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Groff H, Yousfani S, Pantoja-Ruiz C, Douiri A, Bhalla A, Wolfe C, Marshall IJ. A systematic review of the incidence and outcomes of ICD-11 defined stroke. J Stroke Cerebrovasc Dis 2024; 33:107784. [PMID: 38795795 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND The World Health Organisation has expanded the definition of stroke to include people with symptoms less than 24 h if they have evidence of stroke on neuroimaging. The impact is that people previously diagnosed as having a transient ischaemic attack (TIA) would now be considered to have had a stroke. This change will impact incidence and outcomes of stroke and increase eligibility for secondary prevention. We aimed to evaluate the new ICD-11 criteria retrospectively to previous TIA studies to understand the change in incidence and outcomes of this type of stroke. METHODS We conducted a systematic review of observational studies of the incidence and outcomes of clinically defined TIA. We searched PubMed, EMBASE, and Google Scholar from inception to 23rd May 2023. Study quality was assessed using a risk of bias tool for prevalence studies. FINDINGS Our review included 25 studies. The rate of scan positivity for stroke among those with clinically defined TIA was 24 %, (95 % CI, 16-33 %) but with high heterogeneity (I2 = 100 %, p <0.001). Sensitivity analyses provided evidence that heterogeneity could be explained by methodology and recruitment method. The scan positive rate when examining only studies at low risk of bias was substantially lower, at 13 % (95 % CI, 11-15 %, I2 = 0, p = 0.77). We estimate from population-based incidence studies that ICD-11 would result in an increase stroke incidence between 4.8 and 10.5 per 100,000 persons/year. Of those with DWI-MRI evidence of stroke, 6 % (95 % CI, 3-11 %) developed a recurrent stroke in the subsequent 90 days, but with substantial heterogeneity (I2 = 67 %, p = 0.02). CONCLUSION The impact of the ICD-11 change in stroke definition on incidence and outcomes may have been overestimated by individual studies. Community-based stroke services with access to DWI MRI are likely to accurately diagnose greater numbers of people with mild ICD-11 stroke, increasing access to effective prevention.
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Affiliation(s)
- Holli Groff
- School of Life Course and Population Science, King's College London, London, UK
| | - Sariha Yousfani
- School of Life Course and Population Science, King's College London, London, UK
| | - Camila Pantoja-Ruiz
- School of Life Course and Population Science, King's College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ajay Bhalla
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Department of Ageing Health and Stroke, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Charles Wolfe
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Iain J Marshall
- School of Life Course and Population Science, King's College London, London, UK; NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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Liu S, Tang R, Xie W, Chai S, Zhang Q, Luo Y, Guo Y, Chai C, Huang L, Zheng M, Zhu J, Chang B, Yang Q, Jin S, Fan Z, Xia S. Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack. Eur Radiol 2020; 31:2062-2072. [PMID: 32997174 DOI: 10.1007/s00330-020-07327-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to investigate differential characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), and to develop a predictive model for the presence of ischemic stroke and neurological impairment. METHODS Sixty-seven patients with acute ischemic events in MCA territory who underwent high-resolution vessel wall imaging between September 2016 and August 2018 were reviewed retrospectively. Patients were assigned to either the stroke group or TIA group, according to diffusion-weighted imaging and neurological examination. Plaque characteristics and anterograde score (AnS) were calculated. Tmax > 6.0-s volume was acquired by RApid Processing of perfusIon and Diffusion software. Multivariate logistic regression analysis and multiple linear regression analysis were performed to establish a predictive model for irreversible infarction occurrence and clinical severity. RESULTS Forty-five patients were assigned to the stroke group, and 22 were assigned to the TIA group. Plaque length, intraplaque hemorrhage (IPH), enhancement, AnS, and Tmax > 6.0-s volumes were significantly different between the two groups (p < 0.05). IPH and AnS were independent predictors for patients with stroke (p = 0.020 and 0.034, respectively). Tmax > 6.0-s volume, IPH, hypertension, and AnS were associated with high National Institutes of Health Stroke Scale (NIHSS) scores (all p < 0.05, R = 0.725, and adjusted R2 = 0.494). CONCLUSIONS IPH and AnS are useful in predicting stroke occurrence. Tmax > 6.0-s volume, IPH, hypertension, and AnS are associated with neurological impairment of the patients. KEY POINTS • Ischemic stroke and TIA patients have different plaque characteristics and hemodynamics. • Intraplaque hemorrhage and anterograde score have high diagnostic efficiency for ischemic stroke. • The combination of Tmax > 6.0-s volume, intraplaque hemorrhage, hypertension, and anterograde score can predict the National Institutes of Health Stroke Scale scores of patients.
