Distribution of ischemic infarction and stenosis of intra- and extracranial arteries in young Chinese patients with ischemic stroke

Development and Validation of a Nomogram for Predicting Lacunar Infarction in Patients with Hypertension

Background

A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.

Methods

Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively.

Results

The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198, P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets.

Conclusion

Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.

The early predictive value of platelet-to-lymphocyte ratio to hemorrhagic transformation of young acute ischemic stroke

Background

The increasing incidence of acute ischemic stroke (AIS) necessitates a comprehensive understanding of the related factors. Hemorrhagic transformation (HT), a severe complication of AIS, is influenced by platelet-induced inflammation and lymphocyte levels.

Objective

To measure the predictive value of platelet-to-lymphocyte ratio (PLR) in the occurrence of HT in young AIS patients.

Methods

Data of young AIS patients (n = 157) admitted to the hospital for the first time were retrospectively collected. The patients were divided into HT (63 patients) and non-HT groups (94 patients) on the basis of whether HT had occurred after admission. The National Institute of Health stroke scale (NIHSS) score was used to determine the severity of clinical symptoms. The relationship between PLR and HT and NIHSS scores was analyzed to evaluate the predictive value of PLR in the occurrence of HT using receiver operating characteristic (ROC) and area under the curve (AUC).

Results

Multivariate analysis showed that PLR and NIHSS are independent risk factors of HT. The PLR value of the observation group was positively associated with the NIHSS score (r = 0.8075, P < 0.0001). According to the PLR prediction about the occurrence of HT, an AUC of 0.713 (95% CI, 0.652-0.781), a cut-off value of 109.073, and a sensitivity and specificity of 0.806 and 0.674, respectively, were obtained.

Conclusions

PLR value can predict the possibility of HT in young AIS patients to a certain extent. To take effective measures to prevent HT in advance has crucial clinical significance according to PLR value.

Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

Background

Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations.

Methods

Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome.

Results

Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome.

Conclusions

Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Correlation analysis between serum procalcitonin and infarct volume in young patients with acute cerebral infarction

OBJECTIVE

To detect the serum procalcitonin (PCT) level and determine its relationship with the infarct volume in young patients with acute cerebral infarction.

METHODS

According to the infarct volume, young patients with acute cerebral infarction were divided into large group, intermediate group, and small group. The severity of clinical symptoms was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Healthy young people were selected as the control group. Serum PCT levels were measured. The relationship among PCT, volume, and NIHSS score was analyzed.

RESULTS

PCT in observation group was significantly higher than that in control group (t = 6.879, P = 0.011), and PCT in severe group was significantly higher than in mild group (t = 6.978, P = 0.016). PCT in large cerebral infarction group was higher than that in intermediate and small-size infarct group (P = 0.0036 and P < 0.0001, respectively), and PCT in intermediate cerebral infarction group was higher than that in small-size infarct group (P = 0.0024). In observation group, the PCT level was positively correlated with both NIHSS (r = 0.793, P = 0.022) and infarction volume (r = 0.649, P = 0.007).

CONCLUSION

The level of PCT in young patients with acute cerebral infarction may be related to the inflammatory reaction of the cerebral artery and positively related to the volume of cerebral infarction and NIHSS score. To some extent, PCT concentration can predict the disease severity of acute cerebral infarction.

Analysis of young ischemic stroke patients in northeast China

Background

Limited research has been conducted to address stroke etiology in young patients in developing countries. We aimed to analyze risk factors and etiology of ischemic stroke (IS) in young patients of northeast China.

Methods

We retrospectively analyzed ischemic stroke patients aged 15-49 years in a single-center study from January 2013 to December 2017. Demographics and clinical information, including imaging studies, were retrieved for all patients. Patients were first compared according to sex and age. They were then divided into the first-ever and recurrent stroke groups; risk factors and stroke etiology between the two groups were compared.

Results

Of the 956 patients (median age 45 years) included, 78.9% were males. The most frequent risk factors were hypertension (60.0%), dyslipidemia (55.3%), smoking (54.1%), and alcohol consumption (49.6%). The most common etiology of stroke was large-artery atherosclerosis (LAA, 43.7%). In total, 789 patients experienced first-ever stroke and 167 patients experienced recurrent stroke. Recurrent stroke patients more often suffered from hypertension (70.7% versus 57.8%, P=0.002), diabetes (35.3% versus 24.8%, P=0.005), and coronary heart disease (10.2% versus 5.1%, P=0.011), and were less likely to be smokers (44.3% versus 56.1%, P=0.005) and consume alcohol (38.3% versus 52.0%, P=0.001). Recurrent strokes were more frequently caused by LAA (42.1% versus 52.5%, P=0.026) and less often by small-vessel disease (40.9% versus 29.9%, P=0.008).

Conclusions

LAA is the most common etiology in Chinese young stroke patients, especially in those with recurrent stroke. Our data highlight the need of screening of LAA and prevention and management of conventional stroke risk factors in young people of China.

Intracranial artery stenosis: Current status of evaluation and treatment in China

Intracranial artery stenosis (ICAS), a common cause of ischemic stroke, is a growing cause of concern in China. Recently, many epidemiological, etiological, pathophysiological, therapy, and diagnostic imaging studies have focused on ICAS, and guidelines and consensus on the diagnosis and treatment of ICAS have been published and updated by domestic experts. Such work is pivotal to our enhanced comprehension, diagnosis, and treatment of ICAS. In this review, we summarize the latest progress in the evaluation and treatment of ICAS in China.