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Abstract
Background
Although rare, paradoxical embolism sometimes occurs with patent ductus arteriosus
(PDA). This study presents a case of PDA-associated paradoxical embolism with acute
ischemic stroke (AIS) and pulmonary embolism (PE) following thoracoscopic surgery.
Case Presentation
A 65-year-old woman developed acute-onset aphasia and right hemiparesis on the third
day following thoracoscopic resection for a right lung tumor. Brain magnetic resonance
imaging revealed multiple infarcts, and lower extremity venous Doppler ultrasound
revealed deep vein thrombosis. The patient subsequently developed dyspnea, tachycardia,
and hypoxemia. PE was confirmed by percutaneous transfemoral venous selective pulmonary
angiography, which meanwhile demonstrated a PDA lesion. The patient, after receiving
catheter-directed thrombolysis and inferior vena cava filter placement, improved in
both neurological and respiratory status.
Conclusion
For an uncommon but potentially fatal case with PDA-induced paradoxical embolism causing
AIS and PE, early recognition and treatment are vital. Further studies are warranted
to determine the optimal management and prognosis of patients with PDA-related embolic
events.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13019-024-02901-w.
This cross-sectional study investigates the prevalence, incidence, and mortality rate of stroke in China in 2020 using data from a nationally representative sample of rural and urban populations. Question What was the burden of prevalence, incidence, and mortality rate of stroke in China? Findings In this cross-sectional study of 676 394 participants aged 40 years and older, the estimated overall prevalence, incidence, and mortality rate of stroke in mainland China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively. The prevalence of stroke was higher in urban areas than rural areas, but the incidence rate and mortality rate of stroke were higher in rural areas than urban areas. Meaning These findings suggest that there may be an urban-rural disparity in the burden of stroke in China, and an improved stroke prevention strategy is needed. Importance Stroke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited. Objective To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations. Design, Setting, and Participants This cross-sectional study was based on a nationally representative survey that included 676 394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China. Main Outcomes and Measures Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases. Results The study included 676 394 Chinese adults (395 122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100 000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100 000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P = .02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100 000 person-years; P < .001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100 000 person-years; P < .001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]). Conclusions and Relevance In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.
Contemporary data on stroke epidemiology and the availability of national stroke clinical registries are important for providing evidence to improve practice and support policy decisions. To update the most current incidence, case-fatality, and mortality rates on stroke and identify national stroke clinical registries worldwide. We searched multiple databases (based on our existing search strategy) to identify new original papers, published between 1 November 2018 and 15 December 2021, that met ideal criteria for data on stroke incidence and case-fatality, and added these to the studies reported in our last review. To identify national stroke clinical registries, we updated our last search, using PubMed, from 6 February 2015 until 6 January 2022. We also screened reference lists of review papers, citation history of papers, and the gray literature. Mortality codes for International Classification of Diseases (ICD)-9 and ICD-10 were extracted from the World Health Organization (WHO) for each country providing these data. Population denominators were obtained from the United Nations (UN) or WHO (when data were unavailable in the UN database). Crude and adjusted stroke mortality rates were calculated using country-specific population denominators, and the most recent years of mortality data available for each country. Since our last report in 2020, there were two countries (Chile and France) with new incidence studies meeting criteria for ideal population-based studies. New data on case-fatality were found for Chile and Kenya. The most current mortality data were available for the year 2014 (1 country), 2015 (2 countries), 2016 (11 countries), 2017 (10 countries), 2018 (19 countries), 2019 (36 countries), and 2020 (29 countries). Four countries (Libya, Solomon Islands, United Arab Emirates, and Lebanon) reported mortality data for the first time. Since our last report on registries in 2017, we identified seven more national stroke clinical registries, predominantly in high-income countries. These newly identified registries yielded limited information. Up-to-date data on stroke incidence, case-fatality, and mortality continue to provide evidence of disparities and the scale of burden in low- and middle-income countries. Although more national stroke clinical registries were identified, information from these newly identified registries was limited. Highlighting data scarcity or even where a country is ranked might help facilitate more research or greater policy attention in this field.
Department of Neurology, The People’s Hospital of Huantai County (The 9 th People’s
Hospital of Zibo), No. 2198 Huantai Avenue, Suo Town, Huantai Country, Zibo, Shandong
Province 256400 China
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