Background: Leptin, one of the most alleged adipokines, is a key regulator of energy balance and ... more Background: Leptin, one of the most alleged adipokines, is a key regulator of energy balance and body weight. Leptin exerts its tissue protective effect in ischemic injuries via anti-apoptotic mechanisms. However, few studies have elaborated on the association between leptin and tissue damages in intracerebral hemorrhage (ICH). Methods: We induced ICH in ICR mice via the infusion of collagenase, and recombinant leptin or PBS was administered intraperitoneally. To determine the effects of leptin deficiency, ICH-induction was done in wild-type (WT) or leptin-deficient Lep ob /Lep ob ( ob/ob ) mice. Brain water content, reflecting peri-hematomal edema, and hemorrhage volume were measured at 72 hours. The number of inflammatory cells (OX6-positive cells) was measured at 48 hours, and western blotting was performed at 24 hours. To identify the role of STAT3, a phosphorylated-STAT3 (pSTAT3) inhibitor, NCS74859 , was administered after inducing ICH in hyperleptinemic mice. To localize the ...
Background Although the effect of blood pressure on poststroke outcome is well recognized, the lo... more Background Although the effect of blood pressure on poststroke outcome is well recognized, the long‐term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group‐based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all‐cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group , SBPs decreased from 182 to 135 mm Hg ...
BackgroundPreclinical data suggest circadian variation in ischemic stroke progression, with more ... more BackgroundPreclinical data suggest circadian variation in ischemic stroke progression, with more active cell death and infarct growth in rodent models with inactive phase (daytime) than active phase (nighttime) stroke onset. We aimed to examine the association of stroke onset time with presenting severity, early neurological deterioration (END), and long-term functional outcome in human ischemic stroke.Methods and findingsIn a Korean nationwide multicenter observational cohort study from May 2011 to July 2020, we assessed circadian effects on initial stroke severity (National Institutes of Health Stroke Scale [NIHSS] score at admission), END, and favorable functional outcome (3-month modified Rankin Scale [mRS] score 0 to 2 versus 3 to 6). We included 17,461 consecutive patients with witnessed ischemic stroke within 6 hours of onset. Stroke onset time was divided into 2 groups (day-onset [06:00 to 18:00] versus night-onset [18:00 to 06:00]) and into 6 groups by 4-hour intervals. We ...
Background and purpose: Warfarin is one of the most important prevention drugs against ischemic s... more Background and purpose: Warfarin is one of the most important prevention drugs against ischemic stroke. Factors influencing on warfarin adherence in patients with atrial fibrillation have been investigated. However, few studies have elaborated on the significance and related factors of warfarin adherence in patients with ischemic stroke or transient ischemic attack (TIA). Methods: A total of 46,219 patients with ischemic stroke or TIA were enrolled from October 2007 through December 2011 in Clinical Research Center for Stroke as a nationwide project in Korea. The morality information of all patients was based on computerized searches of death certificate data from the “Statistics Korea” of the Korean National Statistical Office, and the whole drug information was obtained from the Health Insurance Review Assessment and Review Service in Korea. Among them, warfarin was prescribed for 5,660 patients over 6 months. Warfarin adherence was defined as % adherence = (n of days’ supply) / (...
Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therap... more Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods— Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4–15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results— Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significan...
Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therap... more Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel-aspirin to that of aspirin monotherapy in patients with acute minor cerebral ischemia using a prospective, nationwide, multicenter, stroke registry database in South Korea. Methods— CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events)-like patients who met eligibility criteria modeled on the CHANCE trial eligibility criteria, including (1) acute minor ischemic stroke defined as National Institutes of Health Stroke Scale score ≤3 or lesion positive transient ischemic attack within 24 hours of onset and (2) noncardioembolic stroke mechanism. Propensity scores using the inverse probability of treatment weighting was used to adjust for baseline imbalances. The primary outcome was the composite of all stroke (ischemic and hemorrhagic), myocardial infarction, and vascular death by 3 months. Results— Among 5590 patients meeting the e...
