Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone

2019 ◽  
Vol 11 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Ameer E Hassan ◽  
Hari Kotta ◽  
Leeroy Garza ◽  
Laurie Preston ◽  
Wondwossen Tekle ◽  
...  
Keyword(s):  
Average Length ◽  
Length Of Hospital Stay ◽  
Functional Independence ◽  
Multivariate Statistical ◽  
Capture Process ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Intravenous Tissue Plasminogen Activator ◽  
Improved Outcomes ◽  
Iv Tpa

ObjectiveTo investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA).MethodsWe retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0–2) were collected. Univariate and multivariate statistical analyses were performed.ResultsOf a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21).ConclusionPatients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.

Abstract P525: Endovascular Thrombectomy Outcomes in Transferred Octogenarians: A Multicenter Pooled Analysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan Greco ◽  
Michael Chen ◽  
Ameer E Hassan ◽  
Nitin Goyal ◽  
Haris Kamal ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Functional Independence ◽  
Pooled Analysis ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Younger Patients ◽  
Profound Disability ◽  
Iv Tpa

Background: Acute ischemic strokes outcomes may be less favorable in elderly patients. Whether transferring octogenarians with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) results in similar outcomes to younger patients is uncertain. Methods: A pooled cohort from 6 centers (Europe, US) from 1/2014 to 5/2020 of pts with (ICA, M1, M2) LVO transferred for EVT ≤ 24 hrs from LKW. Patients were stratified into < 80 vs ≥ 80 years old. We compared 90 day functional independence and safety outcomes and assessed for predictors of good outcome (mRS 0-2) and profound disability (mRS 5-6). Results: Of 1176 pts received EVT as transfers, 216 (18%) were octogenarians. Baseline NIHSS was higher in octogenarians [19 (14, 22) vs 17 (12, 21), p<0.001], while IV tPA (52% vs 54%, p=0.52) and time LKW to EVT center [285 (193, 537) vs 272 (190, 470) min, p=0.15] were similar. Functional independence rates were lower in patients ≥ 80 as compared to < 80 (26% vs 46%, aOR 0.50, 95%CI 0.34-0.75, p=0.001). sICH was similar (8.6 vs 9.9%, p=0.56), but octogenarians had significantly higher 90-day mortality (42% vs 17%, p<0.001). Milder strokes (aOR 0.88, 95%CI 0.86-0.91, p<0.001), earlier presentation (aOR 0.95, 95%CI 0.91-0.98, p=0.004) and IV tPA (aOR 1.34, 95%CI 0.98-1.84, p=0.069) were associated with higher functional independence odds after EVT in octogenarians. Higher stroke severity (12% for each point, aOR=1.12, 95%CI 1.11-1.17-, p<0.001) and delayed reperfusion (3% for each additional hr, aOR 1.03, 95%CI 1.00-1.06, p=0.071) were associated with profound disability following EVT in octogenarians. Conclusion: EVT may be associated with lower independence rates in transferred octogenarians with LVO. Milder stroke severity, earlier presentation and IV thrombolysis increased the odds of good outcomes in octogenarians. Severe strokes and later treatment were associated with profound disability. Optimized selection and workflow is warranted in transferring elderly patients for EVT.

Abstract 2769: A Simple Clinical Index Based On Nihss Score During 1-h Tpa Infusion To Predict Unfavorable Outcome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Masato Osaki ◽  
Fumio Miyashita ◽  
Masatoshi Koga ◽  
Mayumi Fukuda ◽  
Yuya Shigehatake ◽  
...  
Keyword(s):  
Predictive Value ◽  
Predictive Accuracy ◽  
Unfavorable Outcome ◽  
Tissue Type ◽  
Baseline Score ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Clinical Index ◽  
Group D ◽  
Iv Tpa

