XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Chronic conditions and
recurrences
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Asymptomatic PAD is a common diagnosis using Ankle-Brachial Index in patient hospitalized in neurology ward: results of the French ELLIPSE survey.
F.-J.Pinel
For the Ellipse Investigators
Rennes University Hopsital
FRANCE
ELLIPSE is an observational, multicenter, reel life, epidemiological survey among hospitalized patients. Aim: Analyse asymptomatic Peripheral Artery Disease (PAD) frequency using Ankle Brachial Index (ABI) measurement in hospitalized patients, >55 years without symptomatic PAD considered at risk for cardiovascular (CV) event. Method: Patient hospitalized for all reason with an history of documented coronary or cerebrovascular disease (stable angina, unstable angina or myocardial infarction, ischemic stroke or transient ischemic attack) or known cardiovascular risk factor (diabete, hypertension, hypercholesterolemia, tobacco use) was included. 206 investigators (15.8% neurologists) in 94 hospitals included 2444 patients (2146 patients for the analysis). 405 patients was included in neurology ward (18.9%). Results: mean age 71.9 (SD 9.3) years for neurology patients and 72.4 (10.4) for global population. At least one risk factor was found in 96.3% of the overall population. Treated hypercholesterolemia was found in 45.2%, treated hypertension in 73.8%, treated diabete 22.7% and tobacco use (active or past) in 36.5% of neurology patients. Inclusion reasons and incidence of ABI <0.9 are shown in table. In patients hospitalized in neurology ward, we found 38.5% of asymptomatic PAD with an ABI <0.9. Conclusion: Incidence of asymptomatic PAD was high in global and cerebrovascular hospitalized patients. Theses findings reveal the important number of non diagnosed polyvascular patients. Since the first results of REACH registry, we know the prognosis of polyvascular patients with an increased rate of major CV events. The ELLIPSE results highlighted the importance of screening for PAD by measurement of ABI in all hospitalized patients at risk of CV event.
http://www.eurostroke.org/ni_graphics/t_aid3050.htm
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Randomized, Single-Blind, 30-Days Trial of the Antiplatelet Profiles After Extended-Relased Dipyridamole and Low Dose Aspirin versus Clopidogrel with or without Aspirin in Diabetic Patients after TIA
V.L.Serebruany
A.I.Malinin
A.N.Pokov
D.F.Hanley
Johns Hopkins
USA
Background and Purpose -- Clopidogrel , aspirin (ASA), or Aggrenox (ER-DP+ASA) , are widely used in post-stroke regimens, while their antiplatelet properties were never tested in diabetic patients after TIA.. Methods -- Sixty diabetic patients after TIA were randomized to ER-DP+ASA (25/200mg BID); clopidogrel (75mg/QD); or clopidogrel (75mg/QD) + ASA (81mg QD) groups. Platelet biomarkers were assessed at baseline, Day 15, and Day 30 by aggregometry, rapid analyzers, and flow cytometry. Results -- Clopidogrel provided inhibition of ADP-induced aggregation (p=0.001), closure time prolongation (p=0.01), and reduction of Ultegra Analyzer readings (p=0.001). Expression of PECAM-1 (p=0.03), GP IIb/IIIa activity (p=0.01) was reduced already at Day 15 in the clopidogrel-treated patients. Addition of ASA to clopidogrel caused inhibition of collagen-induced aggregometry (p=0.001), and diminished formation of platelet-leukocyte microparticles (p=0.03). In contrast, ER-DP+ASA caused delayed ( at Day 30) reduction of receptor expression such as GP IIb/IIIa activity (p=0.02), PECAM-1 (p=0.03), GP Ib (p=0.001), vitronectin (p=001), P-selectin (p=0.001), LAMP-1 (p=0.001), CD40-ligand (p=0.01), as well as inhibition of PAR-1 intact (p=0.01) and cleaved (p=0.01) epitopes. Conclusion -- The patterns of platelet inhibition were significantlydifferent when patients are treated with ER-DP+ASA , or clopidogrel with or without ASA. While the conventional antiplatelet potency of clopidogrel is stronger, and occurred faster, ER-DP+ASA produced delayed, mild downregulation of multiple activation-dependent platelet receptors making it suitable for the chronic outpatients with mild-to-moderate platelet activation.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Predictors of stroke recurrence in Tbilisi: Results of the first prospective population-based study in Georgia
A. Tsiskaridze
M. Djibuti
T. Vashadze
I. Burduladze
S. Apridonidze
P. Michel
R. Shakarishvili
TSU, Tbilisi, Georgia; Department of Neurology, CHUV, Lausanne Switzerland
GEORGIA
