Publications by authors named "Dong-Eog Kim"
It remains unclear why unilateral proximal carotid artery occlusion (UCAO) causes benign oligemia in mice, yet leads to various outcomes (asymptomatic-to-death) in humans. We hypothesized that inhibition of nitric oxide synthase (NOS) both transforms UCAO-mediated oligemia into full infarction and expands pre-existing infarction. Using 900 mice, we i) investigated stroke-related effects of UCAO with/without intraperitoneal administration of the NOS inhibitor (NOSi) N-nitro-L-arginine methyl ester (L-NAME, 400 mg/kg); ii) examined the rescue effect of the NO-donor, molsidomine (200 mg/kg at 30 minutes); and iii) tested the impact of antiplatelet medications.
View Article and Find Full Text PDFBackground: This study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).
Methods: This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.
Article Synopsis
- This study examined how non-traditional lipid profiles, specifically the LDL/HDL ratio, affect the risk of vascular events within a year in stroke patients already on statins and with low LDL-C levels.
- The analysis included 7028 patients with acute ischemic strokes and found a significant association between higher LDL/HDL ratios and increased risk of recurrent stroke, heart attack, or death after adjusting for other variables.
- The results suggest that even with low LDL-C levels due to statin use, monitoring the LDL/HDL ratio is important to assess residual risk after a stroke.
Article Synopsis
- Delayed-onset post-stroke cognitive decline (PSCD) can provide insights into cognitive impairment and dementia, potentially linked to amyloid pathology and cerebral small vessel disease (cSVD).
- The study assessed patients who were cognitively normal after a stroke and identified those who experienced cognitive decline using MMSE scores and various imaging techniques.
- Among the 208 patients, few showed significant differences in cSVD, with white matter hyperintensities affecting cognitive scores in those who declined, while amyloid positivity was rare, though some non-amyloid decliners exhibited correlation patterns related to cognitive outcomes.
Article Synopsis
- A multi-center MRI study investigated how white matter hyperintensity (WMH) affects recovery after stroke, focusing on different severity levels of ischemic stroke.
- Higher WMH levels were linked to worse outcomes three months later, but the impact varied based on initial stroke severity: mild strokes showed a dose-dependent effect while moderate-to-severe strokes had a threshold effect.
- The study found that WMH impacted 3-month recovery more significantly in those with mild strokes, suggesting that increased WMH burden worsens recovery, but its effect is less pronounced in more severe strokes.
Contemporary Statistics of Acute Ischemic Stroke and Transient Ischemic Attack in 2021: Insights From the CRCS-K-NIH Registry.
J Korean Med Sci
September 2024
Article Synopsis
- The report offers updated statistics on stroke patients in South Korea from a nationwide registry, revealing a male-to-female ratio of 1.5, with average ages of 67 for men and 73 for women.
- Hypertension is the leading risk factor (67%), with notable rates of diabetes (35%) and smoking (21%), while atrial fibrillation is less common (19%) than in Western populations, indicating effective preventive measures.
- There has been a decline in intravenous thrombolysis use, unchanged timing for treatment, and despite favorable outcomes at 3 months, there is a pressing need for improvements in acute stroke care.
Article Synopsis
- A study was conducted to develop deep learning algorithms for the automatic segmentation of white matter hyperintensity (WMH) lesions in patients with cerebral infarction, involving a large dataset of 8,421 patients from multiple hospitals in Korea.
- Two models, 2D UNet and SE-Unet, were trained and validated using FLAIR MRI images, with performance measured against a human-segmented gold standard using various statistical metrics.
- Results showed that while both models had good performance, the SE-Unet outperformed the UNet with higher average Dice Similarity Coefficients (DSCs) in both internal and external validations, indicating it was more reliable for WMH segmentation.
Background And Purpose: The accurate prediction of functional outcomes in patients with acute ischemic stroke (AIS) is crucial for informed clinical decision-making and optimal resource utilization. As such, this study aimed to construct an ensemble deep learning model that integrates multimodal imaging and clinical data to predict the 90-day functional outcomes after AIS.
