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Abstract Background Strokes cause an estimated annual health care burden of 170 billion euros across Europe. Atrial fibrillation is one of the major risk factors for stroke and increases the individual risk 4.2-fold. But prevention with anticoagulants may reduce this risk by 70%. Screening methods are employed to detect previously undetected atrial fibrillation. Screening studies in various European countries show a high degree of undetected atrial fibrillation. This study aims to assess the cost-effectiveness of systematic screening with a smartphone application, named Preventicus Heartbeats. It is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. Methods A previously published model for calculating screening cost-effectiveness was extended to 6 European countries covering a wide range in terms of treatment costs and epidemiologic parameters. Results The use of screening lowers the cost per case in countries with comparatively high levels of health care costs (Switzerland: -€75; UK: -€7). Moderate higher costs per case were observed in 4 countries (Greece: €6; Netherlands: €15). Low levels of health care costs result in less or no potential for further cost reduction (Poland: €20; Serbia: €33). In all countries considered, the model showed an increase in effectiveness measures both in the number of strokes avoided and the quality adjusted life years. The number of strokes avoided per 1000 participants ranged from 2.52 (Switzerland) to 4.44 (Poland). Quality-adjusted life-years per case gained from screening ranged from 0.0105 (Switzerland) to 0.0187 (Poland). The screening procedure dominated in two countries (Switzerland, UK). For the remaining countries, the incremental cost effectiveness ratio ranged from €489/QALY (Greece) to €2548/QALY (Serbia). Conclusion The model results showed a strong dependence of the results on the country-specific costs for stroke treatment. The use of the investigated screening method is close to cost-neutral or cost-reducing in the Western European countries and Greece. In countries with low price levels, higher cost increases due to AF screening are to be expected. Lower costs of anticoagulation, which are expected due to the upcoming patent expiry of direct anticoagulants, have a positive effect on the cost result.

Background: Strokes cause an estimated annual health care burden of 170 billion euros across Europe. Atrial fibrillation is one of the major risk factors for stroke and increases the individual risk 4.2-fold. But prevention with anticoagulants may reduce this risk by 70%. Screening methods are employed to detect previously undetected atrial fibrillation. Screening studies in various European countries show a high degree of undetected atrial fibrillation. This study aims to assess the cost-effectiveness of systematic screening with a smartphone application, named Preventicus Heartbeats. It is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. Methods: A previously published model for calculating screening cost-effectiveness was extended to 6 European countries covering a wide range in terms of treatment costs and epidemiologic parameters. Results: The use of screening lowers the cost per case in countries with comparatively high levels of health care costs (Switzerland: -€75; UK: -€7). Moderate higher costs per case were observed in 4 countries (Greece: €6; Netherlands: €15). Low levels of health care costs result in less or no potential for further cost reduction (Poland: €20; Serbia: €33). In all countries considered, the model showed an increase in effectiveness measures both in the number of strokes avoided and the quality adjusted life years. The number of strokes avoided per 1000 participants ranged from 2.52 (Switzerland) to 4.44 (Poland). Quality-adjusted life-years per case gained from screening ranged from 0.0105 (Switzerland) to 0.0187 (Poland). The screening procedure dominated in two countries (Switzerland, UK). For the remaining countries, the incremental cost effectiveness ratio ranged from €489/QALY (Greece) to €2548/QALY (Serbia). Conclusion: The model results showed a strong dependence of the results on the country-specific costs for stroke treatment. The use of the investigated screening method is close to cost-neutral or cost-reducing in the Western European countries and Greece. In countries with low price levels, higher cost increases due to AF screening are to be expected. Lower costs of anticoagulation, which are expected due to the upcoming patent expiry of direct anticoagulants, have a positive effect on the cost result. [ABSTRACT FROM AUTHOR]

