Atherosclerosis in Trial of Org 10172 in Acute Stroke Treatment Subtypes among Young and Middle-Aged Stroke Patients: The Norwegian Stroke in the Young Study

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

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Three-Month Outcomes Are Poor in Stroke Patients with Cancer Despite Acute Stroke Treatment

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2016.10.021 ◽

2017 ◽

Vol 26 (4) ◽

pp. 809-815 ◽

Cited By ~ 15

Author(s):

Shawna Cutting ◽

Meagan Wettengel ◽

James J. Conners ◽

Bichun Ouyang ◽

Katharina Busl

Keyword(s):

Acute Stroke ◽

Stroke Patients ◽

Stroke Treatment ◽

Patients With Cancer ◽

Acute Stroke Treatment

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Swiss guidelines for the prehospital phase in suspected acute stroke

Clinical and Translational Neuroscience ◽

10.1177/2514183x21999230 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2514183X2199923

Author(s):

Georg Kägi ◽

David Schurter ◽

Julien Niederhäuser ◽

Gian Marco De Marchis ◽

Stefan Engelter ◽

...

Keyword(s):

Acute Stroke ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Current Guideline ◽

Stroke Patients ◽

Stroke Units ◽

Stroke Treatment ◽

Prehospital Phase ◽

Acute Stroke Treatment ◽

The Right

Acute stroke treatment has advanced substantially over the last years. Important milestones constitute intravenous thrombolysis, endovascular therapy (EVT), and treatment of stroke patients in dedicated units (stroke units). At present in Switzerland there are 13 certified stroke units and 10 certified EVT-capable stroke centers. Emerging challenges for the prehospital pathways are that (i) acute stroke treatment remains very time sensitive, (ii) the time window for acute stroke treatment has opened up to 24 h in selected cases, and (iii) EVT is only available in stroke centers. The goal of the current guideline is to standardize the prehospital phase of patients with acute stroke for them to receive the optimal treatment without unnecessary delays. Different prehospital models exist. For patients with large vessel occlusion (LVO), the Drip and Ship model is the most commonly used in Switzerland. This model is challenged by the Mothership model where stroke patients with suspected LVO are directly transferred to the stroke center. This latter model is only effective if there is an accurate triage by paramedics, hence the patient may benefit from the right treatment in the right place, without loss of time. Although the Cincinnati Prehospital Stroke Scale is a well-established scale to detect acute stroke in the prehospital setting, it neglects nonmotor symptoms like visual impairment or severe vertigo. Therefore we suggest “acute occurrence of a focal neurological deficit” as the trigger to enter the acute stroke pathway. For the triage whether a patient has a LVO (yes/no), there are a number of scores published. Accuracy of these scores is borderline. Nevertheless, applying the Rapid Arterial Occlusion Evaluation score or a comparable score to recognize patients with LVO may help to speed up and triage prehospital pathways. Ultimately, the decision of which model to use in which stroke network will depend on local (e.g. geographical) characteristics.

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Quality of medical care for stroke patients in the Moscow region

Consilium Medicum ◽

10.26442/20751753.2020.9.200269 ◽

2020 ◽

Vol 22 (9) ◽

pp. 9-13

Author(s):

Sergei V. Kotov ◽

◽

Elena V. Isakova ◽

Andrei N. Gurov ◽

Elena K. Sorokina ◽

...

Keyword(s):

