Publications by authors named "Yannie Soo"
Background: In patients with symptomatic intracranial atherosclerotic stenosis (sICAS), recent evidence has suggested an association between artery-to-artery embolism (AAE) and cortical borderzone (CBZ) infarcts.
Methods: We recruited patients with 50-99% anterior-circulation sICAS in this cohort. Stroke mechanisms were categorized as isolated parent artery atherosclerosis occluding penetrating artery (PAO), isolated AAE, isolated hypoperfusion, and mixed mechanisms, using two classification systems.
Objectives: The association between SARS-CoV-2 spike protein and cerebrovascular diseases raised a concern of cerebrovascular safety of COVID-19 vaccines. We aimed to determine the risk of radiologic cerebral small vessel disease (cSVD) progression with BNT162b2 and CoronaVac.
Methods: In this community-based prospective cohort study, community-dwelling subjects underwent brain magnetic resonance imaging (MRI) before and 4 months after vaccination with BNT162b2 or CoronaVac.
Article Synopsis
- Cerebral small vessel disease (SVD) can lead to various cerebrovascular issues, but research on sex differences in SVD is limited.
- This study analyzed data from over 20,000 patients with acute ischemic stroke to examine whether the presence and severity of cerebral microbleeds (CMB) and other SVD markers differ between males and females.
- Results showed that males had more frequent CMB while females had fewer lacunes but higher severe white matter hyperintensities, indicating distinct SVD characteristics based on sex.
Introduction: The risk of ischemic stroke and intracerebral hemorrhage (ICH) with intensive lipid control by statins among patients with atrial fibrillation (AF) who require direct oral anticoagulants (DOAC) is unclear. We aimed to determine the risks of ischemic stroke and ICH in AF patients treated with DOAC and statins.
Patients And Methods: In a population-based retrospective cohort study, we identified AF patients concurrently on DOAC and statins from 2015 to 2021 in Hong Kong.
Article Synopsis
- This study looked at whether taking statins, a type of medicine, affects the chances of having a repeat stroke or bleeding in the brain for people who have certain brain issues called cerebral microbleeds (CMBs).
- They analyzed data from many hospitals and included over 16,000 patients, dividing them into those who took statins and those who didn't.
- The results showed that people who used statins had a lower risk of having another stroke but didn't show a clear difference in the risk of brain bleeding compared to those who didn't take statins.
Article Synopsis
- - The study analyzes the prescribing patterns and the effectiveness and safety of edoxaban in Asian patients with atrial fibrillation (AF) over one year, as part of the ETNA-AF program, which collects data from various Asian regions.
- - Out of 3,359 patients treated with edoxaban, 70.9% received the recommended doses, and key clinical outcomes were measured, including rates of death, bleeding, and strokes at the one-year mark.
- - The one-year event rates were relatively low, showing 1.8% for all-cause death and 1.3% for major bleeding, indicating that edoxaban is effective and safe for most Asian patients with AF in everyday practice
Importance: Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) use carries extremely high morbidity and mortality. The clinical effectiveness of hemostatic therapy is unclear.
Objective: To compare the clinical and radiological outcomes of DOAC-associated ICH treated with prothrombin complex concentrate (PCC) vs conservative management.
Article Synopsis
- Visible perivascular spaces (BGPVS) are linked to cerebral small vessel disease and may signal higher future stroke risk based on a large analysis of patient data.
- The study analyzed 7,778 participants with recent ischemic stroke or transient ischemic attack (TIA), examining the relationship between BGPVS, CSOPVS, and various health factors.
- Results indicated that a greater burden of BGPVS correlates with higher risks of ischemic stroke but not intracranial hemorrhage, while CSOPVS showed weaker associations overall.
There may be different mechanisms underlying internal (IBZ) and cortical (CBZ) borderzone infarcts in intracranial atherosclerotic stenosis. In 84 patients with symptomatic, 50-99% atherosclerotic stenosis of M1 middle cerebral artery (MCA-M1) with acute borderzone infarcts in diffusion-weighted imaging, we classified the infarct patterns as isolated IBZ (n = 37), isolated CBZ (n = 31), and IBZ+CBZ (n = 16) infarcts. CT angiography-based computational fluid dynamics models were constructed to quantify translesional, post-stenotic to pre-stenotic pressure ratio (PR) in the MCA-M1 lesion.
View Article and Find Full Text PDFIntroduction: Cerebral small vessel disease (CSVD) commonly exists in patients with symptomatic intracranial atherosclerotic disease (sICAD). We aimed to investigate the associations of hemodynamic features of sICAD lesions with imaging markers and overall burden of CSVD.
Patients And Methods: Patients with anterior-circulation sICAD (50%-99% stenosis) were analyzed in this cross-sectional study.
Background And Objectives: Ischemic stroke despite a direct oral anticoagulant (DOAC) is increasingly common and portends a high risk of subsequent ischemic stroke. The efficacy and safety of antithrombotic regimens after the condition are unclear. We aimed to compare the outcomes of patients with ischemic stroke despite DOACs with and without an alternative antithrombotic regimen and determine the risk factors of recurrent ischemic stroke while on anticoagulation.
