scholarly journals The Effect of Body Mass Index on Outcome after Endovascular Treatment in Acute Ischemic Stroke Patients: A Post Hoc Analysis of the MR CLEAN Trial

2019 ◽  
Vol 48 (3-6) ◽  
pp. 200-206 ◽  
Author(s):  
France Anne Victoire Pirson ◽  
Wouter H. Hinsenveld ◽  
Julie Staals ◽  
Bianca T.A. de Greef ◽  
Wim H. van Zwam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Lower Risk ◽  
Normal Weight ◽  
Stroke Patients ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
The Impact

Background: Though obesity is a well-known risk factor for vascular disease, the impact of obesity on stroke outcome has been disputed. Several studies have shown that obesity is associated with better functional outcome after stroke. Whether obesity influences the benefit of endovascular treatment (EVT) in stroke patients is unknown. We evaluated the association between body mass index (BMI) and outcome in acute ischemic stroke patients with large vessel ­occlusion (LVO), and assessed whether BMI affects the ­benefit of EVT. Methods: This is a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands trial (­ISRCTN10888758). BMI was used as a continuous and categorical variable, distinguishing underweight and normal weight (BMI <25), overweight (BMI 25–30), and obesity (BMI ≥30). We used multivariable ordinal logistic regression analysis to estimate the association of BMI with functional outcome (shift analysis), assessed with modified Rankin Scale (mRs) at 90 days. The impact of BMI on EVT effect was tested by the use of a multiplicative interaction term. Results: Of 366 patients, 160 (44%) were underweight or normal weight, 145 (40%) overweight, and 61 (17%) were obese. In multivariable analysis with BMI as a continuous variable, we found a shift toward better functional outcome with higher BMI (mRS adjusted common OR 1.04; 95% CI 1.0–1.09), and mortality was inversely related to BMI (aOR 0.92; 95% CI 0.85–0.99). Safety analysis showed that higher BMI was associated with lower risk of stroke progression (aOR 0.92, 95% CI 0.87–0.99). Additional analysis showed no interaction between BMI and EVT effect on functional outcome, mortality, and other safety outcomes. Conclusion: Our study confirms the effect of obesity on outcome in acute ischemic stroke patients with LVO, meaning better functional outcome, lower mortality, and lower risk of stroke progression for patients with higher BMI. As we found no interaction between BMI and EVT effect, all BMI classes may expect the same benefit from EVT.

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 WP289: The Impact of Infection on Neurological Deterioration and Outcome in Acute Ischemic Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
Andre D Kumar ◽  
Adrianne M Dorsey ◽  
James E Siegler ◽  
Michael J Lyerly ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Acute Hospitalization ◽  
Stroke Center ◽  
The Impact

Introduction: To date, few studies have assessed the influence of infection on neurological deterioration (ND) and other outcome measures in acute ischemic stroke. Methods: Patients admitted to our stroke center (07/08-12/10) were retrospectively assessed. Patients were excluded if they had an in-hospital stroke, unknown time of symptom onset, or delay from symptom onset to hospital arrival >48 hours. Positive blood or urine culture, or chest x-ray consistent with pneumonia were classified as infection and stratified according to whether the infection was diagnosed within the first 24 hours of admission or after 24 hours. ND was defined as an increase ≥2 points on the NIHSS score within a 24hr period. Poor functional outcome was defined as a mRS score of 3-6 on discharge. Results: Of the 334 patients included in this study, 78 had an infection (19 on admission). The majority of infections were found in the urinary tract (64%), while pneumonia (37%) and bacteremia (24%) were also common. Infection on admission was predictive of ND (Table 1; OR=2.79, 95% CI 1.18-6.64, p=0.0211) and poor functional outcome (OR=3.0, 95% CI 1.1-7.9, p=0.0182). Developing an infection during acute hospitalization was an even stronger predictor of ND (OR=11.9, 95% CI 5.8-24.5, p<0.0001) and poor functional outcome (OR=56.4, 95% CI 7.7-414, p<0.0001). After adjusting for age, NIHSS at baseline and glucose on admission, the development of an infection during acute hospitalization remained a significant predictor of ND (OR=8.9, 95% CI 4.2-18.6, p<0.0001) and poor functional outcome (OR=41.7, 95% CI 5.2-337.9, p=0.005) while an infection on admission was no longer predictive of ND (OR=1.5, 95%CI 0.59-3.99, p=0.3738) or poor functional outcome (OR=1.09, 95%CI 0.3-3.9, p=0.8984). Conclusion: Our data suggest that ischemic stroke patients who develop an infection during their acute hospitalization are at increased odds of experiencing ND and of being discharged with significant disability.

