Acute Stroke Patients Treated with Stent Retrievers in Carotid “T” Occlusions Have Improved Recanalization and Outcome

AbstractBackground: Recanalization rates and patient outcomes in acute occlusion of the carotid terminus have previously been poor. The use of stent-retrievers has resulted in better recanalization and patient outcomes. We sought to compare outcomes in patients treated with stent-retrievers to outcomes in older techniques. Methods: We retrospectively compared a stent-retriever cohort to a historical cohort. We evaluated recanalization rates and good outcomes (defined as mRS < 2 at 30 days or 10 point drop in NIHSS). Results: There were twenty patients treated with stent-retrievers versus nine without. The recanalization rate in patients treated with stent retrievers was significantly higher than that of other modalities (90% vs 33%, p=0.004). Good outcomes were significantly higher in the stent retriever cohort (70% vs 22%, p=0.041). Conclusion: The use of stent-retrievers in patients with carotid “T” occlusions shows promise in comparison to older techniques. A randomized trial comparing stent-retriever therapy to IV thrombolysis is warranted to determine the efficacy of this new generation of devices.

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Abstract WP178: Acute Stroke Ischemic Symptom Onset-to-Arrival Time in Michigan Hospitals

Stroke ◽

10.1161/str.47.suppl_1.wp178 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Muhammad U Farooq ◽

Kathie Thomas

Keyword(s):

African American ◽

Ischemic Stroke ◽

Acute Stroke ◽

Patient Outcomes ◽

Symptom Onset ◽

Arrival Time ◽

Heart Association ◽

The United States ◽

Stroke Patients ◽

White Patients

Objectives: Stroke is the fifth-leading cause of death and the leading cause of disability in the United States. One of the primary goals of the American Heart Association/American Stroke Association is to increase the number of acute stroke patients arriving at emergency departments (EDs) within 1-hour of symptom onset. Earlier treatment with thrombolysis in patients with acute ischemic stroke translates into improved patient outcomes. The objective of this abstract is to examine the association between the use of emergency medical services (EMS) and symptom onset-to-arrival time in patients with ischemic stroke. Methods: A retrospective review of ischemic stroke patients (n = 8873) from 25 Michigan hospitals from January 2012-December 2014 using Get With the Guidelines databases was conducted. Symptom onset-to-ED arrival time and arrival mode were examined. Results: It was found that 17.4% of ischemic stroke patients arrived at the hospitals within 1-hour of symptom onset. EMS transported 69.1% of patients who arrived within 1-hour of symptom onset. During this 1-hour period African American patients (22%) were less likely to use EMS transportation as compared to White patients (72%). The majority of patients, 41.8%, arrived after 6-hours of symptom onset. EMS transported only 40% of patients who arrived after 6-hours of symptom onset. As before, during this 6-hour period African American patients (20%) were also less likely to use EMS transportation as compared to White patients (75%). Symptom onset-to-ED arrival time was shorter for those patients who used EMS. The median pre-hospital delay time was 2.6 hours for those who used EMS versus 6.2 hours for those who did not use EMS. Conclusions: The use of EMS is associated with a decreased pre-hospital delay, early treatment with thrombolysis and improved patient outcomes in ischemic stroke patients. Community interventions should focus on creating awareness especially in minority populations about stroke as a neurological emergency and encourage EMS use amongst stroke patients.

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Abstract P33: Blind Exchange With the Mini-Pinning Technique Using Tron Fx Retriever for M2 Occlusion Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p33 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Takeshi Yoshimoto

Keyword(s):

Stent Retriever ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Target Vessel ◽

Stroke Patients ◽

Technical Improvement ◽

Vessel Size ◽

Blind Navigation ◽

First Pass ◽

Stent Retrievers

Introduction: Technical improvement to enhance M2 occlusion thrombectomy is desirable. Tron FX® is the only stent-retriever that can be deployed through 0.0165-inch microcatheters. Here we report outcomes of blind exchange with mini-pinning (BEMP) technique using Tron stent-retrievers. Methods: Consecutive stroke patients with M2 occlusion treated with 2 x15 mm or 4 x 20 mm Tron stent-retrievers using the BEMP technique were included. The technique involves the deployment of a Tron stent-retriever through a 0.0165-inch microcatheter followed by microcatheter removal and blind navigation of a 3/4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot,. Tron stent-retriever was inserted into aspiration catheter like corkscrew, and subsequently pulled as a unit. A first pass effect (FPE), modified FPE (mFPE) and modified Rankin Scale (mRS) score at 90 days were assessed as outcomes. Results: Fifteen M2 vessels were treated in 13 patients (5 women, median 81 years of age, and median National Institutes of Health Stroke Scale score 18 [11–25]). BEMP technique was successful in all cases. Whether to use 3MAX or 4MAX was determined according to the target vessel size while proceeding with the procedure (3MAX, n=8; 4MAX, n=5). Final mTICI 2b–3 was achieved in 92% (12/13). FPE and mFPE rates were 50% and 64%, respectively. Six patients (46%) were achieved in mRS score 0–2 at 3 months. Conclusions: Tron stent-retriever was successfully and safely used in the BEMP technique for M2 occlusion

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Abstract W P11: A Clinical Scale to Predict Futile Arterial Recanalization in Acute Stroke Patients with Anterior Circulation Arterial Occlusion Treated with Endovascular Therapies.

