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).

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Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy

 Notice that the mentors and senior researchers incorrectly set the outcome measurement as reperfusion rather than 100% recovery.  This tells you all you need to know about stroke research: IT IS A COMPLETE FAILURE! Until we get survivors in charge we'll never even get close to 100% recovery.

Association of Stent-Retriever Characteristics in Establishing Successful Reperfusion During Mechanical Thrombectomy

Results from the ESCAPE-NA1 Trial

• Petra Cimflova,
• Nishita Singh,
• Johanna M. Ospel,
• Martha Marko,
• Nima Kashani,
• Arnuv Mayank,
• Ricardo Hanel,
• Diogo C. Haussen,
• Aditya Bharatha,
• David Volders,
• Manraj K. S. Heran,
• Alexandre Y. Poppe,
• Brian van Adel,
• Bijoy K. Menon,
• Manish Joshi,
• Andrew Demchuk,
• Ryan McTaggart,
• Raul G. Nogueira,
• Jeremy L. Rempel,
• Charlotte Zerna,
• Michael Tymianski,
• Michael D. Hill,
• Mayank Goyal &
• Mohammed A. Almekhlafi 

Clinical Neuroradiology (2022)Cite this article

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Abstract

Background

Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial.

Methods

Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever length and diameter, thrombus position within stent-retriever, bypass effect, deployment in the superior or inferior MCA trunk, use of balloon guide catheter and distal access catheter. Primary outcome was successful reperfusion defined as expanded thrombolysis in cerebral infarction (eTICI) 2b–3 per attempt. The secondary outcome was successful reperfusion eTICI 2b–3 after the first attempt. Separate regression models for each stent-retriever characteristic and an exploratory multivariable modeling to test the impact of all characteristics on successful reperfusion were built.

Results

Of 1105 patients in the trial, 809 with the stent-retriever use (1241 attempts) were included in the primary analysis. The stent-retriever was used as the first-line approach in 751 attempts. A successful attempt was associated with thrombus position within the proximal or middle third of the stent (OR 2.06; 95% CI: 1.24–3.40 and OR 1.92; 95% CI: 1.16–3.15 compared to the distal third respectively) and with bypass effect (OR 1.7; 95% CI: 1.07–2.72). Thrombus position within the proximal or middle third (OR 2.80; 95% CI: 1.47–5.35 and OR 2.05; 95% CI: 1.09–3.84, respectively) was associated with first-pass eTICI 2b–3 reperfusion. In the exploratory analysis accounting for all characteristics, bypass effect was the only independent predictor of eTICI 2b–3 reperfusion (OR 1.95; 95% CI: 1.10–3.46).

Conclusion

The presence of bypass effect and thrombus positioning within the proximal and middle third of the stent-retriever were strongly associated with successful reperfusion.

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References

1. 1.

   Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;83:967–73.

 

Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events

 Useless, you describe a biomarker prediction; THEN GIVE US NOTHING TO PREVENT THAT COGNITIVE DECLINE. What the hell do you think research is for?

Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events

Bibek Gyanwali

,

Mitchell K.P. Lai

,

Benedict Lui

,

Oi Wah Liew

,

Narayanaswamy Venketasubramanian

,

Arthur Mark Richards

,

Christopher Chen

,

Saima Hilal

Originally published11 May 2021https://doi.org/10.1161/STROKEAHA.120.032571Stroke. ;0:STROKEAHA.120.032571

Abstract

Background and Purpose:

Cardiac biomarkers, NT-proBNP (N-terminal probrain natriuretic peptide), hs-cTnT (high-sensitivity-cardiac troponin T), and GDF-15 (growth differentiation factor-15) have been proposed as important biomarkers of early vascular pathology. However, little is known of the longitudinal associations of these cardiac biomarkers with cerebrovascular disease and clinical events. We examine the association of blood-based cardiac biomarkers (NT-proBNP, hs-cTnT, and GDF-15) with cognitive decline, incident cerebrovascular disease, vascular events, and mortality.

Methods:

Four hundred thirty-four memory-clinic patients provided blood samples at baseline, underwent 3 annual neuropsychological assessments and brain magnetic resonance imaging scans at baseline and follow-up. NT-proBNP and hs-cTnT concentrations were measured by electrochemiluminescence immunoassay and GDF-15 by quantitative sandwich immunoassay. Baseline and follow-up magnetic resonance imagings were graded for white matter hyperintensities, lacunes, cerebral microbleeds, cortical infarcts, and intracranial stenosis. Data on incident vascular events and mortality were obtained.