Abstract Background With atrial fibrillation (AF) the risk of stroke is 4.2-fold increased to a comparable population without AF. This risk decreases by up to 70% if AF is detected early enough and effective stroke preventive measures are taken as recommended by international guidelines. Long-term studies found large number of subjects with undiagnosed AF. Preventicus Heartbeats” is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. The aim of this study is to research the cost-effectiveness of systematic screening for AF with this smartphone application. Method Employing a Markov model we analysed the cost-effectiveness of the “Preventicus Heartbeats” screening for Germany, i.e. from the perspective of German statutory sick funds. Results For a cohort of 10,000 insured 75-year-old the use of the diagnostic app could avoid 60 strokes in the remaining lifetime thereof 32 strokes in the next four years. Former models have applied similar cohorts. The same cohort showed an increase in quality-adjusted life years (QALY) in the remaining lifetime of 165 QALYs in the scenario with screening versus. without screening and a decrease in discounted lifetime costs (including risk compensation effects) of €129 per participant (€148 for male, €114 for female participants). Conclusions The modelling demonstrates the health benefits and economic effects of an implementation of a systematic screening on AF with “Preventicus Heartbeats”, given the perspective of the German payer, the statutory health care system.

Introduction: Risk factors for neurological complications in sickle cell disease differ in the adult and pediatric populations. Here, we focused on neurological complications in adults with sickle cell disease. Methods: Patients were selected using the audit data from the St George's Hospital Red Cell Database. The genotyping, demographics, clinical data, and investigation findings were collected. Results: A total of 303 patients were enrolled in the study: hemoglobin S homozygosity (HbSS) genotype 56%, hemoglobin S and C coinheritance (HbSC) genotype 35%, and hemoglobin S and β-thalassemia coinheritance (HbSβ) thalassemia genotype 9%; the mean age was 38.8 years (±13.5 SD) with 46% males. The most common neurological complication was cerebrovascular disease (n = 37, 12%) including those with ischemic stroke (10%), cerebral vasculopathy (3%), and intracranial hemorrhage (1%). Ischemic stroke was common among the HbSS genotype compared with other genotypes (8 vs. 1.6%, p = 0.001). Comparing the patients with sickle cell disease who had suffered a stroke to those who had not, there was a higher proportion of intracranial vasculopathy (p = 0.001, in particular, Moyamoya) and cognitive dysfunction (p < 0.0001). Conclusion: Our cohort supports previous reports that the most common neurological complication in adult sickle cell patients is cerebrovascular disease. Strategies to prevent cerebral vasculopathy and cognitive impairment should be explored. [ABSTRACT FROM AUTHOR]

Introduction: Risk factors for neurological complications in sickle cell disease differ in the adult and pediatric populations. Here, we focused on neurological complications in adults with sickle cell disease.Methods: Patients were selected using the audit data from the St George's Hospital Red Cell Database. The genotyping, demographics, clinical data, and investigation findings were collected.Results: A total of 303 patients were enrolled in the study: hemoglobin S homozygosity (HbSS) genotype 56%, hemoglobin S and C coinheritance (HbSC) genotype 35%, and hemoglobin S and β-thalassemia coinheritance (HbSβ) thalassemia genotype 9%; the mean age was 38.8 years (±13.5 SD) with 46% males. The most common neurological complication was cerebrovascular disease (n = 37, 12%) including those with ischemic stroke (10%), cerebral vasculopathy (3%), and intracranial hemorrhage (1%). Ischemic stroke was common among the HbSS genotype compared with other genotypes (8 vs. 1.6%, p = 0.001). Comparing the patients with sickle cell disease who had suffered a stroke to those who had not, there was a higher proportion of intracranial vasculopathy (p = 0.001, in particular, Moyamoya) and cognitive dysfunction (p < 0.0001).Conclusion: Our cohort supports previous reports that the most common neurological complication in adult sickle cell patients is cerebrovascular disease. Strategies to prevent cerebral vasculopathy and cognitive impairment should be explored.

