Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke

2019 ◽  
Author(s):  
B.‐H. Cho ◽  
J.‐T. Kim ◽  
J. S. Lee ◽  
M.‐S. Park ◽  
K.‐W. Kang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Endovascular Thrombectomy

scholarly journals Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy

2020 ◽  
Vol 26 (6) ◽  
pp. 793-799
Author(s):  
Nicholas JH Ngiam ◽  
Benjamin YQ Tan ◽  
Ching-Hui Sia ◽  
Bernard PL Chan ◽  
Gopinathan Anil ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and aim Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke. Methods Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months. Results We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation. Conclusion In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.

Endovascular thrombectomy and intra-arterial interventions for acute ischaemic stroke

2021 ◽  
Vol 2021 (6) ◽  
Author(s):  
Melinda B Roaldsen ◽  
Mirza Jusufovic ◽  
Eivind Berge ◽  
Haakon Lindekleiv
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Endovascular Thrombectomy

Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis

QJM ◽  
2020 ◽  
Author(s):  
J N Ngiam ◽  
C W S Cheong ◽  
A S T Leow ◽  
Y -T Wei ◽  
J K X Thet ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Venous Blood ◽  
Intravenous Thrombolysis ◽  
Glycated Haemoglobin ◽  
Stress Hyperglycaemia ◽  
As Stress

Summary Background Transient hyperglycaemia in the context of illness with or without known diabetes has been termed as ‘stress hyperglycaemia’. Stress hyperglycaemia can result in poor functional outcomes in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy. We investigated the association between stress hyperglycaemia and clinical outcomes in AIS patients undergoing intravenous thrombolysis (IVT). Methods We examined 666 consecutive patients with AIS who underwent IVT from 2006 to 2018. All patients had a glycated haemoglobin level (HbA1c) and fasting venous blood glucose measured within 24 h of admission. Stress hyperglycaemia ratio (SHR) was defined as the ratio of the fasting glucose to the HbA1c. Univariate and multivariate analyses were employed to identify predictors of poor functional outcomes (modified Rankin Scale 3–6 at 3 months) after IVT. Results Three-hundred and sixty-one patients (54.2%) had good functional outcomes. These patients tended to be younger (60.7 ± 12.7 vs. 70 ± 14.4 years, P &lt; 0.001), male (70.7% vs. 51.5%, P &lt; 0.001), had lower prevalence of atrial fibrillation (13.0% vs. 20.7%, P = 0.008) and lower SHR (0.88 ± 0.20 vs. 0.99 ± 26, P &lt; 0.001). Patients with high SHR (≥0.97) were slightly older than those with low SHR (&lt;0.97) and were more likely to have diabetes mellitus. On multivariate analysis, higher SHR was independently associated with poor functional outcomes (adjusted odds ratio 3.85, 95% confidence interval 1.59–9.09, P = 0.003). Conclusion SHR appears to be an important predictor of functional outcomes in patients with AIS undergoing IVT. This may have important implications on the role of glycaemic control in the acute management of ischaemic stroke.

scholarly journals Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke

2018 ◽  
Vol 3 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Mark R Etherton ◽  
Khawja A Siddiqui ◽  
Lee H Schwamm
Keyword(s):  
Length Of Stay ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Serotonin Reuptake ◽  
Functional Outcomes ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Negative Impact ◽  
Univariate Analysis ◽  
Stroke Recovery ◽  
Selective Serotonin

BackgroundSelective serotonin reuptake inhibitors (SSRIs) have been implicated in contributing to recovery after acute ischaemic stroke. In particular, poststroke initiation of an SSRI has been demonstrated to improve motor recovery. The role of prestroke SSRI use on functional outcomes and stroke recovery is less clear. We aimed to examine the effect of prestroke SSRI use on metrics of hospitalisation and functional recovery.MethodsWe included 4968 consecutive patients from January 2006 to June 2015 in our local Get With The Guidelines-Stroke registry in whom a preadmission drug list could be extracted from an administrative research data registry. Univariate and multivariate analyses were performed to identify predictors of functional outcomes.ResultsOn univariate analysis, among 4698 ischaemic strokes (740 SSRI users and 3948 non-users), SSRI use before acute ischaemic stroke did not impact the National Institutes of Health Stroke Scale (NIHSS) admission score, length of stay or rate of symptomatic haemorrhage. Patients using SSRIs prior to their stroke were more likely to present with weakness (57% vs 47.3%; P<0.001) and have hospitalisations complicated by pneumonia (7.6% vs 5.7%; P<0.001). Moreover, prestroke SSRI use was associated with a negative impact on ambulatory status at discharge and discharge to home. On multivariate regression analysis, SSRI use was associated with lower likelihood of discharge to home (adjusted OR 0.79, 95% CI 0.62 to 0.997, P<0.05).ConclusionsSSRI use preceding an acute ischaemic stroke is associated with lower rates of discharge to home despite no significant increase in length of stay or NIHSS score.

Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis

2017 ◽  
Vol 13 (8) ◽  
pp. 996-1002 ◽  
Author(s):  
Alis Heshmatollah ◽  
Puck Fransen ◽  
Olvert Berkhemer ◽  
Debbie Beumer ◽  
Aad van der Lugt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Subgroup Analysis ◽  
Endovascular Thrombectomy ◽  
Mr Clean

scholarly journals Update on cell therapy for stroke

2017 ◽  
Vol 2 (2) ◽  
pp. 59-64 ◽  
Author(s):  
Cynthia L Kenmuir ◽  
Lawrence R Wechsler
Keyword(s):  
Cell Therapy ◽  
Ischaemic Stroke ◽  
Functional Outcomes ◽  
Treatment Options ◽  
Cell Delivery ◽  
Delivery Methods ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Specific Effects ◽  
New Treatment

Ischaemic stroke remains a leading cause of death and disability. Current stroke treatment options aim to minimise the damage from a pending stroke during the acute stroke period using intravenous thrombolytics and endovascular thrombectomy; however, there are no currently approved treatment options for reversing neurological damage once a stroke is completed. Preclinical studies suggest that cell therapy may be safe and effective in improving functional outcomes. Several recent clinical trials have reported safety and some improvement in outcomes following cell therapy administration in ischaemic stroke, which are reviewed. Cell therapy may provide a promising new treatment for stroke reducing stroke-related disability. Further investigation is needed to determine specific effects of cell therapy and to optimise cell delivery methods, cell dosing, type of cells used, timing of delivery, infarct size and location of infarct that are likely to benefit from cell therapy.

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