Background White matter hyperintensities ( WMHs ) are commonly asymmetric between hemispheres but... more Background White matter hyperintensities ( WMHs ) are commonly asymmetric between hemispheres but for unknown reasons. We investigated asymmetric WMHs associated with lacunar infarcts. Methods and Results A total of 267 consecutive patients with small first‐ever supratentorial infarcts (≤20 mm) were included. None had a relevant vascular stenosis. WMH asymmetry was measured based on the hemispheric difference of a modified Scheltens scale score (≥3 defined as asymmetric). We analyzed the association of the hemispheric WMH asymmetry with old silent lacunar infarcts or acute lacunar infarcts. We compared lesion frequency maps between groups and generated t‐statistics maps. The mean age of patients was 64 years, and 63% were men. Asymmetric WMH was more than 3‐fold as frequent ( P <0.001) in the group with old silent lacunar infarcts (42%, 43/102) than in the group without old silent lacunar infarcts (15%, 24/165). In patients with left hemispheric dominance of WMHs , an acute lacun...
Cerebral vascular territories are of key clinical importance in patients with stroke, but availab... more Cerebral vascular territories are of key clinical importance in patients with stroke, but available maps are highly variable and based on prior studies with small sample sizes. To update and improve the state of knowledge on the supratentorial vascular supply to the brain by using the natural experiment of large artery infarcts and to map out the variable anatomy of the anterior, middle, and posterior cerebral artery (ACA, MCA, and PCA) territories. In this cross-sectional study, digital maps of supratentorial infarcts were generated using diffusion-weighted magnetic resonance imaging (MRI) of 1160 patients with acute (<1-week) stroke recruited (May 2011 to February 2013) consecutively from 11 Korean stroke centers. All had supratentorial infarction associated with significant stenosis or occlusion of 1 of 3 large supratentorial cerebral arteries but with patent intracranial or extracranial carotid arteries. Data were analyzed between February 2016 and August 2017. The 3 vascular...
Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiab... more Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevate...
This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of is... more This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondar...
Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent st... more Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent card...
plaque, even if the animals remained on a high fat diet and plaque growth was not attenuated. 5 T... more plaque, even if the animals remained on a high fat diet and plaque growth was not attenuated. 5 The study suggested that circulating adiponectin and soluble vascular cell adhesion molecule-1 (sVCAM-1) might be related to the reduced MMP activity in atheromas, but the mechanisms for this effect were not known. The present study aims to address the mechanisms leading to this observation, relating the MMP-modulating effect of diet and exercise to cytokine homeostasis. We also considered body mass and visceral fat amount, which could be affected by diet and exercise, and ultimately contribute to obesity-related re-A theromatous matrix metalloproteinase (MMP) activity is related to plaque vulnerability and rupture, the final common pathway for the thromboembolic complications of atherosclerosis, such as ischemic stroke or myocardial infarction. 1-4 Identifying the principal factors that affect atheromatous MMP activity may help predict and prevent these events. Using an MMP-activatable protease reporter, we previously described that 10-weeks of treadmill exercise reduced in vivo atheromatous MMP-2/9 activity in Apolipoprotein-E (ApoE) knockout (ApoE −/−) mice with pre-existing
Several models have been developed to predict the risk of symptomatic intracranial hemorrhage (SI... more Several models have been developed to predict the risk of symptomatic intracranial hemorrhage (SICH) and functional outcome in patients treated with intravenous tissue plasminogen activator (IV-TPA). Although a more complex model provides more precise estimates, its application to a practice setting requiring emergent decision and swift treatment is limited. 1-10 Among numerous clinical and imaging variables, age and stroke severity are immediately accessible and powerful predictors of SICH risk and functional outcome after IV-TPA treatment. We aimed to provide simple estimates of SICH risk and good functional outcome, based on the patients' age and initial National Institute of Health Stroke Scale (NIHSS) score.
Cerebrovascular diseases (Basel, Switzerland), Jan 21, 2017
The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstra... more The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios...
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 15, 2017
Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits i... more Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorab...
The aim of the study was to assessed the impact of short-term exposure to air pollution on ischem... more The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Particulate matter <10 μm and SO2 concentrations were independ...
Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imag... more Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis sho...
We compared baseline characteristics and outcomes at 3 months between patients with minor anterio... more We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.0...