Aim Vertebral artery injury associated with blunt traumatic cervical spine injury sometimes causes severe cerebellar and brain stem infarction. No treatment guidelines for vertebral artery injury aimed at preventing stroke have been decided. We have conducted endovascular embolization in patients with up to Denver grade IV cerebrovascular injury complicated by unstable cervical spine injury before open reduction and fixation surgery. The purpose of this study was to validate the clinical course of vertebral artery injury and especially endovascular treatment for grade IV patients in our hospital. Methods Participants comprised of patients diagnosed as having traumatic cervical spine injury in our hospital between January 2015 and April 2018. Among these patients, we selected those with vertebral artery injury and retrospectively examined the background characteristics of the patients, details of treatment, and complications with or without stroke. Results Traumatic cervical spine injury was diagnosed in 89 patients. Among these patients, 15 (16.7%) showed a complicating vertebral artery injury. Mean age was 62.6 years, and almost 50% of the patients were injured in falls. Three types of cervical spine injury caused vertebral artery injury: subluxation, Jefferson fracture, and fracture involving the foramen transversarium. Vertebral artery injury was classified as grade IV in 12 patients, of whom nine required spinal surgery. All patients who needed spinal surgery underwent endovascular therapy before surgery, and none experienced a stroke. Conclusion Endovascular embolization of the vertebral artery occlusion in patients with unstable cervical spine injury before open reduction and fixation surgery can be a treatment option to prevent stroke.

Prior stroke plays an important role in the development of cognitive impairment (CI), the prevention of which requires detailed study.Patients and methods. A total of 350 patients (mean age, 65±17.7 years; 49% men) who had experienced a stroke with a small degree of neurological deficit were followed up. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE), Mattis dementia rating scale, the clock drawing test, the test on memorizing 12 words, and the Schulte table. During 5 years of follow-up, 61 (17.4%) patients died, including 45 (12.8%) from recurrent stroke; 89 recurrent strokes developed.Results. The first examination did not reveal CI in 59 (17%) patients; 73 (21%) were found to have marked CI (mild or moderate dementia). After 1, 3, and 5years of follow-up, the proportion of patients with marked CI increased up to 23.2, 29.5, and 34.5%, respectively. Within 5 years, there was an average decline of 2 MMSE scores. The maximum decrease in cognitive functions was seen in patients who had experienced a recurrent stroke, but this also occurred in the absence of a stroke. Cognitive functions were substantially better in a group of patients with blood pressure (BP) normalization.Conclusion. The 5-year follow-up has shown that post-stroke CI gradually progresses, which is associated with the progression of both vascular disease and a concomitant neurodegenerative process. BP normalization during antihypertensive therapy contributes to the prevention of progressive post-stroke CI.

Background: With atrial fibrillation (AF) the risk of stroke is 4.2-fold increased to a comparable population without AF. This risk decreases by up to 70% if AF is detected early enough and effective stroke preventive measures are taken as recommended by international guidelines. Long-term studies found large number of subjects with undiagnosed AF. Preventicus Heartbeats" is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. The aim of this study is to research the cost-effectiveness of systematic screening for AF with this smartphone application. Method: Employing a Markov model we analysed the cost-effectiveness of the "Preventicus Heartbeats" screening for Germany, i.e. from the perspective of German statutory sick funds. Results: For a cohort of 10,000 insured 75-year-old the use of the diagnostic app could avoid 60 strokes in the remaining lifetime thereof 32 strokes in the next four years. Former models have applied similar cohorts. The same cohort showed an increase in quality-adjusted life years (QALY) in the remaining lifetime of 165 QALYs in the scenario with screening versus. without screening and a decrease in discounted lifetime costs (including risk compensation effects) of €129 per participant (€148 for male, €114 for female participants). Conclusions: The modelling demonstrates the health benefits and economic effects of an implementation of a systematic screening on AF with "Preventicus Heartbeats", given the perspective of the German payer, the statutory health care system. [ABSTRACT FROM AUTHOR]

