[inventory] selected articles of stroke in March 2020 (I)

< br / > < br / > < br / > stroke: the ability of havoc score to predict the risk of atrial fibrillation remains to be determined < br / > < br / > in order to predict the risk of atrial fibrillation in patients with stroke < br / > stroke, a score model of havoc (hypertension, age, valvular heart disease, peripheral < br / > vascular < br / > disease, obesity, congestive heart failure and coronary artery disease) is proposedOnly 2.5% of patients with low-risk (i.e0-4) havoc score were diagnosed with new atrial fibrillationRecently, stroke journal published a study to evaluate the effect of havoc score model in the external cohort of patients with cryptogenic thrombotic stroke< br / > < br / > based on the atrial fibrillation embolism stroke database, researchers evaluated the discriminant ability, calibration value, specificity, negative predictive value and accuracy of havoc score for predicting new onset atrial fibrillationAccording to the initial publication recommendations, patients with a havoc score of 0-4 can be considered as low-risk population< br / > < br / > 658 patients (median age 67 years, 44% female) with cryptogenic embolic stroke were included in the studyThe median score of havoc was 2 (quartile range 3), 540 (82%) patients had a score of 0-4, 118 (18%) patients had a score of ≥ 5, 95 (14.4%) patients had a new diagnosis of atrial fibrillation [28.8% patients had a score of ≥ 5], 11.3% of the patients had a score of 0-4 (age and gender adjusted or = 2.29; 95% CI: 1.37-3.82))The predictive specificity of low-risk havoc score for patients without new onset atrial fibrillation was 88.7%In addition, the negative predictive value of low-risk havoc score was 85.1%, the accuracy rate was 78.0%, and the area under the curve was 68.7% (95% CI: 62.1% - 73.3%)< br / >The havoc scoring model needs to be further evaluated before clinical practice is implemented as a routine measurehttps：//article.do ? Id = 70e918844959 < br / > < br / > stroke: bilateral subcortical lesions affect the recovery of swallowing function in patients with ischemic stroke < br / > < br / > after stroke onset, patients usually face dysphagia, and the recovery time of swallowing function is differentRecently, stroke journal published a study to explore the clinical and radiologic prognostic factors affecting the long-term recovery of swallowing function in patients with dysphagia after stroke attack, and established and verified a prognostic model by using machine learning algorithm< br / > < br / > A retrospective study was conducted in 137 patients with acute ischemic stroke who underwent swallowing function testThe dysphagia was monitored six months after stroke onsetThe clinical and radiologic factors affecting swallowing function were analyzed by Kaplan Meier method and Cox regression modelThe patients were divided into two categories: good recovery of swallowing function (6 months without tube feeding or diet adjustment) and poor recovery of swallowing function (6 months tube feeding or diet adjustment)The results showed that 24 patients (17.5%) had persistent dysphagia in the first 6 months, with an average duration of 65.6 daysThe duration of dysphagia after stroke was significantly different due to feeding status, dysphagia degree, gender, high intensity of white matter, bilateral radiation crown / basal ganglia / internal capsule lesions (CR / BG / IC)Among them, Cox regression model analysis showed that tube feeding state (P < 0.001), bilateral Cr / BG / IC lesions (P = 0.001) and clinical dysphagia score (P = 0.042) were important prognostic factors affecting swallowing functionIn addition, the tree network enhanced classifier based on 10 factors (gender, Cr, BG / IC and insular lesions, laterality, anterolateral area of brain stem, bilateral lesions of Cr / BG / IC, high intensity of severe white matter, classification of clinical dysphagia and tube feeding status) stratified the patients, which was more accurate than other benchmark classifiers developed in this study< br / > < br / > this study showed that the severity of dysphagia and bilateral lesions of Cr / BG / IC were important prognostic factors for the recovery of swallowing function at 6 monthsBased on clinical and radiologic factors, Bayesian network model can be used to predict the recovery of swallowing function of patients at 6 monthsIn addition, the researchers emphasized that bilateral subcortical lesions are very important prognostic factors for swallowing function recovery, based on which a long-term swallowing recovery prediction model can be establishedhttps：//article.do ? Id = 7c36188553b5 < br / > < br / > stroke: the high risk characteristic of carotid plaque is the cause of ESUs < br / > < br / > unknown source of embolism (ESUs) accounted for 17% (9% - 25%) of all ischemic strokeIn ESUs patients, the detection rate of ipsilateral mild carotid stenosis (plaque with lumen stenosis < 50%) is close to 40%The etiology of these patients may be atherosclerosis embolismAssessment of < br / > vascular < br / > imaging features of carotid plaques may be important in assessing stroke risk, In particular, plaque hemorrhage, massive lipid rich necrotic core, thin or ruptured fiber cap, asymptomatic embolic infarction, progression, irregular or ulceration, echolucency, neovascularization, inflammation, large marginal hypoechoic area, large plaque volume, microembolic signal and impaired cerebrovascular reserve< br / > < br / > ESUs patients with high-risk plaques may benefit from special interventions to prevent < br / > strokeIn January 2020, Joseph kamtchum tatuene and others from Canada published their systematic review and meta-analysis results on stroke to explore the incidence of mild carotid