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Hemorrhagic Stroke

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (15 March 2022) | Viewed by 28813

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Special Issue Editors

Prof. Dr. Hans Henkes

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Guest Editor

Neuroradiological Clinic, Klinikum Stuttgart—Katharinenhospital, Kriegsbergstrasse 60, 70174 Stuttgart, Germany
Interests: neuroradiology; stroke; ischemia; myelography; cerebral and spinal diagnostic angiographies; endovascular treatment of aneurysms; endovascular treatment of stenoses of carotid arteries and cranial arteries
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Hansjörg Bäzner

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Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
Interests: stroke; ischemia; diagnosis; therapy
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Oliver Ganslandt

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Guest Editor

Klinikum Stuttgart, University of Erlangen Nuremberg, Erlangen, Germany
Interests: aneurysm; glioma; surgery; vascular surgery; vascular diseases; neuro-oncology; brain injury; spine surgery; traumatic brain injury; spinal cord injury

Special Issue Information

Dear Colleagues,

Hemorrhagic stroke is an essential part of the daily clinical work of neurosurgeons, stroke neurologists, neuro-intensivist, and, last but not least, neuroradiologists. Different disorders, such as subarachnoid hemorrhage, epidural and subdural hematoma, intracerebral and intraventricular hemorrhage, are summarized under this term. Among the many causes, primary intracerebral hemorrhage, cerebral aneurysms, brain arteriovenous malformations, cavernomas, and dural arteriovenous fistulas are only a few.

Prognostic tools, diagnosis, critical care, as well as microsurgical, radiosurgical, and endovascular treatment of hemorrhagic stroke, have seen tremendous progress during the last three decades. Research has always created controversies, and the treatment of incidental intracranial aneurysms and brain AVMs is far from being a matter of common sense.

The Guest Editors of the Special Issue of JCM on “Hemorrhagic Stroke” are soliciting high-profile manuscripts on this topic. Reviews, meta-analyses, and original papers will be considered.

Dr. Hans Henkes
Prof. Dr. Hansjörg Bäzner
Prof. Dr. Oliver Ganslandt
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Hemorrhagic stroke
Subarachnoid hemorrhage
Epidural and subdural hematoma
Intracerebral and intraventricular hemorrhage

Published Papers (12 papers)

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Editorial

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9 pages, 1951 KiB

Open AccessEditorial

Will Coiling Survive through the Next Decade?

by Hans Henkes, Joachim Klisch and Pedro Lylyk

J. Clin. Med. 2022, 11(11), 3230; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11113230 - 06 Jun 2022

Cited by 2 | Viewed by 1706

Abstract

During the past three decades, neuroendovascular therapy has evolved from a focus on new disease concepts to revised treatment strategies and, ultimately, to versatile new technologies [...] Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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Research

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19 pages, 2094 KiB

Open AccessArticle

by Ali Khanafer, Pervinder Bhogal, Victoria Hellstern, Christoph Harmening, Hansjörg Bäzner, Oliver Ganslandt and Hans Henkes