Results:

Patients with higher levels of NT-proBNP, hs-cTnT, and GDF-15 showed greater decline in memory domain. Additionally, hs-cTnT was associated with decline in global cognition, executive function, and visuomotor speed. Higher levels of NT-proBNP were associated with incident cerebral microbleeds and hs-cTnT with incident cortical infarcts. During a mean follow-up of 3 years, 26 (5.9%) patients died and 35 (8.1%) developed vascular events. Patients with higher levels of NTpro-BNP and hs-cTnT were at increased risk of vascular events whereas those with higher levels of NT-proBNP and GDF-15 were at risk of mortality.

Conclusions:

Higher levels of blood-based cardiac biomarkers were associated with decline in memory and risk of vascular events and mortality. Moreover, NT-proBNP and hs-cTnT were associated with incident cerebral microbleeds and cortical infarcts. Thus, these biomarkers are potentially useful in identifying patients at risk of adverse vascular events and death.

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The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients—Preliminary Reports

I like that this was for chronic and at a spa which most persons would have some access to. But you'll have to ask your doctor to get the protocol for the spa treatments used. That should be the responsibility of our stroke associations but we have fucking failures of stroke associations doing nothing for survivors. And once again we have researchers that don't know the purpose of stroke research,

 The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients—Preliminary Reports

Bogumiła Pniak 1
, Justyna Leszczak 2,* , Jadwiga Kurczab 1
, Aleksandra Krzemi ´nska 1
, Joanna Pi ˛eta 1
,
Agnieszka Plis 1
, Ewelina Czenczek-Lewandowska 2 and Agnieszka Guzik 2





Citation: Pniak, B.; Leszczak, J.;
Kurczab, J.; Krzemi ´nska, A.; Pi ˛eta, J.;
Plis, A.; Czenczek-Lewandowska, E.;
Guzik, A. The Efficiency of Spa
Rehabilitation in Chronic Ischemic
Stroke Patients—Preliminary Reports.
Brain Sci. 2021, 11, 501. https://
doi.org/10.3390/brainsci11040501
Received: 19 March 2021
Accepted: 13 April 2021
Published: 15 April 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
1 Excelsior Health and Rehabilitation Hospital, Al. Torosiewicza 2, 38-440 Iwonicz-Zdrój, Poland;
gabipniak@vp.pl (B.P.); milak_123@wp.pl (J.K.); okrzemien159@gmail.com (A.K.);
joannapieta1@gmail.com (J.P.); a.plis8833@gmail.com (A.P.)
2
Institute of Health Sciences, Medical College, University of Rzeszów, ul. Kopisto 2a, 35-959 Rzeszów, Poland;
e.czenczek@univ.rzeszow.pl (E.C.-L.); agnieszkadepa2@wp.pl (A.G.)
* Correspondence: leszczakjustyna.ur@gmail.com; Tel.: +48-17-872-11-53

Abstract: 

Background: 

Rehabilitation-oriented therapy after a stroke must continue in various forms
as a life-long effort. 

Aim: 

The study investigated the impact of spa rehabilitation on the quality of life
and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods:
The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients
with strokes who participated in a three-week rehabilitation program. Three examinations were
performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of
life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. 

Results: 

The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I(79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039).
Conclusions: 

