Impact of systemic inflammatory response syndrome on acute ischemic stroke patients treated with mechanical thrombectomy

2021 ◽  
pp. 119988
Author(s):  
Mostafa Jafari ◽  
Kalman Katlowitz ◽  
Carlos De la Garza ◽  
Alexander Sellers ◽  
Shawn Moore ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Systemic Inflammatory Response ◽  
Stroke Patients

Abstract TP151: Association of Splenic Contraction And Development of Systemic Inflammatory Response Syndrome After Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alicia M Zha ◽  
Bhargav Tippinayani ◽  
Jaskaren Randhawa ◽  
Nicole J Pariseau ◽  
Farhaan S Vahidy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Systemic Inflammatory Response ◽  
Secondary Brain Injury ◽  
Stroke Patients

Background: Animal models have demonstrated the deleterious contribution that immunocytes from the spleen exert on secondary brain injury after stroke. While previous work has demonstrated that there is splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have connected the systemic inflammatory response syndrome (SIRS) with SC. We aim to associate SIRS and its individual components with SC in acute stroke Methods: This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients in a tertiary care center from 2010-2013. Spleen contraction was defined compared to previously established normograms of healthy volunteers from the same study. SIRS was defined as the presence of 2 or more of the following: body temperature <36 or >38C, heart rate >90 beats, respiratory rate >20, and serum white blood cell count >12,000 or <4000 mm3 in the absence of infection. SC was evaluated in patients at 24 and 72 hrs after AIS with SIRS as a primary outcome. Results: 91 patients had verified AIS without concurrent infection at admission and 70 of these patients remained inpatient at 72 hrs. SIRS was not associated with admission SC at 24hr and 72 hrs. Patients with SIRS at 24 and 72 hrs were more likely to have higher admission NIHSS. SIRS was associated with higher discharge mRS (OR 4.24, 95% CI 1.64-10.9, p=0.0028) and PEG placement (OR 3.70, 95% CI 0.95-15.11, p=0.05). 16 patients (22.9%) developed SIRS by 72hrs, only 5 of whom had SC initially. 28 patients (47%) had SIRS on admission that persisted, 12 of whom had SC. SC was not associated with SIRS at 72 hrs (OR 1.05, 95% CI 0.35-2.79, p = 0.92). 14 patients (15%) developed infections while hospitalized, of which 85% had SIRS on admission. Conclusion: Based on our initial evaluation, SC detected within 24 hrs of stroke onset is not associated with SIRS suggesting that the relationship between the two may be more complicated in humans. Consistent with prior studies, however, SIRS is associated with worse outcome. Further studies and additional time points are necessary to further clarify the role of the spleen in the development of SIRS in stroke patients.

Abstract 1122‐000007: Impact of Systemic Inflammatory Response Syndrome on Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mostafa Jafari ◽  
Kalman Katlowitz ◽  
Carlos De la Garza ◽  
Alexander Sellers ◽  
Shawn Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Systemic Inflammatory Response ◽  
Sample Population ◽  
Poor Outcomes

Introduction : Systemic inflammatory response syndrome (SIRS) has been associated with poor outcomes after acute ischemic stroke (AIS). The primary goal of this study was to determine whether SIRS status on admission correlated with functional outcomes in AIS treated with mechanical thrombectomy (MT). Methods : Consecutive patients from September 2015 to April 2019 were retrospectively reviewed for SIRS on admission. SIRS was defined as the presence of ≥2 of the following: temperature <36°C or >38°C, heart rate >90, respiratory rate >20, and white blood cell count <4000/mm or >12 000 mm. Results : Of 202 patients, 188 met inclusion criteria. 49 patients (26%) had evidence of SIRS. Neither basic patient demographics nor standard stroke risk factors predicted the development of SIRS. However, presentation with SIRS was correlated with higher rates of death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2‐5.5) as well as lower rates of favorable functional outcomes at discharge (OR, 0.09; 95% CI, 0.02‐0.40) and 3‐month follow up (OR 0.12; 95% CI 0.03‐0.43). These results remained significant even after adjustment for age, sex, baseline NIHSS, recanalization status, and prior co‐morbidities. Conclusions : In our sample population, SIRS was associated with worse outcomes and higher rates of mortality in AIS patients treated with MT. Recognition of key risk factors can provide better prognostication and possible future therapeutic targets.

scholarly journals Correlation of Systemic Inflammatory Response With Infarct Volume in Acute Ischemic Stroke Patients

Stroke ◽  
2005 ◽  
Vol 36 (2) ◽  
pp. 228-229 ◽  
Author(s):  
Hedley C.A. Emsley ◽  
Craig J. Smith ◽  
Rachel F. Georgiou ◽  
Andy Vail ◽  
Pippa J. Tyrrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Systemic Inflammatory Response ◽  
Stroke Patients

Abstract TP278: Prevalence Of Systemic Inflammatory Response Syndrome and its Impact On Outcome In Acute Ischemic Stroke Patients Receiving IV tPA Therapy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Niren Kapoor ◽  
Amelia K Boehme ◽  
Karen C Albright ◽  
Michael J Lyerly ◽  
Reza Bavarsad Shahripour ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Systemic Inflammatory Response ◽  
Short Term ◽  
Sirs Criteria ◽  
Iv Tpa