J. Clin. Med. 2022, 11(16), 4642; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11164642 - 09 Aug 2022

Cited by 4 | Viewed by 1871

Abstract

Background: Vasospasm after the rupture of an intracranial aneurysm is a frequent phenomenon and is the main cause of morbidity and mortality in patients who have survived intracranial hemorrhage and aneurysm treatment. We analyzed the diagnosis and management of patients with aneurysmal subarachnoid hemorrhage who eventually died from ischemic brain damage due to vasospasm. Methods: Between January 2007 and December 2021 (15 years), a total of 1064 patients were diagnosed with an aneurysmal intracranial hemorrhage in a single comprehensive neurovascular center. Vasospasm was diagnosed in 408 patients (38.4%). A total of 187 patients (17.6%) died within 90 days of the aneurysm rupture. In 64 of these 187 patients (33.7%), vasospasm was considered to be the cause of death. In a retrospective analysis, demographic and clinical data for patients without, with non-fatal, and with fatal vasospasm were compared. The patients with fatal vasospasm were categorized into the following subgroups: “no diagnosis and treatment” (Group a), “delayed diagnosis” (Group b), “cardiovascular complications” (Group c), and “vasospasm-treatment complications” (Group d). Results: Among the patients with fatal vasospasm, 31 (48.4%) were assigned to group a, 26 (40.6%) to group b, seven (10.9%) to group c, and none (0%) to group d. Conclusion: The early recognition of severe posthemorrhagic vasospasm is a prerequisite for any treatment and requires routine diagnostic imaging in all unconscious patients. Aggressive endovascular vasospasm treatment may fail to prevent death but is infrequently the cause of a fatal outcome. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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10 pages, 276 KiB

Open AccessArticle

Safety and Efficacy of Intravenous Alteplase before Endovascular Thrombectomy: A Pooled Analysis with Focus on the Elderly

by Asaf Honig, Hen Hallevi, Naaem Simaan, Tzvika Sacagiu, Estelle Seyman, Andrei Filioglo, Moshe J. Gomori, Ofer Rotschild, Tali Jonas-Kimchi, Udi Sadeh, Anat Horev, Ronen R. Leker, José E. Cohen and Jeremy Molad

J. Clin. Med. 2022, 11(13), 3681; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133681 - 26 Jun 2022

Cited by 4 | Viewed by 1601

Abstract

Current guidelines advocate intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for all patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). We evaluated outcomes with and without IVT pretreatment. Our institutional protocols allow AIS patients presenting early (<4 h from onset or last seen normal) who have an Alberta Stroke Program Early CT Score (ASPECTS) ≥6 to undergo EVT without IVT pretreatment if the endovascular team is in the hospital (direct EVT). Rates of recanalization and hemorrhagic transformation (HT) and neurological outcomes were retrospectively compared in consecutive patients undergoing IVT+EVT vs. direct EVT with subanalyses in those ≥80 years and ≥85 years. In the overall cohort (IVT+EVT = 147, direct EVT = 162), and in subsets of patients ≥80 years (IVT+EVT = 51, direct EVT = 50) and ≥85 years (IVT+EVT = 19, direct EVT = 32), the IVT+EVT cohort and the direct EVT group had similar baseline characteristics, underwent EVT after a comparable interval from symptom onset, and reached similar rates of target vessel recanalization. No differences were observed in the HT frequency, or in disability at discharge or after 90 days. Patients receiving direct EVT underwent more stenting of the carotid artery due to stenosis during the EVT procedure (22% vs. 6%, p = 0.001). Direct EVT and IVT+EVT had comparable neurological outcomes in the overall cohort and in the subgroups of patients ≥80 and ≥85 years, suggesting that direct EVT should be considered in patients with an elevated risk for HT. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

9 pages, 1637 KiB

Open AccessArticle

Andexanet Alfa for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage: Observational Cohort Study

by Sebastian Rauch, Hans-Peter Müller, Jens Dreyhaupt, Albert C. Ludolph, Jan Kassubek and Katharina Althaus

