Abstract 3311: Acute stroke and endovascular outcomes in Elderly Population: A Single Center Experience.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tanzila Shams ◽  
Jitendra Sharma ◽  
Richard Jung ◽  
Kristine Blackham
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Prospective Trial ◽  
Standard Of Care ◽  
The Elderly ◽  
Treatment Modalities ◽  
Safety And Efficacy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
All Cause Mortality

Background: In the setting of acute ischemic stroke, endovascular intervention, once considered experimental, is now gold standard of care of appropriately selected patients. Among the elderly, aged 80 and above, patients have multiple comorbidities, and little data exists regarding clinical outcome for those undergoing different endovascular treatment modalities. Objectives: To assess the safety and efficacy of different endovascular treatment modalities in elderly, aged 80 and above, compared to patients younger than 80 with acute ischemic stroke Methods: Restrospective chart review was performed in 150 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2008 and 2011, between age range 17 -93 years. Elderly patients (EP) age 80 and above (n=34) were compared to nonelderly patients age <80 (NEP) (n=116). The patients in both groups underwent mechanical (including MERCI and or Penumbra and/or angioplasty and stenting) and/or chemical thrombolysis (intra-arterial tPA). We compared the specific outcome parameters of EP vs NEP groups, including discharge NIHSS, modified Rankin Scale (mRS), rate of partial to complete recanalization (TIMI 2-3), symptomatic intracerebral hemorrhage (ICH), and all cause mortality. Results: In EP, mean age was 84.9 ± 3.3, with 32.3% (n=11) males and 67.6% (n=23) females. In NEP mean age was 63.6 ± 13.1, with 50.9% (n=59) males and 49.1% (n=57) females. 91.3% (n=106) In EP vs NEP, mean initial NIHSS were 19±7 and 16±6, and discharge NIHSS 9±7 and 12±8, respectively. Rates of recanalization occurred in 67.6% (n=23) in EP, and 71.6% (n=83) in NEP. Discharge mRS 3 or less was 2.9% (n=1) in EP, and 17.2% (n=20) in NEP. Symptomatic ICH occurred in 20.6% (n=7) in EP and 14.7% (n=17) in NEP. All cause mortality rate at discharge in EP group was 41.2% (n=14) and 19.8% (n=23) in NEP. Conclusions: In our experience EP had poor clinical outcomes with increased mortality and hemorrhage rate compared to NEP irrespective of similar recanalization rate. Further prospective trial is warranted to evaluate safety and efficacy of endovascular treatment in patients aged 80 years old and above.

Abstract TP1: The Promising System to Support Rural Area Where No Intervenitionists to Perform Embolectomy for Acute Ischemic Stroke "Drive and Retrieve Method"

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Toshiya Osanai
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Rural Area ◽  
Median Time ◽  
Prospective Trial ◽  
Large Vessel ◽  
Full Time ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Introduction: In Japan, endovascular treatment for acute ischemic stroke from large vessel occlusion should be performed by neurointerventionists. However, most hospitals in rural area , that offer treatment for cerebral vascular disease do not have access to a neurointerventionist; the rural areas are especially affected. Thus, Our University has offered support to institutions without a neurointerventionist, to perform endovascular treatment. The neurointerventionists stationed in other hospitals drive to retrieve the resultant clot since the acute ischemic stroke from large vessel occlusion. We called this the “drive and retrieve system” method, and launched the prospective trial to evaluate the validity and efficacy of this method. Herein, we report the initial results of this trial. Methods: Nine institutes across our affiliated hospitals within a one-hour drive from Sapporo City took part in this trial. Three of these 9 institutes that have a full-time neurointerventionist were registered as the source. When an episode of acute ischemic stroke requiring intervention occurred in the other 6 hospitals, the available neurointerventionist provided treatment based on the drive and retrieve method. The neurointerventionists’ schedules was updated and distributed to all participating units twice a week, so that the supported hospitals could immediately make contact when required. We analysis the data of 44 cases in this trial from July 2015 to April 2016. Results: For 41 out of 44 cases (93%), Neurointerventionaists were able to respond immediately. The median time from door-to-puncture was 90 min (interquartile range [IQR]: 72-125). The median time from puncture to recanalization was also 76 min (IQR: 57.5-99.5). The recanalization rate (TICI 2b/3) was 77 %. mRS 0-2 was 39%. Conclusion: The drive and retrieve system has the potential to support rural medical institutes that do not have access to a full-time neurointerventionist.