Background: Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state linked to a release of various pro- and anti-inflammatory cytokines and associated with fibrin deposition, platelet aggregation, and coagulopathies. Although SIRS is associated with various inflammatory and ischemic conditions, its prevalence and impact on patients with acute ischemic stroke (AIS) has not been extensively studied. Methods: A retrospective cross sectional study was used to look at the prevalence of SIRS and its impact on outcome in AIS patients treated with IV tPA between 2009-2011 at our tertiary care center. SIRS was diagnosed if two or more of the following were present: temperature < 36°C or > 38°C, heart rate > 90/min, respiratory rate >20/min or PaCO 2 <32 mmHg and WBC count <4000/mm 3 or >12000/mm 3 or 10% bands. Patients meeting the SIRS criteria for at least 24h were included in the study. Patients with signs of active infection such as pneumonia, UTI, bacteremia, and sinusitis or deep venous thrombosis were excluded from the study. The discharge modified Rankin score (mRS) was used to compare the short-term outcomes between patients with and without SIRS. An mRS of 4-6 was used to define poor functional outcome. Results: Out of the 212 patients screened, 44 met the SIRS criteria (21%). The median NIHSS for SIRS patients was 9 (range 0-32). SIRS patients were more likely to have a longer length of stay than non-SIRS patients (5 vs. 3 days; p<0.0001). Patients with SIRS had worse functional outcomes compared to patients without SIRS (OR=2.824, 95% CI, 1.358 - 5.871, p=0.0054). Adjusting for pre-tPA NIHSS, age and race, SIRS remained a predictor of poor outcome (OR= 2.581, 95% CI, 1.163 - 5.727, p=0.0197). Presence of SIRS did not have a significant effect upon in-hospital mortality (OR=1.978, 95% CI, 0.774 - 5.057, p=0.1545). Conclusions: One out of five AIS patients treated with IV tPA developed SIRS. The presence of SIRS is associated with poor short-term functional outcomes and prolonged length of stay.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

116 Effect of Annual Hospital Procedure Volume on Outcomes After Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Neurosurgery ◽  
2016 ◽  
Vol 63 ◽  
pp. 149 ◽  
Author(s):  
Vishal B. Jani ◽  
Chiu Yuen To ◽  
Achint Patel ◽  
Prashant S. Kelkar ◽  
Boyd Richards ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Patients ◽  
Procedure Volume

scholarly journals Anestezijos metodo reikšmė pacientų, sergančių ūminiu išeminiu insultu ir gydytų mechanine trombektomija, ankstyvai neurologinei būklei Relevance of anaesthesia type on early neurological outcome in acute ischemic stroke patients undergoing mechanical thrombectomy

2019 ◽  
Vol 22 (78) ◽  
pp. 325-329
Author(s):  
L. Šalaševičius ◽  
A. Vilionskis
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Mechanical Thrombectomy ◽  
Stroke Patients

Įvadas. Sąmonės sedacija (SS) ir bendroji endotrachėjinė anestezija (BETA) – anestezijos metodai, taikomi mechaninės trombektomijos (MTE) metu. Tikslių rekomendacijų dėl anestezijos metodo pasirinkimo MTE metu nėra. Retrospektyviniai tyrimai teigia, kad BETA yra susijusi su blogesnėmis pacientų išeitimis, tačiau naujuose klinikiniuose tyrimuose tokio skirtumo nestebima. Darbo tikslas buvo nustatyti anestezijos metodo įtaką mechaninės trombektomijos efektyvumui ir saugumui ligoniams, patyrusiems ūminį išeminį insultą. Tiriamieji ir tyrimo metodai. Į tyrimą įtraukti dviejuose Vilniaus centruose gydyti ūminį išeminį insultą patyrę ligoniai, kuriems buvo atlikta MTE. Ligoniai suskirstyti į 2 grupes pagal taikytą anestezijos metodą: bendroji endotrachėjinė anestezija (BETA) ir sąmonės sedacija (SS). Abiejose grupėse vertinti demografiniai, klinikiniai ir logistiniai rodikliai. Pirminiu vertinimo kriterijumi pasirinkta gera baigtis po 24 valandų. MTE saugumas vertintas pagal 7 parų mirštamumą ir simptominių intrasmegeninių kraujosruvų (sISK) dažnį. Rezultatai. Į tyrimą įtraukta 248 pacientai. 105 pacientams (42,3 %) taikyta BETA ir 143 (57,7 %) – SS. Pagal pradines charakteristikas abi grupės statistiškai nesiskyrė, išskyrus prieširdžių virpėjimo dažnį (55,9 % – SS vs 37,1 % – BETA grupėje, p = 0,003) ir intraveninės trombolizės taikymą iki MTE (66,4 % – SS grupėje ir 46,7 % – BETA grupėje, p = 0,003). Gera baigtis po 24 val. nustatyta 51,4 % (n = 54) ligonių – BETA grupėje ir 58,7 % (n = 84) ligonių – SS grupėje (p = 0,252). 7 parų mirštamumo sISK dažnis abiejose grupėse statistiškai reikšmingai nesiskyrė. Regresinė analizė parodė, kad geros baigties nepriklausomi prognoziniai veiksniai yra laikas nuo atvykimo į stacionarą iki rekanalizacijos ir sėkminga rekanalizacija. Išvados. Anestezijos tipas nėra reikšmingas mechaninės trombektomijos efektyvumo ir saugumo veiksnys ankstyvai pacientų baigčiai. Siekiant tiksliau įvertinti anestezijos reikšmę mechaninės trombektomijos baigčiai ir nustatyti procedūros baigties prognozinius veiksnius, reikalingi papildomi atsitiktinės atrankos tyrimai.

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