Background: When intravenous tissue-type plasminogen activator therapy (IV-tPA) does not work, additional endovascular thrombectomy is a promising choice. However, there is no clear standard of timing to add thrombectomy after IV-tPA. We sought to create a handy clinical index to judge insufficient effects of IV-tPA immediately after the therapy based on posttreatment NIH Stroke Scale (NIHSS) score. Methods: Consecutive ischemic stroke patients with the baseline NIHSS score ≥8 and occlusion at the ICA or MCA on the initial MRA, who received IV-tPA within 3 h of onset, were retrospectively studied. NIHSS was assessed 30 min and 1 h after the initiation of IV-tPA and change from the baseline score was calculated (ΔNIHSS). The subjects were divided into 2 groups according to the arterial occlusion sites; ICA or proximal M1 with the residual length <5 mm (Group P) and distal M1 or M2 (Group D). Optimal cutoff scores of NIHSS and ΔNIHSS for predicting unfavorable outcome at 3 months, corresponding to the modified Rankin Scale of 3 to 6, were determined using receiver operating characteristic curves. The predictive accuracy of unfavorable outcome by NIHSS score and its combination with ΔNIHSS score was assessed. Results: Forty two patients (16 women, 75±9 years old, 27 ICA, 15 M1) were enrolled as Group P and 78 patients (22 women, 77±12 years old, 50 M1, 28 M2) as Group D. In Group P, 35 patients (83%) had unfavorable outcome; cutoff NIHSS scores predicting unfavorable outcome were ≥14 at both 30 min (AUC 0.855) and 1 h (0.916), and cutoff ΔNIHSS scores were ≤1 at both 30 min (0.829) and 1 h (0.888). In Group D, 42 patients (54%) had unfavorable outcome; cutoff NIHSS scores were ≥11 at 30 min (AUC 0.684) and ≥12 at 1 h (0.723), and cutoff ΔNIHSS scores were ≤6 at 30 min (0.615) and ≤7 at 1 h (0.631). In each time-point of both groups, cutoff NIHSS scores themselves were good predictors of unfavorable outcome, and the combination with cutoff ΔNIHSS scores strengthen the predictive accuracy more. In Group P, ‘NIHSS 30min ≥14 plus ΔNIHSS 30min ≤1’ showed the sensitivity (SEN) of 67%, specificity (SPEC) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 39% in predicting the outcome, and ‘NIHSS 1h ≥14 plus ΔNIHSS 1h ≤1’ showed SEN 66%, SPEC 100%, PPV 100%, and NPV 37%. In Group D, ‘NIHSS 30min ≥11 plus ΔNIHSS 30min ≤6’ showed SEN 71%, SPEC 67%, PPV 71%, and NPV 67%, and ‘NIHSS 1h ≥12 plus ΔNIHSS 1h ≤7’ showed SEN 62%, SPEC 78%, PPV 77%, and NPV 64%. Conclusion: Combination of the NIHSS score and its change from the baseline score during 1-h tPA infusion seems to be a good predictor of unfavorable outcome at 3 months and helpful to decide the timing of adding endovascular thrombectomy. In particular, the combination showed high specificity and PPV of the outcomes in patients with occlusion at the proximal carotid axis.

Thrombectomy for acute ischemic stroke in nonagenarians compared with octogenarians

2019 ◽  
Vol 12 (3) ◽  
pp. 266-270 ◽  
Author(s):  
Eric S Sussman ◽  
Blake Martin ◽  
Michael Mlynash ◽  
Michael P Marks ◽  
David Marcellus ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Independence ◽  
Inclusion Criteria ◽  
Related Factors ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Improved Outcomes ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Difference

