Research Talk - Yan Hou - Hartford Hospital

October 27, 2021

ID7086

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00:00From Hartford, Ala.
00:21OK, good afternoon.
00:22So can you see my screen yes
00:26alright perfect so let me.
00:32OK, so many of the young,
00:35so I was a spirit stroke
00:38night fellow last year.
00:40Today I'm very happy to talk about my
00:44research in young patients with the issues.
00:48So the title of my presentation
00:50today is a potential embolic
00:53sources differ in patients with
00:56embolic stroke of undetermined
00:58source according to age.
01:02And so the term embolic stroke
01:05of and determine the source
01:08issues was introduced by issues
01:11international working Group in 2014.
01:15So as we know issues refers to non
01:19lacunar infarct without extra or intra
01:23cranial actress chlorosis causing
01:26greater than 50% stenosis in the
01:29arteries supplying the ischemic region.
01:32Uh, no major cardioembolic source and
01:35no other specific cause of a stroke.
01:38So about 17 of ischemic stroke meet
01:43the criteria of issues and issues
01:47is associated with the yearly
01:50stroke recurrence rate of about 5%.
01:53Uhm, so in patient with the E
01:57feels the causal embolic source,
02:00such as a true fibrillation or high grade.
02:03Crowded stenosis are not identified
02:07after initial standard evaluation,
02:10so, but there are various potential
02:14embolic source as known as TS,
02:18so the key is identified in
02:22previous study included.
02:23Atrial cardiopathy AHO fibrillation,
02:27flutter,
02:28or arrhythmia detected during the follow
02:31up so left ventricular dysfunction,
02:35cardiac valvular disease,
02:38patent frame over or septal aneurysm,
02:43and arterial disease with the next
02:48nautik proximal arterial plaque.
02:51So in stroke patients with mean.
02:54Mean age of 65 years old who were
02:58enrolled to navigate easiest trial.
03:01So the three most common PS or
03:05atrial cardiopathy left ventricular
03:08dysfunction and arterial disease.
03:11Uhm,
03:12so uh Ian Young patients on the
03:16potential and body sores of issues
03:20and the associated risk of stroke
03:24recurrence were not well studied,
03:26so we assume the rate of P as
03:29and associated stroke recurrence
03:31in young patient with the issues
03:35differ from that in older patients.
03:38So by doing the study we try to.
03:42Identify a high prevalent PS and PS
03:47associated with high risk of a stroke
03:51recurrence in young patients with the
03:54issues so which may guide secondary
03:58provision in that group of patients.
04:02And so we did a retrospective cohort study.
04:08So the young patients with issues
04:11at age of 18 to 49 year old and the
04:16meeting to have her hospital from 20
04:20from 2006 to 2019 were identified and
04:24each young patient were matched with
04:28an older issues patient at age of
04:345299 year old. My admission date so
04:37the patients were followed after
04:40discharge for a median of three years.
04:46Uhm, so according to the
04:49guidelines on proposed by American
04:52Stroke Association in 2019,
04:54so in our study we diagnosis,
04:58we diagnose issues after
05:00negative initial evaluation,
05:03which included twelve leads,
05:05EKG at least 24 hour ECG monitoring,
05:11Pte MRA head and neck, and.
05:16So patients who are
05:19younger than 55 years old?
05:21Uh, they need to have a negative.
05:26Fedia screening, so we excluded patients
05:29with a history of cancer who may have a
05:35hypercoagulable state from malignancy.
05:39So, uh, we did Trump reveal of the
05:44test reports and images to identify
05:47individual PS and account numbers.
05:51Also, PS for each patient and we
05:54so collected data off of baseline
05:58characteristics and clinical
06:00characteristics and the stroke recurrence.
06:04So the comparisons in young and
06:07older patient with issues were
06:10performed by chisquare test.
06:15So, uh, we identified 85
06:18young patients with issues,
06:21and those patients were matched
06:24with 84 older patients with issues.
06:28And so the mean age of young
06:31and older issues patients,
06:33or 39 and 74 years old respectively.
06:38The young issues patients are
06:40more women and non Caucasian
06:43as compared to other issues.
06:45Patient, a better this trend didn't
06:48reach statistical significance,
06:50so as compared to older patients
06:53on the young patients with issues
06:55had lower rates of hypertension,
06:57hyperlipidemia and diabetes.
06:59However, the rate of active smoking
07:03with a similar in young and
07:06older patients with issues. Uhm?
07:11So uhm, the initial and nitric war,
07:14as well as the rate of a large vessel
07:17occlusion or similar in young and
07:20older patients with issues about 60 to
07:2465% of young or older patients with issues,
07:29had a low energy for less than six,
07:32but about 20% of young or
07:36older issues patients,
07:37so they have high score
07:40above 10 and suffered.
07:41Run large vessel occlusion so more young
07:46patients up about 70% or discharge
07:49home as compared to older patients and
07:53more patients up about 80 most patient,
07:58about 80 to 90% of both young
08:02and older patients with issues,
08:05so they were treated with
08:08antiplatelet and stroke prevention.
08:12So the rate of stroke recurrence during