Medical Care ◽

Acute Stroke ◽

Moscow Region ◽

Stroke Patients ◽

Stroke Treatment ◽

Quality Of Medical Care ◽

Acute Stroke Treatment

Цель. Изучение качества помощи больным с инсультом в Московской области в 2005, 2015 и 2019 гг. Материалы и методы. Изучены ежегодные отчеты, медицинские документы 5 сосудистых центров, ГБУ «Московский областной медицинский ин-формационно-аналитический центр». Результаты. В 2005–2019 гг. заболеваемость острым нарушением мозгового кровообращения была на уровне 3,7–4,4 на 1 тыс. населения в год, рост числа больных с 28,5 до 33,7 тыс., летальность снизилась с 27,1 до 21,1%. В 2019 г. функционировало 38 сосудистых центров, профильная гос-питализация составила 82,1%. Необходимый объем исследований в 2005 г. был проведен у 5–51%, в 2015 г. – у 45–95%, в 2019 г. – у всех больных, увеличено число системного тромболизиса с 3% в 2015 г. до 10% в 2019 г. Определение подтипа по TOAST (Trial of Org 10172 in Acute Stroke Treatment) в 2015 г. было выполнено в 35% случаев, в 2019 г. – в 47%. С 40 до 87% выросло число пациентов, которым назначена вторичная профилактика (p<0,05). Уменьшение оценки по шкале Рэнкина не менее 1 балла отмечено у 65, 80 и 97% больных соответственно. Заключение. Отмечено увеличение доли профильной госпитализации больных с 5,1 до 82,1%, но в первые 4,5 ч – менее трети, что ограничивает возможности проведения тромболизиса. Недостаточно число пациентов, у которых определен подтип ишемического инсульта по TOAST, что ведет к упущениям в тактике лечения и снижению эффективности вторичной профилактики. Считаем важным, чтобы программа вторичной профилактики была обязательно включена в выписной эпикриз. Ключевые слова: инсульт, заболеваемость, летальность, качество, объем обследований, патогенетический подтип. Для цитирования: Котов С.В., Исакова Е.В., Гуров А.Н. и др. Качество оказания медицинской помощи больным с инсультом в Московской области. Consilium Medicum. 2020; 22 (9): 9–13. DOI: 10.26442/20751753.2020.9.200269

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Acute stroke treatment and outcome in the oldest old (90 years and older) at a tertiary care medical centre in Germany-a retrospective study showing safety and efficacy in this particular patient population

BMC Geriatrics ◽

10.1186/s12877-021-02566-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jil Kauffmann ◽

Daniel Grün ◽

Umut Yilmaz ◽

Gudrun Wagenpfeil ◽

Klaus Faßbender ◽

...

Keyword(s):

Retrospective Study ◽

Acute Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Oldest Old ◽

Tertiary Care ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Stroke Treatment ◽

Acute Stroke Treatment

Abstract Background Stroke is among the most common causes of death and disability worldwide. Despite the relevance of stroke-related disease burden, which is constantly increasing due to the demographic change in industrialized countries with an ageing population and consecutively an increase in age-associated diseases, there is sparse evidence concerning acute stroke treatment and treatment-related outcome in the elderly patient group. This retrospective study aimed at analysing patient characteristics, therapy-related complications and functional outcome in stroke patients aged 90 years or older who underwent acute stroke treatment (i.e. intravenous thrombolysis, mechanical thrombectomy, or both). Methods We identified files of all inpatient stays at the Department of Neurology at Saarland University Medical Center (tertiary care level with a comprehensive stroke unit) between June 2011 and December 2018 and filtered for subjects aged 90 years or older at the time of admission. We reviewed patient files for demographic data, symptoms upon admission, (main) diagnoses, comorbidities, and administered therapies. For patients admitted due to acute stroke we reviewed files for therapy-related complications and functional outcome. We compared the modified Rankin scale (mRS) scores upon admission and at discharge for these patients. Results We identified 566 inpatient stays of subjects aged 90 years or older. Three hundred sixty-seven of the 566 patients (64.8%) were admitted and discharged due to symptoms indicative of stroke. Two hundred eleven patients received a diagnosis of ischaemic stroke. These 211 patients were analysed subsequently. Sixty-four patients qualified for acute stroke treatment (intravenous thrombolysis n = 22, mechanical thrombectomy n = 26, intravenous thrombolysis followed by mechanical thrombectomy n = 16) and showed a significant improvement in their functional status as measured by change in mRS score (admission vs. discharge, p 0.001) with 7 (10.9%) observed potentially therapy-related complications (relevant drop in haemoglobin n = 2, subarachnoidal haemorrhage n = 1, cerebral haemorrhage n = 3, extracranial bleeding n = 1). One intravenous thrombolysis was stopped because of an uncontrollable hypertensive crisis. Patients who did not qualify for these treatments (including those declining acute treatment) did not show a change of their functional status between admission and discharge (p 0.064). Conclusion Our data indicate that acute stroke treatment is effective and safe in the oldest old. Age alone is no criterion to withhold an acute intervention even in oldest old stroke patients.

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