Publications by authors named "Ntaios G"
Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability.
View Article and Find Full Text PDFBackground And Aims: Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry.
Methods: In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020.
Background: There is paucity of data on the long-term outcomes after acute ischemic posterior circulation stroke (PCS). Additionally, the long-term prognostic value of the New England Medical Center-Posterior Circulation Registry (NEMC-PCR) classification of PCS has not been studied.
Patients And Methods: All consecutive patients with PCS registered in the Athens Stroke Registry between 01/1993 and 12/2012 were prospectively followed for up to 10 years and included in the analysis.
For any physician treating a patient with a medical condition of unclear etiology, the differential diagnosis aims to identify the actual most probable cause among various potential etiologies, in order to tailor treatment options. In patients with embolic stroke of undetermined source (ESUS), this can be challenging due to the frequent presence of multiple potential embolic sources, raising difficulties to identify the most likely cause. Additionally, despite targeted preventive measures for the presumed embolic source, patients may remain at risk for stroke and cardiovascular events due to other unrecognized or underestimated pathologies.
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- * Common causes of IS during ECMO include thromboembolic events and reduced blood flow to the brain, which can be hard to diagnose due to patients' severe conditions and sedation.
- * Diagnosis involves immediate brain imaging, such as CT and CT angiography, while treatment typically requires mechanical thrombectomy instead of thrombolytic therapy due to ongoing anticoagulation, necessitating close collaboration between radiologists and the ECMO team.
Article Synopsis
- Over the past 50 years, more invasive cardiovascular procedures have been performed worldwide, increasing risks of acute brain injury during and after these interventions.
- Current international guidelines often overlook the issue of acute brain injury from cardiovascular procedures, which can lead to worse medical outcomes and higher healthcare costs.
- The international Consensus Statement aims to provide recommendations for prevention, diagnosis, and treatment of this acute brain injury while also highlighting areas where more research is needed.
Background: Emerging evidence indicates a frequent occurrence of atrial fibrillation (AF) detection among patients with established causes of ischemic stroke unrelated to AF. This systematic review and meta-analysis aimed to evaluate AF detection rates in stroke patients with large or small vessel disease, considering the AF detection modality and duration of cardiac rhythm monitoring.
Aims: We conducted a comprehensive search of PubMed and Scopus databases up to 2 March 2024, to identify randomized controlled trials, non-randomized prospective studies, and retrospective studies assessing the frequency of AF detection in stroke patients with large or small vessel disease.
Article Synopsis
- The study focuses on patients with ischemic stroke classified as embolic stroke of undetermined source (ESUS), highlighting the need for personalized treatment options between anticoagulation and antiplatelet therapy for secondary prevention.
- A meta-analysis of 7 trials with nearly 15,000 patients showed that, overall, anticoagulation did not significantly reduce the risk of recurrent ischemic stroke compared to antiplatelet therapy.
- However, in patients with a patent foramen ovale (PFO), anticoagulation demonstrated improved outcomes, while results varied for those with left atrial enlargement (LAE) depending on whether cardiac monitoring was allowed after randomization.*
Article Synopsis
- Pulse wave velocity (PWV) serves as a strong indicator of arterial stiffness and is a better predictor of cardiovascular events compared to traditional risk factors, especially in the context of acute ischemic stroke (AIS).
- The meta-analysis reviewed studies on AIS patients, showing a higher PWV is linked to poorer functional outcomes and higher long-term risks such as mortality and stroke recurrence.
- Findings suggest that monitoring PWV can enhance risk assessment and management in patients with vascular aging, indicating the importance of incorporating this measure into clinical practice.
Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke.
Clin Appl Thromb Hemost
August 2024
Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications.
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- The study focused on the prevalence and associated factors of carotid atherosclerosis in stroke patients with atrial fibrillation (AF), finding that 34.6% of patients had this condition.
- Among 2,955 patients analyzed, 6.9% had carotid stenosis of 50% or more, and 5.7% experienced carotid occlusion, with age and previous vascular conditions being significant risk factors.
- The research concluded that atherosclerosis in multiple arterial beds is a strong predictor of significant carotid stenosis, indicating a high level of cardiovascular risk in these patients.