IntroductionMultiple randomized trials have shown that endovascular thrombectomy (EVT) leads to improved outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Elderly patients were poorly represented in these trials, and the efficacy of EVT in nonagenarian patients remains uncertain.MethodsWe performed a retrospective cohort study at a single center. Inclusion criteria were: age 80–99, LVO, core infarct <70 mL, and salvageable penumbra. Patients were stratified into octogenarian (80–89) and nonagenarian (90–99) cohorts. The primary outcome was the ordinal score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included dichotomized functional outcome (mRS ≤2 vs mRS ≥3), successful revascularization, symptomatic intracranial hemorrhage (ICH), and mortality.Results108 patients met the inclusion criteria, including 79 octogenarians (73%) and 29 nonagenarians (27%). Nonagenarians were more likely to be female (86% vs 58%; p<0.01); there were no other differences between groups in terms of demographics, medical comorbidities, or treatment characteristics. Successful revascularization (TICI 2b–3) was achieved in 79% in both cohorts. Median mRS at 90 days was 5 in octogenarians and 6 in nonagenarians (p=0.09). Functional independence (mRS ≤2) at 90 days was achieved in 12.5% and 19.7% of nonagenarians and octogenarians, respectively (p=0.54). Symptomatic ICH occurred in 21.4% and 6.4% (p=0.03), and 90-day mortality rate was 63% and 40.9% (p=0.07) in nonagenarians and octogenarians, respectively.ConclusionsNonagenarians may be at higher risk of symptomatic ICH than octogenarians, despite similar stroke- and treatment-related factors. While there was a trend towards higher mortality and worse functional outcomes in nonagenarians, the difference was not statistically significant in this relatively small retrospective study.

scholarly journals Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

2020 ◽  
Vol 22 (1) ◽  
pp. 130-140 ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Maher Saqqur ◽  
Vijay K. Sharma ◽  
Alejandro Brunser ◽  
Jürgen Eggers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Recovery ◽  
Treatment Time ◽  
Functional Independence ◽  
National Institutes Of Health ◽  
Clinical Recovery ◽  
Intravenous Tissue Plasminogen Activator ◽  
Improved Outcomes ◽  
Observational Cohort

Background and Purpose Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable.Methods We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0–1 and 0–2 respectively.Results We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (<i>P</i><0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19).Conclusions Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

Improved Outcomes Using a Systematic and Evidence-Based Approach to the Laparoscopic Roux-En-Y Gastric Bypass in a Single Academic Institution

2007 ◽  
Vol 73 (10) ◽  
pp. 955-958 ◽  
Author(s):  
Soo Hwa Han ◽  
Carlos Gracia ◽  
Amir Mehran ◽  
Nicole Basa ◽  
Joe Hines ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Average Length ◽  
Anastomotic Stricture ◽  
Preoperative Evaluation ◽  
Length Of Hospital Stay ◽  
Marginal Ulcer ◽  
Ulcer Bleeding ◽  
Evidence Based ◽  
Improved Outcomes

No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33–96 kg/m2). The mean age was 44 (range 15–67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2–13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.

Abstract 2: Good Outcome After Successful Recanalization is Time Dependent in the Swift Prime Randomized Controlled Trial

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Mayank Goyal ◽  
Ashutosh P Jadhav ◽  
Alain Bonafe ◽  
Hans Diener ◽  
Vitor Pereira ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Controlled Trial ◽  
Early Period ◽  
Functional Independence ◽  
Randomized Controlled ◽  
Intravenous Tissue Plasminogen Activator ◽  
Improved Outcomes ◽  
Tissue Plasminogen ◽  
Stent Retrievers ◽  
The Relationship

Background and Purpose: The SWIFT PRIME trial demonstrated superior outcomes in patients presenting with disabling acute ischemic stroke (AIS) who underwent endovascular therapy vs. intravenous tissue plasminogen activator (t-PA) alone. We sought to understand the relationship between functional independence and time to reperfusion in study patients assigned to thombectomy. Methods: SWIFT PRIME is a global, multi-center, prospective, randomized, open, blinded endpoint study comparing functional outcomes in AIS subjects treated with either IV t-PA alone or IV t-PA in combination with Solitaire stent retriever device. Among patients in whom substantial reperfusion (TICI 2b/3) was achieved, we analyzed the effect onindependent outcome (mRS 0-2) of time from stroke onset to reperfusion (OTR) and from qualifying imaging to reperfusion Results: Among 83 patients undergoing thrombectomy, substantial reperfusion was achieved in 73 (88%). A marked effect of OTR was noted (Figure 1A). The rate of functional independence was 87% if reperfusion was achieved 150 minutes from symptoms onset. The absolute rate of good outcomes decreased by 10% over the next 60 minutes of delay in OTR and by 15% with every 60 minute delay there-after. Faster post-arrival workflow speed improved outcomes among patients presenting directly to study hospitals (Figure 1B). Conclusions: Speed of reperfusion is a dominant determinant of functional outcome among patients treated with stent retrievers. In the early period after, every 6 minute delay in reperfusion causes 1 more out of 100 treated patients to not achieve functional independence.