J. Clin. Med. 2022, 11(12), 3399; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11123399 - 13 Jun 2022

Cited by 3 | Viewed by 2045

Abstract

Background: Intracranial hemorrhage (ICH) is associated with high mortality and morbidity, especially in patients under anticoagulative treatment. Andexanet alfa (AA) is a modified recombinant form of human factor Xa (FXa) developed for reversal of FXa-inhibitors, e.g., in the event of ICH, but experience is still limited. Methods: This monocentric retrospective observational cohort study included 46 patients with acute FXa-inhibitor-associated non-traumatic ICH (FXa-I-ICH) of whom 23 were treated with AA within 12 h after symptom onset, compared to 23 patients with usual care (UC). Volumetrically analyzed hematoma expansion (HE) in brain imaging, clinical outcome and incidence of adverse events were analyzed. Results: All patients (mean age 79.8 ± 7.2 years) were effectively anticoagulated. The cohort included severely ill patients with large hematoma volumes (median 20.4, IQR 7.8–39.0 mL). Efficacy, as assessed by HE in imaging, was very good in the AA-group. There was no (0.0%) relevant HE (>33%) in contrast to UC-group (26.1%). Nevertheless, we observed a high incidence of thromboembolic events (30.4% vs. 4.4%) and non-favorable outcomes (death/palliative condition) in 43.5% vs. 26.1%. Conclusions: There was no HE in the volumetric neuroimaging assessment in the AA-group, but clinical outcomes remained often worse. Large randomized trials for the use of AA in patients with acute FXa-inhibitor-associated ICH are needed to investigate the clinical outcome in consideration of the rates of thromboembolism. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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7 pages, 223 KiB

Open AccessArticle

Effects in Israel of Arab and Jewish Ethnicity on Intracerebral Hemorrhage

by Naaem Simaan, Andrei Filioglo, José E. Cohen, Yonatan Lorberboum, Ronen R. Leker and Asaf Honig

J. Clin. Med. 2022, 11(8), 2117; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11082117 - 11 Apr 2022

Cited by 1 | Viewed by 1249

Abstract

Intracerebral hemorrhages (ICH) characteristics reportedly differ between different ethnic groups. We aimed to compare the characteristics of Jewish and Arab ICH patients in Israel. Consecutive patients with primary ICH were included in a prospective institutional database. Demographics, vascular risk factors, clinical and radiological parameters were compared between Arab and Jewish ICH patients residing in Jerusalem. The study included 455 patients (311 Jews). Arab patients were younger (66.1 ± 13.4 vs. 72.2 ± 12.2 years, p < 0.001) and had higher rates of diabetes (60% vs. 29%, p < 0.001) and smoking (26% vs. 11%, p < 0.001). Arab patients had higher rates of deep ICH (74% vs. 62%, p = 0.01) and lower rates of lobar ICH (18% vs. 31%, p = 0.003). In a sub-analysis of deep ICH patients only, Arab patients were younger (64.3 ± 12.9 vs. 71.4 ± 11.8 years, p < 0.001) and less frequently male (56% vs. 68%, p = 0.042), with higher rates of diabetes (61% vs. 35%, p < 0.001) and smoking (31% vs. 14%, p < 0.001). In conclusion, the two ethnic populations in Israel differ in the causes and attributes of ICH. Heavy smoking and poorly controlled diabetes are commonly associated with deep ICH in the Arab population and may offer specific targets for secondary prevention in this population. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

16 pages, 469 KiB

Open AccessArticle

Hemorrhagic Transformation in Acute Ischemic Stroke: A Quantitative Systematic Review

by Asaf Honig, Jennifer Percy, Amir A. Sepehry, Alejandra G. Gomez, Thalia S. Field and Oscar R. Benavente

J. Clin. Med. 2022, 11(5), 1162; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051162 - 22 Feb 2022

Cited by 16 | Viewed by 4903

Abstract

The prevalence and risk factors of hemorrhagic transformation (HT) after acute ischemic stroke HT have not been adequately delineated. We performed a systematic review and meta-analysis to identify English-language prospective observational MEDLINE and EMBASE-listed reports of acute ischemic stroke with HT published from 1985–2017. Studies that used the ECASS-2 definitions of hemorrhagic transformation subtypes, hemorrhagic infarction (HI), and parenchymal hematoma (PH) were included. Patients treated with intravenous thrombolysis with tissue plasminogen activator (IV-tPA) were compared with those who did not receive thrombolysis. A total of 65 studies with 17,259 patients met inclusion criteria. Overall, HT prevalence was 27%; 32% in patients receiving IV-tPA vs. 20% in those without. Overall PH prevalence was 9%; 12% in IV-tPA treated patients vs. 5% in those without. HT was associated with a history of atrial fibrillation (OR 2.94) and use of anticoagulants (OR 2.47). HT patients had higher NIHSS (Hedge’s-G 0.96) and larger infarct volume (diffusion-weighted MRI, Hedge’s-G 0.8). In IV-tPA treated patients, PH correlated with antiplatelet (OR 3) and statin treatment (OR 4). HT (OR 3) and PH (OR 8) were associated with a poor outcome at 90-day (mRS 5–6). Hemorrhagic transformation is a frequent complication of acute ischemic stroke and is associated with poor outcome. Recognition of risk factors for HT and PH may reduce their incidence and severity. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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6 pages, 238 KiB

