Abstract TP249: Drip, Drive, and Retrieve - New Application of Mobile Neuro IVR Team -

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yohei Takenobu ◽  
Akira Ishii ◽  
Kazumichi Yoshida ◽  
Takayuki Kikuchi ◽  
Mitsushige Ando ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Information ◽  
Parent Artery ◽  
Stroke Treatment ◽  
Parent Artery Occlusion ◽  
Aneurysm Embolization ◽  
The Mean

[Background and Purpose] Neuro-interventional radiology (NIVR) is increasingly recognized as an essential option for acute stroke treatment. However, the access to NIVR physician or NIVR-capable hospital is still limited. Patient transfer system between primary stroke centers (PSCs) and comprehensive stroke centers has a problem about deterioration during transfer, insufficient information transmission, small area coverage, and loss of time. We organized a mobile NIVR team consisting of 6-7 board certified NIVR physicians, and concluded a NIVR alliance program with affiliating PSCs. The team performed procedures at the local sites on request of PSCs. [Methods] Between 2008 and 2012, we concluded a NIVR alliance program with 7 affiliated PSCs. The team dispatched NIVR physicians to the PSCs immediately after receiving "rescue call." Clinical information including medical images was updated in real-time and interactive manner during travel. [Results] We received 23 calls and reacted to all cases. We treated 8 cases of acute ischemic stroke (6 mechanical thrombectomy, 3 carotid stenting, 5 for non-responder to intravenous rt-PA), and 15 for subarachnoid hemorrhage (14 aneurysm embolization, one parent artery occlusion). The mean travel distance was 39.0 km (min - max: 6.3 - 90.3). For acute ischemic stroke, the mean "door-to-puncture time" was 154 minutes (min - max: 130 - 168). For subarachnoid hemorrhage, procedure was performed on the onset or the next day. All the procedure were successfully performed and no deterioration related to procedure were observed. [Conclusions] The new application of NIVR delivery system can safely enable to avoid deterioration during transfer, cover larger area without delay, and enlarge the opportunity to access NIVR therapy for acute stroke patients.

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.

scholarly journals Platelet-rich clots as identified by Martius Scarlet Blue staining are isodense on NCCT

2019 ◽  
Vol 11 (11) ◽  
pp. 1145-1149 ◽  
Author(s):  
Sean T Fitzgerald ◽  
Shunli Wang ◽  
Daying Dai ◽  
Andrew Douglas ◽  
Ramanathan Kadirvel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Inverse Correlation ◽  
Clinical Information ◽  
Blue Staining ◽  
Histopathological Analysis ◽  
Blue Stain ◽  
The Mean ◽  
Learning Software ◽  
Ct Density

BackgroundCurrent studies on clot characterization in acute ischemic stroke focus on fibrin and red blood cell composition. Few studies have examined platelet composition in acute ischemic stroke clots. We characterize clot composition using the Martius Scarlet Blue stain and assess associations between platelet density and CT density.Materials and methodHistopathological analysis of the clots collected as part of the multi-institutional STRIP registry was performed using Martius Scarlet Blue stain and the composition of the clots was quantified using Orbit Image Analysis (www.orbit.bio) machine learning software. Prior to endovascular treatment, each patient underwent non-contrast CT (NCCT) and the CT density of each clot was measured. Correlations between clot components and clinical information were assessed using the χ2 test.ResultsEighty-five patients were included in the study. The mean platelet density of the clots was 15.7% (2.5–72.5%). There was a significant correlation between platelet-rich clots and the absence of hyperdensity on NCCT, (ρ=0.321, p=0.003*, n=85). Similarly, there was a significant inverse correlation between the percentage of platelets and the mean Hounsfield Units on NCCT (ρ=−0.243, p=0.025*, n=85).ConclusionMartius Scarlet Blue stain can identify patients who have platelet-rich clots. Platelet-rich clots are isodense on NCCT.

scholarly journals Age Predicts Functional Outcome in Acute Stroke Patients with rt-PA Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Jarin Chindaprasirt ◽  
Kittisak Sawanyawisuth ◽  
Paiboon Chattakul ◽  
Panita Limpawattana ◽  
Somsak Tiamkao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Multiple Logistic Regression Analysis ◽  
Asian Population ◽  
Limited Data ◽  
Stroke Patients ◽  
The Mean

The standard treatment for acute ischemic stroke is thrombolytic therapy. There is limited data on prognostic factors of acute stroke with thrombolytic therapy particularly in Asian population. Acute ischemic stroke patients who were treated with thrombolytic therapy at Srinagarind Hospital between May 2008 and July 2010 were included. Factors associated with Barthel index more than 80 were studied by multiple logistic regression analysis. There were 75 patients included in the study. The mean NIHSS scores before treatment and at 3 months were 9.16 ± 4.82 and 3.83 ± 4.00, respectively, and median Barthel index at 3 months was 86. Only significant predictor for having Barthel index more than 80 points at 3 months was age (adjusted odds ratio 0.929, 95% confidence interval 0.874, 0.988). Four patients developed intracranial hemorrhage after the treatment (5%), and two died (2.6%). In conclusion, age predicts Barthel index in acute stroke patients with rt-PA treatment.