Background: Leptin, one of the most alleged adipokines, is a key regulator of energy balance and ... more Background: Leptin, one of the most alleged adipokines, is a key regulator of energy balance and body weight. Leptin exerts its tissue protective effect in ischemic injuries via anti-apoptotic mechanisms. However, few studies have elaborated on the association between leptin and tissue damages in intracerebral hemorrhage (ICH). Methods: We induced ICH in ICR mice via the infusion of collagenase, and recombinant leptin or PBS was administered intraperitoneally. To determine the effects of leptin deficiency, ICH-induction was done in wild-type (WT) or leptin-deficient Lep ob /Lep ob ( ob/ob ) mice. Brain water content, reflecting peri-hematomal edema, and hemorrhage volume were measured at 72 hours. The number of inflammatory cells (OX6-positive cells) was measured at 48 hours, and western blotting was performed at 24 hours. To identify the role of STAT3, a phosphorylated-STAT3 (pSTAT3) inhibitor, NCS74859 , was administered after inducing ICH in hyperleptinemic mice. To localize the ...
Background Although the effect of blood pressure on poststroke outcome is well recognized, the lo... more Background Although the effect of blood pressure on poststroke outcome is well recognized, the long‐term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group‐based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all‐cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group , SBPs decreased from 182 to 135 mm Hg ...
BackgroundPreclinical data suggest circadian variation in ischemic stroke progression, with more ... more BackgroundPreclinical data suggest circadian variation in ischemic stroke progression, with more active cell death and infarct growth in rodent models with inactive phase (daytime) than active phase (nighttime) stroke onset. We aimed to examine the association of stroke onset time with presenting severity, early neurological deterioration (END), and long-term functional outcome in human ischemic stroke.Methods and findingsIn a Korean nationwide multicenter observational cohort study from May 2011 to July 2020, we assessed circadian effects on initial stroke severity (National Institutes of Health Stroke Scale [NIHSS] score at admission), END, and favorable functional outcome (3-month modified Rankin Scale [mRS] score 0 to 2 versus 3 to 6). We included 17,461 consecutive patients with witnessed ischemic stroke within 6 hours of onset. Stroke onset time was divided into 2 groups (day-onset [06:00 to 18:00] versus night-onset [18:00 to 06:00]) and into 6 groups by 4-hour intervals. We ...
Background and purpose: Warfarin is one of the most important prevention drugs against ischemic s... more Background and purpose: Warfarin is one of the most important prevention drugs against ischemic stroke. Factors influencing on warfarin adherence in patients with atrial fibrillation have been investigated. However, few studies have elaborated on the significance and related factors of warfarin adherence in patients with ischemic stroke or transient ischemic attack (TIA). Methods: A total of 46,219 patients with ischemic stroke or TIA were enrolled from October 2007 through December 2011 in Clinical Research Center for Stroke as a nationwide project in Korea. The morality information of all patients was based on computerized searches of death certificate data from the “Statistics Korea” of the Korean National Statistical Office, and the whole drug information was obtained from the Health Insurance Review Assessment and Review Service in Korea. Among them, warfarin was prescribed for 5,660 patients over 6 months. Warfarin adherence was defined as % adherence = (n of days’ supply) / (...
Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therap... more Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods— Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4–15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results— Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significan...
Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therap... more Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel-aspirin to that of aspirin monotherapy in patients with acute minor cerebral ischemia using a prospective, nationwide, multicenter, stroke registry database in South Korea. Methods— CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events)-like patients who met eligibility criteria modeled on the CHANCE trial eligibility criteria, including (1) acute minor ischemic stroke defined as National Institutes of Health Stroke Scale score ≤3 or lesion positive transient ischemic attack within 24 hours of onset and (2) noncardioembolic stroke mechanism. Propensity scores using the inverse probability of treatment weighting was used to adjust for baseline imbalances. The primary outcome was the composite of all stroke (ischemic and hemorrhagic), myocardial infarction, and vascular death by 3 months. Results— Among 5590 patients meeting the e...