Methods: We used data from the Korean Stroke Neuroimaging Initiative database, a prospective multicenter stroke registry to construct an ensemble model integrated individual 3D convolutional neural networks for diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR), along with a deep neural network for clinical data, to predict 90-day functional independence after AIS using a modified Rankin Scale (mRS) of 3-6.
Article Synopsis
- Accurate classification of ischemic stroke subtypes is crucial for effective prevention strategies, and a deep learning algorithm was developed using diffusion-weighted imaging (DWI) and atrial fibrillation (AF) data for this purpose.
- The study involved training models on a dataset of 2,988 stroke patients using two algorithms: one based solely on DWI and another incorporating AF as a factor.
- Results showed that the DWI+AF algorithm achieved higher agreement rates with expert opinions compared to the DWI-only method, indicating its effectiveness in accurately classifying stroke subtypes.
Article Synopsis
- - The study reviews how dual antiplatelet therapy (DAPT-AC) with aspirin and clopidogrel has been increasingly used among stroke patients who didn't qualify for major clinical trials, particularly after the CHANCE trial results became available in 2013.
- - Analysis of data from over 32,000 patients from 2008 to 2022 showed that the usage of DAPT-AC rose significantly from 33% in 2008 to 78% in 2022, while the use of other antiplatelet medications decreased.
- - Despite this increase in DAPT-AC usage, clinical outcomes, including stroke rates and mortality, improved only slightly, indicating ongoing efforts are needed to enhance recovery
Objective: We evaluated the efficacy of endovascular thrombectomy (EVT) on the functional outcome of patients with acute basilar artery occlusion and low posterior circulation acute stroke prognosis early computed tomography score (PC-ASPECTS).
Methods: We identified patients with acute ischemic stroke due to basilar artery occlusion and PC-ASPECTS of 6 or less, presenting within 24 h between August 2008 and April 2022. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days.
Article Synopsis
- Novel oral anticoagulants (NOACs) are recommended for stroke prevention in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF), but their real-world effectiveness is unclear.
- This study analyzed data from nearly 13,000 patients over eight years to examine trends in clinical outcomes related to AIS and AF, particularly looking at how NOAC prescriptions influenced these trends.
- Results showed that NOAC prescriptions rose significantly from 0% to 75.6%, correlating with a decrease in 1-year incidences of major adverse outcomes from 28.3% to 21.7%, suggesting NOACs may play a key role in improving patient outcomes.
Introduction: Detection of atrial fibrillation (AF) is crucial for preventing recurrence in patients with ischemic stroke. We aimed to examine whether the left atrial volume index (LAVI) and global longitudinal peak strain (GLPS) are associated with AF in patients with ischemic stroke.
Methods: We prospectively analyzed 678 consecutive patients with ischemic stroke.
Background And Purpose: Multiple attempts at intracranial hemorrhage (ICH) detection using deep-learning techniques have been plagued by clinical failures. We aimed to compare the performance of a deep-learning algorithm for ICH detection trained on strongly and weakly annotated datasets, and to assess whether a weighted ensemble model that integrates separate models trained using datasets with different ICH improves performance.
Methods: We used brain CT scans from the Radiological Society of North America (27,861 CT scans, 3,528 ICHs) and AI-Hub (53,045 CT scans, 7,013 ICHs) for training.
Background And Purpose: The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO).
Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0-5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds.
Article Synopsis
- Ischemic strokes vary in type, which may affect how low-density lipoprotein (LDL) cholesterol levels relate to early health outcomes like stroke recurrence, heart attacks, and overall mortality.
- A study involving over 38,500 acute ischemic stroke patients found that those with the lowest LDL cholesterol levels (<70 mg/dl) had the highest rates of adverse outcomes within three months.
- The research revealed that the relationship between LDL cholesterol levels and mortality differed by stroke subtype, indicating that both high and low LDL levels present different risks depending on the stroke type.
Article Synopsis
- The study examined nonhypertensive white matter hyperintensity (WMH) as a risk factor in acute ischemic strokes and transient ischemic attacks, involving over 3,000 patients, half with hypertension and half without.