08:15the first year after the initial stroke
08:18with two point 7% in young issues,
08:22patients as compared to older issues.
08:25Patients who had a rate of recurrence
08:30stroke of a 6.3% after one year
08:33and after a median of a three year
08:37follow up on the stroke recurrence
08:40rate in young patients.
08:42Was 4.1% as compared to 11.4% in order
08:49issue station so the rate of stroke
08:53recurrence with lowering young issues
08:56patients as compared to older patients.
08:59However,
09:00the difference approached but it did
09:04not reach statistical significance.
09:07So this table shows the rate of each
09:11individual PS and multiple PS in
09:15young and older patients with issues.
09:18So in order issues patient so we
09:22can see the three most common P
09:26eyes or atrial cardiopathy and
09:31left ventricular dysfunction and
09:34the arterial disease.
09:37Uh,
09:38so about 17% of the older issues
09:42patients had three or more PS
09:45identified and in young issues patients.
09:49So the PFO was the only common TS and
09:53the so the rate of other pies was with low,
09:58about 2 to 7%,
10:00so none of the young patients with
10:03issues I had three or more PS about
10:071/3 of the young issues patient.
10:09Uh, so they have no P as identified.
10:14Uhm so.
10:15Uh,
10:15this table shows the rate of a stroke
10:19recurrence by individual RTS and multiple PS.
10:24And then we can see.
10:26So during a median of three year
10:30follow up about 1/3 of other issues.
10:33Patients with the three or more
10:37PS identified they had recurrent
10:40stroke and among individual PS
10:44about 1/4 of other issues.
10:46Patients with a sub and 1/5 of other issues
10:51patient with the actual cardiopathy.
10:55Uh,
10:55so they had recurrent stroke,
10:58so in young patients.
11:02Only three patients had recurrent stroke.
11:06Uh, after the discharge.
11:08UM, so two of them,
11:11so they had PFO without closure
11:14and one one patient had.
11:18A cardiac or valvular disease.
11:21So, uhm. So basically, UM,
11:26as compared to the older patient
11:29with issues so in our study we
11:32found a young patients with issues,
11:35so they had a lower rate of PS and.
11:41Lower rate alpha T as overlapping,
11:44so the PPFO is the the only common key,
11:49as in young patient with issues
11:52uh and the rate of other PS is
11:56low 1/3 of young issues patient
11:58they don't have any PS identified.
12:02So the recurrence rate of stroke
12:06in young patients A is pretty low.
12:10However,
12:10we were unable to assess the
12:14association of individual PS
12:16and risk of stroke recurrence.
12:21Due to the overall low rate
12:24up and the small sample size,
12:26so there were no recurrent stroke in
12:31patients in young patient with issues
12:36who didn't have any PS identified.
12:40Uhm? Sorry.
12:43So, uhm, so for young patient with issues.
12:47UM, given the low rate of PS,
12:51except for the PFO.
12:53So other hypothetical causes
12:57may include unknown.
13:01In Malik's wars,
13:02which cannot be identified by
13:05current imaging or testing,
13:06or there's a iansiti Rambo sis do too.
13:12KIRO Wall abnormality.
13:14Or maybe there's a transient
13:17hypercoagulable state or a little spasm.
13:20Those can be the potential cost
13:24of issues in young and so this
13:28fight the source of the scramble
13:32and bolik stroke right now in
13:36young still remain unclear,
13:38but then according to our study if no PS.
13:42Was identified,
13:43then the risk of having
13:46recurrent stroke is very low.
13:49Uhm,
13:49so our study is a first study to identify,
13:55try to identify the TS and
13:58its associated risk of having
14:00recurrent stroke in young patients.
14:04However,
14:04it's a retrospective study and
14:08then by reveal the record in a
14:12single center over 10 years.
14:15So there's a limitation such as.
14:19Incomplete record and lots of follow up.
14:23Uhm, so uh?
14:25And so those further radios the sample size.
14:31So in the future?
14:32Uhm,
14:33so prospective multicenter study is
14:37needed to identify new and possible
14:42causal PS4 young patient with the issues.
14:46Uhm, so which may help to
14:50guide secondary prevention?
14:52Uhm,
14:52and so in our study we found
14:57about 20% of our young issues.
15:00Patient had a large vessel
15:02occlusion and half of them didn't
15:05have any peas identified,
15:07so the cloud analysis and may
15:10help to a size if the thrombus is
15:14cardiogenic versus arterial genic uhm?
15:21So here I wanna say thank you
15:23to doctor UM water corner and
15:26then uh that's all I have.
15:29Thank you, uh,
15:31so much John suggestions or questions.
15:36Thank you so much again,
15:39I I don't see any questions in the chat box.
15:42Sometimes small dissections.
15:44They're not picked up on CTA's and
15:47you know if you don't do an MRA
15:49WhatsApp with fat suppressed images,
15:51you won't diagnose it.
15:53So add add dissection.
15:56The potential causes of easis and
16:00young patients and other such.
16:03The suggestion is you know
16:05we do have a lot of.
16:07Data and our database.
16:09So if you'd like to validate your
16:12findings so speeds reach out and
16:14we're happy to work together.
16:17And thank you so much.
16:18This was very informative and
16:20I will share my slides because
16:23I'm giving the next.