Background And Objectives: Prolonged cardiac monitoring (PCM) increases atrial fibrillation (AF) detection after ischemic stroke, but access is limited, and it is burdensome for patients. Our objective was to assess whether midregional proatrial natriuretic peptide (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) could classify people who are unlikely to have AF after ischemic stroke and allow better targeting of PCM.
Methods: We analyzed people from the Biomarker Signature of Stroke Aetiology (BIOSIGNAL) study with ischemic stroke, no known AF, and ≥3 days cardiac monitoring.
New Ischemic Cerebral Lesions in Postprocedural Magnetic Resonance Imaging in Carotid Artery Stenting Versus Carotid Endarterectomy: A Systematic Review and Meta-Analysis.
Ann Vasc Surg
September 2024
Background: Recent randomized controlled trials (RCTs) have demonstrated similar outcomes in terms of ischemic stroke incidence after carotid endarterectomy (CEA) or carotid artery stenting (CAS) in asymptomatic carotid disease, while CEA seems to be the first option for symptomatic carotid disease. The aim of this meta-analysis is to assess the incidence of silent cerebral microembolization detected by magnetic resonance imaging (MRI) following these procedures.
Methods: A systematic search was conducted using PubMed, Scopus, and Cochrane databases, including comparative studies involving symptomatic or asymptomatic patients undergoing either CEA or CAS and reporting on new cerebral ischemic lesions in postoperative MRI.
Idarucizumab is an antibody fragment specific for the immediate reversal of dabigatran anticoagulation effects. The use of idarucizumab is approved for dabigatran-treated patients suffering from life-threatening or uncontrolled bleeding and those in need of urgent surgery or invasive procedures. Data from randomized controlled clinical trials and real-world experience provide reassuring evidence about the efficacy and safety of idarucizmab use in patients with acute stroke.
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- The study investigates whether the size of a brain infarct influences the effectiveness and safety of initiating direct oral anticoagulants (DOACs) soon after an ischemic stroke in patients with atrial fibrillation.
- This was a post hoc analysis of the ELAN trial, involving nearly 2,000 participants from over 100 sites worldwide, comparing early DOAC initiation within 48 hours versus late initiation according to the severity of the stroke.
- The main outcome measured was serious complications (like recurrent strokes or bleeding) within 30 days, with findings suggesting minimal difference in outcomes between early and late DOAC initiation for minor strokes specifically.
Early vascular aging in acute ischemic stroke: A systematic review and meta-analysis.
J Stroke Cerebrovasc Dis
August 2024
Background: While arterial stiffening is a known risk factor for cardiovascular diseases, it remains unclear whether there is an early vascular aging (EVA) in patients who have experienced acute ischemic stroke (AIS). This systematic review and meta-analysis aims to investigate whether patients with AIS exhibit EVA through pulse wave velocity (PWV) measurements shortly after the stroke onset, shedding light on the relationship between arterial stiffness, hypertension, and stroke.
Methods: Thirteen case-control studies were included, comparing PWV measurements between AIS patients and non-AIS individuals.
Article Synopsis
- Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are effective treatments for acute stroke, but their safety and efficacy in patients with atrial fibrillation (AF) are debated.
- A study analyzed data from two multicenter studies to compare outcomes of AF patients with acute ischemic stroke treated with reperfusion therapies versus those who weren't.
- Results showed that AF patients treated with reperfusion therapies had better functional outcomes and lower mortality rates compared to those who received conservative treatment.
Article Synopsis
- The study explores how the use of antihypertensive medications before and during an acute ischemic stroke affects blood pressure levels and variability in stroke patients.
- A post-hoc analysis of 228 stroke patients indicated that most were on antihypertensive treatments, with specific medications linked to different blood pressure outcomes and variability patterns.
- Patients on these medications showed lower mortality rates, suggesting that personalizing blood pressure management based on individual medication history could improve care for acute ischemic stroke patients.
Background: Whether hemorrhagic transformation (HT) modifies the treatment effect of early compared with late initiation of direct oral anticoagulation in people with ischemic stroke and atrial fibrillation is unknown.
Methods: This is a post hoc analysis of the ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation). The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, major extracranial bleeding, systemic embolism, or vascular death within 30 days.
One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention.
View Article and Find Full Text PDFBackground: In patients surviving stroke, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk.
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