Abstract 2268: Trends In Reasons For Non-eligibility For tPA

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Mary G George
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Advanced Age ◽  
Stroke Patients ◽  
Rapid Improvement ◽  
Nihss Score ◽  
Mild Stroke ◽  
Over Time ◽  
Iv Tpa

Background: Use of IV tPA has increased over time, as has the adherence to the NQF endorsed performance measure for receipt of IV tPA within 3 hours. Little is known about trends in the reasons for patient ineligibility for IV tPA. This study examines trends in reasons for not providing IV tPA over time and by race and gender among acute ischemic stroke patients in the Paul Coverdell National Acute Stroke Registry (PCNASR), a quality improvement program for acute stroke implemented by state health departments. Methods: There were 13,164 PCNASR patients enrolled from 2008- 2010 with a clinical diagnosis of acute ischemic stroke with documentation of LKW and who arrived within 2 hours of LKW. Cochran-Armitage tests were used to test for trend on accepted reasons for not providing IV tPA within 3 hours of time last known well (LKW). Chi-square tests were used to test for differences among reasons between men and women and between non-Hispanic whites and minorities. Multiple reasons for not giving tPA could be selected. Results: Among 13,164 acute ischemic patients admitted between 2008 and 2010 with documentation of LKW and who arrived within 2 hours of LKW, 3781 (28.7%) received IV tPA, 7284 (55.3%) had documented reasons for not receiving IV tPA, and 2099 (16.0%) did not receive IV tPA. Contraindications to IV tPA, advanced age, rapid improvement and inability to determine eligibility increased over time. Mild stroke decreased over time. Conditions with warning, advanced age, limited life expectancy and family refusal were more common in women; mild stroke and rapid improvement were more common in men. Contraindications were more common in minorities; advanced age, mild stroke and rapid improvement, and family refusal were more common in non-Hispanic whites. When advanced age was selected, 46.6% of patients were over age 90 and 3.4% were under age 80. When stroke too mild was selected, 44.8% of patients had missing NIHSS scores, 42.1% of scores were 0-4, 8.8% were 5-9, and 4.3% were ≥ 10. The three most common reasons for not providing tPA were rapid improvement (40.9%), mild stroke (33.0%), and contraindications (29.2%) in 2010. Conclusions: More than half of ischemic stroke patients arriving within 2 hours of LKW were ineligible to receive IV tPA. There was little use of advanced age for patients under age 80. Documentation of stroke too mild was not substantiated by an NIHSS score in nearly half of patients. Better documentation of NIHSS score should be provided.

Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Time Of Day ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
The Impact ◽  
Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kerrin Connelly ◽  
Rishi Gupta ◽  
Raul Nogueira ◽  
Arthur Yancey ◽  
Alexander Isakov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Transport Protocol ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Public ◽  
State Office ◽  
Stroke Center ◽  
Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

DWI Lesion Characteristics As A Predictor For Outcome In Acute Stroke Patients Treated By IV-tPA

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
H Aref ◽  
S Farag ◽  
S Helmy ◽  
H Mahmoud
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Type ◽  
P Value ◽  
Stroke Patients ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Iv Tpa

Abstract Background Thrombolysis with tissue-type plasminogen activator (IV-tPA) is a well-proved, widely used treatment in acute ischemic stroke patients, many predictors of functional outcome have been proposed as Age, vascular risk factors, initial clinical evaluation on admission using National institute of health stroke scale(NIHSS), functional state of patient(b.L) baseline before stroke and 3 months (3m) after stroke using modified Rankin stroke scale (MRS)and the most controversial Diffusion weighted image characteristics (volume, heterogeneity) Objective To evaluate DWI MRI characteristics (volume, heterogeneity) as a predictor for outcome in Acute stroke patients treated by IV-tPA Patients and Methods This study will be done on a sample of 100 acute ischemic stroke Egyptian patients receiving intra-venous tissue -type plasminogen activator presenting to Ain-Shams university hospitals Results Highly statistically significant (p-value &lt; 0.001) Positive correlation (r = 0.394) between volume (DWI) and MRS (3m) post discharge in studied patients, No statistically significant (pvalue &gt; 0.05) relation between heterogeneity and other studied parameters (MRS, NIHSS D & ADC values) in studied patients Conclusion DWI infarct volume is a predictor for outcome in acute ischemic stroke patients treated by tPA

