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Objectives: Wake-up Stroke (WUS) accounts for about 25% of all ischemic strokes. Differences according to sex in the WUS subgroup has been poorly investigated so far, so we aimed to assess these differences by differentiating the enrolled population based on treatment administered., Materials & Methods: We retrospectively analysed clinical and imaging data of WUS patients admitted to our hospital between November 2013 and December 2018 dividing them in two groups: rTPA-treated and non-rTPA treated group. To point out outcome differences we evaluated: NIHSS at 7 days or at discharge, mRS at discharge and ΔNIHSS., Results: We enrolled 149 WUS patients, 74 rTPA treated and 75 non-rTPA treated. Among rTPA treated patients, time from last known well (LKW) to Emergency Department (ED) admission was longer in females than males (610 vs 454 min), while females had a higher ΔNIHSS than males (5 vs 3). Finally, among non-rTPA treated patients, females were older than males (85 vs 79 years), had a higher pre-admission mRS (although very low in both cases), had a longer length of stay (17 vs 13 days) and shown a higher NIHSS at discharge (4 vs 2) compared to males., Conclusions: Females not receiving thrombolytic treatment had worse functional outcome than males, showing a higher NIHSS at discharge but, in contrast, when treated with rTPA they showed better neurological recovery as measured by a greater ΔNIHSS. We emphasize the importance of a prompt recognition of WUS in females since they seem to benefit more from rTPA treatment., (© 2024. Fondazione Società Italiana di Neurologia.)

Introduction: Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to investigate a possible ancillary effect of thrombolysis in mitigating Stroke-Heart Syndrome after acute ischaemic stroke., Patients and Methods: We retrospectively collected ischaemic stroke patients admitted to our Stroke Unit between August 1, 2017 and December 31, 2020 and acutely treated for an intracranial anterior circulation occlusion, without anamnestic ischaemic cardiopathy. We divided patients into Group B ("Bridge") including patients treated with both thrombolysis and thrombectomy and Group D ("Direct") including primary thrombectomies., Results: 120 patients were included in the study. Group B consisted of 92 patients, Group D of 28 patients, without significant differences in age, baseline and discharge NIHSS, cardiovascular risk factors or TOAST aetiology. Whilst admission, troponin levels were similar in both groups, significant differences in troponin peak (median 16 ng/L in Group B vs 45 ng/L in Group D, p = 0.022) and BNP values (median 455 pg/mL in Group B vs 784 pg/mL in Group D, p = 0.031) were found in the first 72 h since admission. Functional independence at discharge was significantly higher in Group B than Group D (mRS 0-2 36% vs 10%, p = 0.011)., Discussion and Conclusion: Significant differences in troponin peak and BNP values suggest a reduced stroke-related heart impairment in patients treated with bridge therapeutic approach: thrombolysis prior to thrombectomy could have a complementary effect on reducing Stroke-Heart Syndrome, improving overall neurological outcome., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Cardiac involvement following an acute stroke (Stroke Heart Syndrome—SHS) is an established complication and it is linked to the involvement of sympathetic activation, inflammation, and neuro-endocrine response. Troponin "rise and fall pattern" > 30% is one marker of SHS. The aim of this study was to evaluate the role of reperfusion treatments in the prevention/pathogenesis of SHS with different stroke sizes and locations (OCSP classification). Methods: We retrospectively analyzed data of 890 patients admitted to the Stroke Unit of Trieste (Italy) between 2018 and 2020. Out of them, 411 met the inclusion criteria (acute ischemic non-lacunar stroke). Clinical data were collected for each patient, imaging characteristics, and markers of cardiac injury [troponin I (TnI), NT-proBNP, "rise and fall pattern" > 30%]. We compared different stroke subtypes according to OCSP, while evaluating any differences in patients with and without SHS. Results: In treated total anterior circulation infarct (TACI) patients, the rate of SHS is lower than in non-treated TACI. Similar SHS rate was found in partial anterior (PACI) and posterior stroke (POCI), and between treated and non-treated patients. Focusing on TACI group, we compared SHS-TACI and non-SHS-TACI, we performed a univariate and multivariate analysis; treatment (OR 0.408 CI95% 0.185–0.900; p = 0.026) and diabetes (OR 2.618 CI95% 1.181–5.803; p = 0.018) were significantly associated to SHS. No clear insular effect was found in SHS development. Conclusions: In severe anterior stroke (TACI), reperfusion treatment may be effective in preventing SHS. Conversely, diabetes is an independent risk factor for SHS. PACI and POCI have similar troponin elevation rate. [ABSTRACT FROM AUTHOR]