Recurrent Ischemic Stroke – A Systematic Review and Meta-Analysis

Kolmos, Mia; Christoffersen, Laura Cathrine; Kruuse, Christina

doi:10.1016/j.jstrokecerebrovasdis.2021.105935

Cited by 124 publications

(88 citation statements)

References 40 publications

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“…The aGAPSS is a tool that has proven to predict extracranial thrombotic events; 10,11 therefore, as there is no defined cut-off value for intracranial events, we explored by univariable analysis if there was a difference in the total score of this prediction tool between patients who had an AIS recurrence and those who did not, finding that there was no statistical difference. Furthermore, despite adequate anticoagulation, our AIS recurrence rate also falls within the 5-year recurrence rate of 14-26% reported in non-APS patients, 42,43 reinforcing the need for strict goaloriented care of comorbidities as in patients without APS. 1,34 This study has several limitations.…”

Section: Discussionsupporting

confidence: 70%

Antiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes

García‐Grimshaw

Posadas-Pinto

Jiménez‐Ruiz

et al. 2022

Lupus

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Objectives The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. Methods Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. Results We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35–52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12–96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. Conclusion We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.

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Section: Discussionsupporting

confidence: 70%

Antiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes

García‐Grimshaw

Posadas-Pinto

Jiménez‐Ruiz

et al. 2022

Lupus

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“…The risk of stroke recurrence depends on the subtypes of ischemic stroke. As compared to other stroke subtypes, the recurrence rate of cardioembolic stroke is relatively high (5,6). Moreover, cardioembolic strokes are often followed by strokes of the same type (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…As compared to other stroke subtypes, the recurrence rate of cardioembolic stroke is relatively high (5,6). Moreover, cardioembolic strokes are often followed by strokes of the same type (6,7). Atrial fibrillation (AF) is the most common cause of cardioembolic stroke, and even embolic stroke of undetermined source (ESUS) may originate from subclinical AF (8).…”

Section: Introductionmentioning

confidence: 99%

Automated risk assessment of newly detected atrial fibrillation poststroke from electronic health record data using machine learning and natural language processing

Sung

Sung²,

Pan³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTimely detection of atrial fibrillation (AF) after stroke is highly clinically relevant, aiding decisions on the optimal strategies for secondary prevention of stroke. In the context of limited medical resources, it is crucial to set the right priorities of extended heart rhythm monitoring by stratifying patients into different risk groups likely to have newly detected AF (NDAF). This study aimed to develop an electronic health record (EHR)-based machine learning model to assess the risk of NDAF in an early stage after stroke.MethodsLinked data between a hospital stroke registry and a deidentified research-based database including EHRs and administrative claims data was used. Demographic features, physiological measurements, routine laboratory results, and clinical free text were extracted from EHRs. The extreme gradient boosting algorithm was used to build the prediction model. The prediction performance was evaluated by the C-index and was compared to that of the AS5F and CHASE-LESS scores.ResultsThe study population consisted of a training set of 4,064 and a temporal test set of 1,492 patients. During a median follow-up of 10.2 months, the incidence rate of NDAF was 87.0 per 1,000 person-year in the test set. On the test set, the model based on both structured and unstructured data achieved a C-index of 0.840, which was significantly higher than those of the AS5F (0.779, p = 0.023) and CHASE-LESS (0.768, p = 0.005) scores.ConclusionsIt is feasible to build a machine learning model to assess the risk of NDAF based on EHR data available at the time of hospital admission. Inclusion of information derived from clinical free text can significantly improve the model performance and may outperform risk scores developed using traditional statistical methods. Further studies are needed to assess the clinical usefulness of the prediction model.

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“…1, 2 Among the etiologies, cardioembolism followed by large artery atherosclerosis (LAA) carries highest risk for recurrent events, while lacunar strokes carries the least risk. 3 Though cryptogenic strokes are associated with a lower risk for recurrent events, recently many authors have reported that long-term behavior of these patients is similar to nonvalvular atrial fibrillation (NVAF) patients, especially those with embolic stroke of unknown source. 4, 5 In LAA, patients managed with optimal medical management and revascularization therapies as per guidelines, the recurrence risk still remains modest-comparable to cryptogenic strokes.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Recurrence in Symptomatic Large Artery Atherosclerosis and Cryptogenic Strokes—A Comparative Study

Lotlikar

Saikiran

George

et al. 2022

Journal of Stroke Medicine

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Background and Purpose: Ischemic stroke has highest recurrence risk in the first-year, ranging from 5.7% to 14%, depending on etiology, with highest reported following cardioembolism and large artery atherosclerosis (LAA), while it is not negligible in cryptogenic strokes. We evaluated the utility of clinical, imaging parameters along with electrographic and echocardiographic biomarkers of atrial dysfunction in 2 etiological groups, namely LAA and cryptogenic strokes and compared the predictors of recurrence risk at 1 year. Methodology: All acute ischemic strokes admitted to Comprehensive Stroke Care Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India for 1 year (July 2019 till June 2020) with 1 year completed follow-up were screened from electronic records. Strokes secondary to LAA and undetermined cause were compared for their clinical, imaging, and cardiac variables to predict risk of recurrence in the first year. Results: Of the 179 patients, 93 had strokes secondary to LAA and 86 had cryptogenic strokes (CS). Seventy-five patients had more than 1 event at presentation/follow-up. Recurrence risk did not differ between the 2 etiological subgroups at 1 year. Hypertension ( P = .016), multiple territory strokes ( P = .02), and dilated left ventricle (LA) chamber ( P = .047) were independently associated with recurrence risk in the entire cohort as well as within the undetermined group. Early hospitalization within 48 h reduced the overall recurrence risk ( P = .01), thus emphasizing the role of early etiological evaluation and initiation of secondary prevention in reducing future events, irrespective of etiology. Conclusion: In optimally managed LAA and cryptogenic strokes, presence of hypertension, multiterritorial infarcts, and dilated LA chambers increases the recurrence risk pointing to a likely cardiac substrate itself contributing to future stroke risk.

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Recurrent Ischemic Stroke – A Systematic Review and Meta-Analysis

Cited by 124 publications

References 40 publications

Antiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes

Antiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes

Automated risk assessment of newly detected atrial fibrillation poststroke from electronic health record data using machine learning and natural language processing

Predictors of Recurrence in Symptomatic Large Artery Atherosclerosis and Cryptogenic Strokes—A Comparative Study

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