Background: Incidence of stroke within 30 days after percutaneous mitral valve repair using the MitraClip varies from 0.7% and 2.6% between registries. Standard medical treatment after the MitraClip procedure, in the absence of risk factors requiring antithrombotic therapy such as atrial fibrillation, is dual antiplatelet therapy using aspirin and clopidogrel. ESC/EACTS and ACC/AHA surgical guidelines show a Class IIa indication for temporary antithrombotic therapy after mitral valve repair/bioprosthetic valve replacement within the first three months even in patients with no additional risk factors. Methods: 470 patients were treated with the MitraClip receiving oral anticoagulation (Coumadin: INR 2.0–3.0) instead of dual antiplatelet therapy for at least 30 days after the procedure. The incidence of stroke, as well as major adverse events such as bleeding, were analysed in comparison to large registries and multi-centre studies. Results: Incidence of stroke within 30 days was significantly reduced as compared to comparative cohorts (0.2% vs. Median 1.3% [0.7–2.6%]; p <.05). Cardiovascular risk factors such as age, atrial fibrillation, hypertension, diabetes, STS score and prior stroke did not differ significantly between cohorts (ns). Bleeding complications were not increased due to 30 days oral anticoagulation treatment (4.6% vs. Median 7.4% [3.4–13.6%]; ns). Conclusions: Temporary oral anticoagulation might be a strategy to reduce the incidence of stroke within the first 30 days after the MitraClip procedure. Bleeding events were not significantly altered due to temporary oral anticoagulation. [ABSTRACT FROM AUTHOR]

Migraines and cerebrovascular diseases are comorbid disorders that are widespread in the population. The close relationship between these states is demonstrated by epidemiological, clinical studies, as well as by pilot studies of their pathophysiology. Patients with migraines have a clear increase in the risk of ischemic stroke, especially when there are risk factors such as female sex, presence of aura symptoms, smoking, hormonal contraceptive use and high incidence of migraines. Despite the abundance of migraine studies, no strategies have been developed to modify her treatment for patients with attendant pathology so far. In the meantime, some studies have convincingly demonstrated the advantages of some therapeutic approaches, which could be used to optimize management of these patients with these frequently co-existing disorders.

Guidelines recommend anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). In the real world, this treatment is underused, probably for pharmacologic limitations of vitamin-K-antagonist (VKA). The new oral anticoagulants (NOAC) overcome many limitations of VKA. The aim of this study is to assess if, after introduction of NOAC, anticoagulated patients are increased. We performed an observational retrospective cohort study about patients with NVAF, hospitalized in Internal Medicine or Geriatrics for any cause in two years, before and after the marketing of NOAC. The results showed: 640 patients enrolled (289 in 2012, 351 in 2015), elderly population (83±7), males 42% females 58%, high morbidity, high thromboembolic (CHA2DS2VASc 5±1.6) and hemorrhagic (HASBLED 2.7±1.2) risks, with frequent chronic renal disease (51% stage ≥3) and contraindications to anticoagulants (21.6%). Therapy at discharge 2012 vs 2015: VKA 124/289 (43%) vs VKA or NOAC 187/351 (53%) (Pvs 70/351 (20%) (Pvs 77/351 (22%) in 2015. NOAC have increased the adherence to guidelines in prescribing oral anti-coagulants in patients with NVAF.

The possibilities of antithrombotic therapy for prevention of thromboembolic events in non-valvular atrial fibrillation (AF) have been significantly expanded after the development and introduction of new oral anticoagulants (NOACs) into clinical practice. Starting the clinical use of NOACs has opened a new page in oral anticoagulant therapy aimed at preventing thromboembolic events in AF. Dabigatran etexilate is the first NOAC that was registered in 2010. After completion of the RE-LY trial, the positive safety and efficacy profile of dabigatran has been confirmed in real practice of over 5 years of clinical use in more than 200,000 patients from nearly 100 countries. An observational cohort study of oral anticoagulants used in more than 134,000 patients was one of the largest independent studies of the Food and Drug Administration (FDA) in the Medicare system. In the dabigatran group, the risk of ischemic stroke, intracranial and intracerebral hemorrhage, and death was statistically significantly lower than in the warfarin group. The incidence of major and all hemorrhages requiring hospitalization, as well as myocardial infarction was comparable. Profuse gastrointestinal bleeding was more common with dabigatran. This study in the Medicare system has demonstrated a favorable benefit/risk ratio for this drug and this requires no additional changes in the current instructions and recommendations for its use.

