E-025 The use of intra-arterial rt-PA improves functional outcomes over mechanical thrombectomy alone in patients undergoing acute stroke therapy

2012 ◽  
Vol 4 (Suppl 1) ◽  
pp. A56.2-A56
Author(s):  
A Rai ◽  
J Carpenter ◽  
T Roberts
Keyword(s):  
Acute Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Stroke Therapy ◽  
Acute Stroke Therapy

Turning Point of Acute Stroke Therapy: Mechanical Thrombectomy as a Standard of Care

2015 ◽  
Vol 83 (6) ◽  
pp. 953-956 ◽  
Author(s):  
Keith G. DeSousa ◽  
Matthew B. Potts ◽  
Eytan Raz ◽  
Erez Nossek ◽  
Howard A. Riina
Keyword(s):  
Acute Stroke ◽  
Turning Point ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Stroke Therapy ◽  
Acute Stroke Therapy

Abstract P695: Rural-Urban Differences in Functional Outcomes After Acute Therapy for Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Shen ◽  
Deepika Budhraja ◽  
Seeta Shah ◽  
Kimberly Martin ◽  
Chen Lin
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Rural Areas ◽  
Functional Outcomes ◽  
Regression Models ◽  
Older Age ◽  
Stroke Therapy ◽  
Acute Therapy ◽  
Acute Stroke Therapy

Introduction: The Southeastern United States, known as the “the stroke belt,” has the highest stroke mortality rate in the country. One possible reason is the high proportion of its residents living in rural areas. Studies suggest stroke care is worse for patients living in rural areas, and they are less likely to receive acute stroke therapy (intravenous thrombolysis or endovascular therapy), leading to worse outcomes. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received acute stroke therapy. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Southeastern US, the University of Alabama at Birmingham. Patients admitted with imaging-confirmed ischemic stroke and had acute stroke therapy between 2014 and 2018 were included for analysis. Individuals were classified as rural or urban dwelling based on US Department of Agriculture’s 2010 Rural-Urban Commuting Area Codes. Clinical and demographic characteristics were collected from the chart. Stepwise logistic regression models were performed with these variables to compare good (mRS 0-1) vs poor (mRS 2-6) functional outcomes. Results: There were 232 patients included in the study (185 urban, and 47 rural). There were no significant differences between groups in age (urban 64.5±15.1; rural 66.2±14.7), gender (urban: 56% male 44% female, rural: 51% male 49% female), or proportion of African-Americans (33% of urban group and 25% of rural group). Mean baseline NIH stroke scale was higher in rural patients than urban (17.0 vs 14.8 respectively, p-value=0.03.). In logistical regression models for good functional outcome (mRS 0-1) at 90-days, analysis of factors including rural/urban status, gender, age, insurance, transfer, and acute stroke therapy, revealed only older age as a significant factor (OR 0.97, 95% CI 0.95-0.99). Conclusions: Our study demonstrated no significant differences in functional outcome between patients from urban and rural locations after receiving acute therapy for treating ischemic stroke. Importantly, only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas can recover similarly to those from urban areas.

scholarly journals Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?

2009 ◽  
Vol 2 (1) ◽  
pp. 67-70 ◽  
Author(s):  
C Nichols ◽  
J Carrozzella ◽  
S Yeatts ◽  
T Tomsick ◽  
J Broderick ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcomes ◽  
Stroke Therapy ◽  
Acute Stroke Therapy

Abstract 96: CTP-Mismatch Maps Improve Interobserver Agreement

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Waimei A Tai ◽  
Archana Purushotham ◽  
Matus Straka ◽  
Rebecca M Sugg ◽  
Naveed Akhtar ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Interobserver Reliability ◽  
Observer Agreement ◽  
Absolute Difference ◽  
Stroke Therapy ◽  
Adequate Quality ◽  
Ischemic Core ◽  
Observer Disagreement ◽  
Acute Stroke Therapy

Introduction: The use of mismatch between the ischemic core and penumbra to select patients who are likely to benefit from acute stroke therapy has gained popularity. Interpretation of the ischemic core and penumbra on standard CT-perfusion (CTP) maps is subjective. This may lead to variability among physicians in the decision if a patient is a good candidate for acute stroke therapy. A CTP-Mismatch map with outlines of the ischemic core and penumbra could limit this variability. The goal of this study was to determine if inter-observer agreement regarding a patient’s suitability for acute stroke therapy improves with the use of a CTP-Mismatch map. The figure shows a typical CTP-Mismatch map. Methods: Ninety-six consecutive patients evaluated with CTP prior to intra-arterial therapy at St. Lukes Hospital in 2008-09 were included. 79 patients had adequate quality CTP for this analysis. Standard CTP maps (CBV, CBF, MTT, and Tmax) and a CTP-Mismatch map were generated with a fully automated program for processing of CTP source images (RAPID). RAPID assessed the ischemic core using a CBF threshold <30% of the contralateral hemisphere (rCBF<30%). The ischemic penumbra was defined by a Tmax threshold of >6 sec (Tmax>6s). The standard CTP maps and the CTP-Mismatch map were independently analyzed by two vascular neurologists in a blinded fashion. The raters assessed a patient's suitability for intra-arterial therapy based on the following mismatch criteria: (1) a ratio between (Tmax>6s) and (rCBF<30%) volumes >1.8 and (2) an absolute difference between (Tmax>6s) and (CBF<30%) volumes >15ml. Interobserver reliability was assessed with Cohen’s kappa. Results: When assessment of suitability for intra-arterial therapy was based on interpretation of standard CTP maps, the two raters agreed in 58 of 79 patients (kappa=0.46; 95% CI=0.24-0.60). The agreement between observers improved when suitability was determined using CTP-Mismatch maps (agreement in 76 of 79 cases; kappa=0.92; 95% CI=0.75-0.92; p<0.001 for difference between kappa values). The 3 cases with inter-observer disagreement had artifact on the CTP-Mismatch map. Following concensus adjudication of these 3 cases, 40 of the 79 patients (51%) were deemed suitable candidates for acute stroke therapy. Conclusion: CTP-Mismatch maps with estimates of ischemic core and penumbra volumes markedly improve inter-observer agreement regarding assessment of suitability for acute stroke therapy. Such maps, which can be generated automatically, may help standardize decision making algorithms for evaluation of potential intra-arterial therapy candidates.

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