,

Diagnostic and Interventional Neuroradiology

Thomas Tourdias MD, Patrice Menegon MD, Jerome Berge, MD, Gauthier Marnat MD,

Stanford Stroke Center

Greg W Albers MD, Michael Mlynash MD, Soren Christensen PhD

CORE LAB

Imaging acquisition and Processing- Soren Christensen PhD and Adrien Guenego MD

Assessment of vessel imaging and angio- Mikael Mazighi MD

Assessment of hemorrhagic transformation- François Caparros MD

Background And Aims

Mechanical thrombectomy has revolutionized the acute treatment of acute brain infarction (BI) due to large vessel occlusion (LVO). However data regarding anterior LVO related BI mechanism are limited. The ASCOD phenotyping offers an exhaustive assessment of BI etiologies. The aim of this study was to determine prospectively in a cohort of acute LVO related BI their mechanism after 3 months follow up.

Methods

This is a predefined substudy of the French Acute Multimodal imaging to Select patient for Mechanical thrombectomy (FRAME). 218 patients were enrolled ; ASCOD phenotype: A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; and D, dissection was systematically assessed at 3 months.

Results

218 patients were enrolled in the study. ASCOD phenotype was missing in 2.1 patient with a final diagnosis of small disease and asymptomatic ICA occlusion was removed from analyses.

Distribution was C1 121 (56%) / C2 13 (6%) ; A1 22 (10%) / A2 27 (12%); D1 10 (5%) / D2 0 (0%); O1 7 (3%) / O2 0 (0%). 37 participants (17%) had no grade 1 or 2. Among those, 21 (10%) did not undergo minimal evaluation.

Distribution between A C and D mechanisms is summarized on the Venn diagram.

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Conclusions

In the FRAME cohort, cardioembolism appears to be the major mechanism of anterior LVO related BI. Overlap between various mechanisms of BI is limited. The rate of patients with undetermined mechanism remains low and mostly due to incomplete evaluation.

Trial Registration Number

ClinicalTrials.gov Identifier: NCT03045146

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TRAJECTORY OF RECOVERY FOLLOWING CLOT RETRIEVAL- INDIVIDUAL PATIENT DATA ANALYSIS FROM THREE THROMBECTOMY TRIALS (DEFUSE 3, ESCAPE, EXTEND-IA)

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:35 PM - 03:40 PM

Abstract

Background And Aims

The trajectory of recovery within the first week of thrombectomy may be useful in providing prognosis, planning rehabilitation or to define a point of plateau in recovery for further intervention. The aim was to analyze the trajectory of stroke deficit in thrombectomy trials.

Methods

Individual patient data on National Institute of Health Stroke Scale (NIHSS) were pooled from three trials (DEFUSE 3, ESCAPE, and EXTEND-IA) at baseline, post-treatment, and day 3 to 5. Linear regression analysis was used to analyze the trajectory of recovery in the first 24-hour and the post 24-hour period. In the second part, Group Based Trajectory Modelling (GBTM) was used to cluster the longitudinal trajectory of NIHSS in the first five days and entered as covariates in logistic regression to predict 90-day disability (modified Rankin Scale >2).

Results

Thrombectomy (n=224) patients achieved a steeper improvement in NIHSS, from baseline to 24 hours (β=-8.18, 95% -9.42 – -6.93) compared with (n=197) control (β=-3.05, 95% -4.48 – -1.63; p<0.001). Recovery was not statistically different between thrombectomy and control patients beyond 24 hours (β=-2.41, 95% -3.81 – - 1.00 versus β=-1.05, 95% -2.85 – 0.75; p=0.24). Model 1: trajectory clusters, age, diabetes and trial component were significant predictors of disability (AUC=0.81, 95% CI 0.77 – 0.86); addition of day 3 to 5 NIHSS increases AUC (0.92, 95% CI 0.89 – 0.95)

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Conclusions

Thrombectomy patients had steeper recovery compared with control in the first 24 hours of treatment. Trajectory cluster provides additional information to prediction of outcome.

Trial Registration Number

Not applicable

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N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE (NT-PROBNP) IMPROVES THE PREDICTIVE ACCURACY OF THE ACUTE STROKE REGISTRY AND ANALYSIS OF LAUSSANE (ASTRAL) SCORE. RESULTS OF THE SICFAIL STUDY

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:40 PM - 03:45 PM

Abstract

Background And Aims

Outcome prognostication in acute ischemic stroke (IS) patients is challenging. Attempts of improvement using blood-based biomarkers have mostly used non-validated or very simple models as baseline comparators. We investigated whether NT-proBNP, a promising candidate according to our systematic review of prognostic biomarkers, may improve the accuracy of ASTRAL, the best performing score in available head-to-head comparisons.

Methods

Data were collected within the prospective Stroke Induced Cardiac FAILure in mice and men (SICFAIL) cohort study. We investigated the discrimination of poor functional outcome (defined as modified Rankin Scale score >2 one year after IS) of the ASTRAL score and NT-proBNP using the area under the receiver operating characteristics curve with 95% confidence intervals. We assessed the improvement provided by NT-proBNP in the discrimination of the ASTRAL score using the DeLong test

Results

Between 01/2014-02/2017, 696 acute IS patients were enrolled (median age 71 years, IQR 60-79; 61.6% male). One-year functional outcome was available in 446 of 544 (82%) patients with NT-proBNP measurement at baseline. The discriminatory accuracy of NT-proBNP alone to predict poor outcome was good (0.738; 0.688–0.788) and comparable to the ASTRAL score (0.753; 0.703–0.803, p=0.64). NT-proBNP improved the accuracy of the ASTRAL score (0.774; 0.726–0.823, p=0.0077) for the prediction of poor functional outcome.

