scholarly journals Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023265 ◽  
Author(s):  
Jan F Scheitz ◽  
Henrik Gensicke ◽  
Sanne M Zinkstok ◽  
Sami Curtze ◽  
Marcel Arnold ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Research Collaboration ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Laboratory Findings ◽  
Endovascular Thrombectomy ◽  
Multicentre Research

PurposeThe ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration aims to address clinically relevant questions about safety and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy. The findings can provide observational information on treatment of patients derived from everyday clinical practice.ParticipantsTRISP is an open, investigator-driven collaborative research initiative of European stroke centres with expertise in treatment with revascularisation therapies and maintenance of hospital-based registries. All participating centres made a commitment to prospectively collect data on consecutive patients with stroke treated with IVT using standardised definitions of variables and outcomes, to assure accuracy and completeness of the data and to adapt their local databases to answer novel research questions.Findings to dateCurrently, TRISP comprises 18 centres and registers >10 000 IVT-treated patients. Prior TRISP projects provided evidence on the safety and functional outcome in relevant subgroups of patients who were excluded, under-represented or not specifically addressed in randomised controlled trials (ie, pre-existing disability, cervical artery dissections, stroke mimics, prior statin use), demonstrated deficits in organisation of acute stroke care (ie, IVT during non-working hours, effects of onset-to-door time on onset-to-needle time), evaluated the association between laboratory findings on outcome after IVT and served to develop risk estimation tools for prediction of haemorrhagic complications and functional outcome after IVT.Future plansFurther TRISP projects to increase knowledge of the effect and safety of revascularisation therapies in acute stroke are ongoing. TRISP welcomes participation and project proposals of further centres fulfilling the outlined requirements. In the future, TRISP will be extended to include patients undergoing endovascular thrombectomy.

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

Stroke ◽  
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.

scholarly journals Low-Dose Tirofiban Improves Functional Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy

Stroke ◽  
2017 ◽  
Vol 48 (12) ◽  
pp. 3289-3294 ◽  
Author(s):  
Wenbo Zhao ◽  
Ruiwen Che ◽  
Shuyi Shang ◽  
Chuanjie Wu ◽  
Chuanhui Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Low Dose ◽  
Stroke Patients ◽  
Endovascular Thrombectomy

scholarly journals Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

2021 ◽  
Vol 9 (3) ◽  
pp. 166-176
Author(s):  
Jia Feng ◽  
Zhihan Zhu ◽  
Ahmed Waqas ◽  
Lukui Chen
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Objective:To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.Methods:A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.Results:As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).Conclusion:Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.

scholarly journals Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Author(s):  
Xuting Zhang ◽  
Shenqiang Yan ◽  
Wansi Zhong ◽  
Yannan Yu ◽  
Min Lou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Median Serum ◽  
The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

2019 ◽  
Vol 21 (9) ◽  
pp. 1181-1188 ◽  
Author(s):  
Peng Zhang ◽  
Zhen-Ni Guo ◽  
Xin Sun ◽  
Yingkai Zhao ◽  
Yi Yang
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Good Functional Outcome

Abstract Introduction The existence of the smoker’s paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT). Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies exploring the association between smoking and good functional outcome (modified Rankin Scale score ≤ 2) following IVT or EVT were searched via the databases of PubMed, Embase, and the Cochrane Library from inception to August 8, 2018. Information on the characteristics of included studies was independently extracted by two investigators. Data were pooled using a random-effects or fixed-effects meta-analysis according to the heterogeneity of included studies. Results Among 20 identified studies, 15 reported functional outcomes following IVT, and five reported functional outcomes following EVT. Unadjusted analyses showed that smoking increased the odds of good functional outcomes with a pooled odds ratio (OR) of 1.48 (95% confidence interval [CI]: 1.36–1.60) after IVT and 2.10 (95% CI: 1.47–3.20) after EVT. Of IVT studies, only eight reported outcomes adjusted for covariates and none of the EVT studies reported adjusted outcomes. After adjustment, the relation between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81–1.59]). Conclusion Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis. Implications The existence of the smoker’s paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional outcome at 3 months in acute ischemic stroke patients who received intravenous thrombolysis (IVT). However, a major limitation of their meta-analysis was that the process of data synthesis was based on unadjusted data. Therefore, we conducted this meta-analysis to investigate the association based on adjusted data and a larger sample size. Our meta-analysis suggested that smoking was not associated with good functional outcome after adjusting for covariates.

Abstract WP262: Intravenous Thrombolysis in Acute Ischemic Stroke Patients With Infective Endocarditis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mangala Gopal ◽  
Sushil Lakhani ◽  
Vivien Lee
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Medical Risk ◽  
Good Functional Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
The Mean

