RESUMO
BACKGROUND: A systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador). METHODS: Participants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association. RESULTS: Out of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (nâ¯=â¯78) or frail (nâ¯=â¯77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (pâ¯=â¯0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate. CONCLUSIONS: This study found no independent relationship between cognitive frailty and LAA burden.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Envelhecimento Cognitivo , Idoso Fragilizado , Fragilidade/epidemiologia , Vida Independente , Arteriosclerose Intracraniana/epidemiologia , Doença Arterial Periférica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral , Envelhecimento Cognitivo/psicologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Equador/epidemiologia , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Fragilidade/psicologia , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Saúde Mental , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Medição de Risco , Fatores de Risco , UltrassonografiaRESUMO
OBJECTIVE: Cerebral small vessel disease (cSVD) and large artery atherosclerosis (LAA) are related to different pathogenetic mechanisms. However, relationships between single biomarkers of cSVD and LAA affecting isolated vascular beds have been reported. Using the Atahualpa Project cohort, we aimed to assess the association between cSVD score categories and LAA burden in community-dwelling older adults. PATIENTS AND METHODS: Atahualpa individuals aged ≥60 years undergoing assessment of the cSVD score and LAA in the peripheral, carotid extracranial, and intracranial vascular beds (n = 333) were included. Multivariate models were fitted to assess independent associations between the cSVD score and LAA burden. RESULTS: The cSVD score was 0 points in 62 % individuals, 1 point in 19 %, 2 points in 13 %, and 3-4 points in 7 %. LAA involved the extracranial carotid bed in 43 % individuals, the intracranial bed in 36 %, and the peripheral bed in 20 %. One vascular bed was involved in 111 (33 %) individuals, two beds in 75 (23 %), and three beds in 23 (7 %). The remaining 124 (37 %) had no atherosclerosis. Ordinal logistic regression models showed progressively greater associations between higher categories of cSVD score and the odds of having more beds involved with LAA. Multinomial logistic regression models showed associations between categories of cSVD score and LAA burden, but only when two or three vascular beds were involved. CONCLUSION: This study demonstrates robust associations between the cSVD score and LAA, which become evident at the upper end of the spectrum of cSVD score (3-4 points) and LAA burden (2-3 vascular beds involved).
Assuntos
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Circulação Cerebrovascular , Estudos de Coortes , Efeitos Psicossociais da Doença , Equador/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Fatores de Risco , UltrassonografiaRESUMO
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. METHODS: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. RESULTS: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. CONCLUSION: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.
Assuntos
Arteriosclerose Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/epidemiologia , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologiaRESUMO
ABSTRACT The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Conclusion: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.
RESUMO O objetivo do presente estudo é analisar a taxa de recorrência a longo prazo em pacientes com o primeiro AVCi secundário à aterosclerose de grande artéria intracraniana em uma amostra brasileira. Métodos: Pacientes admitidos entre outubro de 2012 e setembro de 2015 foram analisados. Os subtipos do mecanismo de AVC foram classificados como cardioembolismo, aterosclerose de grandes artérias, oclusão de pequenos vasos, outras etiologias determinadas e AVCi de causa indeterminada. Resultados: Foram avaliados 359 pacientes com primeiro AVCi. O tempo médio de seguimento foi de 21,6 ± 15,1 meses. A aterosclerose de grande artéria, intracraniana (38,9%) e extracraniana (24,6%), apresentou a maior taxa de recorrência. A aterosclerose de grande artéria intracraniana [HR, 10,2 (3,6-29,1); p < 0,001] e extracraniana [HR, 5,05 (1,79-14,2); p = 0,002] demonstraram correlação positiva com a taxa de recorrência, após o ajuste para fatores de risco, trombólise e gravidade dos sintomas na admissão. Conclusão: A aterosclerose de grande artéria, tanto intracraniana como extracraniana, apresenta maior recorrência comparado aos outros mecanismos de AVCi em uma amostra do Sul do Brasil.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Arteriosclerose Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Recidiva , Brasil/epidemiologia , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/fisiopatologia , Arteriosclerose Intracraniana/epidemiologia , Incidência , Fatores de Risco , Seguimentos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/epidemiologiaRESUMO
INTRODUCTION: Carotid siphon calcifications (CSC) are an important imaging marker of systemic atherosclerosis. Routine assessment of asymptomatic CSC may allow the implementation of intervention strategies before catastrophic cerebrovascular events occur. AIM: To assess whether brachial PP determinations might independently predicts the presence and severity of CSC in community-dwelling adults. METHODS: All Atahualpa residents aged ≥40 years were invited for the practice of a non-enhanced CT scan of the head, and those who signed the informed consent and had no contraindications for this exam were enrolled. The brachial PP was calculated by subtracting the mean diastolic pressure from the mean systolic pressure obtained from three different readings with individuals in the sitting position. RESULTS: Of 830 eligible candidates, 663 (80%) were included. The mean brachial PP was 56.4 ± 19.9 mmHg; 182 persons (27.4%) had PP levels >65 mmHg. CT revealed Grade 1 CSC in 356 (54%), Grade 2 in 141 (21%), Grade 3 in 128 (19%), and Grade 4 in 38 (6%) subjects. Predictive margins of PP (delta method) were significantly lower in individuals with Grade 1 CSC than in the other groups. In the best adjusted linear model, PP levels increased up to 11.7 mmHg as the severity of CSC increased (ß 11.71; 95% C.I. 5.36-18.08: p < 0.001). CONCLUSION: This study provides evidence on the relationship between brachial PP levels and intracranial atherosclerosis. Calculation of the PP may be used for detecting candidates for CT screening, reducing costs during population-based surveys, particularly in remote areas.