Stroke ◽

10.1161/str.45.suppl_1.wp11 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Natalia Perez de la Ossa ◽

Maria Hernández-Pérez ◽

Monica Millán ◽

Meritxell Gomis ◽

Elena López-Cancio ◽

...

Keyword(s):

Acute Stroke ◽

Scale Score ◽

Endovascular Therapy ◽

Univariate Analysis ◽

Arterial Occlusion ◽

Stroke Patients ◽

Anterior Circulation ◽

History Of ◽

Stent Retrievers ◽

Arterial Recanalization

Introduction: Futile arterial recanalization (FAR), considered as a lack of functional recovery despite complete recanalization, is observed in up to 30-50% of acute stroke patients treated with endovascular therapy. We aimed to develop a prognostic scale based on baseline clinical and radiological factors to predict FAR. Methods: Prospective analysis of consecutive stroke patients with anterior circulation occlusion treated with endovascular therapy (97% mechanical thrombectomy with stent-retrievers). Complete recanalization was considered as a TICI 2b-3. FAR was defined as a modified Rankin scale >2 at 90 days in patients with complete recanalization. Baseline factors associated with FAR were detected on univariate analysis and were used to compose the predictive scale. Results: From a total of 229 patients with anterior arterial occlusion, 166 (72.5%) achieved complete recanalization. FAR was observed in 80/166 (48.2%). Factors significantly associated with FAR were included to compose the predictive scale as follow: Age (scoring 0 if ≤70 and 1 if >70 years old), history of diabetes mellitus (0 if absent, 1 if present), history of hypertension (0 if absent, 1 if present), NIHSS (1 if NIHSS ≤10, 2 if NIHSS 10-19, 3 if NIHSS>19), ASPECTS (1 if ASPECTS 9-10, 2 if ASPECTS 7-8, 3 if ASPECTS<7) and i.v tPA use (0 if yes, 1 if not). The higher the scale score, the higher the risk of FAR (Figure). The scale showed a good predictive value of FAR (c-statistics 0.71). A scale score <5 was associated with a low rate of FAR (25%) whereas a score >7 increased FAR up to 86%. Conclusion: We developed a simple scale that can easily predict futile arterial recanalization (FAR) in stroke patients with large arterial occlusion treated with endovascular therapies. A larger validation study is necessary to confirm the utility of this predictive scale.

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Does stroke etiology play a role in predicting outcome of acute stroke patients who underwent endovascular treatment with stent retrievers?

Journal of the Neurological Sciences ◽

10.1016/j.jns.2016.11.006 ◽

2017 ◽

Vol 372 ◽

pp. 104-109 ◽

Cited By ~ 16

Author(s):

Semih Giray ◽

Ozcan Ozdemir ◽

Demet F. Baş ◽

Yusuf İnanç ◽

Zulfikar Arlıer ◽

...

Keyword(s):

Endovascular Treatment ◽

Acute Stroke ◽

Stroke Patients ◽

Stroke Etiology ◽

Stent Retrievers ◽

Predicting Outcome

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Pharmacists as Care Providers for Stroke Patients: A Systematic Review

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.233 ◽

2017 ◽

Vol 45 (1) ◽

pp. 49-55 ◽

Cited By ~ 7

Author(s):

Jade E. Basaraba ◽

Michelle Picard ◽

Kirsten George-Phillips ◽

Tania Mysak

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Acute Stroke ◽

Patient Care ◽

Patient Outcomes ◽

Stroke Patient ◽

Full Text ◽

Stroke Patients ◽

Pharmacist Interventions ◽

The Impact

AbstractBackground:Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes.Methods: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed.Results: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life.Conclusions: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

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A RANDOMIZED TRIAL OF A SOCIAL WORKER LED HOME-BASED CASE MANAGEMENT TO IMPROVE OUTCOMES FOR CAREGIVERS OF ACUTE STROKE PATIENTS DURING THE TRANSITION PERIOD

10.26226/morressier.5ab8f559d462b8029238c753 ◽

2018 ◽

Author(s):

Mathew Reeves

Keyword(s):