Abstract 2545: Does Participation in a Stroke Registry Improve tPA Administration Rates?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Moges Ido ◽  
Lydia Clarkson ◽  
Deborah Camp ◽  
Kerrie Krompf ◽  
Michael Frankel
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Patient Care ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Hospital Size ◽  
Stroke Registry ◽  
Over Time ◽  
Iv Tpa

Background: The purpose of the Georgia Coverdell Acute Stroke Registry (GCASR) is to improve the quality of patient care. GCASR conducts regular quality improvement activities to educate hospital staff and improve systems and processes. Administration of intravenous tissue plasminogen activator (IV tPA) is standard treatment for eligible acute ischemic stroke patients and can dramatically improve outcomes. Purpose: To determine whether GCASR hospitals were more likely to administer tPA to acute ischemic stroke patients than non-GCASR hospitals. Methods: Hospitalization data from acute care hospitals in Georgia was provided by the Georgia Hospital Association for November 2005 through December 2009. Acute ischemic stroke patients receiving tPA were identified using ICD-9 codes (433 and 434), procedure codes (9910), and healthcare common procedure system codes (J2997). A hospital was defined as a GCASR facility if it was actively participating in the registry at the time of patient hospitalization. A generalized estimating equation with robust variance estimation was applied using the SAS GLIMMIX procedure. “Hospital” was treated as a random variable. Relative risks for receiving tPA were estimated and adjusted for demographics, co-morbidities, hospital size, urbanicity, and length of stay. Results: A total of 55,403 patients were admitted with a principal diagnosis of acute ischemic stroke during the study period, and two percent (1,231) received tPA. Three percent of patients (871) seen at registry facilities received tPA, compared to 1.4% (360) of those seen at non-GCASR facilities. Age, gender, race, length of stay, hospital size, and participation in the registry all predicted tPA administration, either at or near significant levels (p-values from <0.0001 to 0.0646). Although IV tPA administration has increased over time in both hospital groups, patients treated at GCASR facilities were more likely to receive tPA after controlling for confounders (OR=1.64; 95% CI: 0.97-2.78), which approached significance (p=0.0646). Approximately 340 fewer people would have received tPA had all study patients been treated at non-GCASR facilities. Conclusions: Although all Georgia hospitals have improved their rate of tPA administration over time, GCASR hospitals maintained a higher rate than non-GCASR hospitals. This may be due in part to the quality improvement activities that registry facilities participate in and the assistance they receive. These results support the stroke registry model as a method of improving stroke patient care and outcomes.

RESEARCH IN SERUM COPEPTIN CONCENTRATION IN THE ACUTE STROKE PATIENTS

2017 ◽  
pp. 156-163
Author(s):  
Thanh Cong Nguyen ◽  
Thi Bich Thuan Le ◽  
Chuyen Le ◽  
Thi Minh Phuong Phan
Keyword(s):  
Ischemic Stroke ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Stroke Patients ◽  
Nihss Score ◽  
Coma Scale