Open AccessArticle

Characteristics of Cerebral Sinus Venous Thrombosis Patients Presenting with Intracerebral Hemorrhage

by Naaem Simaan, Jeremy Molad, Shlomi Peretz, Andrei Filioglo, Eitan Auriel, Hen Hallevi, Estelle Seyman, Rani Barnea, José E. Cohen, Ronen R. Leker and Asaf Honig

J. Clin. Med. 2022, 11(4), 1040; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11041040 - 17 Feb 2022

Cited by 4 | Viewed by 1721

Abstract

Patients with cerebral venous sinus thrombosis (CVST) occasionally present with intracerebral hemorrhage (ICH). In this study, we aimed to identify predictors for ICH in CVST patients. Prospective CVST databases from three academic centers were retrospectively analyzed. CVST patients with and without ICH upon presentation were compared. Among the 404 included patients (mean age 41.8 years, 33% male), 74 (18.3%) had an ICH. The patients with ICH were older (45 ± 20.6 vs. 41.1 ± 18 years, p = 0.045), and were more often pregnant or postpartum women (15% vs. 6%, p = 0.011), or chronically hypertensive (15% vs. 5%, p = 0.001). The ICH patients had higher rates of seizures (60% vs. 15%, p < 0.001), and focal neurological deficits (53% vs. 23%, p < 0.001). The ICH group had lower rates of excellent outcome measured by 90-day mRS 0 (56.7% vs. 80.3%, p < 0.001) and higher rates of 90-day mortality (8% vs. 3%, p = 0.041). Radiological variables associated with ICH included superior sagittal sinus (SSS) thrombosis (63% vs. 36%), isolated cortical vein thrombosis (38% vs. 8%), and presence of venous infarction (34% vs. 7%) (p < 0.001 for all). Upon multivariate analysis, chronic hypertension (OR 3.7, p = 0.027), being either pregnant or postpartum (OR 4.3, p = 0.006), isolated cortical thrombosis (OR 3.5, p = 0.007), and SSS involvement (OR 3.4, p < 0.001) were independently associated with ICH upon admission. In conclusion, among CVST patients, the following present higher for ICH: pregnant or postpartum women, and individuals with chronic hypertension, cortical vein, or SSS involvement. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

13 pages, 873 KiB

Open AccessArticle

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

by Marta Aguilar Pérez, Hans Henkes, Wiebke Kurre, Carlos Bleise, Pedro Nicolás Lylyk, Javier Lundquist, Francis Turjman, Hanan Alhazmi, Christian Loehr, Stephan Felber, Hannes Deutschmann, Stephan Lowens, Luigi Delehaye, Markus Möhlenbruch, Jörg Hattingen and Pedro Lylyk

J. Clin. Med. 2022, 11(3), 884; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030884 - 08 Feb 2022

Cited by 7 | Viewed by 1918

Abstract

Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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9 pages, 1357 KiB

Open AccessArticle

Assessment of Clinical Scales for Detection of Large Vessel Occlusion in Ischemic Stroke Patients from the Dijon Stroke Registry

by Gauthier Duloquin, Mathilde Graber, Lucie Garnier, Sophie Mohr, Maurice Giroud, Catherine Vergely and Yannick Béjot