stenosis with high-risk characteristics in ESUs patients There were 323 patients in 8 studies The prevalence of mild ipsilateral carotid stenosis with high-risk features was 32.5% (95% CI, 25.3 – 40.2) and 4.6% (95% CI, 0.1 – 13.1) in the contralateral carotid artery High risk characteristic plaque: the ratio of ipsilateral vs contralateral was 5.5 (95% CI, 2.5 – 12.0) < br / > < br / > in ESUs patients, the proportion of ipsilateral carotid plaques with high-risk features is 5 times higher than that of the contralateral, suggesting that it is related to stroke risk https：// article.do ? Id = 494f188614ab < br / >? < br / > < br / > does isolated posterior cerebral artery occlusion need recanalization? To answer this question, David strambo and others from Switzerland published their research results on stroke in January 2020 < br / > Among 106 patients with isolated PCA occlusion, 21 received intravascular treatment (13 bridging), 34 received intravenous thrombolysis alone, and 51 received conservative treatment (excluding intravenous thrombolysis) The average age was 76 years old, 47% of them were female, and the average score of NIHSS was 7 The 24-hour complete recanalization rate of intravenous thrombolysis was higher than that of conservative treatment (51% versus 9%; or [95% CI] = 10.62 [2.13 – 52.92]), and that of intravascular treatment was higher than that of optimal medical treatment (conservative treatment and intravenous thrombolysis) (68% versus 34%; or [95% CI] = 4.11 [1.35 – 12.53]) The patients in the intravenous thrombolysis group had a better prognosis rate of disability, vision and cognition than those in the conservative treatment group? 4.52), 2.01 (0.58-7.01), 2.94 (0.35-24.4); similarly, the good prognosis rate of disability, vision and cognition in the intravascular treatment group was higher than that in the best medical treatment group, and the adjers were 1.44 (0.51-4.10), 4.28 (1.00-18.29), 4.37 (0.72-26.53), respectively Intravenous thrombolysis or intravascular therapy did not increase bleeding complications and mortality < br / > < br / > finally, the author thinks that intravenous thrombolysis increases the rate of recanalization, especially the rate of recanalization in intravascular therapy We found a trend in the benefits (disability, visual and cognitive outcomes) of intravenous thrombolysis (vs conservative treatment) and intravascular therapy (vs optimal medical treatment) https：// article.do ? Id = 2643188615ae < br / > Despite the efforts of researchers and pharmaceutical companies, the risk of stroke recurrence is still high It has been proved that aspirin is safe and beneficial to prevent recurrence of stroke, but aspirin can only reduce recurrent vascular events by 20% Previous studies have examined the effect of aspirin combined with clopidogrel on secondary prevention of stroke, but no net benefit has been found due to the high complications of bleeding Recently, studies have found that patients with acute high risk benefit more than aspirin alone < br / > < br / > cilostazol is a selective inhibitor of phosphodiesterase 3, which can increase the activity of camp in cells and thus inhibit platelet aggregation In some ways, the drug is a powerful alternative to aspirin In previous clinical trials and meta-analyses, for example, cilostatin significantly reduced the risk of stroke recurrence and bleeding events compared to aspirin However, previous meta-analysis did not confirm and compare the efficacy of cilostatin alone with that of its combination therapy Therefore, for different clinical conditions, the effect of different treatment measures is not clear Recently published Picasso trials have found that cilostazol has a significant effect on preventing cardiovascular events in patients with previous intracerebral hemorrhage or multiple intracerebral microbleeds Recently, for patients with high-risk ischemic stroke, cilostazol combined with aspirin or clopidogrel can further reduce the number of ischemic events without increasing the risk of bleeding < br / > < br / > based on these results, Seung Min Kim et al From South Korea updated the systematic review and meta-analysis on stroke in December 2019 (added Picasso and CSPS.com To investigate the efficacy and safety of cilostatin in combination with aspirin or clopidogrel in the treatment of stroke < br / > < br / > ten studies were included, five of which were designed as single cilostazol (n = 5429) and the other five as combination therapy (n = 2456) In terms of the relative risk of stroke recurrence, ischemic stroke and composite outcome, cilostazol alone and cilostazol combined therapy were significantly lower than the traditional single antiplatelet therapy (mainly aspirin), and there was no significant heterogeneity The indirect comparison of these three outcomes shows that the combination of cilostazol is better Cilostazol alone had a lower risk of hemorrhagic stroke than the traditional single antiplatelet therapy, and the combination of cilostazol did not increase the risk of hemorrhagic stroke (vs the traditional single antiplatelet therapy) The efficacy and safety of cilostazol is better than that of traditional single antiplatelet therapy (mainly aspirin) Cilostazol treatment can also be adjusted according to the clinical situation, because the drug as a combined treatment can more effectively reduce recurrent and ischemic stroke, but as a single treatment is more beneficial for hemorrhagic stroke https：// article.do ? Id = c76d18862581 < br / >? < br / > < br / > nearly half of the patients with large vessel occlusion (LVO) stroke who underwent endovascular therapy (EVT) remained disability at 90 days The blood pressure after EVT is a parameter easy to modify, which may improve the prognosis of patients < br / >