Background White matter hyperintensities ( WMHs ) are commonly asymmetric between hemispheres but... more Background White matter hyperintensities ( WMHs ) are commonly asymmetric between hemispheres but for unknown reasons. We investigated asymmetric WMHs associated with lacunar infarcts. Methods and Results A total of 267 consecutive patients with small first‐ever supratentorial infarcts (≤20 mm) were included. None had a relevant vascular stenosis. WMH asymmetry was measured based on the hemispheric difference of a modified Scheltens scale score (≥3 defined as asymmetric). We analyzed the association of the hemispheric WMH asymmetry with old silent lacunar infarcts or acute lacunar infarcts. We compared lesion frequency maps between groups and generated t‐statistics maps. The mean age of patients was 64 years, and 63% were men. Asymmetric WMH was more than 3‐fold as frequent ( P <0.001) in the group with old silent lacunar infarcts (42%, 43/102) than in the group without old silent lacunar infarcts (15%, 24/165). In patients with left hemispheric dominance of WMHs , an acute lacun...
Cerebral vascular territories are of key clinical importance in patients with stroke, but availab... more Cerebral vascular territories are of key clinical importance in patients with stroke, but available maps are highly variable and based on prior studies with small sample sizes. To update and improve the state of knowledge on the supratentorial vascular supply to the brain by using the natural experiment of large artery infarcts and to map out the variable anatomy of the anterior, middle, and posterior cerebral artery (ACA, MCA, and PCA) territories. In this cross-sectional study, digital maps of supratentorial infarcts were generated using diffusion-weighted magnetic resonance imaging (MRI) of 1160 patients with acute (<1-week) stroke recruited (May 2011 to February 2013) consecutively from 11 Korean stroke centers. All had supratentorial infarction associated with significant stenosis or occlusion of 1 of 3 large supratentorial cerebral arteries but with patent intracranial or extracranial carotid arteries. Data were analyzed between February 2016 and August 2017. The 3 vascular...
Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiab... more Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevate...
This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of is... more This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondar...
Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent st... more Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent card...
plaque, even if the animals remained on a high fat diet and plaque growth was not attenuated. 5 T... more plaque, even if the animals remained on a high fat diet and plaque growth was not attenuated. 5 The study suggested that circulating adiponectin and soluble vascular cell adhesion molecule-1 (sVCAM-1) might be related to the reduced MMP activity in atheromas, but the mechanisms for this effect were not known. The present study aims to address the mechanisms leading to this observation, relating the MMP-modulating effect of diet and exercise to cytokine homeostasis. We also considered body mass and visceral fat amount, which could be affected by diet and exercise, and ultimately contribute to obesity-related re-A theromatous matrix metalloproteinase (MMP) activity is related to plaque vulnerability and rupture, the final common pathway for the thromboembolic complications of atherosclerosis, such as ischemic stroke or myocardial infarction. 1-4 Identifying the principal factors that affect atheromatous MMP activity may help predict and prevent these events. Using an MMP-activatable protease reporter, we previously described that 10-weeks of treadmill exercise reduced in vivo atheromatous MMP-2/9 activity in Apolipoprotein-E (ApoE) knockout (ApoE −/−) mice with pre-existing
Several models have been developed to predict the risk of symptomatic intracranial hemorrhage (SI... more Several models have been developed to predict the risk of symptomatic intracranial hemorrhage (SICH) and functional outcome in patients treated with intravenous tissue plasminogen activator (IV-TPA). Although a more complex model provides more precise estimates, its application to a practice setting requiring emergent decision and swift treatment is limited. 1-10 Among numerous clinical and imaging variables, age and stroke severity are immediately accessible and powerful predictors of SICH risk and functional outcome after IV-TPA treatment. We aimed to provide simple estimates of SICH risk and good functional outcome, based on the patients' age and initial National Institute of Health Stroke Scale (NIHSS) score.
Cerebrovascular diseases (Basel, Switzerland), Jan 21, 2017
The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstra... more The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios...
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 15, 2017
Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits i... more Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorab...
The aim of the study was to assessed the impact of short-term exposure to air pollution on ischem... more The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Particulate matter <10 μm and SO2 concentrations were independ...
Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imag... more Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis sho...
We compared baseline characteristics and outcomes at 3 months between patients with minor anterio... more We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.0...
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Papers by Wi-Sun Ryu