Conclusions

NT-proBNP improved the accuracy property of the ASTRAL score and might serve as additive prognostic marker in acute IS patients. Using validated prognostic scores as baseline comparators may facilitate the external validation of further promising biomarkers and ease their adoption in the clinical routine

Trial Registration Number

DRKS00011615

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EFFECT OF SEX ON CLINICAL OUTCOME AND IMAGING AFTER ENDOVASCULAR TREATMENT OF LARGE-VESSEL ISCHEMIC STROKE IN THE EXTENDED TIME WINDOW

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:45 PM - 03:50 PM

Abstract

Group Name

the CRISP study Investigators

Background And Aims

Whether sex influences outcome after endovascular treatment (EVT) of acute ischemic stroke is a subject of debate. We studied the effect of sex on 90-day functional outcome and advanced imaging characteristics in acute stroke patients who underwent EVT up to 18 hours after last seen well included in the Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke (CRISP) study.

Methods

We compared baseline and follow-up characteristics between men and women and used ordinal regression analysis and a univariable and multivariable regression model to examine the association between sex and functional outcome.

Results

We included 198 acute stroke patients of whom 46% were female. Women were older. They had smaller baseline perfusion lesion and penumbral volumes, and more often had a target mismatch perfusion profile. Women experienced less ischemic core growth and had smaller final infarct volumes. Female sex was associated with a favorable shift on the modified Rankin Scale after adjustment for confounders (adj cOR 1.86 [1.01 – 3.46]; p = 0.047; Fig 1) and a lower odds of death or severe disability in univariable (OR 0.38 [0.17 – 0.87]; p = 0.02) and multivariable (adj OR 0.30 [0.11 – 0.81]; p = 0.02) analysis.

fig1.png

Conclusions

In patients who underwent EVT up to 18 hours after last seen well, we found better functional outcomes amongst women. Possibly, differences in outcome are related to better collateral circulation in women. Our findings should be validated in other datasets.

Trial Registration Number

Not applicable

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LOW PRESENTING BLOOD PRESSURE AND ADVERSE CLINICAL OUTCOME IN ACUTE STROKE: SECONDARY ANALYSIS OF THE INTERNATIONAL HEADPOST TRIAL

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:50 PM - 03:55 PM

Abstract

Background And Aims

Studies have not clearly clarified associations of low blood pressure (BP) and clinical outcomes and serious adverse events in acute stroke.

Methods

Post-hoc analyses of the pragmatic, cluster crossover, HeadPoST randomised trial of lying-flat versus sitting-up head positioning in 11,093 acute stroke patients from nine countries. Restricted cubic spline (RCS) and hierarchical logistic-regression models were used to visualize and determine the associations, respectively. Outcomes for analysis included death or dependency (modified Rankin scale [mRS] of 3-6) and serious adverse events (SAEs) at 90 days.

Results

Compared to other patients, those admitted with low BP (SBP <120, DBP <70 mmHg) were younger, less likely to have a stroke due to intracerebral haemorrhage (ICH), and had higher baseline NIHSS scores, history of heart disease and prior disability. Non-linear J-shaped relationship was evident for SBP and poor outcome (Figure). Compared to normal SBP (120-139 mmHg), low baseline SBP was associated with a significantly increased risk of poor outcome (adjusted odds ratio [aOR] 1.29, 95%CI 1.03-1.61). The associations were consistent for acute ischaemic stroke (aOR 1.20, 95% CI 0.95-1.52) and ICH (OR 1.21, 95% CI 0.39-3.71). Low SBP was associated with higher rates of cardiac and sepsis events, which appeared related to pre-morbid factors rather than in-hospital BP management.

figure_abstract.jpg

Conclusions

Low BP is associated with increased risks of adverse outcomes in acute stroke patients, driven in part by pre-existing cardiac disease and susceptibility to sepsis.

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RED BLOOD CELL DISTRIBUTION WIDTH IS ASSOCIATED WITH MORTALITY AFTER ACUTE ISCHEMIC STROKE: A COHORT STUDY AND SYSTEMATIC REVIEW

Session Type
Rapid Communications
Date
07.11.2020, Saturday
Session Time
03:20 PM - 04:10 PM
Room
Product Theatre
Lecture Time
03:55 PM - 04:00 PM
Presenter

Abstract

Background And Aims

Whether Red blood cell distribution width (RDW) is associated with the prognosis of acute ischemic stroke is inconclusive according to recent studies. We performed a cohort study and meta-analysis to explore the association between RDW and functional outcome.

Methods

Patients with ischemic stroke admitted to the department of neurology within 24 hours of stroke onset between January, 1, 2015 to December 31, 2018 were enrolled. Blood was sampled within 24 hours after admission. We searched PubMed, Embase, Web of Science databases up to Nov 2019 to identify studies investigating the association between RDW values and prognosis following stroke. Outcomes included 3-month death and poor functional outcome (defined by modified Rankin Scale score ≥3).

Results

We included 1558 patients in cohort study. RDW was independently associated with 3-month death (odds ratio [OR], 1.19; 95% confidence interval [CI] 1.03, 1.37), but not associated with 3-month poor outcome (OR 1.05, 95% CI 0.95, 1.16), after adjustment for confounders. A dose-dependent relationship between RDW levels and 3-month death was revealed in the restricted cubic spline plot. Seven observational studies with 4407 patients were identified for systematic review. When combining our study and previous studies, the association was significant for RDW predicting death (5 studies with 3366 patients, OR 1.25 95% CI 1.15, 1.35), as well as for poor outcome (4 studies with 3483 patients, OR 1.23, 95% CI 1.05, 1.44).

Conclusions

RDW was an independent predictor of 3-month functional outcome, and a trend of dose-dependent relationship between RDW and 3-month death was detected.

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