Background: Stroke recurrence is not rare and is characterized by high mortality and disability. We aimed to determine predictors of stroke recurrence in Tbilisi, capital of Georgia, a developing country in the South Caucasian region using data of the ongoing prospective Swiss-Georgian population-based project on stroke epidemiology. Methods: We identified a cohort of 233 first-ever stroke patients from 2000 to 2003 in Sanzona suburb of Tbilisi and followed-up prospectively. All cases of recurrent stroke and stroke mortality in this cohort were registered by using overlapping sources of information and standard diagnostic criteria. Results: Since November 2000 to date, 98 (42%) patients experienced recurrent stroke. Among those 47 (20%) events were fatal. By multivariate analysis (Cox proportional-hazards model), predictors of stroke recurrence were age (Hazard Ratio {HR} 1.8; 95% Confidence Interval {CI} 1.1-6.8), diabetes mellitus HR 2.4; 95% CI 1.2-7.1), ischemic nature of the index stroke (HR 2.8; 95% CI 1.5-5.8), cardioembolic stroke (HR 4.7; 95% CI 2.2-6.9) and lacunar stroke (HR 3.0; 95% CI 1.8-7.5), while only age and cardioembolic stroke were independently associated with fatal recurrent stroke (HR 2.2; 95% CI 1.2-14.5 and HR 5.3; 95% CI 1.5-18.4, respectively). Conclusion: Stroke in Tbilisi, Georgia is characterized by high recurrence rate. This may be due to inadequacy of stroke service and shortages in the secondary preventive measures. Predictors of stroke recurrence in Georgian population are mostly similar to those reported in other population-based registries.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Reproducibility of light transmittance aggregometry in stroke patients
A. Tomek
M. Sramek
Charles University, 2nd School of Medicine
CZECH REPUBLIC
Background: Recurrent stroke is a frequent catastrophy despite proper antiplatelet medication. One of the possible reasons of this failure is variability of antiplatelet response tested in vitro (phenomenon of resistance). Light transmittance aggregometry (LTA) is considered to be the "gold standard" of platelet function testing. Recent studies have suggested correlation between laboratory hyporesponsiveness and worse clinical outcome (including more frequent stroke recurrence). A little is known about intraindividual variability of LTA results in time. Aim of study: To evaluate intrapersonal variability of LTA in individual patients between two consecutive examinations. Methods: LTA was performed in 28 patients taking antiplatelet agent after stroke with good compliance. 20 patients were treated with aspirin (50-200mg daily), 4 patients with ticlopidine (500mg daily) and 4 with clopidogrel (75mg daily). The interval between the two LTA tests was 28 days (+/- 3 days). LTA results were assessed in agreement (both examinations resistant or not resistant) or different (one examination not resistant and the second resistant). The same procedure in sampling and transporting specimens and LTA methodics was maintained. Results: In 21 patients (75%) was agreement between the examinations, in 7 patients (25%) were results different between the two examinations (5 treated with aspirin and 2 treated with ticlopidine). Reproducibility was calculated as coeficient kappa = 0.34, i.e. fair agreement between the examinations. Conclusion: Variability of LTA results in time could be one of the possible drawbacks for its routine clinical application and needs further study.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Clinical Decisions on Secondary Prevention after Recurrent Stroke
J. Petersson
A. Lindgren
T. Leoo
M. von Arbin
Malmö University Hospital, Lund University, Malmö
SWEDEN
Implementation of guidelines for secondary prevention is crucial to enable advances in medical science to decrease stroke burden. Analysis of which factors influence clinician’s decisions may provide tools for improvement. The Recurrent Stroke Quality and Epidemiology (RESQUE) study prospectively included 889 patients with recurrent stroke at 23 stroke units in Sweden. 758 patients with ischemic stroke and alive at discharge from stroke unit were included in this analysis. Risk factors, adequacy of previous treatment (optimal or non-optimal as judged by treating clinician), changes in medication for stroke prevention and planned interventions were recorded, as well as age, gender and smoking habits. In 52% of patients, medication was considered non-optimal at recurrent stroke onset. Three common risk factors – hypertension, atrial fibrillation and hyperlipidemia were associated with non-optimal treatment. Medication was altered in 91% of patients with non-optimal treatment compared to 46% in patients with optimal treatment (P<0.001). Use of antihypertensive medication increased from 72% at admission to 76% (P<0.05) at discharge. Lipid-lowering drugs increased from 42% to 52% (P<0.05). Even though use of platelet inhibitors marginally increased from 79% to 81% (n.s.), platelet inhibitors were changed in no less than 37% of cases from ASA to either clopidogrel or ASA + dipyridamole in patients with non-optimal treatment. Beta-blockers were more often used in women while ACE inhibitors were more common in men. Lipid lowering medication was less common at higher age and in women. Use of warfarin was negatively related with high age. The RESQUE data provide an extensive basis for analysis of treatment changes and patterns for clinical decisions. Although half of these patients at high risk for stroke were considered to have an inadequate treatment, relatively small changes in medication occurred overall. Some risk factors are more often perceived as inadequately treated. Differences for gender and age suggest that guidelines are not uniformly applied.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Effects of pre-existing statin treatment on matrix metalloproteinases/-inhibitor expression after acute human stroke
M. Fatar
M. Stroick
B. Reuter