Case Management ◽

Acute Stroke ◽

Randomized Trial ◽

Social Worker ◽

Transition Period ◽

Stroke Patients ◽

Home Based

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Abstract WMP2: Trevo 2000: Real-World Experience in the First 1247 Patients

Stroke ◽

10.1161/str.48.suppl_1.wmp2 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mandy J Binning ◽

Ronald F Budzik ◽

Blaise W Baxter ◽

Bruno M Bartolini ◽

David S Liebeskind ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Real World ◽

Stent Retriever ◽

Future Research ◽

Real World Data ◽

Open Label ◽

Eligibility Criteria ◽

Secondary Endpoints ◽

Stent Retrievers

Objective: The Trevo Registry is designed to assess real world outcomes of the Trevo Retriever in patients experiencing ischemic stroke. This is the largest prospective study for acute stroke intervention, with 1247 patients currently enrolled and 90 day outcomes in 1021 patients. The primary endpoint is revascularization status based on post-procedure TICI score and secondary endpoints include 90-day mRS, 90-day mortality, neurological deterioration at 24 hours and device/procedure related adverse events. Methods: The study is a prospective, open-label, consecutive enrollment, multi-center, international registry of patients undergoing mechanical thrombectomy for acute stroke using the Trevo stent retriever as the initial device. Enrollment is expected to reach 2000 subjects at up to 100 sites. Results: As of August 13, 2016 a total of 1247 patients were enrolled. The median NIHSS at admission was 16 (IQR 11-20). Most patients (66.2%) were treated at >/= 6 hours from last known normal with a median procedure time of 50 minutes (32-77). The occlusion site was M1 or M2 in 74.5%. General anesthesia was employed in 46.6% of procedures. TICI 2b or 3 revascularization was 92.8% with an average of 1.6 passes with the device. Median NIHSS at 24 hours and discharge was 6 and 4 respectively. Fifty-five percent of patients had mRS ≤2 at 3 months and the overall mortality rate was 15.4%. Patients treated after 8 hours of symptom onset had a 94.9% revascularization rate and 52.8% mRS ≤2 at 3 months. The symptomatic ICH rate was 1.2%. Patients who met the revised AHA criteria for thrombectomy were found to have 58.4% mRS 0-2 at 90 days. Conclusions: The Trevo Retriever Registry represents the first real world data with stent retriever use in the era of clinical trials showing the overwhelming benefit of stent retrievers to treat acute ischemic stroke. Due to the fact that this data represents real world use of the Trevo Retriever, (e.g. subjects pre-stroke mRS >1 (16.5%) and those treated 6-24 hours after stroke symptoms (33.8%), this data cannot be compared to the results from recent trials with restricted eligibility criteria. Future subgroup analysis of this large cohort will help to identify areas of future research to enhance outcomes further with this treatment modality.

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Abstract TMP78: Tick Tock we Don't Stop - 24/7 Stroke Nurse Clinician Response Improves Care in the Stroke Patient

Stroke ◽

10.1161/str.47.suppl_1.tmp78 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Mary Zimmermann

Keyword(s):

Acute Stroke ◽

Patient Outcomes ◽

Stroke Patients ◽

Stroke Treatment ◽

Core Measure ◽

Nurse Clinician ◽

Multiple Challenges ◽

Core Measures ◽

Iv Tpa

Background: Large community hospitals often face multiple challenges in the emergent care of acute stroke patients. Some of these challenges include decreasing door to IV tPA (activase) time and consistently meeting core measures. The 24/7 utilization of specialized nurses (Stroke Clinicians) trained to respond to acute stroke patients in the ED and inpatient areas improves the outcomes for stroke patients. Utilizing the Stroke Clinician role for 24/7 response to all acute strokes improves each patient’s ability to access complex stroke treatment. Purpose: The purpose of implementing 24/7 Stroke Clinician coverage for the ED and all inpatient units was to reduce door to needle times for patients receiving tpa, to increase stroke core measure compliance, and to improve patient outcomes. In addition to responding to acute strokes, the Stroke Clinicians also provide concurrent chart review and patient education. Methods The role of the Stroke Clinician was expanded to provide acute stroke response coverage on a continual, 24/7 basis in the first quarter of 2015. Stroke Program administration discussed options for the expanded coverage and subsequently trained the Cardiovascular Clinicians to cover stroke call from 11pm to 7am. These clinicians were already in-house, thus no additional cost was associated with the coverage. Results: The door to needle times have consistently decreased from an average of 70 minutes to an average of 50 minutes. There has been a steady improvement in patient outcomes evidenced by doubling the number of stroke patients who have received endovascular therapy since the prior year. Conclusion: The implementation of 24 hours per day/7 days per week stroke clinician coverage improved IV tPA door to needle times, improved the utilization of endovascular stroke treatment, and improved compliance with the stroke core measures.

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