Delayed Intravenous Thrombolysis in Patients with Minor Stroke

2018 ◽  
Vol 46 (1-2) ◽  
pp. 52-58 ◽  
Author(s):  
Joonsang Yoo ◽  
Sung-Il Sohn ◽  
Jinkwon Kim ◽  
Seong Hwan Ahn ◽  
Kijeong Lee ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Minor Stroke ◽  
Acute Stroke Care ◽  
Nihss Score ◽  
Delayed Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Stroke Group ◽  
Suspected Stroke ◽  
Iv Tpa

Background: The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). Methods: We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score < 5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time > 40 min. Results: During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], p < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], p < 0.001) and door-to-imaging time (20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], p < 0.001) than did the non-minor stroke group. However, the imaging-to-needle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], p = 0.001). Conclusions: Our findings show that the door-to-needle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.

scholarly journals Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 15-21
Author(s):  
Tsun-Haw Toh ◽  
Khairul Azmi Abdul Kadir ◽  
Mei-Ling Sharon Tai ◽  
Kay Sin Tan
Keyword(s):  
Computed Tomography ◽  
Signs And Symptoms ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Ct Angiogram ◽  
Improved Outcomes ◽  
Computed Tomography Angiogram ◽  
Left Middle

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging – a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) – achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.

scholarly journals Intravenous Thrombolysis for Acute Ischaemic Stroke in Young Adult Patients

2009 ◽  
Vol 36 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Alexandre Y. Poppe ◽  
Alastair M. Buchan ◽  
Michael D. Hill
Keyword(s):  
Intravenous Thrombolysis ◽  
Favourable Outcome ◽  
Adult Patients ◽  
Nihss Score ◽  
Risk Of Death ◽  
Intravenous Tissue Plasminogen Activator ◽  
Lower Baseline ◽  
Current Cigarette ◽  
Multivariable Regression ◽  
Iv Tpa

Background:Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients ≤50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population.Methods:Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged ≤50 years-old (n=99) were compared with those aged >50 years (n=1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death.Results:Nine percent of patients were ≤50 years-old. Among patients aged ≤50 years, 40.4% were women and median age was 42 ± 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p<0.05) and their baseline median NIHSS score was lower (13 versus 15, P=0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age ≤50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH.Conclusions:Adult patients ≤50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age ≤50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH.

Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke

2019 ◽  
Vol 12 (1) ◽  
pp. 30-32 ◽  
Author(s):  
William K Diprose ◽  
Michael T M Wang ◽  
Andrew McFetridge ◽  
James Sutcliffe ◽  
P Alan Barber
Keyword(s):  
Ischemic Stroke ◽  
Glycated Hemoglobin ◽  
Multiple Logistic Regression Analysis ◽  
Functional Independence ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Glucose Levels ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Hba1c Levels

BackgroundIn ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy.ObjectiveTo evaluate the association between admission HbA1c and glucose levels and outcome following endovascular thrombectomy.MethodsConsecutive patients treated with endovascular thrombectomy with admission HbA1c and glucose levels were included. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0–2 at 3 months. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) score ≥8 points, or NIHSS score of 0–1 at 24 hours), symptomatic intracerebral hemorrhage (sICH), and mortality at 3 months.Results223 patients (136 (61%) men; mean±SD age 64.5±14.6) were included. The median (IQR) HbA1c and glucose were 39 (36-45) mmol/mol and 6.9 (5.8–8.4) mmol/L, respectively. Multiple logistic regression analysis demonstrated that increasing HbA1c levels (per 10 mmol/mol) were associated with reduced functional independence (OR=0.76; 95% CI 0.60–0.96; p=0.02), increased sICH (OR=1.33; 95% CI 1.03 to 1.71; p=0.03), and increased mortality (OR=1.26; 95% CI 1.01 to 1.57; p=0.04). There were no significant associations between glucose levels and outcome measures (all p>0.05).ConclusionsHbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.

Sign in / Sign up

Export Citation Format

Share Document