Assuntos
Pressão Sanguínea , Artéria Braquial/fisiopatologia , Doenças das Artérias Carótidas/fisiopatologia , Arteriosclerose Intracraniana/fisiopatologia , Calcificação Vascular/fisiopatologia , Adulto , Idoso , Artéria Braquial/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Angiografia Cerebral/métodos , Distribuição de Qui-Quadrado , Angiografia por Tomografia Computadorizada , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologiaRESUMO
BACKGROUND: The investigation of ischemic stroke etiology is commonly limited to the heart and extracranial vessels. Nevertheless, the diagnosis of intracranial stenosis may carry important therapeutic implications. The aims of this study were to determine the prevalence and clinical predictors of intracranial atherosclerotic stenosis (ICAS) in a sample of patients with ischemic stroke. METHODS: Consecutive patients admitted to a university-based outpatient stroke clinic underwent CT angiography of the intracranial and extracranial brain vessels. Clinical, demographic, and laboratory characteristics were compared between patients with increasing levels of stenosis. Ankle-brachial index (ABI) was measured to quantify peripheral arterial disease, defined as an ABI less than or equal to .9. Multivariable ordinal logistic regression was constructed to predict increasing stenosis grades (none, 1%-49%-mild, 50%-69%-moderate, 70%-100%-severe). RESULTS: We studied 106 subjects, mean age 62 ± 15 years, 54% female. ICAS was present in 38 (36%) patients: 19 (50%) mild, 7 (18%) moderate, and 12 (32%) severe. Of 74 patients where ABI was measured, low ABI was found more frequently with increasing ICAS severity (26%, 42%, 67%, and 89% of patients with none, mild, moderate, and severe ICAS, respectively). In univariable analysis, higher age, presence of diabetes, abdominal obesity, and low ABI correlated with increasing stenosis grades. In multivariable analysis, only low ABI remained independently associated with increasing stenosis grades. CONCLUSIONS: The ABI is independently associated with increasing severity of ICAS, making it a potentially useful triaging tool for more invasive test selection.
Assuntos
Índice Tornozelo-Braço , Isquemia Encefálica/epidemiologia , Arteriosclerose Intracraniana/diagnóstico , Doença Arterial Periférica/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Brasil/epidemiologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Estudos Transversais , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Arteriosclerose Intracraniana/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ambulatório Hospitalar , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologiaRESUMO
IMPORTANCE: Limited data exist regarding the natural history of proximal intracranial arterial occlusions. OBJECTIVE To investigate the outcomes of patients who had an acute ischemic stroke attributed to an anterior circulation proximal intracranial arterial occlusion. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study at 2 university-based hospitals from 2003 to 2005 in which nonenhanced computed tomography scans and computed tomography angiograms were obtained at admission of all adult patients suspected of having an ischemic stroke in the first 24 hours of symptom onset. EXPOSURE: Anterior circulation proximal intracranial arterial occlusion. MAIN OUTCOMES AND MEASURES: Frequency of good outcome (defined as a modified Rankin Scale score of ≤ 2) and mortality at 6 months. RESULTS: A total of 126 patients with a unilateral complete occlusion of the intracranial internal carotid artery (ICA; 26 patients: median National Institutes of Health Stroke Scale [NIHSS] score, 11 [interquartile range, 5-17]), of the M1 segment of the middle cerebral artery (MCA; 52 patients: median NIHSS score, 13 [interquartile range, 6-16]), or of the M2 segment of the MCA (48 patients: median NIHSS score, 7 [interquartile range, 4-15]) were included. Of these 3 groups of patients, 10 (38.5%), 20 (38.5%), and 26 (54.2%) with ICA, MCA-M1, and MCA-M2 occlusions, respectively, achieved a modified Rankin Scale score of 2 or less, and 6 (23.1%), 12 (23.1%), and 10 (20.8%) were dead at 6 months. Worse outcomes were seen in patients with a baseline NIHSS score of 10 or higher, with a modified Rankin Scale score of 2 or less achieved in only 7.1% (1 of 14), 23.5% (8 of 34), and 22.7% (5 of 22) of patients and mortality rates of 35.7% (5 of 14), 32.4% (11 of 34), and 40.9% (9 of 22) among patients with ICA, MCA-M1, and MCA-M2 occlusions, respectively. Age (odds ratio, 0.94 [95% CI, 0.91-0.98]), NIHSS score (odds ratio, 0.73 [95% CI, 0.64-0.83]), and strength of leptomeningeal collaterals (odds ratio, 2.37 [95% CI, 1.08-5.20]) were independently associated with outcome, whereas the level of proximal intracranial arterial occlusion (ICA vs MCA-M1 vs MCA-M2) was not. CONCLUSIONS AND RELEVANCE: The natural history of proximal intracranial arterial occlusion is variable, with poor outcomes overall. Stroke severity and collateral flow appear to be more important than the level of proximal intracranial arterial occlusion in determining outcomes. Our results provide useful data for proper patient selection and sample size calculations in the design of new clinical trials aimed at recanalization therapies.