J. Clin. Med. 2021, 10(24), 5893; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245893 - 15 Dec 2021

Cited by 5 | Viewed by 2192

Abstract

(1) Background: The limited availability of thrombectomy-capable stroke centres raises questions about pre-hospital triage of patients with suspected stroke (IS) due to large vessel occlusion (LVO). Aims: This study aimed to evaluate the diagnostic accuracy of clinical stroke severity scales available for LVO detection. (2) Methods: Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). Clinical signs and arterial imaging data were collected. LVO was defined as an occlusion site affecting the terminal intracranial internal carotid artery, the M1 segment of the middle cerebral artery (MCA), or the basilar artery (restricted definition). A wide definition of LVO also included the M2 segment of the MCA. For each of the 16 evaluated scales, a receiver operator characteristic (ROC) analysis was performed, and the c-statistic representing the area under the ROC curve was evaluated to assess discrimination for predicting LVO. (3) Results: 971 patients were registered, including 123 patients (12.7%) with an LVO according to the restricted definition. The c-statistic for LVO detection ranged between 0.66 and 0.80 according to the different scales, with a sensibility varying from 70% to 98% and a specificity from 33% to 86%. According to the wide definition of LVO (174 patients, 17.9%), the c-statistic was slightly lower, ranging between 0.64 and 0.79. The sensitivity was 59% to 93%, and the specificity was 34% to 89%. (4) Conclusion: The clinical scales failed to combine a high sensitivity and a high specificity to detect LVO. Further studies are needed to determine the best strategy for pre-hospital triage of IS patients. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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11 pages, 647 KiB

Open AccessArticle

The Q and A—The MIVI Q Catheters for Aspiration Thrombectomy—Initial Experience from London

by Levansri Makalanda, Joseph Lansley, Ken Wong, Oliver Spooner and Pervinder Bhogal

J. Clin. Med. 2021, 10(24), 5844; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245844 - 13 Dec 2021

Cited by 3 | Viewed by 2560

Abstract

Background: Aspiration thrombectomy is a widely accepted treatment option for large vessel occlusion (LVO). The MIVI aspiration system has a novel design to maximize the lumen size. We present the results of our initial experience with this innovative aspiration thrombectomy system. Materials and Methods: Retrospectively, we reviewed our database to find all cases of LVO treated with the MIVI Q system (February 2019 and July 2020). In addition, we recorded the baseline demographics, NIHSS, ASPECT, mTICI scores, procedural time, complications, and 90 day mRS. Results: Herein, we identified 25 patients with an average age of 65.3 ± 19.3 years (range 19–89), majority of whom were female (n = 14, 56%). The average NIHSS was 16.9 ± 6.7 (range 6–30), and the average CT ASPECT was 7.9 ± 1.4 (range 5–10). The most common clot location was the M1 segment of the MCA (n = 16, 64%). Four of the patients had tandem lesions (16%). The average clot length was 21.7 ± 31 mm (range 2–130 mm). Of the 23 cases where the Q catheter reached the proximal clot face, mTICI ≥ 2b was achieved on the first pass in 11 cases (44%), and at the end of the ‘Q aspiration’ only the procedures with 16 patients achieved mTICI ≥ 2b recanalization (64%). Stent-retrievers were used in 13 cases (52%). At the end of the procedure, 24 patients (96%) achieved mTICI ≥ 2b with 18 patients (72%) achieving mTICI ≥ 2c. The average number of passes with the Q catheter, including when it was used for SOLUMBRA, was 2.1 ± 2.2 (range 1–10). The mean procedure time was 69 ± 32 mins (range 7–116 mins). No complications were associated with the MIVI Q. Conclusions: The MIVI aspiration system is a novel technology with regards to aspiration mechanical thrombectomy. The system is easy to use with early results comparable to other large-bore catheter systems. However, further studies are needed. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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9 pages, 235 KiB

