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Basilar artery occlusion is a relatively uncommon but neurologically devastating condition. If revascularization is not achieved, the potential for death and disability is substantial. During the last several years, there have been positive endovascular stroke trials for the treatment of large vessel occlusion; however, all of them excluded patients with basilar artery occlusion. The current treatment of basilar artery occlusion is still founded on small observational studies or meta-analyses. As case selection for revascularization and treatment protocols often vary widely across institutions, sample sizes remain limited. In this article, we aim to review some of the larger observational studies in stroke due to basilar artery occlusion, considering potential treatment strategies and resultant outcomes.

Background: Asian Americans comprise a rapidly increasing segment of the population, but little is known of their outcomes after acute ischemic stroke. We compared Asians and whites presenting to a San Francisco Bay Area tertiary/quaternary stroke center that uniquely serves a high proportion of Asian American patients, and reviewed the treatment rates and outcomes of Asian Americans presenting with acute ischemic stroke compared to whites. Methods: We performed a retrospective study of ischemic stroke patients presenting to our center between 1/2014-7/2020, conducting univariate analyses of demographics, comorbidities, and clinical outcomes in those designated as Asian compared with white patients. Odds ratios and chi-square analyses were conducted between groups. Asians were defined as those of Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese descent. Results: Between 1/2014 and 7/2020, 3958 patients presented with ischemic stroke; 852 (21.5%) were Asian and 2107 (53.2%) were white. Asians were older and more likely to have hypertension, hyperlipidemia, and diabetes, and less likely to have atrial fibrillation (Table 1). More Asians presented directly to our center, while more whites were transferred in. IV rt-PA rates are described in Table 1. Overall, Asians were less likely to receive endovascular treatment (Table 1). Asians had a higher NIHSS at discharge, although there was no difference in the proportion who expired or who were discharged home. Conclusions: Asians with ischemic stroke tended to have more comorbid conditions than whites. Though there was a trend towards similar IV rt-PA rates between Asians and whites presenting to the ED, Asians were less likely to receive endovascular treatment, and had worse NIHSS on discharge with similar proportion going home. This may have to do with local geographic/socioeconomic distribution, or differences in stroke etiology. Further analyses are needed to better elucidate these disparities.

Aims To test a hypothesis that women with diabetes mellitus (DM) versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. Methods We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs) of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. Results Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. Discussion Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.

Background and Purpose: A survival advantage among individuals with higher body mass index (BMI) has been observed for diverse acute illnesses, including stroke, and termed the obesity paradox. However, prior ischemic stroke studies have generally tested only for linear rather than nonlinear relations between body mass and outcome, and few studies have investigated poststroke functional outcomes in addition to mortality. Methods: We analyzed consecutive patients with acute ischemic stroke enrolled in a 60-center acute treatment trial, the NIH FAST-MAG acute stroke trial. Outcomes at 3 months analyzed were (1) death; (2) disability or death (modified Rankin Scale score, 2–6); and (3) low stroke-related quality of life (Stroke Impact Scale Results: Among 1033 patients with acute ischemic stroke, average age was 71 years (±13), 45.1% female, National Institutes of Health Stroke Scale 10.6 (±8.3), and BMI 27.5 (±5.6). In both unadjusted and adjusted analysis, increasing BMI was linearly associated with improved 3-month survival ( P =0.01) odds ratios in adjusted analysis for mortality declined across the BMI categories of underweight (odds ratio, 1.7 [CI, 0.6–4.9]), normal (odds ratio, 1), overweight (0.9 [CI, 0.5–1.4]), obese (0.5, [CI, 0.3–1.0]), and severely obese (0.4 [CI, 0.2–0.9]). In unadjusted analysis, increasing BMI showed a U-shaped relation to poststroke disability or death (modified Rankin Scale score, 2–6), with odds ratios of modified Rankin Scale score, 2 to 6 for underweight, overweight, and obese declined initially when compared with normal weight patients, but then increased again in severely obese patients, suggesting a U-shaped or J-shaped relation. After adjustment, including for baseline National Institutes of Health Stroke Scale, modified Rankin Scale score 2 to 6 was no longer related to adiposity. Conclusions: Mortality and functional outcomes after acute ischemic stroke have disparate relations with patients’ adiposity. Higher BMI is linearly associated with increased survival; and BMI has a U-shaped or J-shaped relation to disability and stroke-related quality of life. Potential mechanisms including nutritional reserve aiding survival during recovery and greater frequency of atherosclerotic than thromboembolic infarcts in individuals with higher BMI.

