scholarly journals Perceived Control and Cognitive Function Among Acute Ischemic Stroke Patients in China

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Zhijian Liu ◽  
Xiangjing Kong ◽  
Jing Wang ◽  
Qin Wang ◽  
Bei Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Function ◽  
Acute Ischemic Stroke ◽  
Perceived Control ◽  
Cognitive Assessment ◽  
Acute Stage ◽  
Stroke Severity ◽  
Cognitively Normal ◽  
Gender And Education ◽  
Stroke Center

Abstract This study explored an association between perceived control and cognitive function among 437 acute ischemic stroke (AIS) patients in China. We collected data from one stroke center in each of the three cities (Shanghai, Nanjing, and Linyi) from June to December, 2020. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), and perceived control was assessed by Perceived Control in Health Care Questionnaire at acute stage. Hierarchical linear regression was used. The average of perceived control and MoCA were 81.36±0.877 and 19.66±0.304, respectively. A number of 374 (85.6%) patients were in cognitive impairment and 63(14.4%) were cognitively normal. Perceived control was positively associated with cognitive function (β=0.103, p＜0.001). After controlling for stroke severity, age, gender and education, the association was still significant (β=0.041, p=0.014). These findings suggest that perceived control may be a potential target in cognitive interventions for AIS patients.

scholarly journals TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion: Prioritize IV or endovascular treatment—A randomized trial

2019 ◽  
Vol 15 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Anne Behrndtz ◽  
Søren P Johnsen ◽  
Jan B Valentin ◽  
Martin F Gude ◽  
Rolf A Blauenfeldt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Hospital Setting ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Stroke Severity ◽  
Study Results ◽  
Primary Stroke Center ◽  
Stroke Center

Rationale For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. Aim For patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome. Sample size We aim to randomize 600 patients, 1:1. Design A national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed. Outcomes The primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients. Discussion Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.

Abstract W P242: Clinical Implications of Changes of Aspirin Reaction Unit in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Kang-Ho Choi ◽  
Man-Seok Park ◽  
Ki-Hyun Cho
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Aspirin Resistance ◽  
Acute Stage ◽  
Increased Risk ◽  
Early Neurological Deterioration ◽  
Reaction Unit ◽  
Stroke Center ◽  
Hospital Days

Background: Some studies have shown that biological aspirin resistance (BAR) could be associated with an increased risk of early neurological deterioration (END). Considering the risk of END and recurrent stroke is greatest during the acute phase, it would be important to investigate the influences of acute BAR on early outcomes in acute ischemic stroke. However, it is still controversial if assays of aspirin resistance might accurate and consistent. Therefore, we sought to find whether the changes of aspirin responsiveness might be associated with END in patients with acute ischemic stroke. Methods: This study was a part 1 study of ongoing, single center, prospective observational study. Patients of part 1 study were consecutively recruited from our tertiary stroke center. These patients were those who (1) presented and were evaluated within the first 24 hours of symptom onset; (2) were no potential risks of cardioembolism; and (3) provided written informed consent. Aspirin reaction unit (ARU) was assessed using the VerifyNow. Acute ARU (aARU) was measured at 3 hours after aspirin loading in emergent department. Follow-up ARU (fuARU) was performed after 5 consecutive days of aspirin medication. An ARU value ≥ 550 was defined as BAR. Differences between fuARU and aARU were defined as “changes of ARU”. To evaluate the association between changes of ARU and END, ‘changes of ARU’ were classified according to 4 equal sized groups. END was defined as an increase in NIHSS scores by 1 or more points between hospital days 0 and 5. Results: Three-hundreds forty nine patients were performed both aARU and fuARU. END occurred in 72 (20.6%) patients. Patients with END had higher values of changes of ARU than those without (-7.1 vs -29.6, p=0.040, respectively). Furthermore, END more frequently occurred in patients in forth quartiles than those in other quatiles of changes of ARU (4 th quartiles: OR, 3.188; 95% CI, 1.431-7.104; p=0.005). Conclusions: Our results showed that increase of fuARU was independently associated with END. The results of our study suggested that in acute stage of ischemic stroke, it may be helpful for serial assay of aspirin responsiveness to evaluate the association between early outcomes and aspirin resistance.