Three-week spa rehabilitation seems to favorably affect the functional efficiency and
quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time
from stroke onset.
Keywords: quality of life; stroke; spa rehabilitation; functional efficiency; spa hospital
1. Introduction
Rehabilitation-oriented therapy after a stroke should be initiated as soon as possible
and continue as a life-long effort, because in most individuals, a stroke leads to disability.
However, one should bear in mind that during the first few weeks following a stroke,
rehabilitation should not be too intensive [1]. The purpose of physiotherapy applied poststroke is to improve(WRONG,WRONG, WRONG! It's to get back to 100% recovery. This is the reason you, your mentors and senior researchers should not be in stroke.) the patient’s functional efficiency and restore their self-sufficiency and
psychophysical balance as much as possible [2,3].
Specialist rehabilitation centers, referred to as “spa facilities”, located in areas with
favorable environmental conditions and natural therapeutic resources, provide excellent
conditions for recovery. Such facilities may continue comprehensive treatments Please
carefully check the accuracy of names and affiliations. Changes will not be possible after
proofreading. specially designed for patients who have lost their functional capacities [4,5].
Furthermore, those participating in “retreat-based therapy” have an opportunity to relax,
experience a new environment and establish new social contacts, all of which may promote
their recovery in various domains [6]. Spa rehabilitation programs include a wide range of
balneotherapies, making use of natural mineral waters and administered at various temperatures. Other treatments apply peloids or gases with medicinal properties. Hydrogen
sulphides, carbonic acid, as well as iodine and bromine baths improve microcirculation,
Brain Sci. 2021, 11, 501. https://doi.org/10.3390/brainsci11040501 https://www.mdpi.com/journal/brainsciBrain Sci. 2021, 11, 501 2 of 13
stimulate the metabolism and alleviate many adverse symptoms, including spasticity. Treatments based on balneotherapy have been found to strengthen immunity and support faster
recovery [7] as well as normalize blood pressure. Carbonic acid and hydrogen sulphide
baths are helpful for reducing systolic blood pressure [8]. Physical exercise performed in a
rehabilitation pool has been found to decrease pain and reduce spasticity [9,10]. In addition
to balneotherapy, spa rehabilitation programs include a wide range of treatments based on
a variety of specialized physiotherapeutic methods and kinesitherapy (e.g., proprioceptive
neuromuscular facilitation, neurodevelopmental treatment [11] and constraint-induced
movement therapy), as well as tools applying biofeedback. Biofeedback-supported devices
have been shown to promote the recovery of lost functions in patients with neurological
problems (e.g., manifested by gait impairment) [12,13]. Beneficial effects have also been confirmed in the case of complementary physical treatments, such as tonolysis, low-frequency
variable magnetic fields, functional electrical stimulation (FES) and cryotherapy [14].
According to the definition from the World Health Organization (WHO), quality of
life is an “individual’s perception of their position in life in the context of the culture and
value systems in which they live and in relation to their goals, expectations, standards
and concerns”. The related indicators include one’s ability to play life roles, as well as
one’s adaptability, good mental condition and functioning in society [2,15]. Therapies
designed for people presenting post-stroke dysfunctions are primarily aimed at improving
the musculoskeletal system. However, efforts to improve the patient’s functioning in the
psychological and social domains are equally necessary to enable optimum recovery after
a stroke incident [16]. Quality of life after a stroke, as well as the effects of post-stroke
rehabilitation, have been extensively investigated. Indeed, the focus on neurosciences
and various types of post-stroke rehabilitation increased significantly during the so-called
Decade of the Brain. Advancements in neurobiology related to the complexity of effects
resulting from central nervous system damage, as well as brain plasticity, provided better
insight into the mechanisms of regeneration and functional recovery in patients after
strokes [17–19]. It has been established that the largest progress in the recovery of functional
capacities can be expected during the early period after a stroke, when patients frequently
present considerable improvements in neuromotor functions [20,21] due to the fact that
recovery-related changes within the ischemic penumbra adjacent to the focal lesion occur
relatively rapidly following onset, and later, the process slows down [22,23]. Given the
above, the present study was designed to focus on a population of patients at a chronic stage
of recovery (i.e., over six months from stroke onset). At this stage, patients tend to present
persistent patterns and are largely accustomed to functioning in their own environment.
Despite this, the authors hypothesized that significant improvement in quality of life and
functional efficiency may still be feasible at this stage of recovery and that changes in these
areas would be promoted by spa rehabilitation. The above hypothesis is encouraged by
research findings showing that interneuronal connections are constantly remodeled by
physical activity. If complex motor activities are performed systematically, the area of
cortical representation of such activity increases. This suggests that brain plasticity may
be enhanced as a result of various types of training [24,25]. This process has already been
investigated with regard to hospital and ambulatory post-stroke rehabilitation [26–30], but
not in relation to spa rehabilitation.
In summary, a review of the literature confirms that the entire post-stroke treatment
process, including rehabilitation, is primarily conducted in hospitals, clinics and outpatient
facilities. However, there are no studies assessing the effectiveness of treatments continued
in spa facilities, which can create favorable conditions for the recovery of full physical and
mental efficiency [2].
In view of the above, the aim of the current study was to assess the effects of a spa
rehabilitation program, reflected in the quality of life and functional efficiency in patients
after ischemic strokes at a chronic stage of recovery. The second aim of the study was to
assess the effect of spa rehabilitation relative to the age, gender and time from stroke onset.

 

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