Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

Background: Clopidogrel reduces the risk of non-cardioembolic ischemic stroke, but it is unclear whether it affects the severity and outcome of stroke. We aimed at evaluating the effect of prior treatment with clopidogrel on acute non-cardioembolic ischemic stroke severity and in-hospital outcome. Methods: We prospectively studied 608 consecutive patients (39.5% males, age 79.1 ± 6.6 years) who were admitted with acute ischemic stroke. The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥21. The outcome was assessed using the dependency rates that prevailed at the time of discharge (i.e. modified Rankin scale between 2 and 5) and with in-hospital mortality. Results: At admission, 397 patients did not have atrial fibrillation or heart valve disease. Among these 397 patients, 69 were receiving monotherapy with clopidogrel prior to stroke, 69 were receiving monotherapy with aspirin and 236 patients were not on any antiplatelet treatment. The prevalence of severe stroke was lower in patients who were receiving clopidogrel than in patients who were receiving aspirin and patients who were not on antiplatelets (1.4, 13.0 and 11.0%, respectively; p < 0.05). Independent predictors of severe stroke at admission were male gender (relative risk (RR) 0.31, 95% CI 0.12-0.78, p < 0.05) and treatment with clopidogrel prior to stroke compared with no antiplatelet treatment (RR 0.13, 95% CI 0.02-0.97, p < 0.05). Treatment with aspirin prior to stroke did not predict severe stroke compared with no antiplatelet treatment (RR 1.24, 95% CI 0.51-2.98, p = NS). The rate of dependency at discharge did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (57.9, 47.8 and 59.7%, respectively; p = NS). Independent predictors of dependency at discharge were age (RR 1.12, 95% CI 1.05-1.19, p < 0.001) and NIHSS at admission (RR 1.67, 95% CI 1.46-1.92, p < 0.001). In-hospital mortality rate also did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (4.3, 4.3 and 5.0%, respectively; p = NS). The only independent predictor of in-hospital mortality was NIHSS at admission (RR 1.22, 95% CI 1.14-1.30, p < 0.001). Conclusions: Treatment with clopidogrel prior to acute non-cardioembolic ischemic stroke attenuates the severity of stroke at admission but does not appear to affect the functional outcome at discharge or the in-hospital mortality of these patients.

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Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽

10.1024/0301-1526/a000328 ◽

2014 ◽

Vol 43 (1) ◽

pp. 55-61 ◽

Cited By ~ 10

Author(s):

Konstantinos Tziomalos ◽

Vasilios Giampatzis ◽

Stella Bouziana ◽

Athinodoros Pavlidis ◽

Marianna Spanou ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Ankle Brachial Index ◽

Arterial Disease ◽

National Institutes Of Health ◽

Limited Data ◽

Severe Stroke ◽

Hospital Outcome ◽

Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.101 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Ignatius Ivan ◽

Budi Riyanto Wreksoatmodjo ◽

Octavianus Darmawan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Severe Stroke ◽

History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords: Atrial fibrillation, heart failure, ischemic stroke, myocardial infarction, National Institutes of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

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Is Endovascular Treatment Still Good for Ischemic Stroke in Real World?

Stroke ◽

10.1161/strokeaha.120.029742 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3250-3263

Author(s):

Zixu Zhao ◽

Jiarui Zhang ◽

Xin Jiang ◽

Li Wang ◽

Zixiao Yin ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Scale Score ◽

Real World ◽

Observational Studies ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Severe Stroke ◽

Stroke Group ◽

Mild Stroke

Background and Purpose: Although endovascular treatment (EVT) for acute ischemic stroke is classified as I evidence, outcomes after EVT in real-world practice appear to be less superior than those in randomized clinical trials (RCTs). Additionally, the effect of EVT is unclear compared with medical treatment (MT) for patients with mild symptoms defined by National Institutes of Health Stroke Scale score <6 or with severe symptoms defined by Alberta Stroke Program Early CT Score <6. Methods: Literatures were searched in big databases and major meetings from December 6, 2009, to December 6, 2019, including RCTs and observational studies comparing EVT against MT for patients with acute ischemic stroke. Observational studies were precategorized into 3 groups based on imaging data on admission: mild stroke group with National Institutes of Health Stroke Scale score <6, severe stroke group with Alberta Stroke Program Early CT Score <6 or ischemic core ≥50 mL, and normal stroke group for all others. Outcome was measured as modified Rankin Scale score of 0 to 2, mortality at 90 days, and symptomatic intracranial hemorrhage (sICH) at 24 hours. Results: Fifteen RCTs (n=3694) and 37 observational studies (n=9090) were included. EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality in RCTs and normal stroke group, whereas EVT was associated with higher sICH rate in normal stroke group, and no difference of sICH rate appeared between EVT and MT in RCTs. In severe stroke group, EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality, whereas no difference of sICH rate was found. In mild stroke group, there was no difference in modified Rankin Scale 0 to 2 rate between EVT and MT, whereas EVT was associated with higher mortality and sICH rate. Conclusions: Evidence from RCTs and observational studies supports the use of EVT as the first-line choice for eligible patients corresponding to the latest guideline. For patients with Alberta Stroke Program Early CT Score <6, EVT showed superiority over MT, also in line with the guidelines. On the contrary to the guideline, our data do not support EVT for patients with National Institutes of Health Stroke Scale score <6.