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- Cerebral microbleeds increase the risk of both ischemic stroke and intracranial hemorrhage, complicating treatment choices for patients with atrial fibrillation on various antithrombotic therapies.
- A study analyzed 7,839 patients, finding that microbleeds significantly raised the relative risk of intracranial hemorrhage (2.74 times) and ischemic stroke (1.29 times), particularly with combination therapies of anticoagulants and antiplatelets.
- For patients on combination therapy, those with multiple microbleeds faced a higher absolute risk of intracranial hemorrhage compared to ischemic stroke, indicating a need for more research to develop effective preventive strategies.
Artery-to-artery embolism (AAE) is a common stroke mechanism in intracranial atherosclerotic disease (ICAD), associated with a considerable risk of recurrent stroke. We aimed to investigate cerebral hemodynamic features associated with AAE in symptomatic ICAD. Patients with anterior-circulation, symptomatic ICAD confirmed in CT angiography (CTA) were recruited.
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- International guidelines advise against using intravenous thrombolysis (IVT) in ischemic stroke patients who have recently taken direct oral anticoagulants (DOAC).
- A multicenter study examined the risk of symptomatic intracranial hemorrhage (sICH) in 832 patients who underwent IVT within 48 hours of DOAC use, compared to over 32,000 controls without recent DOAC intake.
- Results highlighted varied outcomes based on prior DOAC therapy, with focus on sICH incidence measured through established stroke scales, and included an analysis of DOAC levels and reversal treatments prior to IVT.
Background And Aims: The shape of a stent could influence focal hemodynamics and subsequently plaque growth or in-stent restenosis in intracranial atherosclerotic stenosis (ICAS). In this preliminary study, we aim to investigate the associations between stent shapes and focal hemodynamics in ICAS, using computational fluid dynamics (CFD) simulations with manually manipulated stents of different shapes.
Methods: We built an idealized artery model, and reconstructed four patient-specific models of ICAS.
Article Synopsis
- Researchers studied patients with certain types of strokes (IS or TIA) to find out how a brain condition called cortical superficial siderosis (cSS) affects their risk of having more strokes in the future.
- They looked at data from a large group of patients and found that those with cSS had a higher chance of having more strokes than those without it.
- Patients with cSS who took both types of blood-thinning medicines had an even higher risk of severe strokes and intracranial hemorrhage (bleeding in the brain).
Background And Objective: Drug-drug interactions between direct oral anticoagulants (DOAC) and antiseizure medications via the cytochrome P450 (CYP) or the P-glycoprotein (P-gp) systems may lead to under-anticoagulation. The clinical relevance of these interactions is unclear. We aimed to elucidate the risk of thromboembolism with concurrent DOAC and CYP/P-gp modulating antiseizure medications.
View Article and Find Full Text PDFBackground And Purpose: Symptomatic intracranial atherosclerotic stenosis (sICAS) is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment. Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics (CFD) models were associated with the risk of stroke recurrence. We aimed to develop and compare stroke risk prediction nomograms in sICAS, based on vascular risk factors and these metrics.
View Article and Find Full Text PDFObjective: As Hong Kong faced the 5th wave of the COVID-19 pandemic, the facilitators and hurdles toward effective vaccination is important for healthcare professionals to understand the vaccination gap among patients with epilepsy.
Methods: A cross-sectional, pragmatic study of COVID-19 vaccination was performed at a tertiary epilepsy center with regards to patterns of vaccination and any unusually high rate of adverse events. Patients having recent visits at the epilepsy center (4 months) had their anonymized electronic linkage records examined 12 months after the inception of vaccination program for types of vaccines, seizure demographics, and adverse events following immunization (AEFI).
Introduction: The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown.
Methods: This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures.
Objectives: The predisposition of intracranial atherosclerotic disease (ICAD) to East Asians over Caucasians infers a genetic basis which, however, remains largely unknown. Higher prevalence of vascular risk factors (VRFs) in Chinese over Caucasian patients who had a stroke, and shared risk factors of ICAD with other stroke subtypes indicate genes related to VRFs and/or other stroke subtypes may also contribute to ICAD.
Methods: Unrelated symptomatic patients with ICAD were recruited for genome sequencing (GS, 60-fold).
Background: Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions.
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- The study compares the effects of using Newtonian versus non-Newtonian fluid models in simulating cerebral blood flow in patients with intracranial atherosclerotic stenosis (ICAS) using computational fluid dynamics (CFD).
- The research involved creating virtual and patient-specific artery models to analyze pressure ratios (PR) and wall shear stress (WSS) under different fluid assumptions, finding minimal differences in PR but notable variations in WSS measurements, especially in low WSS regions.
- The findings suggest that while Newtonian models are adequate for calculating PR, caution is recommended for WSS simulations, particularly in severe cases of ICAS.
Background: Stroke not only substantially increases the risk of incident dementia early after stroke but also the risk remains elevated years after.
Aim: We aimed to determine the risk factors of dementia onset more than three to six months after stroke or transient ischemic attack.
Methods: This is a single-center prospective cohort study.