Presenter of 2 Presentations
CEREBRAL ARTERIAL STENOSIS IS ASSOCIATED WITH RECURRENCE IN PATIENTS WITH ACUTE ISCHEMIC STROKE WITH ATRIAL FIBRILLATION – A CASE-COHORT STUDY
Abstract
Background and Aims
Cerebral arterial stenosis (CAS) is prevalent in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). This study investigated the impact of CAS on stroke recurrence risk in these patients.
Methods
The East-Asian ischemic STroke patients with Atrial Fibrillation cohort enrolled 2287 patients with AIS and AF from 14 stroke centers. In this case-cohort study, we identified 95 patients with recurrent stroke and randomly sampled 114 patients (5%) as a subcohort for comparison. CAS and clinically relevant stenosis were assessed with MR or CT angiography. We assessed total stenosis burden score (TSBS) by adding stenosis scores (1: ≤50%, 2: >50%, 3: occlusion) of 22 intracranial and 4 extracranial segments and categorized into 3 groups (0,1-5,≥6).
Results
The recurrence group was more likely to have CAS (82% vs. 62%, p=0.004), relevant CAS (29% vs. 19%, p=0.008), and TSBS of ≥6 (41% vs. 20%, p=0.0004) than control group. On weighted Cox proportional hazard analysis after adjusting conventional vascular risk factors and anticoagulant use, CAS was associated with an increased risk of recurrence (aHR 3.06, 95% CI [1.52-6.16], p=0.002). The increase in recurrence risk was observed in both relevant (3.37,[1.47-7.76],p=0.004) and irrelevant CAS groups (2.88,[1.37-6.09],p=0.006). There was a dose-response relationship between the recurrence risk and TSBS; TSBS of ≥6 (4.66,[1.99-10.91],p<0.001) showed higher HR than TSBS of 1-5 (2.35,[1.08-5.13],p=0.031).
Conclusions
Our findings suggest that CAS may increase the recurrence risk in AF-AIS patients by almost 3 times or higher, and should be considered for future risk estimation and secondary stroke prevention strategy.
CURRENT TRENDS IN REPERFUSION THERAPY FOR ACUTE ISCHEMIC STROKE: ANALYSIS FROM A NATIONWIDE MUTICENTER REGISTER
Abstract
Background and Aims
Reperfusion therapy is the most effective treatment for acute ischemic stroke (AIS). We aimed to analyze the changes in reperfusion therapy in real-world practice over the past 10 years when the advances in techniques of endovascular therapy (EVT) and expansion of therapeutic time window have been established.
Methods
Using data from the Clinical Research Center for Stroke-Korea, a nationwide multicenter stroke register, we analyzed trends in intravenous thrombolysis (IVT) and EVT between 2011 and 2020. Time trends were assessed for rates of IVT, EVT, door to needle (DTN) time, and door to puncture (DTP) time. Trends were analyzed with adjusting for age, sex, initial stroke severity using generalized linear mixed model with random effect for center.
Results
Among 70,450 AIS patients enrolled 17 participating centers, patients receiving reperfusion therapy increased from 14.7% in 2011 to 17.5% in 2020 (P<0.001). During the study period, EVT rate almost doubled from 5.4% in 2011 to 10.6% in 2020. However, IVT rate increased from 12.9% in 2011 to 15.5% in 2014 and then decreased to 10.9% in 2020. Among IVT cases, the proportions of DTN time either ≤60 min or ≤45 min has not changed over time, whereas that of DTP time ≤60 min among EVT cases has increased.
Conclusions
In a large multicenter register, we observed a significant increase in the reperfusion therapy rate with a marked increase in EVT for the treatment of AIS over the past 10 years, but IVT rate showed a decreasing trend from the mid-2010s.