CHARACTERISTICS OF ACUTE ISCHEMIC STROKE PATIENTS DUE TO SMALL VESSEL OCCLUSION

Background: Ischemic stroke account for about 87% of all stroke cases. This study will focus on ischemic stroke due to small vessel occlusion as one of the subtypes based on TOAST (trial of ORG 10172 in acute stroke treatment). Objective: To determine the characteristics of ischemic stroke patients caused by small vessel occlusion and are expected to be used as a basis for further research. Methods: A descriptive observational retrospective study regarding the characteristics of acute ischemic stroke patients due to small vessel occlusion at Sanglah Hospital. Secondary data were obtained from patient medical records. Results: The total number of cases of small vessel occlusion was 338. The majority of the sample were men (64.5%) between 40-60 years old (53.6%). Most of the samples were patients who had experienced an ischemic stroke for the first time (75.1%) with NIHSS (National Institute of Health Stroke Scale) scores showing mild (48.2%) and moderate (51.5%) symptoms. Around half of them had a history of hypertension (60.1%), dyslipidemia (59.5%), and diabetes mellitus (44.1%). The most common location of infarction was in the anterior circulation (77.5%) with almost the same ratio of right and left hemisphere locations. Conclusion: Ischemic stroke due to occlusion of small vessels at Sanglah Hospital Denpasar for 3 years was 35.2% of the total ischemic stroke cases. Half of the total sample had classic vascular risk factors. Further research is needed to determine another effective treatment strategy other than just secondary prevention such as life style moderation to prevent recurrency

Digital subtraction angiography findings of stroke in young adult population: a multi-center record-based study

Abstract Background Stroke is one of the main causes of disability, in which nearly 2/3 of survivors experience disability and interferes with the patient’s daily functional activities. Hypertension, dyslipidemia, obesity, and smoking habits are the main causes of stroke in young adults. Vascular abnormalities are also risk factor for stroke in young adults. Advanced imaging examinations such as cerebral digital subtraction angiography (DSA) can provide a clear picture of the vasculature of the blood vessels of the human brain and provide a real-time picture of the hemodynamic status, blood flow and collateral circulation of the cerebral vessels. Results There were approximately 999 patients who had DSA cerebral examination during the study period. The total young adult population was 147 [92 males (62.4%) and 55 females (37.6%)]. There were 82 patients with ischemic stroke (60.7%). The main etiology of ischemic stroke in this study was intracranial atherosclerotic disease (ICAD) [44 (53.65%)]. The young adult population had 53 hemorrhagic stroke patients (39.3%). The main cause of hemorrhagic stroke is hypertensive vasculopathy (41.5%), followed by a ruptured cerebral arteriovenous malformation (CAVM) (37.7%). There were 12 patients with cerebral sinus venous thrombosis (CSVT). Headache is the main complaint of patients with venous stroke, followed by seizures and hemiparesis. The transverse sinus is the most common site for occlusion (66.7%). Conclusion This study describes the characteristics and prevalence of stroke in young adults based on the results of cerebral DSA examination. Stroke in young adults is not uncommon. Several traditional risk factors in old age are now found in young people. Lifestyle modification is needed to reduce the prevalence of stroke in young adults

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020