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis

2021 ◽  
pp. neurintsurg-2021-017963
Author(s):  
Gang Deng ◽  
Jun Xiao ◽  
Haihan Yu ◽  
Man Chen ◽  
Ke Shang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Serum Glucose ◽  
Female Sex ◽  
Symptomatic Intracerebral Hemorrhage

BackgroundDespite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.MethodsPubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.ResultsTwelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.ConclusionThis study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.

Abstract TP18: Endovascular Treatment in the Elderly with Acute Ischemic Stroke - Is it Safe in Clinical Practice?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Thabele M Leslie-Mazwi ◽  
Syed F Ali ◽  
Sanjeeva R Onteddu ◽  
Adewumi D Amole ◽  
Mehmet S Akdol ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
The Elderly ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Younger Patients

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

scholarly journals Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kenan Alkhalili ◽  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
David Hasan ◽  
Robert M. Starke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Treatment Strategies ◽  
Endovascular Intervention ◽  
Treatment Modalities ◽  
Efficacy And Safety ◽  
The Past ◽  
Endovascular Approach

Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

Systematic evaluation of stroke thrombectomy in clinical practice: The German Stroke Registry Endovascular Treatment

2018 ◽  
Vol 14 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Anna C Alegiani ◽  
Franziska Dorn ◽  
Moriz Herzberg ◽  
Frank A Wollenweber ◽  
Lars Kellert ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Active Sites ◽  
Intravenous Thrombolysis ◽  
Standard Of Care ◽  
Systematic Evaluation ◽  
Stroke Treatment ◽  
Stroke Registry

Background Endovascular treatment has become standard of care for the treatment of acute ischemic stroke with large vessel occlusion. However, patients treated in clinical practice differ from the selected populations randomized in clinical trials. Aims The German Stroke Registry Endovascular Treatment (GSR-ET) aims at a systematic evaluation of outcome, safety, and process parameters of endovascular stroke treatment in standard of care in Germany. Methods The GSR-ET is an academic, independent, prospective, multicenter, observational registry study. Participating stroke centers from all over of Germany consecutively enroll patients transferred to the angiography suite with an intention to be treated with endovascular stroke treatment. Patients receive regular care. Data are collected as part of clinical routine. Baseline clinical and procedural information and clinical follow-up information after 90 days are recorded. Here, we present an analysis of baseline data of the first 1662 patients included in the GSR-ET. Results The registry was established in June 2015. By 31 December 2017, 1662 patients were enrolled in 23 active sites. Mean age was 72 ± 13 years, 50% were female, and median National Institutes of Health Stroke Scale on admission was 15 (IQR 10–19), 88% had anterior circulation occlusion. Median ASPECT score was 8 (IQR 7–10) prior to intervention. Fifty-nine percent of patients received intravenous thrombolysis prior to thrombectomy. Mean “onset-to-groin” time was 224 ± 176 min. Conclusions Baseline characteristics of stroke patients undergoing thrombectomy in clinical practice differ from those in the randomized trials. The GSR-ET will provide valuable insights into practices of endovascular treatment in routine care of acute ischemic stroke. (GSR-ET ClinicalTrials.gov Identifier: NCT03356392.)

