IRMA study: Prevalence of subdiaphragmatic visceral infarction in ischemic stroke and atrial fibrillation

Weisenburger‐Lile, David; Lopez, Delphine; Russel, S.; Kahn, Jean‐Emmanuel; Hellmann, Ana Veiga; Scherrer, Antoine; Ramdane, Nassima; Wang, Adrien; Évrard, Serge; Decroix, Jean‐Pierre; Mellot, François; Bourdain, Frédéric; Lapergue, Bertrand

doi:10.1177/1747493016677983

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…[7][8][9] Furthermore, in reports limited to organs beneath the diaphragm, abdominal MRI within 1 week of ischemic stroke onset has revealed evidence of splenic or renal infarction in 14% of cases. 19 This study found almost the same in the frequencies reported in previous studies. What makes this study important is that it examined systemic embolism in the hyperacute phase of ischemic stroke.…”

Section: Discussionsupporting

confidence: 87%

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

Sakuta,

Yaguchi,

Nakada

et al. 2023

Vasc Endovascular Surg

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Purpose In the majority of cases, large vessel occlusion (LVO) in ischemic stroke patients has an embolic origin. Systemic embolism can occur simultaneously with brain thrombosis. This retrospective study evaluated the frequency and locations of systemic embolism in LVO stroke patients receiving revascularization therapy. Materials and Methods In our facility, we use contrast-enhanced computed tomography (CE-CT) to assess suspected stroke patients and routinely perform CE-CT from the chest to the abdomen after brain CT angiography to rule out contraindications like aortic dissection and trauma for thrombolysis. Systemic embolism is also assessed using these images, while myocardial infarction is evaluated based on electrocardiograms and laboratory findings. Other relevant clinical features of each patient are also analyzed. Results In total, 612 consecutively admitted stroke patients and 32 LVO patients who underwent revascularization therapy were included in the present study. Systemic embolism was identified in four patients (13%). The spleen was the most commonly affected organ, followed by the heart, kidneys, limbs, and lungs. All four patients with systemic embolism exhibited LVO resulting from embolism as the underlying mechanism. Conclusion Systemic embolism was observed in 13% of our LVO patients, all of whom had LVO of embolic origin.

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Section: Discussionsupporting

confidence: 87%

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

Sakuta,

Yaguchi,

Nakada

et al. 2023

Vasc Endovascular Surg

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“…Prior studies of abdominal magnetic resonance imaging in patients with cardioembolic stroke show a 20% prevalence of visceral infarcts. 3, 6 Our results build on these studies by demonstrating the prevalence of visceral infarction differs across ischemic stroke subtypes. We found no visceral infarcts among patients with lacunar stroke, supporting this stroke subtype as a distinct entity resulting from in-situ occlusion of the cerebral vasculature.…”

Section: Discussionsupporting

confidence: 65%

Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Finn

Hung

Patel

et al. 2018

Stroke

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Background and Purpose Most cryptogenic strokes are thought to have an embolic source. We sought to determine whether cryptogenic strokes are associated with visceral infarcts, which are usually embolic. Methods Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR), we selected those with a contrast-enhanced abdominal computed tomography (CT) scan within 1 year of admission. Our exposure variable was adjudicated stroke subtype per the TOAST classification. Our outcome was renal or splenic infarction, as assessed by a single radiologist blinded to stroke subtype. We used Fisher’s exact test and multiple logistic regression to compare the prevalence of visceral infarcts among cardioembolic strokes, strokes of undetermined etiology, and non-cardioembolic strokes (large- or small-vessel strokes). Results Among 227 patients with ischemic stroke and a contrast-enhanced abdominal CT scan, 59 had a visceral infarct (35 renal and 27 splenic). The prevalence of visceral infarction was significantly different among cardioembolic strokes (34.2%; 95% confidence interval [CI], 23.7-44.6%), strokes of undetermined etiology (23.9%; 95% CI, 15.0-32.8%), and strokes from large-artery atherosclerosis or small-vessel occlusion (12.5%; 95% CI, 1.8-23.2%) (P = 0.03). In multiple logistic regression models adjusted for demographics and vascular comorbidities, we found significant associations with visceral infarction for both cardioembolic stroke (odds ratio [OR], 3.5; 95% CI, 1.2-9.9) and stroke of undetermined source (OR, 3.3; 95% CI, 1.1-10.5) as compared with non-cardioembolic stroke. Conclusions The prevalence of visceral infarction differed significantly across ischemic stroke subtypes. Cardioembolic and cryptogenic strokes were associated with a higher prevalence of visceral infarcts than non-cardioembolic strokes.

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“…[120][121][122][123][124][125] In a study of 227 patients with acute-ischemic stroke, the prevalence of visceral infarct differed significantly by stroke type: 34.2% in cardioembolic strokes (95% CI: 7-44.6%), 23.9% in strokes of undetermined etiology (95% CI: 15.0-32.8%), and 12.5% for large-artery atherosclerotic strokes/small-vessel occlusions combined (95% CI: 1.8-23.2%) 124 ; this is consistent with prior studies. [120][121][122] Despite their frequency, the clinical significance, risk factors, and pathophysiology of visceral infarctions remain poorly understood. In cardioembolic stroke, atrial remodeling and impaired contractility contribute to blood stasis/endothelial injury, and visceral infarction is likely a clinical manifestation of the prothrombotic state.…”

Section: Fecal Incontinencementioning

confidence: 99%

“…120 121 122 123 124 125 In a study of 227 patients with acute-ischemic stroke, the prevalence of visceral infarct differed significantly by stroke type: 34.2% in cardioembolic strokes (95% CI: 7–44.6%), 23.9% in strokes of undetermined etiology (95% CI: 15.0–32.8%), and 12.5% for large-artery atherosclerotic strokes/small-vessel occlusions combined (95% CI: 1.8–23.2%) 124 ; this is consistent with prior studies. 120 121 122 Despite their frequency, the clinical significance, risk factors, and pathophysiology of visceral infarctions remain poorly understood. In cardioembolic stroke, atrial remodeling and impaired contractility contribute to blood stasis/endothelial injury, and visceral infarction is likely a clinical manifestation of the prothrombotic state.…”

Section: Known Gastrointestinal Complications Secondary To Acute Isch...mentioning

confidence: 99%

Gastrointestinal Dysfunction in Stroke

2023

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Gastrointestinal (GI) complications are seen in over 50% of ischemic stroke survivors; the most common complications are dysphagia, constipation, and GI bleeding. The bidirectional relationship of the gut–brain axis and stroke has recently gained traction, wherein stroke contributes to gut dysbiosis (alterations in the normal host intestinal microbiome) and gut dysbiosis perpetuates poor functional neurologic outcomes in stroke. It is postulated that the propagation of proinflammatory cells and gut metabolites (including trimethylamine N-oxide and short-chain fatty acids) from the GI tract to the central nervous system play a central role in gut–brain axis dysfunction. In this review, we discuss the known GI complications in acute ischemic stroke, our current knowledge from experimental stroke models for gut–brain axis dysfunction in stroke, and emerging therapeutics that target the gut–brain axis.

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IRMA study: Prevalence of subdiaphragmatic visceral infarction in ischemic stroke and atrial fibrillation

Cited by 6 publications

References 7 publications

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Gastrointestinal Dysfunction in Stroke

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