M. Griebe
A. Alonso
M.G. Hennerici
Faculty of Medicine Mannheim, University of Heidelberg
GERMANY
Background: Recent studies demonstrated beneficial effects of statin treatment in stroke beyond lipid lowering effects. Among several changes in the inflammatory and vascular system altered matrix metalloproteinases (MMP) and tissue inhibitors of matrix metalloproteinases (TIMP) expression in the acute phase of stroke may also be important under this treatment. Methods: 25 patients with acute neurological deficit <24h and ischemic stroke in imaging were recruited if on statin treatment before onset. Stroke patients without pre-existing statin treatment and matched for age, sex, type and aetiology of infarction were used as controls (n=25). Participants were further classified by risk factors, Doppler sonography and NIHSS. Blood samples were obtained on days 1, 2, 3 and 7 and serum levels of MMP-2, MMP-9, TIMP-1, TIMP-2 and C-reactive protein (CRP) and neuron-specific enolase (NSE) were measured using ELISA techniques. Results: Statin treated patients showed similar levels of MMP-2, TIMP-1, TIMP-2, at all measured time-points, but MMP-9 was elevated on all days, reaching significant levels on days 3 and 7 (678.4+/-276.4 ng/µl vs. 463.6+/-169.7 ng/µl, p<0.05 on day 3 and 915.4+/-401.5 ng/µl vs. 537.0+/-297.4 ng/µl on day 7, p<0.005). Discussion: Our data suggests that pre-existing statin treatment increase MMP-9 expression after acute stroke. This should be considered as a potential mechanism in patients treated with statins after primary hemorrhagic strokes.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Renal dysfunction is associated with increased risk of death, angor pectoris and non-fatal stroke recurrences in a cohort of ischemic stroke patients.
G. Piñol-Ripoll
F. Purroy
J. Sanahuja
Hospital Santa Maria
SPAIN
Background: Patients with ischemic stroke and renal dysfunction (RD) are considered to be at high risk of complications and death. Little data are available concerning the prognostic implications of renal function abnormalities in stroke patients and their evolution over time. Methods: We compared clinical characteristics and long term prognosis (24 months of follow-up) of 268 consecutive ischemic stroke patients in three categories of renal function according glomerular filtration rate (GFR) calculated using the Cockroft-Gault formula: (1) normal renal function (> 60 ml/min/m2) (n =169), (2) mild to moderate RD (60-25 ml/min/ m2) (n=61), and (3) end-stage RD (< 25 ml/min/ m2) (n= 39). Results: Patients with RD were older and more likely to have other co-morbidities such as hypertension, diabetes mellitus, prior stroke and angina. During admission, non-differences about death was observed in patients with and without RD (p=0.3). After the first year of follow-up, abnormal renal function patients had more mortality (p=0.044), ischemic stroke (p=0.027) and angor pectoris (p=0.042). During second year of follow-up, patients with RD had higher mortality, but no morbidity than normal renal function patients (p=0.012 and p>0.05, respectively). After two years of follow-up, patients with GFR lower than 60 ml/min had higher mortality (p=0.012) and morbidity (p=0.002) compared to normal renal function. Conclusions: Patients with renal dysfunction were more likely to experience serious complications (angor pectoris and ischemic stroke) and death after two years of ischemic stroke.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 2
Obesity paradox in patients with ischemic stroke
G. Piñol-Ripoll
I. De la Puerta
F. Purroy
Hospital Santa Maria
SPAIN
Purpose: An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure, hypertension and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with ischemic stroke is not known. Methods: A total of 268 patients with ischemic stroke admitted in our hospital were follow-up for 24 months. Patients were classified into 3 groups according to baseline BMI: less than 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight) and more than 30 kg/m2 (obesity). We evaluated the incidence of death, coronary heart disease (CHD), stroke, transient ischemic stroke (TIA) and peripheral arterial disease in this group of patients. Results: With patients of normal weight (BMI <25 kg/m2) as the reference group, the risk of primary outcome was not lower compared to overweight patients (adjusted hazard ratio [HR] 0.92, 95% confidence interval [CI], 0.80-1.04, p=0.9) or obese patients (adjusted HR 0.95, 95% CI, 0.83-1.07, p=0.9). Stroke patients with previous CHD or hypertension history did not shown differences between incidence of death (28% and 18% normal weight, 50% and 25% overweight 33% and 27.6% obese patients respectively), CHD ( 0% and 2% normal weight, 22.2% and 10.3% overweight, 0% and 0% obese patients respectively) or cerebrovascular events ( 0% and 11.1% normal weight, 22% and 14.7% overweight, 0% and 19.2% obese patients respectively; p>0.05 in all subgroups). Conclusions: In our population with ischemic stroke, obese and overweight patients had not a decreased risk of primary outcome compared with patients of normal weight. Our results further do not suggest a protective effect of obesity in ischemic stroke patients with known CHD or hypertension.