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The impact of post-stroke complications on in-hospital mortality depends on stroke severity

European Stroke Journal ◽

10.1177/2396987316681872 ◽

2016 ◽

Vol 2 (1) ◽

pp. 54-63 ◽

Cited By ~ 7

Author(s):

Alejandro Bustamante ◽

Dolors Giralt ◽

Teresa García-Berrocoso ◽

Marta Rubiera ◽

José Álvarez-Sabín ◽

...

Keyword(s):

Ischemic Stroke ◽

Random Forest ◽

Hospital Mortality ◽

Brain Edema ◽

Respiratory Infections ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Post Stroke ◽

The Impact

Introduction Controversies remain on whether post-stroke complications represent an independent predictor of poor outcome or just a reflection of stroke severity. We aimed to identify which post-stroke complications have the highest impact on in-hospital mortality by using machine learning techniques. Secondary aim was identification of patient’s subgroups in which complications have the highest impact. Patients and methods Registro Nacional de Ictus de la Sociedad Española de Neurología is a stroke registry from 42 centers from the Spanish Neurological Society. Data from ischemic stroke patients were used to build a random forest by combining 500 classification and regression trees, to weight up the impact of baseline characteristics and post-stroke complications on in-hospital mortality. With the selected variables, a logistic regression analysis was performed to test for interactions. Results 12,227 ischemic stroke patients were included. In-hospital mortality was 5.9% and median hospital stay was 7(4–10) days. Stroke severity [National Institutes of Health Stroke Scale > 10, OR = 5.54(4.55–6.99)], brain edema [OR = 18.93(14.65–24.46)], respiratory infections [OR = 3.67(3.02–4.45)] and age [OR = 2.50(2.07–3.03) for >77 years] had the highest impact on in-hospital mortality in random forest, being independently associated with in-hospital mortality. Complications have higher odds ratios in patients with baseline National Institutes of Health Stroke Scale <10. Discussion Our study identified brain edema and respiratory infections as independent predictors of in-hospital mortality, rather than just markers of more severe strokes. Moreover, its impact was higher in less severe strokes, despite lower frequency. Conclusion Brain edema and respiratory infections were the complications with a greater impact on in-hospital mortality, with the highest impact in patients with mild strokes. Further efforts on the prediction of these complications could improve stroke outcome.

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Exploration of factors affecting prognosis of stroke preceded by transient ischemic attack

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i4.14704 ◽

2016 ◽

Vol 7 (4) ◽

pp. 68-74

Author(s):

Nermien Adly ◽

Safaa Hussein Ali

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Medical Sciences ◽

Severe Stroke ◽

Factors Affecting ◽

Brain Computed Tomography ◽

Regional Brain ◽

Ischemic Attack

Background: Age is the most important risk factor for stroke. The regional brain affection was not considered in a comparison between different brain locations as a predictor for outcome in those with and without prior TIA.Aims and Objectives: Can transient Ischemic attack predict stroke prognosis?Materials and Methods: Fifty nine patients, aged ≥ 55 years old, with recent ischemic stroke were studied, with (cases, 40.68%) and without (controls) antecedent TIA. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (MRS), and California risk score (CRS) were assessed. A brain computed tomography was done.Results: Older age was a predictor of more severe stroke (P<0.001). Different latencies for TIA were studied. With reference to our controls, better prognosis was found only in cases with TIA ≤ seven days as a predictor for better NIHSS and MRS. In cases, CRS was a significant predictor of shorter latency. Infratentorial ischemic stroke, not supratentorial ischemic stroke, with prior TIA, was a significant predictor of lower NIHSS.Conclusion: TIA ≤ seven days is a predictor for better NIHSS and MRS.Asian Journal of Medical Sciences Vol.7(4) 2016 68-74

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Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-021-02523-2 ◽

2021 ◽

Author(s):

Thang S. Han ◽

Giosue Gulli ◽

Christopher H. Fry ◽

Brendan Affley ◽

Jonathan Robin ◽

...

Keyword(s):

Scale Score ◽

Stroke Unit ◽

National Institutes Of Health ◽

Stroke Severity ◽

Modified Rankin Scale ◽

National Audit ◽

Severe Stroke ◽

Nihss Score ◽

Hyperacute Stroke ◽

Level Of Consciousness

AbstractComplications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4–11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1–10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3–7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5–18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6–8.4); moderately-severe or severe disability (modified Rankin Scale score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1–10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7–15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal–Wallis test: χ2 = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = − 4 vs 0, χ2 = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service.

