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Author: search.filters.author.Ayrton MassaroSubject: search.filters.subject.stroke

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    Demographics, Socio-Economic Characteristics, and Risk Factor Prevalence in Patients with Non-Cardioembolic Ischaemic Stroke in Low- and Middle-Income Countries: The OPTIC Registry
    (2012)
    Halim Abboud
    ;
    Julien Labreuche
    ;
    Antonio Arauz
    ;
    Alan Bryer
    ;
    Pablo G Lavados
    <jats:sec><jats:title>Background</jats:title><jats:p> There is a paucity of data on patients with stroke/transient ischaemic attack in low- and middle-income countries. We sought to describe the characteristics and management of patients with an ischaemic stroke and recent transient ischaemic attack or minor ischaemic strokes in low- or middle-income countries. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The Outcomes in Patients with TIA and Cerebrovascular disease registry is an international, prospective study. Patients ≥45 years who required secondary prevention of stroke (either following an acute transient ischaemic attack or minor ischaemic strokes (National Institutes of Health Stroke Scale &lt;4) of &lt;24 h duration, or recent (&lt;6 months), stable, first-ever, non-disabling ischaemic stroke) were enrolled in 17 countries in Latin America, the Middle East, and Africa. The main measures of interest were risk factors, comorbidities, and socio-economic variables. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Between January 2007 and December 2008, 3635 patients were enrolled in Latin America ( n =1543), the Middle East ( n =1041), North Africa ( n = 834), and South Africa ( n = 217). Of these, 63% had a stable, first-ever ischaemic stroke (median delay from symptom onset to inclusion, 25 days interquartile range, 7–77); 37% had an acute transient ischaemic attack or minor ischaemic stroke (median delay, two-days; interquartile range, 0–6). Prevalence of diabetes was 46% in the Middle East, 29% in Latin America, 35% in South Africa, and 38% in North Africa; 72% had abdominal obesity (range, 65–78%; adjusted P &lt; 0·001); prevalence of metabolic syndrome was 78% (range, 72–84%, P &lt; 0·001). Abnormal ankle brachial index (&lt;0·9) was present in 22%, peripheral artery disease in 7·6%, and coronary artery disease in 13%. Overall, 24% of patients had no health insurance and 27% had a low educational level. </jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p> In this study, patients in low- and middle-income countries had a high burden of modifiable risk factors. High rates of low educational level and lack of health insurance in certain regions are potential obstacles to risk factor control. </jats:p></jats:sec><jats:sec><jats:title>Funding</jats:title><jats:p> The Outcomes in Patients with TIA and Cerebrovascular disease registry is supported by Sanofi-Aventis, Paris, France. </jats:p></jats:sec>
      5Scopus© Citations 24
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    Latin American Consensus Statement for the Use of Contrast-Enhanced Transcranial Ultrasound as a Diagnostic Test for Detection of Right-to-Left Shunt
    (2019)
    Viviane Flumignan Zetola
    ;
    Marcos Christiano Lange
    ;
    Valeria Cristina Scavasine
    ;
    Rodrigo Bazan
    ;
    Gabriel Pereira Braga
    <jats:p>&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients’ management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies.</jats:p>
      48Scopus© Citations 19
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    Specificities of Ischemic Stroke Risk Factors in Arab-Speaking Countries
    (2017)
    Halim Abboud
    ;
    Leila Sissani
    ;
    Julien Labreuche
    ;
    Antonio Arauz
    ;
    Marie-Germaine Bousser
    <jats:p>&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (&lt;i&gt;n&lt;/i&gt; = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both &lt;i&gt;p &lt;/i&gt;≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; &lt;i&gt;p &lt;/i&gt;= 0.07). &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.</jats:p>
    Scopus© Citations 5  1
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    Impact of Low Ankle-Brachial Index on the Risk of Recurrent Vascular Events Insights From the OPTIC Registry
    (2019)
    Halim Abboud
    ;
    Linsay Monteiro Tavares
    ;
    Julien Labreuche
    ;
    Antonio Arauz
    ;
    Alan Bryer
    <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> Among 3487 enrolled patients, abnormal ABI (&lt;0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely ( <jats:italic>P</jats:italic> &lt;0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI &lt;0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6–25.8 versus 13.7%; 21.4–15.1; <jats:italic>P</jats:italic> &lt;0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6–0.9; 0.9–1; 1–1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0–48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8–25.0 for ABI 0.6–0.9 versus 14.3%; 95% CI, 12.4–16.6 for ABI 0.9–1 versus 13.3%; 95% CI, 11.6–15.2 for ABI 1–1.4; <jats:italic>P</jats:italic> &lt;0.001). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.</jats:p> </jats:sec>
      2Scopus© Citations 19