Deans' stroke musings: Correlation Between Intracranial Carotid Artery Calcification and Prognosis of Acute Ischemic Stroke After Intravenous Thrombolysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 28, 2022

Correlation Between Intracranial Carotid Artery Calcification and Prognosis of Acute Ischemic Stroke After Intravenous Thrombolysis

You described a problem but DID NOTHING to solve it. Useless. Do you not understand, prognosis is useless for stroke survivors. It does nothing to get them recovered. There are a lot of mentors and senior researchers that need to be re-educated on the purpose of stroke research.

Correlation Between Intracranial Carotid Artery Calcification and Prognosis of Acute Ischemic Stroke After Intravenous Thrombolysis

Yuan Shen^1,2,3,

Zhifeng Dong⁴,

Gang Xu⁵,

Jianguo Zhong¹,

Pinglei Pan⁶,

Zhipeng Chen¹ and

Haicun Shi^1,2,3^*

¹Department of Neurology, Yancheng Third People's Hospital, Yancheng, China
²Department of Neurology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
³The Sixth Affiliated Hospital of Nantong University, Nantong, China
⁴Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
⁵Department of Medical Imaging, Yancheng Third People's Hospital, Yancheng, China
⁶Department of Central Laboratory, Yancheng Third People's Hospital, Yancheng, China

Objective: To investigate the correlation between prognosis and intracranial carotid artery calcification (ICAC) in patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT).

Methods: A total of 156 AIS patients who received IVT from March 2019 to March 2020 were enrolled. The modified Woodcock visual score was used to evaluate ICAC in nonenhanced head CT scans. Patients were divided into high calcification burden (HCB; score ≥3) and low calcification burden (LCB; score <3) groups. Demographic, laboratory, imaging and clinical data were compared between the two groups, and whether HCB was a prognostic factor was evaluated.

Results: Compared with the LCB group, the HCB group had a higher incidence of atrial fibrillation (49.2 vs.22.1%, P < 0.001) and coronary heart disease (24.6 vs. 10.0%, P = 0.019) and higher serum homocysteine [15.31 (12.15, 17.50) vs. 14.40 (11.20, 16.20), P = 0.036] and hemoglobin A1c (6.93 ± 1.77 vs. 6.37 ± 0.74, P = 0.023) levels. Binary logistic regression analysis showed that atrial fibrillation (OR = 3.031, 95% CI: 1.312–7.006, P = 0.009) and HbA1c (OR = 1.488, 95% CI: 1.050–2.109, P = 0.026) were independent risk factors for ICAC. After adjusting for other risk factors, symptomatic-side and bilateral ICACs were independent risk factors for poor prognosis (OR = 1.969, 95% CI: 1.220–3.178, P = 0.006), (OR = 1.354, 95% CI: 1.065–1.722, P = 0.013) and mortality (OR = 4.245, 95% CI: 1.114–16.171, P = 0.034), (OR = 2.414, 95% CI = 1.152–5.060, P = 0.020) in patients with AIS who received IVT.

Conclusion: ICAC is closely related to the prognosis of acute ischemic stroke after intravenous thrombolysis.

Introduction

Thrombolysis is known to improve outcomes following acute ischemic stroke. Intravenous thrombolysis using recombinant tissue-type plasminogen activator (rt-PA) is still considered the first line of treatment (1). However, the effect of thrombolysis is influenced by many factors.

Intracranial carotid artery calcification (ICAC) was first observed with radiographic pathology in the early 1960s (2). Later studies found that 69.4% of Chinese patients (3) and 82.2% of Dutch patients who were >55 years had ICAC on conventional head computed tomography (CT) (4). Vascular calcification is part of the atherosclerotic process and may indicates severe stenosis (5). Atherosclerotic calcification occurs in the form of hydroxyapatite deposits that resemble bone mineralization (6). The more advanced stages consist of calcified plaques. Confirmation of the coronary calcium score as a predictor of future cardiac events has spurred researchers' interest in ICAC. Recent clinical studies have demonstrated the risk factors for intracranial arterial calcification and its clinical significance (7). Studies have shown that intracranial vascular calcification is related to a higher risk of stroke independent of cardiovascular risk factors (8, 9). However, in contrast to the coronary vasculature, few studies have investigated the relationship between ICACs and the prognosis of patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT) (10–13). And the conclusions of these studies are controversial. The question of whether atherosclerotic calcification might have distinct prognostic effects on stroke patients and therefore warrant specific treatment strategies still needs to be investigated.

In this context, we examined the relationship of the burden of ICAC with poor outcome, complications and mortality in patients treated with IVT for AIS. Studying the effect of ICAC on the prognosis of IVT in AIS may not only help to understand the relationship between ICAC and stroke, but also modify the acute management strategy, because ICAC information is usually available before treatment decision-making (13).