scholarly journals Toward a more inclusive paradigm: thrombectomy for stroke patients with pre-existing disabilities

2020 ◽  
pp. neurintsurg-2020-016783 ◽  
Author(s):  
Robert W Regenhardt ◽  
Michael J Young ◽  
Mark R Etherton ◽  
Alvin S Das ◽  
Christopher J Stapleton ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Infarct Size ◽  
Acute Stroke ◽  
Medical History ◽  
Coronary Disease ◽  
Vulnerable Population ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Final Infarct Size

BackgroundPersons with pre-existing disabilities represent over one-third of acute stroke presentations, but account for a far smaller proportion of those receiving endovascular thrombectomy (EVT) and thrombolysis. This is despite existing ethical, economic, legal, and social directives to maximize equity for this vulnerable population. We sought to determine associations between baseline modified Rankin Scale (mRS) and outcomes after EVT.MethodsIndividuals who underwent EVT were identified from a prospectively maintained database. Demographics, medical history, presentations, treatments, and outcomes were recorded. Baseline disability was defined as baseline mRS≥2. Accumulated disability was defined as the delta between baseline mRS and absolute 90-day mRS.ResultsOf 381 individuals, 49 had baseline disability (five with mRS=4, 23 mRS=3, 21 mRS=2). Those with baseline disability were older (81 vs 68 years, P<0.0001), more likely female (65% vs 49%, P=0.032), had more coronary disease (39% vs 20%, P=0.006), stroke/TIA history (35% vs 15%, P=0.002), and higher NIH Stroke Scale (19 vs 16, P=0.001). Baseline mRS was associated with absolute 90-day mRS ≤2 (OR=0.509, 95%CI=0.370–0.700). However, baseline mRS bore no association with accumulated disability by delta mRS ≤0 (ie, return to baseline, OR=1.247, 95%CI=0.943–1.648), delta mRS ≤1 (OR=1.149, 95%CI=0.906–1.458), delta mRS ≤2 (OR 1.097, 95% CI 0.869–1.386), TICI 2b–3 reperfusion (OR=0.914, 95%CI=0.712–1.173), final infarct size (P=0.853, β=−0.014), or intracerebral hemorrhage (OR=0.521, 95%CI=0.244–1.112).ConclusionsWhile baseline mRS was associated with absolute 90-day disability, there was no association with accumulated disability or other outcomes. Patients with baseline disability should not be routinely excluded from EVT based on baseline mRS alone.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

scholarly journals STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

2017 ◽  
Vol 9 (8) ◽  
pp. 94
Author(s):  
Syed Junaid Ahmed ◽  
Abdur Rahman Mohd Masood ◽  
Safiya Sumana ◽  
Khadeer Ahmed Ghori ◽  
Javed Akhtar Ansari ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Observational Study ◽  
Hospital Admission ◽  
Acute Stroke ◽  
Mean Difference ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Mean

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks.

Abstract T P299: Ambulatory Status: A Protective Mechanism against Venous Thromboembolism in Acute Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jason-Flor Sisante ◽  
Michael Abraham ◽  
Sandra Billinger ◽  
Manoj Mittal
Keyword(s):  
Venous Thromboembolism ◽  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Early Mobilization ◽  
Protective Mechanism ◽  
Stroke Patients ◽  
Ambulatory Status ◽  
Stroke Type ◽  
The Relationship