Objectives: To determine serum Copeptin concentration and correlation between serum Copeptin concentration with some major predictors of acute stroke patients (ischemic stroke and intracerebral hemorrhage). Subjects and Methods: Cross-sectional descriptive study with 72 patients (40 acute ischemic stroke patients and 32 intracerebral hemorrhage patients at Hue University Hospital. Data processing method is according to usual medical statistics and SPSS 20.0. Results: 1. The serum Copeptin concentration in the patients with acute stroke: - The serum Copeptin concentration in the patients with acute ischemic stroke was 11.28 ± 5.2 pmol/L (admission) and 8.81 ± 4.94 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute intracerebral hemorrhage was 9.17 ± 7.97 pmol/L (admission) and 7.14 ± 6.62 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute stroke at admission and after 7 days there was not statistically significant difference between female and male (p > 0.05). 2. The correlation between serum Copeptin concentration and severity of acute stroke patients: - The serum Copeptin concentration correlated positively with size of injury (ischemic stroke: r = 0.743; p< 0.001 and intracerebral hemorrhage: r = 0.502; p= 0.003). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score at admission (ischemic stroke: r = 0.657, p < 0.001 and intracerebral hemorrhage: r = 0.408, p = 0.021). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score after 7 days (ischemic stroke: r = 0.486, p < 0.001 and intracerebral hemorrhage: r = 0.359, p = 0.044). - The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score at admission (ischemic stroke: r = - 0.564, p < 0.001 and intracerebral hemorrhage: r = - 0.466, p = 0.007).The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score after 7 days (ischemic stroke: r = - 0.499, p < 0.001 and intracerebral hemorrhage: r = - 0.38, p = 0.032). Conclusions: There was correlation between serum Copeptin concentration with severity of acute stroke patients. Key words: Copeptin, acute stroke, ischemic stroke, intracerebral hemorrhage

scholarly journals Advanced Age and Higher National Institutes of Health Stroke Scale Score as Predictors of Poor Outcome in Ischemic Stroke Patients Treated with Alteplase: A Study from a Tertiary Care Centre in Rural North-west India

2017 ◽  
Vol 08 (02) ◽  
pp. 236-240 ◽  
Author(s):  
Amit Bhardwaj ◽  
Girish Sharma ◽  
Sunil Kumar Raina ◽  
Ashish Sharma ◽  
Monica Angra
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Care ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Nihss Score ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor

ABSTRACT Introduction: Thrombolytic therapy in acute ischemic stroke has been approved for treatment of acute stroke for past two decades. However, identification of predictors of poor outcome after the intravenous (IV) alteplase therapy in acute stroke patients is a matter of research. The present study was conducted with the aim of identifying poor prognostic factors in patients of acute ischemic stroke patients. Methods: The data of 31 acute stroke patients treated with alteplase were gathered to identify the factors that were independent predictors of the poor outcome. Outcome was dichotomized using modified Rankin scale (mRS) score and National Institutes of Health Stroke Scale (NIHSS) score at 3 months after treatment into good outcome mRS - 0–2 and poor outcome mRS - 3–6. Predictors of poor outcome were analyzed. Results: Good outcome (mRS – score 0–2) was seen in 15 (48.4%) patients with median age of (60) and poor outcome (mRS – score 3–6) was seen in 16 (51.6%) patients median age of 75 years, which was statistically significant with the P = 0.002. The presence of risk factors such as hypertension, diabetes, dyslipidemia, smoking, alcohol intake, history of stroke, coronary artery disease, and rheumatic heart disease among the two groups did not seem influence outcome. The severity of stroke as assessed by NIHSS score at the time of presentation was significantly higher among the patients with poor outcome, with P = 0.01. Conclusion: Advance age and higher NIHSS score at the time of onset of stroke and are the independent predictors of the poor outcome after thrombolysis with IV alteplase treatment in acute ischemic stroke patients.

