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Abstract For Stroke Research
I am currently doing stroke research and here is a poster abstract about my project.
Date : 09/03/2020
Author Information
Uploaded by : Alexander
Uploaded on : 09/03/2020
Subject : Medicine
Background Ischaemic stroke is a major global health issue. We constructed a database including stenoses across arteries in the cerebral circulation with their severity and distribution included. We aim to explore the differences of prognosis in patients from different subgroups described below and investigate the role of collateralisation and anatomical aberrances in the cerebrovascular system. Preliminary results of this ongoing study are presented. Aims and Objectives This study aims to investigate prognostic variations across patient subgroups (Significant LAD versus non-significant LAD& significant intracranial arterial stenoses [ICAS] only, significant extracranial arterial stenoses [ECAS] only and both) through analysing their cardiovascular-related factors. Anatomical aberrances, collateralisation behaviour and stenotic distribution are also considered. Methods This retrospective study utilises a cohort of 1004 patients recruited from Queen Mary Hospital admitted with cerebrovascular symptoms. Magnetic resonance angiography (MRA) images of the Circle of Willis and neck arteries are examined for any signs of focal narrowing, abnormal anatomy and cessation of flow. Stenoses are classified according to the NASCET Criteria into four grades (0-49%, 50%-69%, 70%-99% and 100%, aka occlusion). Significant LAD is defined as bearing stenosis >& 50% in any artery analysed. Diffusion-weighted imaging (DWI) identifies patients with symptomatic lesions. DWI+ lesions are defined as any region of hyperintensity larger than 15mm across its longest diameter. Arterial Spin Labelling (ASL) is utilised for the functionality assessment of collateralisation. The primary outcome is major adverse cardiovascular/cerebrovascular events (MACE), defined as an all-composite score including all-cause mortality, cardiovascular mortality, recurrent stroke, acute coronary events, new-onset revascularisation, new-onset peripheral vascular disease and congestive heart failure. It is compared across the following subgroups: significant LAD versus non-significant LAD, and patients with ICAS only, ECAS only and both. Secondary outcomes include variations in stenotic distributions, anatomical aberrances and collateralisation efficacy. Conclusions and Preliminary Results The cohort includes 1004 (valid=947) patients during the period 2010-2014. According to preliminary results, 505 (53.3%) patients are found to have significant LAD, whereas 427 (46.7%), without. 193 (20.4%) patients have ICAS only, while 166 (17.5%) have ECAS only. 145 (15.3%) have both ICAS and ECAS. 95 (10.0%) patients are identified with total occlusion(s). Patients with significant LAD have higher MACE than those without (n=111 vs 76, 22.0% vs 17.2%, p=0.37). Patients with both ICAS and ECAS have higher MACE than those with ECAS only and ICAS only (26.2% vs 23.3% vs 16.8%, p=0.37). The right Middle Cerebral Artery (MCA) is found to be the most affected intracranial artery (n=72& 14.3%) in the cohort whereas the right Vertebral Artery is the most affected extracranial artery (n=79, 15.6%) in the cohort. Anatomical aberrances including artery of Percheron (n=1) and vertebrobasilar dolichoectasia (n=9) have also been identified. Following this, variations in MACE, cardiovascular-related mortality and all-cause mortality in patients with specific arterial disease (e.g. right MCA significant stenosis) will be compared to the aforementioned subgroups. Collateralisation is also our major consideration. However, reviewing the prognostic implication of anatomical aberrances requires validation by a larger cohort.
This resource was uploaded by: Alexander