2.Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore.
Ei Zune THE ; Mei Yen NG ; Geelyn JL NG ; Bernadette GC ER ; Amy ML QUEK ; Prakash PALIWAL ; Leonard L YEO ; Bernard CHAN ; Vijay K SHARMA ; Hock Luen TEOH ; Eric YH KHOO ; Raymond CS SEET
Annals of the Academy of Medicine, Singapore 2021;50(1):16-25
INTRODUCTION:
Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with diabetes in a multi-ethnic Asian cohort.
METHODS:
Consecutive patients with ischaemic stroke were recruited from the National University Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events.
RESULTS:
Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43% with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up. A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per 1,000 person-month), comprising 133 cerebrovascular and 42 coronary artery events. The adjusted hazard ratio of diabetes was 1.50 (95% CI 1.08-2.10). In a multivariable Cox proportional hazards model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified as independent predictors of recurrent cardiovascular events.
CONCLUSION
Our study provides quantitative data on the event rates of ischaemic stroke patients with diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which may have implications in the design of future interventional studies.
3.Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios Are Associated with Recurrent Ischemic Stroke in Patients with Embolic Stroke of Undetermined Source
Tony Y.W. LI ; Ching-Hui SIA ; Bernard P.L. CHAN ; Jamie S.Y. HO ; Aloysius S. LEOW ; Mark Y. CHAN ; Pipin KOJODJOJO ; Mary Joyce GALUPO ; Hock-Luen TEOH ; Vijay K. SHARMA ; Raymond C.S. SEET ; Leonard L.L. YEO ; Benjamin Yong-Qiang TAN
Journal of Stroke 2022;24(3):421-424
4.Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion
Isabel SIOW ; Benjamin Y.Q. TAN ; Keng Siang LEE ; Natalie ONG ; Emma TOH ; Anil GOPINATHAN ; Cunli YANG ; Pervinder BHOGAL ; Erika LAM ; Oliver SPOONER ; Lukas MEYER ; Jens FIEHLER ; Panagiotis PAPANAGIOTOU ; Andreas KASTRUP ; Maria ALEXANDROU ; Seraphine ZUBEL ; Qingyu WU ; Anastasios MPOTSARIS ; Volker MAUS ; Tommy ANDERSON ; Vamsi GONTU ; Fabian ARNBERG ; Tsong Hai LEE ; Bernard P.L. CHAN ; Raymond C.S. SEET ; Hock Luen TEOH ; Vijay K. SHARMA ; Leonard L.L. YEO
Journal of Stroke 2022;24(1):128-137
Background:
and Purpose Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.
Methods:
This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).
Results:
Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not asComorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).
Conclusions
Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.