Assuntos
Angiografia Cerebral , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral/métodos , Estudos de Coortes , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Arteriosclerose Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Acidente Vascular Cerebral/terapia , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X/métodosRESUMO
Stroke is a leading cause of mortality and disability in Brazil. Among the risk factors for cerebrovascular disease, some have more influence than others in certain stroke subtypes. Little data are available in the literature on the prevalence of stroke subtypes in Latin America. We analyzed data from 688 patients with acute ischemic stroke (52.3% women; mean age, 65.7 years) who were enrolled in a stroke data bank. Standardized data assessment and stroke subtype classification were used. The most common stroke subtype was large-artery atherosclerosis (n = 223; 32.4%), followed by cardioembolism (n = 195; 28.3%), and microangiopathy (n = 127; 18.5%). Stroke risk factors differ among stroke subtypes. The population of South America is ethnically diverse, and few previous studies have describe the distribution of risk factors among stroke subtypes in this population. In this study, the most important risk factors were hypertension and dyslipidemia.
Assuntos
Acidente Vascular Cerebral/epidemiologia , Idoso , Brasil/epidemiologia , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Distribuição de Qui-Quadrado , Dislipidemias/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertensão/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnósticoRESUMO
OBJECTIVE: To describe the prevalence and the types of cerebrovascular diseases (CVDs) in autopsied elderly individuals. METHOD: Consecutive clinical charts and neuropathological reports of 242 patients aged 61 years or older were reviewed. The patients died in Hospital das Clínicas, Federal University of Minas Gerais, in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997. RESULTS: The prevalent diseases of the central nervous system (CNS) found in decreasing order were: CVDs (71.9%), infections (12.4%), neoplasms (7.1%), head trauma (3.7%), nutritional diseases (2.5%) and degenerative diseases (1.7%). The most common CVDs were cerebral atherosclerosis (61.2%), hypertensive cerebrovascular disease (25.6%) and cerebral infarct (14.9%). There was an increase in prevalence and severity of atherosclerosis and an increase in prevalence of hypertensive cerebrovascular disease with advancing age. A significant association between hypertensive cerebrovascular disease and atherosclerosis was found. The CVDs patients had clinical stroke and this was the direct cause of death in 42,7% and 17,3% of the cases, respectively. CONCLUSION: The CVDs were the most prevalent group of diseases of the CNS in elderly patients. Atherosclerosis and hypertensive cerebrovascular disease were the most common CVDs, and its prevalence increased with advancing age. Hypertensive cerebrovascular disease was significantly associated with atherosclerosis.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Autopsia , Brasil/epidemiologia , Infarto Cerebral/epidemiologia , Feminino , Humanos , Arteriosclerose Intracraniana/epidemiologia , Hipertensão Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por SexoRESUMO
OBJECTIVE: We made a study of the 79 patients who were discharged from the Instituto Nacional de Neurología (La Havana, Cuba) during 1998, with the diagnosis of cerebral infarct, with the objective of analysing their behavior. PATIENTS AND METHODS: In this analysis we considered: the previous clinical history of factors and illnesses of risk, the certainty of the diagnosis in the emergency room, presenting symptoms, clinical signs, vascular territory, etiopathogenic category and results of cranial computerized axial tomography (CAT). RESULTS AND CONCLUSIONS: Arterial hypertension, smoking, cerebrovascular disease and ischemic cardiopathy were the commonest clinical features seen. There was close agreement between the diagnosis made in the emergency room and the final diagnosis. The presenting symptoms and clinical signs found in these patients were related to the vascular territory and motor involvement was the most constant. There was predominance of the carotid territory, especially of the left side. We also found predominance of atherothrombotic etiopathogenesis, with fewer cardio-embolic or unknown causes. There were few abnormal cranial CAT findings in patients with lacunar infarcts or infarcts localized to the posterior territory.
Assuntos
Encéfalo , Infarto Cerebral/diagnóstico , Infarto Cerebral/reabilitação , Alta do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atrofia/patologia , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Área Programática de Saúde , Infarto Cerebral/epidemiologia , Cuba/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Fumar/epidemiologia , Tomografia Computadorizada por Raios XAssuntos
Círculo Arterial do Cérebro , Arteriosclerose Intracraniana/epidemiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
The incidence of atherosclerosis of the Circle of Willis was evaluated in a study of 100 unselected autopsy cases at the University Hospital of the West Indies. Atheroma was observed in 46 cases. Males were affected slightly more than females. Cerebral atherochlerosis was commonly associated with diabetes mellitus and hypertension. Comparisons are made with the findings in studies conducted elsewhere (AU)