There is outpatient hyperdiagnosis of dyscirculatory encephalopathy (DE) frequently masked by other diseases. Objective: to improve the differential diagnosis of DE on the basis of a comprehensive patient examination, including neuropsychological testing. Patients and methods. Fifty patients, including 10 men and 40 women, aged 45 to 75 years (mean age 68.8±9.0 years), who had been followed up at the polyclinic with a diagnosis of DE for an average of 1.5 years, were examined. All the patients underwent evaluations of cognitive functions and emotional status and otoneurological examination (in case of headache); a psychiatrist consulted patients with anxiety and/or depressive disorders. Results and discussion. Only 9 (18%) patients were found to have vascular cognitive impairments (CIs) and signs of cerebrovascular lesions, as shown by neuroimaging, which may be regarded as DE. Five (10%) patients had CIs and neuroimaging changes that were more characteristic of Alzheimer’s disease (AD) than those of DE. The remaining 36 (72%) patients were established to have other diseases (primary headache, peripheral vestibulopathy, primary anxiety and depressive disorders, etc.), in which CIs were not detected. The diagnosis and effective treatment of these diseases yielded a rapid positive result in most cases. The management of patients with DE and AD was aimed at preventing stroke and improving cognitive functions; moreover, akatinol memantine was noted to be effective in the combination therapy of both DE and AD.

Stroke is one of the top three causes of death in the population and a leading cause of disability in the elderly; ischemic stroke (IS) constitutes a major portion (70–85%) of all strokes so its prevention s a relevant problem of modern medicine. Among the risk factors RFs) of stroke, nonvalvular atrial fibrillation (AF) is of great ignificance, which occurs in persons over 70 years of age in pproximately 5–10% of cases and increases the risk of IS 3–4-fold.The review analyzes RFs for stroke in AF. The CHA2DS2-VASc scale encompassing several RFs is noted to be informative and easy-to-use. There are data of large-scale randomized trials that show that novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) are as good as warfarin or offer an advantage over the latter, by more substantially decreasing the risk of stroke and reducing the likelihood of profuse bleeding, intracranial hemorrhage in particular. There is evidence for the efficacy of rivaroxaban in the secondary prevention of stroke. The authors provide their experience with patient management to prevent recurrent cardioembolic stroke.In our country, most patients who have sustained IS or transient ischemic attack in the presence of AF do not take warfarin due to the fact that it is difficult to regularly monitor the international normalized ratio (INR). It is noted that the administration of the novel anticoagulants, which differs from that of warfarin, does not require INR monitoring and can increase the number of patients on anticoagulant therapy and therefore reduce the incidence of stroke in the presence of AF.