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.

Is Differential Activity of Enoxaparin and Unfractionated Heparin According to the Location of Deep-Vein Thrombosis in Acute Ischemic Stroke Patients Driven by Different Pathogenic Mechanisms?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 303-303
Author(s):  
Ludovic Drouet ◽  
David G. Sherman ◽  
Gregory W. Albers ◽  
Christopher Bladin ◽  
Cesare Fieschi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Relative Risk ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Motor Impairment ◽  
The Body ◽  
Stroke Patients ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
Deep Vein

Abstract Introduction Studies of patients undergoing hip surgery have shown that approximately two-thirds of subsequent deep-vein thromboses (DVT) were ipsilateral to the surgery and that not all thromboprophylactic agents were equally effective in reducing DVT on both sides of the body. This suggests a possible difference in the mechanisms of action of these agents. In PREVAIL, a study of VTE prophylaxis in acute ischemic stroke patients, we assessed the relationship between the side of the body affected by motor impairment, the side on which a DVT occurred, and the comparative effects of enoxaparin and UFH on the incidence of ipsilateral and contralateral DVT. Methods Patients with acute ischemic stroke (confirmed by CT scan or MRI) and unable to walk unassisted due to motor impairment of the leg were randomized, within 48h of symptom onset, to receive enoxaparin 40mg subcutaneously once-daily or UFH 5000 IU subcutaneously every 12h for 10±4 days. DVT was confirmed by venography, or ultrasonography when venography was not practical. Pulmonary embolism (PE) was confirmed by VQ or CT scan, or angiography. We conducted a post hoc analysis to test: the correlation between side of motor impairment and side of subsequent DVT; the relative risk reduction for DVT, associated with enoxaparin versus UFH when DVT and motor impairment were ipsilateral or contralateral. Differences between the sides of motor impairment and VTE were tested using the McNemar test. Results The PREVAIL study reported a 43% relative reduction in the risk of symptomatic or asymptomatic DVT, symptomatic PE, or fatal PE with enoxaparin compared with UFH in acute ischemic stroke patients (10.2% versus 18.1%, p=0.0001), with no increase in clinically important bleeding. The current analyses, investigating the incidence of unilateral DVT, demonstrated a good concordance between the side of the motor impairment and subsequent DVT (McNemar test, p=0.47 suggesting strong correlation). The benefit of enoxaparin compared with UFH for reducing the risk of DVT was significant for ipsilateral DVT, but not contralateral DVT (see Table). Table: DVT incidence in acute ischemic stroke patients relative to the side of motor impairment Side of DVT relative to motor impairment Enoxaparin (N=613) UFH (N=609) Relative Risk [95% CI] P value* *Chi-squared test Ipsilateral, n (%) 33 (5.4) 60 (9.9) 0.55 [0.36–0.82] 0.003 Contralateral, n (%) 21 (3.4) 26 (4.3) 0.80 [0.46–1.41] 0.44 Conclusion Our observations in this post hoc analysis of PREVAIL study data are consistent with the hypothesis that the relative effectiveness of enoxaparin compared with UFH may be more important for flow-dependent thrombogenic factors (ipsilateral side of DVT) than for inflammation (hypercoagulability)-dependent thrombogenic factors (contralateral side of DVT). Further research is warranted to confirm this hypothesis.

