Li and colleagues studied the relation of low-density cholesterol and hs-CRP (high-sensitive C-reactive protein) levels and risk of recurrent ischemic stroke, cardiovascular events (all stroke, myocardial infarction, vascular death), and cardiovascular death. The study was a multicenter study conducted in China, including 11 261 patients with acute ischemic stroke or transient ischemic attack. Patients were grouped into 4 groups: elevated baseline cholesterol and hs-CRP levels, cholesterol at target but high hs-CRP level, high cholesterol but normal hs-CRP, cholesterol levels at target and normal hs-CRP. In cox regression analyses adjusted for baseline confounders, patients with high hs-CRP level, and those with high elevation of both low-density cholesterol and hs-CRP had higher risk of recurrent stroke. The associations were mainly in patients with large artery or cardioembolic stroke mechanisms. Patients in the same groups were more likely to have modified Rankin Scale scores ≥2 at 1 year. Similar associations were observed with composite cardiovascular events but not with death. In patients with cholesterol levels at target on presentation and at 3 months follow-up, higher hs-CRP was associated with higher risk of disability, recurrent stroke, and composite cardiovascular events. This study suggests a role for inflammation in recurrent stroke, and potential patient subgroups that could be included in randomized clinical trials evaluating inflammation as treatment target to reduce recurrent stroke risk. See p 2827.

Mohammaden et al evaluated the association of number of passes in patients undergoing mechanical thrombectomy (2 groups: 4–5 versus ≥6 passes), with successful reperfusion, functional outcome, and mortality. Successful reperfusion was considered as modified Thrombolysis in Cerebral Infarction 2b-3 scores. Favorable functional outcome was defined as a modified Rankin Scale score of 0 to 2 at 90 days. Matching of cases and controls was done for analyses using Euclidean distances, with controls from a group of patients with unsuccessful reperfusion regardless of the number of passes. In the matched case-control analysis within groups, higher number of passes was related to successful reperfusion in both groups. Successful reperfusion, in turn, was related to favorable outcomes in multivariable-adjusted analyses. Rates of hemorrhage were numerically higher in cases than controls with unsuccessful reperfusion in both groups. Limitations of the study included its retrospective design and small sample. Further prospective studies are needed to clarify the risk/benefit balance of higher number of passes during mechanical thrombectomy for acute large vessel occlusion. See p 2757.

A high proportion of patients with central retinal artery occlusion (CRAO) do not have ipsilateral carotid artery disease to account for the event. Mac Grory et al conducted a retrospective, observational cohort study using data from an administrative dataset of ≈30.8 million patients from 62 health systems in the United States, cross-referenced with data from the Medtronic CareLink registry, which contains records from 2.7 million patients with implantable cardiac monitoring devices. The outcome was new diagnosis of atrial fibrillation (AF) in patients with and without CRAO. Analyses included comparisons with matched controls (10:1 ratio based on 8 clinical characteristics) and patients with ischemic stroke. The estimated cumulative incidence of AF detection at 1 and 2 years were as follows: 33.4% and 49.6% post-CRAO, 33.6% and 43.2% after ischemic stroke, and 22.3% and 31.9% in matched controls. Patients with CRAO had a higher rate of new AF than the matched controls (HR, 1.64 [95% CI, 1.17–2.31]) and a similar rate compared with patients with ischemic stroke (HR, 1.01 [95% CI, 0.75–1.36]). The estimated cumulative incidence for AF detection after 30 days of monitoring in patients with 15.1% after initiation of monitoring, and 4.0% after the event. Most AF was short paroxysmal (75.6%). Patients with CRAO had nearly 3-fold higher risk of stroke at 2 years compared with controls. This study has limitations inherent to its study design and data used but supports the use of cardiac monitoring for AF detection in patients with CRAO and unclear cause. See p 2773.