Guidelines recommend anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). In the real world, this treatment is underused, probably for pharmacologic limitations of vitamin-K-antagonist (VKA). The new oral anticoagulants (NOAC) overcome many limitations of VKA. The aim of this study is to assess if, after introduction of NOAC, anticoagulated patients are increased. We performed an observational retrospective cohort study about patients with NVAF, hospitalized in Internal Medicine or Geriatrics for any cause in two years, before and after the marketing of NOAC. The results showed: 640 patients enrolled (289 in 2012, 351 in 2015), elderly population (83±7), males 42% females 58%, high morbidity, high thromboembolic (CHA2DS2VASc 5±1.6) and hemorrhagic (HASBLED 2.7±1.2) risks, with frequent chronic renal disease (51% stage ≥3) and contraindications to anticoagulants (21.6%). Therapy at discharge 2012 vs 2015: VKA 124/289 (43%) vs VKA or NOAC 187/351 (53%) (P<0.01); antiplatelet 114/289 (39%) vs 70/351 (20%) (P<0.0001). For the high comorbidity, frequent use of low-molecular-weight heparin: 42/289 (15%) in 2012 vs 77/351 (22%) in 2015. NOAC have increased the adherence to guidelines in prescribing oral anti-coagulants in patients with NVAF. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the rate of progression of stenosis and development of symptoms in patients with asymptomatic carotid artery stenosis (aCAS) treated with contemporary medical therapy over a prolonged time interval. Methods: This study is a retrospective review of consecutive patients diagnosed with moderate or severe aCAS at our institution between 2000 and 2001. Data were gathered from both carotid arteries for each patient excluding vessels operated within 1 year of diagnosis and occlusions. Multivariate analysis was performed to analyze factors associated with ipsilateral transient ischemic attack (TIA)/stroke. Results: We identified 214 patients (58.8% men; median age 70 years) and collected data on 349 vessels. Degree of stenosis was severe (>70%) upon diagnosis in 92 (26.4%) vessels. Median length of follow-up was 13 years (interquartile range 10-14), and mean number of time points for follow-up imaging were 8.1 ± 3.9. Progression of stenosis was observed in 237 (67.9%) vessels, and 72 (20.6%) patients developed symptoms ipsilateral to the stenosis (TIA in 14.4%, non-disabling stroke in 4%, disabling stroke in 2.2%). Median time to appearance of first symptom was 6 years (range 1-13). On multivariate analysis, degree of baseline stenosis, intracranial stenosis >50%, plaque ulceration, silent infarction and previous history of TIA/stroke were associated with ipsilateral TIA/stroke, but progression of stenosis was not. Conclusions: There was a substantial rate of progression of stenosis in patients with aCAS over time despite adequate medical therapy, but progression of stenosis did not increase the risk of ipsilateral TIA/stroke. Over long-term follow-up, 1 in 5 patients with aCAS developed ipsilateral TIA/stroke, though most events were either transient or non-disabling. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis. Background: Modern clinical trials with short-term follow-up indicate CAS and CEA are equivalent in reducing the risk for ipsilateral ischemic stroke secondary to carotid stenosis. A paucity of data exists regarding long-term outcomes. Methods: Patients of all surgical risks with symptomatic and asymptomatic carotid stenosis (>70%) were randomly selected for CEA or CAS and followed a minimum of 10 years. Results: Long-term follow-up was achieved in 173 patients (91%). Eighty-seven (50.2%) died within this period, most commonly of nonvascular causes. No difference in the risk of stroke ipsilateral to the treated artery was noted among treatment groups (p > 0.05). Restenosis determined by sequential ultrasound was assessed only in the CAS group (3.3%) and remained asymptomatic. The combined risk of fatal or nonfatal heart attack over the 10-year period was highest in individuals with symptomatic versus asymptomatic stenosis (27.5% vs. 11.0%; hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.298 to 4.146, p = 0.005) and was higher in all patients treated with CEA (HR: 2.27, 95% CI: 1.35 to 3.816, p = 0.002). Conclusions: Long-term protection against ipsilateral stroke provided by CAS and CEA did not differ in this trial. The 10-year risk of fatal/nonfatal myocardial infarction was highest in all patients harboring symptomatic carotid stenosis at enrollment. The risk of fatal/nonfatal heart attack was significantly more prevalent in those symptomatic or asymptomatic patients randomized to CEA. [Copyright &y& Elsevier]

Microalbuminuria, assessed by measuring immunoreactive albumin, is common in patients with cerebrovascular disease and is associated with increased risk of stroke. Total urinary albumin (t-uAlb) comprises both immunoreactive albumin (ir-uAlb) and nonimmunoreactive albumin (nir-uAlb). We hypothesized that t-uAlb is a more sensitive indicator of microalbuminuria than ir-uAlb, and that measurement of t-uAlb will increase the prevalence of microalbuminuria in ischemic stroke patients compared with measurement of ir-uAlb and will show a stronger correlation with the severity of stroke and oxidative stress. In urine samples from 98 patients with ischemic stroke, the albumin-to-creatinine ratios t-uAlb/uCreat and ir-uAlb/uCreat were measured by high-performance liquid chromatography (HPLC) and immunoturbidimetry (IT), and the nir-uAlb/uCreat ratio was calculated. Urinary ortho-tyrosine (o-Tyr/uCreat), an indicator of oxidative stress, was measured by HPLC. The severity of stroke was scored based on the National Institutes of Health Stroke Scale (NIHSS). The prevalence of microalbuminuria detected by HPLC was significantly higher than that detetcted by IT (66.3 vs 36.7%). Although all forms of albumin showed significant correlation with stroke severity (t-uAlb: r = 0.24, P < .05 ir-uAlb: r = 0.25, P < .05 nir-uAlb: r = 0.29, P < .05), only nir-uAlb was found to be an independent predictor of stroke severity (B = 0.20, β = 0.35, P < .05). In addition, t-uAlb/uCreat and nir-uAlb/uCreat had a significant correlation with o-Tyr/uCreat (r = 0.336, P < .05 and r = 0.358, P < .05 respectively), whereas ir-uAlb/uCreat did not (r = 0.22, P > .05). Our data suggest that in acute ischemic stroke patients, t-uAlb is a more sensitive indicator of microalbuminuria than the presently used ir-uAlb. Future studies should aim to elucidate the underlying mechanisms for the relationship among urinary albumins and cerebrovascular diseases and the role of urinary albumins in risk stratification for stroke. [ABSTRACT FROM AUTHOR]