Introduction: Deep vein thrombosis (DVT) is reported in 23% to 50% of hemiplegic stroke survivors and the highest rate of incidence occurs within one week of stroke onset. Pulmonary embolism (PE) is reported in up to 5% of stroke patients. There is limited data about the relationship of ambulatory status and the rate of venous thromboembolism (VTE) following a stroke. Hypothesis: The goal of our retrospective cohort study was to understand the relationship between VTE and a patient’s ambulatory status, adjusting for age, gender, and stroke type (ischemic, intracerebral hemorrhage, or subarachnoid hemorrhage). We assessed the hypothesis that the stroke patients who are able to ambulate during hospitalization would have lower rates of DVT and PE. Methods: We retrospectively analyzed 1670 acute stroke patients who were admitted to an academic comprehensive stroke center between Feb 2006 and May 2014. “Get with the guideline data” was used to identify stroke patients and their ambulatory status (yes/no). VTE was identified using discharge diagnosis. Chi square test and logistic regression methods were used for statistical analysis. Results: Mean age was 64.9 ± 14.6 years with 51% men. 1138 (68%) patients were classified as having ischemic stroke; 291 (17.5%) patients had intracerebral hemorrhage; and 241 (14.5%) patients had subarachnoid hemorrhage. During hospitalization, 444 (27%) were ambulatory. Patients able to ambulate during hospitalization had less rate of DVT (6.3% vs 15.3%; p<0.0001) and PE (2.9% vs 5.3%; p=0.04), when compared to non-ambulating patients. After adjusting for age, gender, and stroke type; patients who were able to ambulate still had lower rates of DVT (OR: 0.42, 95% CI 0.27-0.63) and PE (OR: 0.49, 95% CI 0.25-0.88). Conclusion: In conclusion, our findings suggest that the patient’s ambulatory status during hospitalization is an independent predictor of VTE. Further research is needed to understand if early mobilization in non-ambulatory stroke patients would have similar protective effect against VTE or not.

Intravenous Thrombolysis Is Associated with Less Disabling Stroke and Lower Mortality in Multiple-Pass Endovascular Thrombectomy

2021 ◽  
pp. 1-6
Author(s):  
Christopher Blair ◽  
Leon Edwards ◽  
Cecilia Cappelen-Smith ◽  
Dennis Cordato ◽  
Andrew Cheung ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Additional Benefit ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Multiple Pass ◽  
First Pass

<b><i>Background and Purpose:</i></b> The benefit of bridging intravenous thrombolysis (IVT) in acute ischaemic stroke patients eligible for endovascular thrombectomy (EVT) is unclear. This may be particularly relevant where reperfusion is achieved with multiple thrombectomy passes. We aimed to determine the benefit of bridging IVT in first and multiple-pass patients undergoing EVT ≤6 h from stroke onset to groin puncture. <b><i>Methods:</i></b> We compared 90-day modified Rankin Scale (mRS) outcomes in 187 consecutive patients with large vessel occlusions (LVOs) of the anterior cerebral circulation who underwent EVT ≤6 h from symptom onset and who achieved modified thrombolysis in cerebral ischaemia (mTICI) 2c/3 reperfusion with the first pass to those patients who required multiple passes to achieve reperfusion. The effect of bridging IVT on outcomes was examined. <b><i>Results:</i></b> Significantly more first-pass patients had favourable (mRS 0–2) 90-day outcomes (68 vs. 42%, <i>p</i> = 0.001). Multivariate analysis showed an association between first-pass reperfusion and favourable outcomes (OR 2.25; 95% CI 1.08–4.68; <i>p</i> = 0.03). IVT provided no additional benefit in first-pass patients (OR 1.17; CI 0.42–3.20; <i>p</i> = 0.76); however, in multiple-pass patients, it reduced the risk of disabling stroke (mRS ≥4) (OR 0.30; CI 0.10–0.88; <i>p</i> = 0.02) and mortality (OR 0.07; CI 0.01–0.36; <i>p</i> = 0.002) at 90 days. <b><i>Conclusion:</i></b> Bridging IVT may benefit patients with anterior circulation stroke with LVO who qualify for EVT and who require multiple passes to achieve reperfusion.

scholarly journals Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

2021 ◽  
Vol 10 (3) ◽  
pp. 151-161
Author(s):  
Novi Fatni Muhafidzah ◽  
◽  
Sobaryati Mansur ◽  
Emmy Hermiyanti Pranggono ◽  
Yusuf Wibisono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Size ◽  
Acute Stroke ◽  
Primary Data ◽  
Neurogenic Pulmonary Edema ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients

2020 ◽  
Vol 29 (9) ◽  
pp. 105033
Author(s):  
Fang Liu ◽  
Raymond CC Tsang ◽  
Jing Zhou ◽  
Mingchao Zhou ◽  
Fubing Zha ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Barthel Index ◽  
Short Form ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Relationship Of