Introduction: Infective endocarditis (IE) is considered to be an absolute contraindication for intravenous tissue plasminogen activator treatment (IVtPA) in acute ischemic stroke. However during the hyperacute stroke evaluation, the exclusion of IE may be difficult. Methods: We reviewed consecutive patients hospitalized at our comprehensive stroke center from January 1, 2014 to March 31, 2019 with acute ischemic stroke who received IVtPA and identified patients who were diagnosed with infective endocarditis. Data was abstracted on demographics, medical history, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, culture results, and 90 day modified Rankin Scale (mRS). Good functional outcome was defined as mRS ≤ 2. Results: Among 1022 acute ischemic stroke patients who received IVtPA, 5 patients (0.5%) were ultimately diagnosed with IE. Among the 5 patients with IE, the mean age was 53.4 years (range, 25-74) and 3 (60%) were female. The majority, 4 (80%) were white. Medical risk factors for IE were present in 3 (60%) and included intravenous drug use (1) and dialysis (2). Initial NIHSS was 4.6 (range, 1 to 8). Fever was present on initial presentation in only 1 patient (102.7 F). All patients met criteria for IVtPA and there were no protocol violations. The mean time from LKN to IVtPA was 3.0 hours (range, 1.9 to 4.4). Vascular imaging showed MCA occlusion in 4 (80%) and no occlusion in 1 (20%). One patient underwent endovascular thrombectomy with Thrombolysis in cerebral infarction scale 2A recanalization. Two patients (40%) developed hemorrhagic complications, including 1 patient who developed subarachnoid hemorrhage on Hospital Day #2 due to mycotic cerebral aneurysm. The blood culture results included MRSE (1), Streptococci viridans (2) and negative (2). TEE in all patients showed vegetations on the mitral valve. No patients had good functional outcome, and the mean 3 months mRS was 4.8 (range, 3 to 6). Conclusions: In a large series of acute ischemic stroke patients who received IVtPA, undiagnosed IE is rare (0.5%). Fever was not commonly present during initial evaluation. Despite affecting younger patients with initial mild deficits, patients with IE had poor functional outcomes.

Abstract 3263: Cystatin C is Associated with Early Functional Outcome in Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mi-Young Oh ◽  
Seung-Hoon Lee ◽  
Chi Kyung Kim ◽  
Sang-Bae Ko ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Cystatin C ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Kidney Dysfunction ◽  
Nihss Score ◽  
Hb A1c ◽  
Early Functional Outcome

Background: Cystatin C, a competitive inhibitor of lysosomal cysteine protease, is regarded as a sensitive marker of kidney dysfunction. Lower estimated glomerular filtration rate (eGFR) was associated with poor prognosis and all cause of mortality in stroke patients. Cystatin C was a more sensitive and accurate marker to detect subclinical kidney dysfunction, compared to creatinine, or creatinine based eGFR. We evaluated whether Cystatin C would predict functional outcome, independent of eGFR level in ischemic stroke. Methods: We evaluate consecutive patients with acute stroke who were admitted to Seoul National University Hospital between January 2008 and May 2011. We defined the unfavorable outcome group as containing each patient with a discharge mRS score of 1 with admission NIHSS score of 0 to 7, a discharge mRS score of 2 with admission NIHSS score 8 to 14, or a discharge mRS score of ≥3 with admission NIHSS score 15. Results: Among the total patients, 544(76.2%) patients had unfavorable outcome at discharge. Participants with unfavorable outcome tended to be female, older and to have higher Cystatin C, CRP, fibrinogen and Hb A1c concentrations. The proportion of patient with unfavorable outcome was gradually increased according to the cystatin C quartile. Compared to the lowest quartile of Cystatin C (47.2<nmol/L), higher quartiles (47.2 -54.7, 54.7-65.7, 65.7≥nmol/L) were likely to have a higher chance of unfavorable outcome [adjusted OR (95%CI), 1.55(0.73-3.31), 2.66 (1.21-5.87) and 2.84(1.15-7.09)] after adjusting for age, diabetes, Hb A1c, fibrinogen, CRP, NIHSS scale on admission, hemorrhagic transformation, IV thrombolytic treatment. In contrast, eGFR did not show any significant association with unfavorable outcome. Compared to the lowest category of eGFR (≥60 ml/min/1.73m2), higher categories (45.0- 60.0, 15.0-45.0, ≤15.0 ml/min/1.73m2) did not show significant association with unfavorable outcome. Conclusions: An increased level of Cystatin C was associated with functional outcome in stroke patients. Cystatin C may be a potent predictor to predictor of functional outcome after ischemic stroke.

scholarly journals Endovascular Treatment for Acute Stroke in Cerebral Amyloid Angiopathy

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Johannes M. Weller ◽  
Simon Jonas Enkirch ◽  
Christopher Bogs ◽  
Tim Bastian Braemswig ◽  
Milani Deb-Chatterji ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Amyloid Angiopathy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Cerebral Amyloid

Background and Purpose: We aimed to compare outcome of endovascular thrombectomy in acute ischemic stroke in patients with and without cerebral amyloid angiopathy (CAA). Methods: We included patients with and without possible or probable CAA based on the modified Boston criteria from an observational multicenter cohort of patients with acute ischemic stroke and endovascular thrombectomy, the German Stroke Registry Endovascular Treatment trial. We analyzed baseline characteristics, procedural parameters, and functional outcome after 90 days. Results: Twenty-eight (17.3%) of 162 acute ischemic stroke patients were diagnosed with CAA based on iron-sensitive magnetic resonance imaging performed before endovascular thrombectomy. CAA patients were less likely to have a good 90-day outcome (14.3 versus 37.8%). National Institutes of Health Stroke Scale score (adjusted odds ratio, 0.88; P <0.001), successful recanalization (adjusted odds ratio 6.82; P =0.005), and CAA (adjusted odds ratio 0.28; P =0.049) were independent outcome predictors. Intravenous thrombolysis was associated with an increased rate of good outcome (36.3% versus 0%, P =0.031) in CAA. Conclusions: Endovascular thrombectomy with or without thrombolysis appears beneficial in acute ischemic stroke patients with possible or probable CAA, but is associated with a worse functional outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03356392.

scholarly journals Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown

Stroke ◽  
2021 ◽  
Vol 52 (5) ◽  
pp. 1693-1701
Author(s):  
Valerian L. Altersberger ◽  
Lotte J. Stolze ◽  
Mirjam R. Heldner ◽  
Hilde Henon ◽  
Nicolas Martinez-Majander ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Performance Measures ◽  
Care Service ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
National Institutes Of Health ◽  
Reference Period ◽  
Acute Stroke Care ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.

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