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Affiliation(s)
- Song Liu
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Ruowei Tang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Weiwei Xie
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Shengting Chai
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Qingqing Zhang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200081, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Chao Chai
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Meizhu Zheng
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, 100102, China
| | - Binge Chang
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Qi Yang
- Department of Radiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Song Jin
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Jia Z, Song Y, Hu W. Dysphasia is associated with diffusion-weighted MRI abnormalities in patients with transient neurological symptoms. Neurol Sci 2020; 41:1765-1771. [PMID: 32034558 PMCID: PMC7359169 DOI: 10.1007/s10072-020-04258-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/15/2020] [Indexed: 01/17/2023]
Abstract
Background The clinical characteristics of diffusion-weighted imaging (DWI) abnormalities after transient neurological symptoms are of great significance for the early diagnosis and urgent intervention of transient ischemic attack (TIA). This study was aimed to investigate the clinical characteristics associated with acute DWI lesions in transient neurological symptoms. Methods We retrospectively recruited 302 patients with transient neurological symptoms. According to DWI findings, they were divided into DWI positive and DWI negative group. The clinical characteristics and the TIA-related scores such as ABCD2, ABCD3, ABCD3I, Dawson score, and the Diagnosis of TIA (DOT) score were compared between the two groups. Logistic regression analysis and receiver operating characteristic curves were used to identify the independent factors and compare the predictive value of different TIA scores for acute DWI lesions. Results A total of 302 patients were enrolled in this study. The mean age was 61.8 years, and 67.2% were male. We found 89 (29.5%) patients with DWI positivity. Logistic regression analysis showed the characteristic associated with DWI lesions was dysphasia (OR 2.226, 95% CI 1.220–4.062). The area under the curve for Dawson score and the DOT score was 0.610 (95% CI 0.543–0.678) and 0.625 (95% CI 0.559–0.691), respectively. Conclusion We found that DWI lesions were detected in 29.5% of patients with transient neurological symptoms and were associated with dysphasia. Dawson score and DOT score could have a higher predictability of DWI lesions in patients with transient neurological symptoms.
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Affiliation(s)
- Zejin Jia
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yangguang Song
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Transient Ischemic Attack: Which Determines Diffusion-Weighted Image Positivity? J Stroke Cerebrovasc Dis 2019; 28:104397. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 11/20/2022] Open
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Yuan J, Jia Z, Song Y, Yang S, Li Y, Yang L, Qin W, Hu W. Incidence and Predictors of Acute Ischemic Lesions on Brain Magnetic Resonance Imaging in Patients With a Clinical Diagnosis of Transient Ischemic Attack in China. Front Neurol 2019; 10:764. [PMID: 31379718 PMCID: PMC6646584 DOI: 10.3389/fneur.2019.00764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background: The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients. Methods: Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups. Results: A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, P = 0.021), speech abnormalities (odds ratio 4.029, P = 0.024), and ABCD3-I (odds ratio 13.141, P = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%. Conclusion: In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission.
