Clinical relevance of abnormal neuroimaging findings and long‐term risk of stroke recurrence

Nam, Ki Woong; Kwon, Hyung‐Min; Lim, Jae Sung; Han, Moon‐Ku; Lee, Y.-S.

doi:10.1111/ene.13391

Cited by 23 publications

(21 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to patients with transient ischemic attack (TIA), predictors of recurrent ischemic stroke in patients with a recent ischemic stroke are less well known. Clinical factors such as stroke subtype and past medical history of stroke have been reported to be associated with recurrent ischemic stroke [4,5]. Over the last decade, radiological findings have gained more interest in predicting recurrent stroke.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2018

View full text Add to dashboard Cite

Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I²) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Therefore, there is much research on the diagnosis of stroke and its treatment [7][8][9][10]. In the field of traditional medicine, many studies on stroke have been conducted in China, Korea and other East Asian countries [11][12][13], which includes studies on the effectiveness of different types of herbal medicine for stroke [14,15].…”

Section: Discussionmentioning

confidence: 99%

Protocol for Systematic Review of Controlled Trials of Korean and Chinese Herbal Treatments for Stroke

et al. 2017

View full text Add to dashboard Cite

“…Demographic, clinical and cardiovascular risk factors were assessed, including age, sex, hypertension, diabetes, hyperlipidemia, atrial fibrillation, ischaemic heart disease, current smoking, and severity and mechanism of the index stroke . Stroke severity was evaluated by well‐trained neurologists using the National Institutes of Health Stroke Scale (NIHSS) score at the time of admission.…”

Section: Methodsmentioning

confidence: 99%

Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients

Nam

Kwon

Kim

et al. 2019

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purpose The purpose was to evaluate the association between the left ventricular ejection fraction (LVEF) and cerebral small vessel disease (cSVD) in ischaemic stroke patients. Methods Consecutive first‐ever ischaemic stroke patients between 2010 and 2013 were included. White matter hyperintensity (WMH) volumes were rated using both the Fazekas score and quantitative methods on fluid‐attenuated inversion recovery images. As spectra of cSVD, lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVSs) were also evaluated. To assess the dose–response relationship between LVEF and cSVD, the burdens of each radiological marker and the total cSVD score were rated. Results A total of 841 patients were included [median WMH volume 2.98 (1.22–10.50) ml; the frequencies of lacunes, CMBs and moderate to severe EPVSs were 38%, 31% and 35%, respectively]. In the multivariate analysis about predictors of WMH volumes, the LVEF (B = −0.052, P < 0.001) remained significant after adjusting for confounders. LVEF was also a predictor of lacunes [adjusted odds ratio (aOR) 0.978, P = 0.012], CMBs (aOR = 0.96, P < 0.001) and moderate to severe EPVSs (aOR = 0.94, P < 0.001) after adjusting for their confounders. The LVEF values were negatively correlated with the burdens of lacunes (P = 0.026), CMBs (P < 0.001) and EPVSs (P = 0.002). The total cSVD score also showed a negative association with LVEF in a dose–response manner (P < 0.001). Conclusions The burden of cSVD is negatively correlated with the LVEF in a dose–response manner. Our results suggest clues for further studies about determining the pathophysiology of cSVD.

show abstract

Clinical relevance of abnormal neuroimaging findings and long‐term risk of stroke recurrence

Abstract: Abnormal neuroimaging findings, rather than cardiovascular risk factors, are predictive of long-term ischaemic stroke recurrence. Causative mechanism of stroke and underlying hostile brain milieu seem to be associated with long-term stroke recurrence.

Cited by 23 publications

References 30 publications

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

Protocol for Systematic Review of Controlled Trials of Korean and Chinese Herbal Treatments for Stroke

Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients

Contact Info

Product

Resources

About