Acute Stroke

2019 ◽  
Vol 39 (01) ◽  
pp. 061-072 ◽  
Author(s):  
Loris Poli ◽  
Paolo Costa ◽  
Andrea Morotti
Keyword(s):  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Blood Pressure Reduction ◽  
Intravenous Thrombolysis ◽  
Medical Emergency ◽  
Endovascular Thrombectomy ◽  
Stroke Units ◽  
Cerebrovascular Events ◽  
Acute Intracerebral Hemorrhage ◽  
Improved Outcome

AbstractStroke remains one of the leading determinants of death and severe disability worldwide. It is a medical emergency with a narrow window for recognition and administration of outcome-modifying treatment in the emergency department. Ischemic stroke accounts for the majority of cerebrovascular events and revascularization therapies such as intravenous thrombolysis and endovascular thrombectomy are the mainstays of treatment in carefully selected patients. Intracerebral hemorrhage is less common but remains the deadliest type of stroke. Blood pressure reduction and hemostatic treatment in case of coagulopathy are the cornerstones of acute intracerebral hemorrhage treatment. Admission to dedicated stroke units is associated with improved outcome in patients suffering from acute stroke.

Abstract P233: Descriptions of the Meaning of Modified Rankin Scale Outcomes in Acute Stroke Clinical Trials: Meta-Analysis and Call to Corrective Action

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Napasri Chaisinanunkul ◽  
Jeffrey L Saver
Keyword(s):  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Meta Analysis ◽  
Health State ◽  
Modified Rankin Scale ◽  
Policy Makers ◽  
Endovascular Thrombectomy ◽  
The Past ◽  
Large N ◽  
Clinical Meaning

Background: The modified Rankin scale, a 7-level, clinician-reported, measure of global disability, is the most widely employed outcome scale in acute stroke trials. As the meaning of technical mRS scores (e.g. mRS 1, mRS 4) is not well-known among general clinicians, patients, and policy-makers, trialists sometimes apply valence (e.g. “excellent”, “good”) and health-state (e.g. “disabled”, “dependent”) terms to convey the clinical meaning of trial findings. The terms employed have not been well-delineated. Methods: Systematic meta-analysis assessing mRS descriptive terms across all large (n ≥ 100) RCTs for acute ischemic or hemorrhagic stroke reported 2000 - 2020, following PRISMA guidelines. Results: Among the 60 RCTs meeting study entry criteria, patient populations were acute ischemic stroke (AIS) in 88%, intracerebral hemorrhage in 8%, both in 3%. Among the 55 AIS trials, tested agents included: antiplatelet - 28%, endovascular thrombectomy - 20%, IV lytics - 20%, neuroprotective - 11%. The mRS was a major endpoint measure in 82% of trials (primary in 60%, secondary in 22%). Table 1 shows frequency of different valence terms (1A) and health state terms (1B) for 9 types of mRS analysis. Trials often used mutually contradictory terms for particular mRS outcomes. e.g. “good outcome” was applied to outcomes mRS 0-1 (2 trials), mRS 0-2 (2 trials), mRS 0-3 (1 trial), and ordinal mRS (3 trials); “favorable” was applied to mRS 0-1 (5 trials), mRS 0-2 (6 trials), and ordinal mRS (6 trials). Also many trials provided no meaningful descriptor (no valence descriptor in 82%, no health state descriptor in 58%). Conclusion: Across major acute stroke trials of the past 20 years, the valence and health state terms for different mRS outcomes have been often mutually contradictory or not provided at all. A standardized nomenclature for mRS outcome description would improve clinician and policy-maker understanding of trial results

Telemedicine for Evaluation of Stroke Patients

2018 ◽  
pp. 118-127
Author(s):  
Kaustubh Limaye ◽  
Lawrence R. Wechsler
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Video Communication ◽  
Legal Issues ◽  
Comprehensive Care ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Intravenous Alteplase

Telemedicine uses video communication to evaluate patients at an originating site by a distant physician. Telestroke was developed to apply telemedicine for the delivery of stroke expertise to hospitals with limited or no available stroke capability. This chapter reviews the most commonly used models of telestroke networks. It discusses the evidence for telestroke, including its value in managing patients with ischemic stroke who are candidates for intravenous alteplase and endovascular thrombectomy, as well as patients with intracerebral hemorrhage. Economic, legislative, and legal issues of treating patients within a telestroke network are also reviewed. Future advances in telemedicine will continue to deliver expert care in a way that brings comprehensive care to patient’s doorstep.

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