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Affiliation(s)
- Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zejin Jia
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yangguang Song
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Lu Y, Yu J, Hu J, Tan Y, Wu J, Zhao Y, Liu X. Predictive Value of A2HD Scoring for Transient Symptoms Associated with Infarction. Med Sci Monit 2019; 25:52-60. [PMID: 30601800 PMCID: PMC6327777 DOI: 10.12659/msm.911941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Effective early management of cerebral infarction patients with transient ischemic attack (TIA) is undermined by an inability to predict who is at highest risk of stroke. Material/Methods A total of 577 TIA patients with symptoms lasting no more than 1 hour were prospectively investigated and divided into a TIA group and a transient symptoms associated with infarction (TSI) group based on diffusion-weighted magnetic resonance imaging findings after hospital admission. The baseline characteristics, symptoms of TIA, features of disease onset, and findings from clinical examinations were compared between the 2 groups. Factors related to TSI were further analyzed. Results Of 577 TIA patients, 127 patients were in the TSI group and 450 were in the TIA group. Anterior circulation events, hemiplegia, aphasia, multiple seizures, maximal duration, atrial fibrillation, and hypointense plaques were included as risk factors for stroke in a model of multivariate analysis, and results showed that hemiplegia, aphasia, multiple seizures, and atrial fibrillation were independent risk factors for TSI. In the final mode, the area under the curve (AUC) was 0.766 (95% confidence interval: 0.729–0.800). According to the A2HD score and odds ratio, hemiplegia (score 2), aphasia (score 2), multiple seizures (score 2), and atrial fibrillation (score 1) were scored, and any increment in the score increased the risk for cerebral infarction by 1.893-fold (95% confidence interval: 1.643–2.181). Conclusions Risk of TSI seems to be highly predictable. The A2HD score can be used in clinical practice to identify high-risk cerebral infarction patients with TIA who need emergency diagnosis and treatment.
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Affiliation(s)
- You Lu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jia Yu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jian Hu
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Yan Tan
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jiayan Wu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
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Role of echocardiography and cardiac biomarkers in prediction of in-hospital mortality and long-term risk of brain infarction in pulmonary embolism patients. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Meyer IA, Cereda CW, Correia PN, Zerlauth JB, Puccinelli F, Rotzinger DC, Amiguet M, Maeder P, Meuli RA, Michel P. Factors Associated With Focal Computed Tomographic Perfusion Abnormalities in Supratentorial Transient Ischemic Attacks. Stroke 2018; 49:68-75. [DOI: 10.1161/strokeaha.117.018635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ivo A. Meyer
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Carlo W. Cereda
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Pamela N. Correia
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Jean-Baptiste Zerlauth
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Francesco Puccinelli
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - David C. Rotzinger
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Michael Amiguet
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Philippe Maeder
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Reto A. Meuli
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
| | - Patrik Michel
- From the Stroke Center, Service of Neurology (I.A.M., C.W.C., P.N.C., P. Michel) and Department of Diagnostic and Interventional Radiology (F.P., D.C.R., P. Maeder, R.A.M.), Lausanne University Hospital, Switzerland; Department of Neurology, Stroke Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano (C.W.C.); Division of Neuroradiology, Hirslanden Group of Private Hospitals, Clinique Cecil, Lausanne, Switzerland (J.-B. Z.); and Institute of Social and Preventive Medicine, University
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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Patent Foramen Ovale and the Risk of Cerebral Infarcts in Acute Pulmonary Embolism-A Prospective Observational Study. J Stroke Cerebrovasc Dis 2017; 27:357-364. [PMID: 29031497 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/12/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is associated with a risk of consecutive paradoxical embolism with brain infarction through a patent foramen ovale (PFO). The aims of this study were to assess the rate of new ischemic brain lesions (IBLs) using magnetic resonance imaging (MRI) during a 12-month follow-up period with anticoagulation and to evaluate the potential relationship with the presence of PFO on transesophageal echocardiography (TEE). SUBJECTS AND METHODS Seventy-eight patients with acute PE underwent baseline contrast TEE with brain MRI. After the 12-month follow-up, 58 underwent brain MRI. The rates of MRI documenting new IBLs were measured based on the presence of PFO. RESULTS PFO was detected in 31 patients (39.7%). At baseline MRI, IBL was present in 39 of 78 patients (50%). The presence of IBL was not significantly higher in patients with PFO than in patients without PFO (20 [64.5% patients with PFO] versus 19 [40.4% without PFO] of 39 patients with baseline IBL, P = .063). At the follow-up MRI, in the group with new IBL (9 of 58 patients, 15.5%), the number of patients with PFO was significantly higher than that without PFO (7 [33.3%] versus 2 [5.4%], P = .008). PFO was identified as an independent predictor of new IBL (odds ratio 4.6 [1.6-47.4], P = .008). CONCLUSIONS The presence of PFO was associated with new IBL in patients with PE. These patients are at a higher risk of ischemic stroke despite effective anticoagulation therapy.
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Affiliation(s)
- A. Siniscalchi
- Department of Neurology; ‘Annunziata’ Hospital; Cosenza Italy
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