Publications by authors named "Kyusik Kang"

Introduction: This multicenter, double-blind, placebo-controlled trial, commissioned by South Korea's Ministry of Food and Drug Safety, evaluated the effect of oxiracetam for preventing post-stroke cognitive impairment (PSCI) and explored potential interaction with physical activity using neuroimaging.

Patients And Methods: Patients at high risk of PSCI, reporting subjective cognitive decline ⩾3 months after stroke, were randomized 1:1 to receive oxiracetam or placebo for 36 weeks. Physical activity was tracked via wrist-worn actigraphy.

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Background: As populations age, there is an increasing need to optimize endovascular treatment (EVT) and to understand country-specific differences in East Asia. We harmonized stroke registries from Korea and Taiwan to enable comparisons of patient characteristics and outcomes, with a particular focus on the impact of age.

Methods: Multicenter prospective stroke registries in Korea (CRCS-K [Clinical Research Collaboration for Stroke in Korea]) and Taiwan (TREAT-AIS [Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke]) were harmonized to form a unified data set of patients undergoing EVT.

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Hashimoto's encephalopathy (HE) is a rare disease of the central nervous system characterized by diverse neurological symptoms associated with elevated levels of antithyroid antibodies. Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome characterized by typical manifestations such as severe headache, altered mental status, visual impairment, seizures, and vasogenic edema. We experienced a patient with HE presenting with PRES who showed remarkable improvement subsequent to treatment with anti-seizure medication and corticosteroids.

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Background And Purpose: The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90-110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.

Methods: Patients from 14 South Korean centers were analyzed separately.

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Tuberculous meningitis (TBM) is fatal unless treated promptly. Nonconvulsive status epilepticus (NCSE) may cause altered consciousness in patients with TBM. A 25-year-old female presented to the emergency department with a headache and fever along with multiple associated symptoms that had developed 2 days prior.

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We explored effects of (1) training with various sample sizes of multi-site vs. single-site training data, (2) cross-site domain adaptation, and (3) data sources and features on the performance of algorithms segmenting cerebral infarcts on Magnetic Resonance Imaging (MRI). We used 10,820 annotated diffusion-weighted images (DWIs) from 10 university hospitals.

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Backgrounds And Aims: This study investigates the temporal patterns of occult cancer incidence among survivors of acute ischemic stroke (AIS), with a focus on variations by underlying stroke etiology.

Patients And Methods: We analyzed data from a prospective, multicenter stroke registry and a national claims database, identifying AIS patients hospitalized between 2011 and 2013. Patients were categorized by stroke etiology into two groups: unidentified stroke etiology (USE) and identified stroke etiology (ISE).

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Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients.

Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea.

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Background: Elevated heart rate in patients with acute ischemic stroke is associated with increased risk of mortality. Beta-blocker therapy is well known to reduce heart rate.

Methods And Results: This study was a post hoc analysis of patients with acute ischemic stroke with maximum heart rates ≥100 bpm.

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Background: This study aims to evaluate temporal trends of advanced treatments and related clinical outcomes of ischemic stroke through a decade-long trend analysis, using data from a comprehensive, national, multicenter registry. We also seek to identify areas in need of improvement.

Methods And Results: This analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the CRCS-K-NIH (Clinical Research Center for Stroke in Korea-National Institute of Health) registry between 2011 and 2020.

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Background And Purpose: Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes.

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Background: Research specifically addressing the efficacy of rosuvastatin versus atorvastatin in patients with ischemic stroke is insufficient. Using a large stroke registry, we investigated whether 2 commonly used statins, rosuvastatin and atorvastatin, differ in their effectiveness in reducing the risk of vascular events in patients with acute ischemic stroke.

Methods: We analyzed data from a nationwide stroke registry in South Korea between January 2011 and April 2022.

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Background: This study aimed to explore the association between admission HbA1c and the risk of 1-year vascular outcomes stratified by age group in patients with acute ischemic stroke (AIS) and diabetes mellitus (DM).

Methods: This study analyzed prospective multicenter data from patients with AIS and DM. Admission HbA1C were categorized as:≤6.

