Angiographic Microcirculatory Obstructions Distal to Occlusion Signify Poor Outcome after Endovascular Treatment for Acute Ischemic Stroke

2017 ◽  
Vol 9 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Ethem Murat Arsava ◽  
Anil Arat ◽  
Mehmet Akif Topcuoglu ◽  
Ahmet Peker ◽  
Muge Yemisci ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Poor Outcome

scholarly journals A Score Based on Age and DWI Volume Predicts Poor Outcome following Endovascular Treatment for Acute Ischemic Stroke

2013 ◽  
Vol 10 (5) ◽  
pp. 705-709 ◽  
Author(s):  
John T. P. Liggins ◽  
Albert J. Yoo ◽  
Nishant K. Mishra ◽  
Hayley M. Wheeler ◽  
Matus Straka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Poor Outcome

Abstract WP29: Temporal Trends of Intravenous Recombinant Tissue Plasminogen Activator Infusion and Endovascular Treatment for Acute Ischemic Stroke in Japan: J-ASPECT Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ai Kurogi ◽  
Daisuke Onozuka ◽  
Akihito Hagihara ◽  
Akiko Kada ◽  
Kunihiro Nishimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Recombinant Tissue Plasminogen Activator ◽  
Treatment Groups ◽  
Poor Outcome ◽  
Using Data

Objective: This study aimed to investigate recent nationwide trends in the epidemiology of acute ischemic stroke (AIS) in Japan. Methods: We analyzed 328,147 acute ischemic stroke patients in 350 certified training hospitals in Japan using data obtained from the Japanese Diagnosis Procedure Combination Database. Data between the period April 1, 2010 and May 31, 2014 were used. We divided patients into three treatment groups: medical treatment only (group M), intravenous t-PA infusion only (group IVT), and endovascular treatment (group ET). Outcome was assessed by in-hospital mortality and modified Rankin Scale (mRS) score at discharge, and poor outcome was defined as a mRS score of 3-6. Results: The patient proportion in groups M, IVT, and ET changed from 94.3%, 3.2%, and 1.6% in 2010 to 90.9%, 4.3%, and 3.7% in 2014, respectively (P<0.0001). In all AIS patients, in-hospital mortality significantly decreased from 6.5% in 2010 to 5.3% in 2014 (p<0.0001) and poor outcome at discharge also decreased from 42.7% in 2010 to 41.6% in 2014 (p<0.0001). In groups M and IVT, in-hospital mortality significantly decreased from 6.3% and 12.0% in 2010 to 5.0% and 9.1% in 2014, respectively (p<0.0001), and poor outcome at discharge also decreased from 42.1% and 60.7% in 2010 to 40.7% (P<0.0001) and 55.4% (p<0.005) in 2014, respectively. In contrast, in group ET, both in-hospital mortality (from 11% in 2010 to 9.5% in 2014) and poor outcome at discharge (from 53.4% in 2010 to 54.0% in 2014) were not significantly different between the two time points. Conclusion: In Japan, during the 5-year period before the guidelines concerning proper use of ET for AIS were revised in 2015, a significant improvement in in-hospital mortality and functional outcomes of AIS patients undergoing medical treatment and intravenous rt-PA infusion was observed. This was probably due to a gradual increase in the proportion of patients undergoing IVT; the outcomes of ET, however, remained the same.

scholarly journals Predicting Poor Outcome Before Endovascular Treatment in Patients With Acute Ischemic Stroke

2020 ◽  
Vol 11 ◽  
Author(s):  
Lucas A. Ramos ◽  
Manon Kappelhof ◽  
Hendrikus J. A. van Os ◽  
Vicky Chalos ◽  
Katinka Van Kranendonk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Poor Outcome

Abstract WP22: A Scoring System Based on Age and DWI Volume Predicts Poor Functional Outcome Following Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
John Liggins ◽  
Nishant K Mishra ◽  
Hayley M Wheeler ◽  
Matus Straka ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scoring System ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Clinical Variables ◽  
Poor Outcome ◽  
New Scoring

Background: The Houston IAT (HIAT) score predicts poor outcome following endovascular stroke therapy based on clinical variables (age, serum glucose, and NIHSS score). We aimed to validate the HIAT score in an independent cohort of patients treated with endovascular therapy (DEFUSE 2) and determine if prediction of poor outcome could be improved by including neuroimaging variables in the prediction score. Methods: Patients enrolled in the DEFUSE 2 study had a clinical diagnosis of acute ischemic stroke and underwent MRI prior to endovascular treatment. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6 at day 90. The relationship between baseline clinical and neuroimaging variables and poor functional outcome was assessed using univariate and multivariate logistic regression. Statistically significant variables in the multivariate model were used to create a new scoring system. We evaluated the new scoring system and the HIAT score using ROC analysis. Results: One hundred and ten patients were included in the analysis; forty-two patients had a poor functional outcome. Validation of the HIAT score demonstrated similar ROC properties in the DEFUSE 2 cohort (AUC=0.69) compared to the Houston derivation cohort (AUC=0.73). In DEFUSE 2, age (p=0.001), baseline DWI volume (p=0.09), baseline NIHSS score (p=0.03) and hypertension (p=0.003) were associated with poor functional outcome in univariate analysis. In multivariate analysis, age (p<0.001) and baseline DWI volume (p=0.03) were independent predictors of poor functional outcome. Based on this we developed a new scoring system with a maximum of 3 points awarded for age (0 points, < 55; 1 point, 56-69; 2 points, 70-79; 3 points, ≥ 80) and a maximum of 1 point awarded for baseline DWI volume (0 points, volume ≤ 15 cc; 1 point, volume >15 cc). The percentage of patients with poor functional outcomes increased with the number of points awarded (0% poor outcomes in patients with 0 points, 25% with 1 point, 30% with 2 points, 75% with 3 points, and 89% with 4 points). The AUC for the new scoring system was 0.82. Conclusion: The new scoring system that incorporates baseline DWI volume and age predicts poor outcome more accurately than a scoring system based on clinical variables alone.

Endovascular Treatment in Acute Ischemic Stroke - Three Years Clinical Experience

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
S. Andonova ◽  
E. Kalevska ◽  
Ch. Bachvarov ◽  
Tz. Dimitrova ◽  
M. Petkova ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Experience

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

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