Abstract TP161: Low Free Triiodothyronine on Admission Should Be Associated With Post-stroke Infection in Acute Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Satoshi Suda ◽  
Takashi Shimoyama ◽  
Yohei Takayama ◽  
Takahiro Ouchi ◽  
Masafumi Arakawa ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Thyroid Hormone ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Free Triiodothyronine ◽  
Nihss Score ◽  
The Impact

Background and purpose: Post-stroke infection (PSI) is a common and it is associated with a severe prognosis. Recent studies have shown that thyroid hormones play critical roles in the immune system regulation. However, association between PSI and thyroid hormone have not been fully elucidated. We therefore investigated the impact of thyroid hormone on PSI in acute stroke patients. Methods: We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 male, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were evaluated upon admission. PSI was defined as infection occurring during hospitalization. The impact of the thyroid hormone on PSI was evaluated using multiple logistic regression analysis. Separate analyses were conducted according to PSI and quartile serum FT3 concentration. Results: PSI was diagnosed in 107 patients (20.6 %). The most common infection was pneumonia with the prevalence of 65 patients (60.7 %), followed by urinary tract infection recorded in 19 patients (17.8 %). Age ( P < 0.001), body mass index ( P = 0.0044), pre-admission mRS ( P = 0.002), NIHSS score on admission ( P < 0.001), admission FT3 (2.63 ± 0.49 pg/mL vs. 2.24 ± 0.66 pg/mL, P < 0.001), and cardio-embolic stroke ( P < 0.001) were significantly associated with PSI, but no relationship between TSH (2.84 ± 8.12 mIU/L vs. 2.20 ± 1.45 mIU/L, P = 0.4610), FT4 (1.22 ± 0.21 ng/dL vs. 1.21 ± 0.28 ng/dL, P = 0.1478), and PSI were found. On multivariable logistic regression analysis, low FT3 (< 2.29 pg/mL; odds ratio [OR], 2.96; 95% confidence interval [CI], 1.61- 5.45; P = 0.0005) and high admission NIHSS score (≥ 9 points, OR, 7.65; 95% CI, 4.10-14.73; P <0.0001) were independently associated with PSI. In comparisons between PSI and FT3 quartiles (Q1 [≤ 2.25 pg/mL], Q2 [2.26-2.55 pg/mL], Q3 [2.56-2.89 pg/mL], Q4 [≥ 2.90 pg/mL]), patients with PSI were significantly more frequent in Q1 than in Q2, Q3, and Q4 after multivariate adjustment. Conclusions: Our results showed that a low FT3 at admission should be associated with PSI in acute ischemic stroke patients.

scholarly journals Clinical Outcomes of Thrombolytic Therapy in Patients with Mild Stroke: Single-Center Experience in a Tertiary Care Institution

2021 ◽  
Author(s):  
Hasan Karadeli ◽  
Ruken Simsekoglu
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Tertiary Care ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Maximum Delay ◽  
Mild Stroke ◽  
Iv Tpa

Objective: The term ‘mild stroke’ is used to describe stroke patients with a NIHSS score of 0 to 6. There is still no clear decision regarding the application of iv recombinant tissue plasminogen activator (iv-tPA) to patients who is admitted with an acute ischemic stroke and is in the mild stroke category. In our study, we aimed to analyze the data of patients who applied to our stroke center with an acute mild stroke clinic and received iv-tPA treatment and their three-month follow-up. Methods: A total of 47 (age 69.1 ± 14.1, 28 female) mild stroke patients were included out of 350 patients receiving thrombolytic therapy. Intravenous thrombolysis was initiated with a maximum delay of 4.5 hours in all patients. Patients had a NIHS score less than 6. NIHSS scores immediately before starting thrombolytic therapy and scores 24 hours after treatment were recorded. Modified Rankin Scale scores (mRS) at admission, 1 and 3 months were recorded. Results: NIHSS scores of the patients who received tPA decreased significantly after the treatment (p = 0.001). The patients’ 1st and 3rd month mRS scores were statistically significantly decreased according to the mRS scores when they entered the treatment (p = 0.001). Conclusions: This study highlights the efficacy of iv-tPA in acute ischemic stroke patients with mild symptoms and demonstrates the low risk profile of this therapy.

Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amy K Starosciak ◽  
Italo Linfante ◽  
Gail Walker ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Power ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Stroke Patients ◽  
Good Outcome ◽  
Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

Sign in / Sign up

Export Citation Format

Share Document