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Article Synopsis
  • This study examined how non-traditional lipid profiles, specifically the LDL/HDL ratio, affect the risk of vascular events within a year in stroke patients already on statins and with low LDL-C levels.
  • The analysis included 7028 patients with acute ischemic strokes and found a significant association between higher LDL/HDL ratios and increased risk of recurrent stroke, heart attack, or death after adjusting for other variables.
  • The results suggest that even with low LDL-C levels due to statin use, monitoring the LDL/HDL ratio is important to assess residual risk after a stroke.
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  • A multi-center MRI study investigated how white matter hyperintensity (WMH) affects recovery after stroke, focusing on different severity levels of ischemic stroke.
  • Higher WMH levels were linked to worse outcomes three months later, but the impact varied based on initial stroke severity: mild strokes showed a dose-dependent effect while moderate-to-severe strokes had a threshold effect.
  • The study found that WMH impacted 3-month recovery more significantly in those with mild strokes, suggesting that increased WMH burden worsens recovery, but its effect is less pronounced in more severe strokes.
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  • The report offers updated statistics on stroke patients in South Korea from a nationwide registry, revealing a male-to-female ratio of 1.5, with average ages of 67 for men and 73 for women.
  • Hypertension is the leading risk factor (67%), with notable rates of diabetes (35%) and smoking (21%), while atrial fibrillation is less common (19%) than in Western populations, indicating effective preventive measures.
  • There has been a decline in intravenous thrombolysis use, unchanged timing for treatment, and despite favorable outcomes at 3 months, there is a pressing need for improvements in acute stroke care.
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  • A study was conducted to develop deep learning algorithms for the automatic segmentation of white matter hyperintensity (WMH) lesions in patients with cerebral infarction, involving a large dataset of 8,421 patients from multiple hospitals in Korea.
  • Two models, 2D UNet and SE-Unet, were trained and validated using FLAIR MRI images, with performance measured against a human-segmented gold standard using various statistical metrics.
  • Results showed that while both models had good performance, the SE-Unet outperformed the UNet with higher average Dice Similarity Coefficients (DSCs) in both internal and external validations, indicating it was more reliable for WMH segmentation.
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Background And Purpose: Diagnosing Hashimoto's encephalopathy (HE) is challenging. In contrast to other types of autoimmune encephalitis, HE shows an excellent response to steroid treatment. We aimed to investigate the rates of antithyroid antibodies (ATAs) and probable HE in patients with unexplained mental dysfunction and compare the clinical characteristics between the good- and poor-outcome groups.

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Article Synopsis
  • - The study reviews how dual antiplatelet therapy (DAPT-AC) with aspirin and clopidogrel has been increasingly used among stroke patients who didn't qualify for major clinical trials, particularly after the CHANCE trial results became available in 2013.
  • - Analysis of data from over 32,000 patients from 2008 to 2022 showed that the usage of DAPT-AC rose significantly from 33% in 2008 to 78% in 2022, while the use of other antiplatelet medications decreased.
  • - Despite this increase in DAPT-AC usage, clinical outcomes, including stroke rates and mortality, improved only slightly, indicating ongoing efforts are needed to enhance recovery
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Objective: We evaluated the efficacy of endovascular thrombectomy (EVT) on the functional outcome of patients with acute basilar artery occlusion and low posterior circulation acute stroke prognosis early computed tomography score (PC-ASPECTS).

Methods: We identified patients with acute ischemic stroke due to basilar artery occlusion and PC-ASPECTS of 6 or less, presenting within 24 h between August 2008 and April 2022. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days.

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  • Novel oral anticoagulants (NOACs) are recommended for stroke prevention in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF), but their real-world effectiveness is unclear.
  • This study analyzed data from nearly 13,000 patients over eight years to examine trends in clinical outcomes related to AIS and AF, particularly looking at how NOAC prescriptions influenced these trends.
  • Results showed that NOAC prescriptions rose significantly from 0% to 75.6%, correlating with a decrease in 1-year incidences of major adverse outcomes from 28.3% to 21.7%, suggesting NOACs may play a key role in improving patient outcomes.
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  • Aphasic status epilepticus (ASE) is a type of seizure where aphasia, a language disorder, is the only symptom, and Alzheimer's disease (AD) can lead to this condition.
  • The cases of two patients with ASE due to AD showed different types of aphasia (Broca's and global) and unusual EEG patterns that improved with antiepileptic medication.
  • Recognizing the changes in symptoms and EEG after treatment is essential for diagnosing ASE, and timely intervention is crucial to avoid further impairment of consciousness in patients with AD.
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Background And Purpose: The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO).

Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0-5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds.

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