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WorldStrokeAcademy Profile picture
@WorldStrokeEd
Aug 1, 2021 • 12 tweets • 20 min read • Read on X
Scrolly
#WeekendLecture
#PregnancyAndStroke

#Pregnancy and #puerperium confer an ⬆️ risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women

👉doi.org/10.1016/j.ncl.…

a short 🧵 Image
#WeekendLecture
#PregnancyAndStroke

@DrRickSwartz @patrice_lindsay et al metaanalysis
👉11 studies
👉>85 million #pregnancy and #postpartum admissions in various countries
👉overall incidence of #stroke was 30 per 100,000 hospitalizations👈
@IntJStroke

journals.sagepub.com/doi/10.1177/17… ImageImage
#WeekendLecture
#PregnancyAndStroke
RFs:
☑️Age, >40yo OR3.1
☑️Race/ethnicity
☑️Migraine, thrombophilia, SLE, 🫀disease, HTN, thrombocytopenia, diabetes
☑️Pregnancy complications
✅For hemorrhagic stroke: aneurysms, AVM, Hypertensive Disorders of Pregnancy

journals.lww.com/greenjournal/F… ImageImage
#WeekendLecture
#PregnancyAndStroke

It is good to know about the #timing of events during this period
Here, a nice visual approach from Dr Feske and @AneeshSinghalMD review via @ContinuumAAN

journals.lww.com/continuum/Abst… Image
#WeekendLecture
#PregnancyAndStroke

Pregnancy implies changes in:
-#Hemodinamics
-#Vascular and connective tissue
ahajournals.org/doi/full/10.11…

-#Coagulation system
thrombosisresearch.com/article/S0049-…

All contributing to an #increased risk of stroke ImageImage
#WeekendLecture
#PregnancyAndStroke

The #types of strokes reported in various studies depend on:

☑️the #population studied
☑️the detail of stroke #evaluation
☑️the #classification system used

Be aware of “unusual” causes⤵️ ImageImageImage
#WeekendLecture
#PregnancyAndStroke
Pathologic conditions as:
-Hypertensive disorders of pregnancy (including pre/#eclampsia, HELLP
-#PRES
-#RCVS
should be revised, but are beyond the scope of this 🧵
Check it here👉pn.bmj.com/content/16/1/23 ImageImage
#WeekendLecture
#PregnancyAndStroke
☝️Obstetric #CVST is most commonly associated with hypertension/cesarean delivery/infection
ahajournals.org/doi/full/10.11…
☝️Risk of gestational CVST is mostly attributable to the #puerperium
ahajournals.org/doi/10.1161/ST…
Treatment of choice:UFH or #LMWH Image
#WeekendLecture
#PregnancyAndStroke

If a stroke is suspected neuroimaging should be obtained #expeditiously

✅NCCT, #CTA, MRI, MRA with #TOF are all safe in pregnancy

👉Iodinated contrast does not cross the #placenta, gadolinium does

thieme-connect.com/products/ejour… Image
#WeekendLecture
#PregnancyAndStroke
Pregnant women were excluded from rTPa RCTs
There are no clear evidence of harm or benefits
#AHA guide: administration may be considered when the anticipated benefits...outweigh the anticipated⬆️risks of uterine bleeding
doi.org/10.1016/j.ajog…
#WeekendLecture
#PregnancyAndStroke

Pregnant women were excluded from MT RCTs
But from 2016, several case report & series have demonstrated #safety and #feasibility in #ELVO, and most experts agree that should be considered

👉jnis.bmj.com/content/12/6/5…
👉strokejournal.org/article/S1052-… Image
#WeekendLecture
#PregnancyAndStroke
There is a lot more in this issue, and we give you selected works to start going deep in #pregnancy & #stroke

We would like to finish w/ @DrSaccoNeuro's words from his editorial in @JACCJournals when a raised incidence was noted in🇺🇸
#Thanks! Image

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More from @WorldStrokeEd

WorldStrokeAcademy Profile picture
Feb 14, 2022
#WeekendLecture
#ISC22
Highlights

300 invited talks
Nearly 200 oral abstracts
>1000 posters
Here we review some of trials and presentation from Main Events at #ISC22
#ISC22 Highlights
#RESCUE_Japan LIMIT
EVT for acute LVO with #large ischemic #Core

NIHSS>6, #ASPECT 3-5 , CT or MRI (~85%)
<6hr, or DWI/FLAIR mismatch <24hr
🚶mRS 0-3 at 90d: 31 vs 12.8%, RR 2.43🩸sICH,<48hr: 9 vs 4.9% NS
⚫️Death: 18 vs 23.5%, NS

nejm.org/doi/full/10.10…
#ISC22 Highlights
#Rescue-BT EVT with or w/o #tirofiban in LVO stroke
GPIIb/IIIa-R inhibitor could ⏬reocclusion after MT
55🏥in🇨🇳AIS<24hr, no IVT, ASPECT≥6
950pts
🚶mRS at 90d: 3 vs 3
🩸sICH: 9.7 vs 6.4%, NS
⚫️Death: 18.1 vs 16.9%
Treatment effect modification in LAA subgroup
Read 12 tweets
WorldStrokeAcademy Profile picture
Nov 27, 2021
#WeekendLecture
#HistoryofEVT