- Approximately 35% of nonhypertensive patients showed moderate-to-severe WMH, linked to factors like age and previous strokes, while hypertensive patients exhibited different WMH patterns and a stronger correlation to small vessel occlusions.
- The findings indicated that WMH significantly affects functional outcomes after 3 months and is associated with cumulative risks of recurrent stroke and mortality, although its impact varied based on hypertension status.
Background: There is limited information on the delivery of acute stroke therapies and secondary preventive measures and clinical outcomes over time in young adults with acute ischemic stroke. This study investigated whether advances in these treatments improved outcomes in this population.
Methods: Using a prospective multicenter stroke registry in Korea, young adults (aged 18-50 years) with acute ischemic stroke hospitalized between 2008 and 2019 were identified.
Background It is unclear whether statin treatment could reduce the risk of early vascular events when baseline low-density lipoprotein cholesterol (LDL-C) levels are already low, at <70 mg/dL, at the time of the index stroke. Methods and Results This study was an analysis of a prospective, multicenter, nationwide registry of consecutive patients with first-ever acute ischemic stroke with baseline low-density lipoprotein cholesterol levels <70 mg/dL and without statin pretreatment. An inverse probabilities of treatment weights method was applied to control for imbalances in baseline characteristics.
View Article and Find Full Text PDFArticle Synopsis
- The study examines the complex relationship between low LDL cholesterol (LDL-C) levels and early vascular outcomes in acute ischemic stroke patients, noting that lower LDL-C levels might lead to worse outcomes at first glance.
- Researchers analyzed over 32,500 patients and found a U-shaped relationship between LDL-C levels and three-month outcomes, with the highest events occurring in those with low LDL-C, but this trend wasn’t significant after adjustments were made.
- The findings suggest that statin pretreatment may mitigate the negative effects associated with low LDL-C levels, indicating the need for further research on this paradoxical relationship.
Article Synopsis
- Recent research indicates a lack of interchangeability between modified Rankin Scale measures of functional outcomes and mortality measures in assessing hospital performance for acute ischemic stroke patients.
- The study evaluated 8292 hospitalized stroke patients and used various metrics like 1-month and 1-year mortality to assess hospital outcomes.
- Findings revealed no significant correlation between hospitals’ rankings based on functional outcomes and those based on mortality rates, suggesting that these measures evaluate different aspects of hospital performance.
Article Synopsis
- Elevated body mass index (BMI) and waist circumference (WC) may actually protect stroke survivors from recurrent strokes and major vascular events, contrary to the general belief that higher BMI is solely a risk factor for stroke.
- The study involved analyzing data from nearly 15,000 first-ever stroke patients over a period from 2011 to 2019, focusing on different BMI and WC categories to assess their impact on long-term vascular outcomes.
- Findings indicated that being in the second-BMI quintile and fourth-WC quintile was associated with the lowest risks for recurrent strokes and major vascular events, suggesting that some levels of excess weight might be beneficial post-stroke.
Article Synopsis
- Female patients experience greater disability and worse long-term outcomes after ischemic strokes compared to male patients, with distinct clinical manifestations and infarct locations influencing these disparities.
- A study involving 6,464 patients in South Korea utilized MRI and various statistical methods to assess differences in stroke severity and neurological outcomes based on sex.
- Results indicated that while the infarct volumes were similar, female patients had higher stroke severity scores, more neurological deterioration, and distinct lesion patterns, suggesting biological factors may play a role in sex differences related to stroke recovery.
Dual antiplatelet Use for extended period taRgeted to AcuTe ischemic stroke with presumed atherosclerotic OrigiN (DURATION) trial: Rationale and design.
Int J Stroke
October 2023
Article Synopsis
- * It will involve 4,806 participants in a multicenter, randomized, open-label trial, comparing the outcomes of 12 months of DAPT versus 3 months followed by monotherapy for the next 9 months.
- * The primary outcome measures include the occurrence of strokes, heart attacks, and overall mortality over one year, while major bleeding events will be monitored as the primary safety concern.