National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Akiko Kada ◽  
Kuniaki Ogasawara ◽  
Takanari Kitazono ◽  
Kunihiro Nishimura ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Temporal Trends ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

2018 ◽  
Vol 10 (12) ◽  
pp. 1209-1217 ◽  
Author(s):  
Ali Alawieh ◽  
Arindam Chatterjee ◽  
Wuwei Feng ◽  
Guilherme Porto ◽  
Jan Vargas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Medical Management ◽  
High Volume ◽  
The Elderly ◽  
Functional Independence ◽  
Stroke Severity ◽  
Younger Patients ◽  
Stroke Center

IntroductionCompleted randomized trials on endovascular thrombectomy (ET) did not independently assess the efficacy of ET in the elderly (≥80 years old) who were often excluded or under-represented in trials. There were also inconsistent criteria for patient selection in this population across the different trials. This work evaluates outcomes after ET for acute ischemic stroke (AIS) in the elderly at a high volume stroke center.MethodsWe reviewed all cases of AIS that underwent a direct aspiration first pass technique (ADAPT) thrombectomy for large vessel occlusions between March 2013 and October 2017 while comparing outcomes in the elderly with younger counterparts. We also reviewed AIS cases in elderly patients undergoing medical management who were matched to the ET counterparts by demographics, comorbidities, baseline deficits, and stroke severity.ResultsOf 560 patients undergoing ET for AIS, 108 patients were in the elderly group (≥80 years of age), and had a significantly lower likelihood of functional independence (defined as a modified Rankin Scale score of 0–2) at 90 days compared with younger patients (20.5% vs 44.4%, P<0.001), and higher mortality rates (34.3% vs 20%, P<0.001). When compared with patients undergoing medical management, elderly patients did not have a significant improvement in rates of good outcomes (20.5% vs 19.5%, P>0.05), and had significantly higher rates of hemorrhage (40.7% vs 9.3%, P<0.001). We also identified baseline stroke severity and the incidence of hemorrhage as two independent predictors of outcome in the elderly patients.ConclusionsET in the elderly did not show a similar benefit to younger patients when compared with medical management. These findings emphasize the need for more optimal selection criteria for the elderly population to improve the risk to benefit ratio of ET.

Abstract TP95: Novel Biomarkers of Acute Ischemic Stroke Using MicroRNA Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jason King ◽  
Evgeny Sidorov ◽  
Jairam Vanamala ◽  
Cynthia Bejar ◽  
Vijay Indukuri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Chronic Phase ◽  
Rna Isolation ◽  
Acute Stage ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Mirna Regulation ◽  
Case Control Studies

Background: Despite recent advances in treatment, early diagnosis and prognosis of acute ischemic stroke (AIS) suffers from significant limitations. Growing number of mostly case-control studies have determined that noncoding, micro-ribonucleic acid (miRNAs) play a role in the pathophysiologic processes related to cerebral ischemia and post-stroke recovery. This pilot project is a longitudinal study, which investigates difference in miRNA regulation in acute vs. chronic stage of ischemic stroke. Hypothesis: Expression of some miRNAs is significantly altered in acute stage of ischemic stroke. Methods: Blood and urine specimens collected during the acute phase (<72 hours) of ischemic stroke and at follow-up phases (within 3 months) were used to quantify the expression of five selected miRNAs (miRNA 21-5p; miRNA 124-5p, miRNA 126, miRNA 223, and miRNA 298) using 20 sample pairs (N=40) available with urine and blood specimens. Total RNA from frozen blood samples were isolated using the mir VANA RNA isolation kit (Ambion, USA). We extracted exosomal RNA from urine samples using exosome kit (Qiagen, USA). We ran miRNA expression assays using TaqMan probes (Applied Biosciences, USA) on 384-well microplates using QuantStudio 6 available in our lab. Each assay was run in duplicates using endogenous (U6) and blank controls. Results: The miRNA21-5p was significantly down-regulated (p<0.0001) at the acute phase in both blood and urine; inversely, miRNA124 was significantly upregulated (p<0.0001) at the acute phase vs. the chronic phase. The increased expression of miRNA 124-5p in both urine and serum strongly correlated with a lower stroke scale (NIHSS score (<8)), and its expression was significantly diminished with the increase in stroke severity (NIHSS >10). Expression of exosomal miRNA126 extracted from urine, was significantly upregulated (p<0.0001) during the acute phase, but remained unchanged at the acute and chronic phase (p=0.857) in serum. Conclusion: Our study showed the dysregulation of important miRNAs in acute stage of stroke. The upregulation of miRNA 124-5p in strokes with lower NIHSS may serve as early prognostic biomarker. Once replicated in larger scale studies, it will provide novel insights on understanding stroke pathophysiology.

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

2020 ◽  
Vol 132 (4) ◽  
pp. 1182-1187 ◽  
Author(s):  
Carrie E. Andrews ◽  
Nikolaos Mouchtouris ◽  
Evan M. Fitchett ◽  
Fadi Al Saiegh ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Standard Of Care ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

scholarly journals The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

2021 ◽  
Author(s):  
Kilian Fröhlich ◽  
Gabriela Siedler ◽  
Svenja Stoll ◽  
Kosmas Macha ◽  
Thomas M. Kinfe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Middle Cerebral Artery Territory ◽  
Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

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