Abstract P30: Safety and Efficacy of Intravenous Tirofiban in Acute Ischemic Stroke With Extended Window Period

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
VIJAYA PAMIDIMUKKALA ◽  
RANJITH K ◽  
SRINIVASA RAO N ◽  
LAKSHMI PRASANNA K ◽  
SOMA SUNDARAM A ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Total Mortality ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Safety And Efficacy ◽  
Window Period ◽  
Good Outcome ◽  
Symptomatic Intracerebral Hemorrhage

Introduction: Intravenous Thrombolysis is approved upto 4½ hrs and Endovascular Therapy upto 24 hrs in eligible Acute Ischemic Stroke (AIS) patients with Large Vessel Occlusion. There are still substantial number of AIS patients where there is no effective treatment available. In this Study we aim to test the safety and Efficacy of the reversible gp IIb/IIIa receptor inhibitor antagonist Tirofiban in AIS beyond 4 ½ hrs and within 24 hrs. Methodology: Among a total of 750 AIS patients admitted in our Stroke Unit, from July 2019 to March 2020, 100 Consecutive patients were included in this study and received Intravenous tirofiban as an initial bolus followed by infusion. Inclusion criteria were Age 18-80yrs, Window Period 4 ½ to 24 hrs. National Institute of health Stroke Scale score (NIHSS) between 5-20, No contraindication for lytic drugs. CT Brain excluding Hemorrhage or > 1/3 rd infarct. Cardioembolic strokes were excluded. Efficacy Assessments: NIHSS and modified Rankin scale (mRS) performed at baseline, within 48hrs, Day-7 and Day-90. The good outcome was defined as mRS 0-1 at 3 months. The safety outcomes were assessed by the incidence of Symptomatic Intracerebral hemorrhage (SICH), Systemic Bleeding and any mortality. Results: There were 74 males, 26 females with median Age of 56 yrs (range from 18 to 80yrs). The Median NIHSS is 10 (range from 5-20), Majority (87%) had anterior circulation strokes and 13% were in Posterior circulation. One patient (1%) developed symptomatic parenchymal Hemorrhage, 4 patients (4%) had mild haemorrhagic transformation within infarct, 8 patients (8%) had nonfatal systemic bleed in the form of Hematuria. Total Mortality - 2 patients (2%), one patient died in the hospital due to cardiac arrest and another patient died at home after discharge. At 3 months, 62 patients (62%) had good outcome (mRS 0-1) and 33 patients (33%) had favourable outcome (mRS 2-3). Conclusion: In this Observational Study we found that Intravenous Tirofiban is not only safe, but effective in AIS patients with extended window period. However, Randomized Clinical Trials are needed to further clarify our observation.

Differences in Safety and Efficacy of Endovascular Treatment for Acute Ischemic Stroke

2020 ◽  
Author(s):  
Wenjin Yang ◽  
Yongxin Zhang ◽  
Zifu Li ◽  
Lei Zhang ◽  
He Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Safety And Efficacy

scholarly journals Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

2021 ◽  
Author(s):  
Yunlong Ding ◽  
Feng Gao ◽  
Yong Ji ◽  
Tingting Zhai ◽  
Xu Tong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Logistic Regression Models ◽  
The Hours

Abstract Background Acute ischemic stroke (AIS) leads to a substantial burden of disease among the elderly. There may be a delay in or a poor outcome of endovascular treatment (EVT) among AIS patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours. Methods We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between the hours of 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes. Results Among 1788 patients, 1079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than on-hours (165 vs 125 minutes, P=0.002 and 410 vs 392 minutes, P=0.027). However, there were no significant differences between patients presenting during off- and on-hours in any radiological/clinical outcomes (mRS score: 3 vs 3 points, P=0.204; mortality: 15.9% vs 14.3%, P=0.172; successful reperfusion: 88.5% vs 87.2%, P=0.579; sICH: 7.2% vs 8.4%, P=0.492). Conclusions Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay did not lead to worse radiological/clinical outcomes.

scholarly journals The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Lisha Tang ◽  
Xiangqi Tang ◽  
Qianwen Yang
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Symptomatic Intracranial Hemorrhage

<b><i>Objective:</i></b> The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. <b><i>Results:</i></b> The incidence of 3-month modified Rankin Scale (mRS) 0–2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], <i>p</i> = 0.002) with heterogeneity (<i>I</i><sup>2</sup> = 34%, <i>p</i> = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0–2 score (OR = 1.48, 95% CI [1.11, 1.96], <i>p</i> = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], <i>p</i> = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], <i>p</i> = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], <i>p</i> = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], <i>p</i> = 0.003). <b><i>Conclusions:</i></b> The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.

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