Abstract: According to recent epidemiological data in Japan, stroke affects roughly 5.3 males and 3.9 females per 1000 person-years and is the third leading cause of mortality. At present, management strategies for secondary prevention of stroke include aggressive treatment of cardiovascular risk factors (i.e., hypertension, smoking cessation, etc.). Antiplatelet drugs in Japan, namely aspirin and cilostazol, are utilized regularly for the prevention of secondary stroke. While aspirin is beneficial for a wide range of cardiovascular endpoints, including total and ischemic strokes, it is also associated with significantly increased risks for hemorrhagic infarction. Cilostazol, by contrast, has been shown to significantly reduce the risk of recurrent strokes without affecting the occurrence of intracranial hemorrhage. In the Cilostazol Stroke Prevention Study, a randomized double-blind, placebo-controlled trial involving more than 1000 Japanese patients, cilostazol was found to reduce the risk of secondary stroke by 41.7% compared with placebo, a statistically significant reduction (P =0.015). The greatest risk reduction (43.4% in cilostazol versus placebo, P =0.0373) was found in patients who initially had a lacunar infarction, suggesting that cilostazol has a specific effect against small-vessel disease. In addition, cilostazol achieved significant risk reductions on a number of combined endpoints (e.g., cerebral infarction, intracranial hemorrhage, myocardial infarction, or vascular death), and was associated with benefits in intent-to-treat analyses. These findings indicate that cilostazol may have a role as a vascular neuroprotectant, but the clinical implications are limited by the fact that patients were randomized to placebo instead of aspirin, which is the standard of care. [Copyright &y& Elsevier]

Objectives: We report the long-term outcome and rates of recurrent cerebral ischemic events in our cohort of carefully selected patients after STA-MCA bypass for severe steno-occlusive disease of intracranial ICA or MCA with exhausted cerebral vasodilatory reserve., Patients and Methods: In this retrospective study, we reviewed the hospital records for all patients who underwent direct superficial temporal artery-middle cerebral artery bypass surgery at our institution from January 2010 to August 2017. Patients were included in the study if they presented with transient ischemic attack or non-disabling stroke due to a severe steno-occlusive lesions of the intracranial internal carotid artery or middle cerebral artery with abnormal cerebral vasodilatory reserve on imaging. The overall event rate is defined as transient ischemic attack, acute ischemic stroke, peri-operative stroke or death., Results: 69 patients were included in the study. The median age of cohort was 57 years (inter-quartile range 36-78). Median follow up period in our study was 73 months (range 2-90 months). The overall event rate post-treatment during the follow up period is 20.2%. In contrast, previous studies have showed that patients who underwent best medical therapy had a higher recurrent ischemic stroke rate over a 2-3-year period., Conclusion: This study suggests that carefully selected patients with severe steno-occlusive disease and significantly abnormal cerebral hemodynamic reserve who undergo extracranial-intracranial bypass surgery, may benefit from long-term prevention of symptomatic cerebral ischemic events., (Copyright © 2018 Elsevier B.V. All rights reserved.)