scholarly journals Application of capillary index score in predicting three-month functional outcome after endovascular treatment for acute ischemic stroke in China

2020 ◽  
Vol 26 (3) ◽  
pp. 309-315
Author(s):  
Zhenhui Duan ◽  
Xianjun Huang ◽  
Jie Gao ◽  
Ting Hu ◽  
Xiaoyun Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Operating Characteristic ◽  
Index Score ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Score System

Background Preoperative neuroimaging assessment of collateral circulation is important for selecting acute ischemic stroke patients who are appropriate for endovascular treatment. We sought to validate the capillary index score system in an Asian population and compare its ability in predicting clinical outcomes with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system. Methods We continuously enrolled acute ischemic stroke patients from two neurological centers from March 2014 to March 2017. Multivariate analyses were performed to assess the capillary index score system with 90-day clinical outcome (modified Rankin scale score). The scoring systems were compared for predicting good (modified Rankin scale 0–2) and excellent (modified Rankin scale 0–1) functional outcomes using area under the receiver operating characteristic curves. Results We identified 157 patients (median age, 65 years; 96 (61.1%) males), of whom 71 (45.2%) patients with 90-day good functional outcomes were selected. Capillary index score was independently associated with clinical outcome after endovascular treatment (OR 0.63; 95% CI 0.43–0.92; P = 0.016) with its predictive ability for good functional outcome (area under the receiver operating characteristic curve 0.755). For excellent functional outcome, the capillary index score system was not inferior to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system (area under the receiver operating characteristic curve 0.748 versus 0.793, P = 0.09). Conclusions The capillary index score system is a potentially useful tool for predicting 90-day functional outcomes in acute ischemic stroke patients after endovascular treatment.

scholarly journals Path From Clinical Research to Implementation

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 1941-1950
Author(s):  
Eveline J.A. Wiegers ◽  
Kars C.J. Compagne ◽  
Paula M. Janssen ◽  
Esmee Venema ◽  
Jaap W. Deckers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
The Netherlands ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Successful Implementation ◽  
Stroke Patients ◽  
The Impact

Before 2015, endovascular treatment (EVT) for acute ischemic stroke was considered a promising treatment option. Based on limited evidence, it was performed in several dedicated stroke centers worldwide on selected patients. Since 2015, EVT for patients with intracranial large vessel occlusion has quickly been implemented as standard treatment in many countries worldwide, supported by the revised international guidelines based on solid evidence from multiple clinical trials. We describe the development in use of EVT in the Netherlands before, during, and after the pivotal EVT trials. We used data from all patients who were treated with EVT in the Netherlands from January 2002 until December 2018. We undertook a time-series analysis to examine trends in the use of EVT using Poisson regression analysis. Incidence rate ratios per year with 95% CIs were obtained to demonstrate the impact and implementation after the publication of the EVT trial results. We made regional observation plots, adjusted for stroke incidence, to assess the availability and use of the treatment in the country. In the buildup to the MR CLEAN (Multicenter Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands), a slow increase of EVT patients was observed, with 0.2% of all ischemic stroke patients receiving EVT. Before the trial results were formally announced, a statistically significant increase in EVT-treated patients per year was observed (incidence rate ratio, 1.72 [95% CI, 1.46–2.04]), and after the trial publication, an immediate steep increase was seen, followed by a more gradual increase (incidence rate ratio, 2.14 [95% CI, 1.77–2.59]). In 2018, the percentage of ischemic stroke patients receiving EVT increased to 5.8%. A well-developed infrastructure, a pragmatic approach toward the use of EVT in clinical practice, in combination with a strict adherence by the regulatory authorities to national evidence-based guidelines has led to successful implementation of EVT in the Netherlands. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT in all regions of the country.

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