Open AccessArticle

Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy

by José E. Cohen, John Moshe Gomori, Asaf Honig and Ronen R. Leker

J. Clin. Med. 2021, 10(22), 5242; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10225242 - 11 Nov 2021

Cited by 3 | Viewed by 2187

Abstract

Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no deaths, cardiac events, embolic strokes, hyperperfusion syndrome, intracranial hemorrhage, or stent thrombosis within 30 days. Transient intraprocedural hemodynamic instability in 15/32 (47%) and prolonged instability in 4/32 (13%) was managed conservatively. At a mean 16-month follow-up, there were no new neurological events or deterioration. Mean stenosis was reduced from 78.0% ± 9.7% to 17.3% ± 12.2%. This retrospective study included patients AF who were symptomatic (minor stroke (NIHSS ≤ 5)/TIA) with ICA stenosis >50%, or asymptomatic under DOAC therapy with carotid stenosis >80%, who underwent CAS from 6/2014–10/2020. Patients received double antiplatelets and statins. Antiplatelet therapy effectiveness was monitored. Stenting was performed when P2Y12 reaction units (PRU) were <150. DOACs were discontinued 48 h before angioplasty; one 60 mg dose of subcutaneous enoxaparin was administered in lieu. DOAC was restarted 12–24 h after intervention. Patients were discharged under DOAC and one nonaspirin antiplatelet. 32 patients on DOAC were included (26 male, mean age 71). 19 (59.4%) presented with stroke (ICA stenosis-related in 14); 13 (40.6%) were asymptomatic. Stents were deployed under filter protection following pre-angioplasty; post-angioplasty was performed at least once in 12 patients (37.5%). Our experience suggests that CAS can be safely performed in selected patients with CAS and AF requiring DOAC. The role of CAS in AF patients under DOAC warrants study in rigorous trials. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

14 pages, 270 KiB

Open AccessArticle

Secondary Stroke Prevention in Polish Adults: Results from the LIPIDOGRAM2015 Study

by Beata Labuz-Roszak, Maciej Banach, Michal Skrzypek, Adam Windak, Tomasz Tomasik, Miroslaw Mastej, Maciej Tomaszewski, Dimitri P. Mikhailidis, Peter P. Toth, Alberico Catapano, Kausik K. Ray, George Howard, Gregory Y. H. Lip, Fadi J. Charchar, Naveed Sattar, Bryan Williams, Thomas M. MacDonald, Peter Penson, Jacek J. Jozwiak and on behalf of the LIPIDOGRAM2015 Investigators

J. Clin. Med. 2021, 10(19), 4472; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194472 - 28 Sep 2021

Cited by 3 | Viewed by 2641

Abstract

Background: The purpose of the study was to evaluate secondary stroke prevention in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methods: From all patients in LIPIDOGRAM2015 Study (n = 13,724), 268 subjects had a history of ischaemic stroke and were included. Results: 165 subjects (61.6%) used at least one preventive medication. Oral antiplatelet and anticoagulation agents were used by 116 (43.3%) and 70 (26.1%) patients, respectively. Only 157 (58.6%) participants used lipid-lowering drugs, and 205 (76.5%) were treated with antihypertensive drugs. Coronary heart disease (CHD) and dyslipidaemia were associated with antiplatelet treatment (p = 0.047 and p = 0.012, respectively). A history of atrial fibrillation, CHD, and previous myocardial infarction correlated with anticoagulant treatment (p = 0.001, p = 0.011, and p < 0.0001, respectively). Age, gender, time from stroke onset, place of residence, and level of education were not associated with antiplatelet or anticoagulant treatment. Only 31.7% of patients were engaged in regular physical activity, 62% used appropriate diet, and 13.6% were current smokers. Conclusions: In Poland drugs and lifestyle modification for secondary stroke prevention are not commonly adhered to. Educational programmes for physicians and patients should be developed to improve application of effective secondary prevention of stroke. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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