Abstract 2736: Is Treatment Of Young Ischemic Stroke Patients Improving? Insights From The Nationwide Inpatient Sample

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amit Kansara ◽  
Seemant Chaturvedi ◽  
Pratik Bhattacharya
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Nationwide Inpatient Sample ◽  
Mechanical Thrombectomy ◽  
Young Patients ◽  
International Classification Of Diseases ◽  
Discharge Data ◽  
Time Period ◽  
Young Ischemic Stroke

Background and purpose: Recent studies have shown a trend for increasing use of thrombolysis among acute ischemic stroke (AIS) patients. However, data is lacking for use of thrombolysis among young (19-44 years) AIS patients. It is important to follow the trend as costs and burden of stroke related disability can be significantly higher in young adults as they are more likely to live longer than elderly people with stroke. Method: Discharge data were obtained from Nationwide Inpatient Sample from 2001 to 2009. AIS were defined by discharge diagnosis codes from International Classification of Diseases ICD 9 revision (433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436). For thrombolysis treatment ICD 9 code 99.10 was used. For mechanical thrombectomy, code 39.74 was used for year 2006 to 2009. Cochran Armitage test was used for trend analysis. Result: From 2001 through 2009, there were an estimated 4,917,217 admissions for acute ischemic stroke. Out of that, 204,703 (4.16%) were young patients with AIS. Numbers of AIS among young adults increased from 19293(3.30% of total AIS) in 2001 to 24816 (4.57%) in 2009 (p<0.0001). 51.4% patients were female in 2001 and 49.3% in 2009. Thrombolysis in young ischemic stroke increased from 354 (1.84% of young AIS) in 2001 to 1237 (4.97%) in 2009 (p<0.0001). Thrombolysis among all AIS increased from 1.00% to 3.84% (p<0.0001) in the same time period. Number of mechanical thrombectomy increased from 53 (0.14%) in 2006 to 527 (0.82%) in 2009 (p<0.0001) in young AIS. In the same time period, mechanical thrombectomy rate in all AIS patients increased from 0.05% to 0.48% (p<0.0001). Conclusion: Thrombolysis rate among young AIS significantly increased from 2001 to 2009. Thrombolysis rate was higher in young AIS than all AIS for all the years from 2001 to 2009. Mechanical thrombectomy rate also significantly increased from 2006 to 2009 among young AIS and it was almost twice the rate all AIS patients. Data on outcomes of young AIS treated with thrombolysis or mechanical thrombectomy are needed.

Abstract WP252: Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vaelan Molian ◽  
Amir Shaban ◽  
Aayushi Garg ◽  
Kaustubh Limaye ◽  
Kanika Sharma ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Diagnostic Studies ◽  
Stroke In Young Adults ◽  
Chi Squared ◽  
Comprehensive Stroke Center

Introduction: Because acute ischemic stroke (AIS) in young adults is not rare, understanding trends in etiology may help decisions about evaluation and secondary stroke prevention. This study describes probable causes of AIS in a cohort of young adults and identifies changes in etiologies and diagnostic studies compared to 20 years ago. Methods: We retrospectively reviewed all patients aged 15-45 admitted to our comprehensive stroke center between 1/2010-11/2016 with AIS. Diagnostic studies and stroke etiologies for each patient were reviewed. We then compared our results to a historic sample of young patients who presented to our center in 1977-1993 using univariate chi-squared comparison for each etiology. Results: We identified 333 young adults, 169 (50.8%) were women. The mean age was 36.4±7.1 years. Vessel imaging was performed in 305 (91.3%) cases vs. 68.9% in the historic sample. Of these, 247 (81.0%) had magnetic resonance angiography (MRA). Transthoracic echocardiography (TTE) was performed in 101 (30.3%) and transesophageal echocardiography (TEE) was performed in 171 (51.4%) cases compared to 67.1% who underwent TTE in the historic sample. Etiologic comparisons to the historic sample yielded significant decline in small vessel disease ( P = .029) and a major increase in stroke of other identified cause ( P = .024). Other TOAST etiologies illustrated in Figure 1. The most common etiology for stroke in our sample was arterial dissection 84 (25.2%), whereas this was found in only 6.0% of patients in the historic sample ( P< .001). Conclusions: Using the TOAST classification, the most common subtype in young adults was stroke of other identified cause; a rate that reflects a marked increase in the diagnosis of dissection. Despite advancement in diagnostic studies, cryptogenic stroke remains a common category in young adults.

scholarly journals Endovascular Treatment of Acute Ischemic Stroke in Patients Younger than 18 Years

2021 ◽  
Author(s):  
Sibasankar Dalai ◽  
Uday Limaye ◽  
Satyarao Kolli ◽  
Mohan V. Sumedha Maturu ◽  
Randhi Venkata Narayana ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Young Patients ◽  
Major Complication ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Arterial Recanalization ◽  
The Mean

AbstractRapid and effective revascularization is very important in the treatment of acute ischemic stroke (AIS). Endovascular treatment is a promising modality in the management of AIS in young patients. We evaluated the clinical and imaging records in 14 patients younger than 18 years presenting within 6 hours of AIS. They received endovascular therapy (ET) either by mechanical thrombectomy, thromboaspiration, or both (Solumbra) between July 2017 and June 2021 in our institute. The National Institute of Health Stroke Scale (NIHSS) score was calculated on admission and before the discharge of all patients. The 90-day modified Rankin Scale (mRS) score on disability-free outcome was also evaluated. The mean preprocedure NIHSS score was 10.78 ± 2.11 that improved to 4.5 ± 1.88 after the procedure. Thrombolysis in cerebral infarction (TICI) grade 2b and 3 blood flow could be established in 12 (85.72%) patients. One patient had TICI 2a flow and one patient had recurrent occlusion despite repeated recanalization (TICI grade 0). The disability-free outcome, mRS score at 90 days was 0 to 1 in 12 (85.72%) patients, mRS score 2 in one (7.14%) patient, and mRS score 3 in one patient (7.14%). We did not have any major complication related to the procedure. ET provides high rates of arterial recanalization and favorable disability-free outcomes in young patients with AIS.

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

2020 ◽  
Vol 132 (4) ◽  
pp. 1182-1187 ◽  
Author(s):  
Carrie E. Andrews ◽  
Nikolaos Mouchtouris ◽  
Evan M. Fitchett ◽  
Fadi Al Saiegh ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Standard Of Care ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak in France: Decreased Activity, and Increased Care Delays

2020 ◽  
Author(s):  
Basile Kerleroux ◽  
Thibaut Fabacher ◽  
Nicolas Bricout ◽  
Martin Moise ◽  
Benoit Testud ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy

scholarly journals Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (4) ◽  
pp. 504
Author(s):  
Dalibor Sila ◽  
Markus Lenski ◽  
Maria Vojtková ◽  
Mustafa Elgharbawy ◽  
František Charvát ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Good Clinical Outcome ◽  
Significant Difference ◽  
Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

Impact of recanalisation by mechanical thrombectomy in mild acute ischemic stroke with large anterior vessel occlusion

2021 ◽  
Author(s):  
A. Karam ◽  
B. Casolla ◽  
M. Ferrigno ◽  
J. Labreuche ◽  
C. Cordonnier ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Vessel Occlusion
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