It’s no secret that #EVT for AIS has been a complete game changer for the field resulting in dramatic reduction in death & disability

Join us to explore the #history of EVT in collaboration with @SVINJournal, to celebrate the inaugural issue Image
Many thanks to @Mahmoudneuro, #RaulNogueira and @DiogoHaussen whose review entitled:
👉“Tx Advancements in the Endovascular Management of Stroke” celebrates the advances in #ETV

🆓 #openaccess

✅ahajournals.org/doi/full/10.11…
1st #Fun fact: Interventional treatment of AIS dates all the way back to 1950s‼️
Sussman & Fitch reported 3 cases of IA infusion of fibrinolytics
Didn’t work 😫. Probably because they were performed in a non-hyperacute fashion
But this laid the foundation for years of refinement Image
Read 21 tweets
WorldStrokeAcademy Profile picture
Oct 17, 2021
#WeekendLecture
#Tenecteplase #TNK
Part 1
✅3rd generation rtPA
🧬Targeted genetic upgrade
3 specific alterations to #alteplase molecule:
👉⬆️Half life
👉⬆️Binding affinity for #fibrin
👉⬆️Resistance to inactivation by #PAI-1
bit.ly/3pqbEb1 Image
#WeekendLecture
#TNK

👉⬆️T1/2 allows single bolus dosing and⬆️clot exposure to TNK
👉Higher affinity to fibrin-rich clots & + potent/faster clot #lysis vs alteplase
👉 < consumption of fibrinogen/plasminogen/ a2- antiplasmin👉⬇️systemic fibrinolytic effect👉⏬risk for bleeding Image
#WeekendLecture
#TNK
First analysis in stroke patients was a #dose-scalation safety study
There was no #symptomatic ICHs in dosis of 0.1-0.2-0.4mg/kg, and 15% (2 of 13) in 0.5mg/kg
No differences in clinical outcomes
bit.ly/3DNHamV ImageImage
Read 11 tweets
WorldStrokeAcademy Profile picture
Oct 11, 2021
#WeekendLecture
Intracranial Atherosclerotic Disease #ICAD

#ICAD leads to changes ranging from minor wall thickening to #hemodynamically significant luminal stenosis and is one of the most #common causes of #stroke worldwide
ahajournals.org/doi/10.1161/CI…

🧵 Image
#WeekendLecture
#ICAD

✅10% of stroke, based on autopsy studies
bit.ly/3v6Lhrd
✅More prevalent in #African Americans, #Hispanics, and #Asians as compared with whites
bit.ly/3AuSiDt

Other risk factors in table Image
#WeekendLecture
#ICAD

In postmortem studies
👉degree of luminal #stenosis
👉% of the plaques containing >40% #lipid area
👉prevalence of intraplaque #hemorrhage, #neovasculature and #thrombus,
were higher in those #plaques associated with #infarct
🔹karger.com/Article/Abstra… Image
Read 13 tweets
WorldStrokeAcademy Profile picture
Oct 4, 2021
#WeekendLecture
#GeneticsAndStroke

#Genetics is involved in several #stroke related conditions, such as small vessel disease #SVD, aneurysms, dissections, cavernomas, and intracranial #hemorrhages

Check this 🧵!
Prepared by @J_Rosales_MD
Edited by @interneurona Image
#Weekendlecture

#Genetic & #SVD
🧬🧠

✅1,5% of cerebral #SVD are #monogenic disorders
✅AR, AD or X-linked
☝🏼Absence of family history doesn't rule out diagnosis because of
👉de novo mutation
👉reduced expression or
👉incomplete penetrance
✅ahajournals.org/doi/10.1161/ST…
#Weekendlecture

#Genetic & #SVD

When to #suspect?🕵️‍♀️

✅early onset stroke without vascular RFs
✅systemic features and neuroimaging of an specific monogenic disorder
✅consanguinity
✅negative work up for other causes of SVD

👉ahajournals.org/doi/10.1161/ST… Image
Read 15 tweets
WorldStrokeAcademy Profile picture
Aug 29, 2021
#WeekendLecture
#CarotidArteryDisease #CAD

#CAD causes ~ 10-20% of #strokes
Atherosclerosis occurs most frequently at carotid #bifurcation, an area of low vessel-wall shear stress and oscillatory/turbulent blood flow

Welcome to this mini review!
#WeekendLecture
#CAD
Endothelial dysfunction
⬇️
Inflammatory response to Lp retention in arterial wall
⬇️
Accelerated accumulation of Lp in subendothelial matrix
⬇️
Macrophages
⬇️
VSCM migrate/proliferate to fibroblast-like cells👉 production of EC matrix
atm.amegroups.com/article/view/7…
#WeekendLecture
#CAD
Stroke Mechanisms
✅#artery_to_artery embolization: retinal (amaurosis fugax) or cerebral circulation
✅#thrombosis in situ
✅#Flow reduction in high grade stenosis: #watershed infarcts, repetitive and brief TIAs (ie limb shaking)

nejm.org/doi/full/10.10…
Read 12 tweets

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