Background: Age is a major determinant of stroke outcome, but few studies have investigated whether the effect of age differs between men and women. Methods: Analysis of all patients enrolled in a multicenter acute stroke trial (FAST-MAG) presenting with acute cerebral ischemia and treated without intravenous thrombolysis. Effects of age and sex were evaluated for: 1) disability or death (modified Rankin Scale, mRS, 2-6); 2) reduced stroke-related quality of life (Stroke Impact Scale, SIS < 80); and 3) mortality, unadjusted and adjusted for baseline NIHSS, ASPECTS, and 7 additional prognostic variables. Results: Among the 772 patients meeting entry criteria, age was 71.2, 44.0% were women, and presenting NIHSS 6.8. Overall, men were slightly younger than women (69.9 vs 73.0), without difference in initial NIHSS (6.4 vs 7.2), nor in 3m outcomes: mRS 2-6, 44.7% vs 50.2%, p=0.13; SIS Conclusions: The relationship between age and functional outcome in supportively treated acute cerebral ischemia patients differs between the sexes, with women but not men showing better outcomes in early senescence than either midlife or very late-life. This contrasting outcome profile may reflect sex-specific biological differences in ischemic stroke mechanism and neuroplasticity, cultural differences in social roles and support, or additional factors that merit further study.

Introduction and Hypothesis: High troponin levels reflect myocardial damage in patients with heart disease and predict poor prognosis in stroke and cardiomyopathies. In the study, we test the hypothesis that high troponin levels in the setting of chronic renal insufficiency (CRI) significantly predict the risk of first time stroke. Method: The Chronic Renal Insufficiency Cohort Study enrolled a total of 3,477 patients with no previous history of stroke at baseline were used in this study. High troponin level is defined as troponin levels ≥0.03 ug/L. Incident hemorrhagic and ischemic strokes were classified using ICD-9. The associations between baseline troponin levels and incidence of hemorrhagic and ischemic stroke and risk of all-cause mortality were analyzed prospectively using multivariate Cox’s regression analysis technique. Results: With an average (SD) of 7.7 (1.5) years of follow-up, 23 participants developed incident hemorrhagic stroke (HS), and 84 developed incident ischemic stroke (IS). Participants with high troponin had significantly higher IS rate than those with low troponin (9.69% vs. 2.81%, p Conclusion: In CRI patients elevated serum troponin levels were significantly associated with the risk of first time IS and higher all-cause mortality risk. The risk is further amplified significantly in females compared to males indicating sex differences play an important role in first time stroke risk in CRI. These findings represent an unexplored risk of IS.

We aimed to examine the trend in the prevalence of hospitalization attributable to hypertensive disease and its subtypes among United States adults aged ≥35 years from 1980 to 2007. Data (n = 4,598,488,000 hospitalized cases) from the National Hospital Discharge Surveys were used to examine the trends of hospitalized patients with first (the reason for admission) and patients with any second to seventh (a co-morbid condition when admission) diagnosis of hypertensive disease (International Classification of Disease, 9th Revision, Clinical Modification: 401 to 405) by gender and geographic region. Age-adjusted rates of disease were calculated using the United States 2000 standard population. The results show that age-adjusted hospitalization rates due to first diagnosis of hypertensive disease increased from 1.74% to 2.06% in men (p0.01), and from 2.0% to 2.09% in women (p = 0.06) from 1980 to 1981 to 2006 to 2007. Age-adjusted rates due to any second to seventh diagnosis of hypertensive disease significantly increased from 7.06% to 35.09% in men (p0.001), and from 7.88% to 31.98% (p0.001) in women from 1980 to 1981 to 2006 to 2007. Patients with second to seventh diagnosis of essential hypertension and hypertensive chronic kidney disease had the highest and the second highest annual percent increases. Subjects living in the Southern region of the United States had the highest prevalence of hospitalization due to any second to seventh diagnosis of hypertensive disease compared with all other regions in 2006 to 2007. In conclusion, the prevalence of hospitalization due to hypertensive disease significantly increased in the United States from 1980 to 2007.

Objectives. We aimed to test the hypothesis that metabolic syndrome (MetS) is significantly associated with cognitive decline (CoD) in elderly adults and further assess whether MetS and inflammation have a significant joint effect on CoD. Methods. Data (n=2975) from the U.S. National Health and Nutrition Examination Survey (1999–2002) in participants aged ≥60 years who had Digit Symbol Substitution Tests (DSS: a standard measure of cognitive function) were studied. CoD was defined as those in the lowest quintile of DSS score. MetS was defined as having ≥3 of 5 MetS traits (large waist circumference (WC), high blood pressure (BP), elevated glucose, triglycerides, and decreased high density lipoprotein cholesterol). Results. Of 2975 participants, the prevalence of CoD (DSS score P<0.001). There was a significant dose-response relationship between an increased number of MetS traits and CoD (P<0.001). A significant joint effect of MetS and CRP on the odds of CoD was observed. Conclusion. The study, using a nationally representative sample, extended previous studies by highlighting a significant MetS-CoD relationship and a joint effect of MetS and CRP on CoD. These novel findings add to our understanding of the association of neurometabolic disorders and cognition and have implications that may be relevant to primary care practice.