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Initial Stroke Severity in Patients With Atrial Fibrillation According to Antithrombotic Therapy Before Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.030138 ◽

2020 ◽

Vol 51 (9) ◽

pp. 2733-2741 ◽

Cited By ~ 2

Author(s):

Yo Han Jung ◽

Young Dae Kim ◽

Jinkwon Kim ◽

Sang Won Han ◽

Mi Sun Oh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Scale Score ◽

Neurological Deficit ◽

Odds Ratio ◽

Medication Use ◽

National Institutes Of Health ◽

Stroke Severity ◽

Modified Rankin Scale ◽

Antithrombotic Medication

Background and Purpose: Atrial fibrillation (AF) is the leading cause of ischemic stroke. Preventive antithrombotic use, especially for anticoagulation, reduces the incidence of ischemic stroke in patients with AF. Using data from the nationwide multicenter stroke registry, we investigated the trends of preceding antithrombotic medication use in patients with acute ischemic stroke (AIS) with AF and its association with initial stroke severity and in-hospital outcomes. Methods: This study included 6786 patients with AIS with known AF before stroke admission across 39 hospitals between June 2008 and December 2018. We collected the data on antithrombotic medication use (no antithrombotic/antiplatelet/anticoagulant) preceding AIS. Initial stroke severity was measured using the National Institutes of Health Stroke Scale, and in-hospital outcome was determined by modified Rankin Scale score at discharge. Results: During the study period, anticoagulant use continued to increase. However, nearly one-third of patients with AIS with known AF did not receive antithrombotics before stroke. Initial National Institutes of Health Stroke Scale scores varied according to preceding antithrombotic therapy ( P <0.001). It was higher in patients who did not receive antithrombotics than in those who received antiplatelets or anticoagulants (median National Institutes of Health Stroke Scale score: 8 versus 7 and 8 versus 6, respectively). Favorable outcome at discharge (modified Rankin Scale score, 0–2) was more prevalent in patients who received antiplatelets or anticoagulants ( P <0.001). Use of antiplatelets (odds ratio, 1.23 [95% CI, 1.09–1.38]) and anticoagulants (odds ratio, 1.31 [95% CI, 1.15–1.50]) was associated with a mild initial neurological deficit (National Institutes of Health Stroke Scale score ≤5) in patients with AIS with AF. Conclusions: Throughout the study period, the proportion of patients taking anticoagulants increased among patients with AIS with known AF. However, a large portion of AF patients still did not receive antithrombotics before AIS. Furthermore, prehospitalization use of anticoagulants was associated with a significantly higher likelihood of a mild initial neurological deficit and favorable outcome at discharge.

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Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Cerebrovascular Diseases ◽

10.1159/000445299 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 81-89 ◽

Cited By ~ 28

Author(s):

Mohamed Al-Khaled ◽

Christine Matthis ◽

Andreas Binder ◽

Jonas Mudter ◽

Joern Schattschneider ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Fatality ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Increased Risk ◽

Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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Abstract WP9: Primary Aspiration Thrombectomy in Acute Ischemic Stroke: A Single-Center Experience

Stroke ◽

10.1161/str.48.suppl_1.wp9 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ganesh Asaithambi ◽

Amy L Castle ◽

Lana J Stein ◽

Sandra K Hanson ◽

Jeffrey P Lassig

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Single Center ◽

Aspiration Thrombectomy ◽

Discharge Disposition ◽

Single Center Experience ◽

Symptomatic Intracerebral Hemorrhage ◽

Stent Retrievers

Background: Recent endovascular stroke studies utilizing primarily stent retrievers have proven clinical benefit among eligible patients. It remains unclear if this benefit is exclusive to stent retrievers. We present the results of a single-center experience for patients undergoing primary aspiration thrombectomy for acute ischemic stroke (AIS). Methods: A retrospective analysis of all AIS patients receiving primary aspiration thrombectomy from January 2014 to March 2016 was performed. We assessed stroke severity at admission and discharge as defined by the National Institutes of Health Stroke Scale score (NIHSSS), median onset to puncture and onset to recanalization times, location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of TICI 2b/3 reperfusion. Outcomes adjudicated included rates of symptomatic intracerebral hemorrhage (sICH), favorable discharge disposition to home, and 90-day modified Rankin Scale (mRS) score ≤2. Results: During the study period, 121 patients (mean age 68.7±16.5 years, 53.7% women) received primary aspiration thrombectomy for 124 occlusions (26% terminal internal carotid artery, 45% M1, 15% M2, 11% basilar artery, 3% other). Median admission NIHSSS was 19 [11, 22] and improved to 6 [1, 15] upon discharge. Median onset to puncture and onset to recanalization times were 258 [148, 371] and 300 [180, 409] minutes, respectively. The rate of TICI 2b/3 reperfusion was 84.7%, and 52% received adjunctive IV alteplase. Rates of favorable discharge to home was 28.9% and 90-day mRS ≤2 was 39.8%. Only one patient developed sICH. Conclusion: Our single-center experience shows that primary aspiration thrombectomy can yield both favorable angiographic and clinical outcomes with minimal adverse effect.

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Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽

10.1161/str.52.suppl_1.p75 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

James E Siegler ◽

Pere Portela ◽

Juan F Arenillas ◽

Alba Chavarria-Miranda ◽

Ana Guillen ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Significant Risk ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Cerebrovascular Events ◽

Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

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