Abstract P85: Impact of Covid-19 Pandemic on Hospitalizations and Outcomes of Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (pcnasp)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Sallyann Coleman King ◽  
Erika Odom ◽  
Quanhe Yang
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
The United States ◽  
Emergency Department Visits ◽  
National Institutes Of Health ◽  
Hospital Death ◽  
Stroke Patients ◽  
Stroke Treatment

Introduction: Studies suggest a significant reduction in emergency department visits and hospitalizations for acute ischemic stroke (AIS) during the COVID-19 pandemic in the United States. Few studies have examined AIS hospitalizations, treatments, and outcomes during the pandemic period. The present study compared the demographic and clinical characteristics of patients hospitalized with AIS before and during the COVID-19 pandemic (weeks 11-24 in 2019 vs. 2020). Method: We identified 42,371 admissions with a clinical diagnosis of AIS, from 370 participating hospitals who contributed data during weeks 11-24 in both 2019 and 2020 to the Paul Coverdell National Acute Stroke Program (PCNASP). Results: During weeks 11-24 of the COVID-19 period, AIS hospitalizations declined by 24.5% compared to the same period in 2019 (18,233 in 2020 vs. 24,138 in 2019). In 2020, the percentage of individuals aged <65 years who were hospitalized with AIS was higher compared with the same period in 2019 (34.6% vs. 32.7%, p<0.001); arriving by EMS were higher in 2020 compared with 2019 (47.7% vs. 44.8%, p<0.001). Individuals admitted with AIS in 2020 had a higher mean National Institutes of Health Stroke Scale (NIHSS) score compared with 2019 (6.7 vs. 6.3, p<0.001). In 2020, the in-hospital death rates increased by 16% compared to 2019 (5.0% vs. 4.3%, p<0.001). However, there were no differences in rates of alteplase use, achievement of door to needle in 60 minutes, or complications from reperfusion therapy between the two time periods. Conclusion: A higher percentage of younger (<65 years) individuals and more severe AIS cases were admitted to the participating hospitals during weeks 11 to 24 of the COVID-19 pandemic in 2020 compared to the same period in 2019. The AIS in-hospital death rate increased 16% during the pandemic weeks as compared to the same weeks in 2019. Additional studies are needed to examine the impacts of the COVID-19 pandemic on stroke treatment and outcomes.

scholarly journals Acute Reperfusion Therapies for Acute Ischemic Stroke

2021 ◽  
Vol 10 (16) ◽  
pp. 3677
Author(s):  
Rajeel Imran ◽  
Ghada A Mohamed ◽  
Fadi Nahab
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Ischemic Injury ◽  
Stroke Treatment ◽  
Tremendous Progress ◽  
Acute Stroke Treatment

The field of acute stroke treatment has made tremendous progress in reducing the overall burden of disability. Understanding the pathophysiology of acute ischemic injury, neuroimaging to quantify the extent of penumbra and infarction, and acute stroke reperfusion therapies have together contributed to these advancements. In this review we highlight advancements in reperfusion therapies for acute ischemic stroke.

scholarly journals A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

2020 ◽  
Vol 7 (9) ◽  
pp. 1307
Author(s):  
Mohammed Alqwaifly
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

Angioplasty of Intracranial Occlusion Resistant to Thrombolysis in Acute Ischemic Stroke

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1282-1290 ◽  
Author(s):  
Andrew J. Ringer ◽  
Adnan I. Qureshi ◽  
Richard D. Fessler ◽  
Lee R. Guterman ◽  
L. Nelson Hopkins
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Balloon Angioplasty ◽  
Therapeutic Benefit ◽  
National Institutes Of Health ◽  
Arterial Infusion ◽  
The Mean ◽  
Distal Occlusion ◽  
Arterial Thrombolysis

Abstract OBJECTIVE Thrombolysis has been demonstrated to improve revascularization and outcome in patients with acute ischemic stroke. Many centers now apply thrombolytic therapy locally via intra-arterial infusion. One therapeutic benefit is the ability to cross soft clots with a guidewire and to perform mechanical thrombolysis. In some instances, reopened arteries reocclude as a result of either thrombosis or vasospasm. We report the use of balloon angioplasty during thrombolysis for acute stroke. METHODS From June 1995 through June 1999, 49 patients underwent intra-arterial therapy for acute stroke. In this group, nine patients (seven men and two women) were treated with balloon angioplasty after inadequate recanalization with thrombolytic infusion. The mean age of these patients was 67.9 years. Nine matched control patients who underwent thrombolysis alone without angioplasty were chosen for comparison. RESULTS In the group of nine patients who had angioplasty, the mean National Institutes of Health Stroke Scale score at presentation was 21.8 ± 5.4. Four patients had residual distal occlusion after angioplasty, and one patient had a hemorrhagic conversion. Of the five patients in which recanalization was successful, none had reocclusion of the balloon-dilated vessel. The mean score at 30 days for the five survivors was 12.6 ± 14.9, for an improvement of 7.0 ± 14.2. Among the nine control patients, the mean score at presentation was 20.3 ± 5.2; the mean score at 30 days for the five survivors was 19.4 ± 7.7, for an improvement of 4.2 ± 7.8. CONCLUSION In our experience, balloon angioplasty is a safe, effective adjuvant therapy in patients who are resistant to intra-arterial thrombolysis. The use of balloon angioplasty may prevent reocclusion in a stenotic artery and permit distal infusion of thrombolytic agents.

scholarly journals Fifty Years of Acute Ischemic Stroke Treatment: A Personal History

2021 ◽  
pp. 1-15
Author(s):  
James C. Grotta
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Ischemia ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Systems Of Care ◽  
Medical Science ◽  
Tissue Type ◽  
Stroke Units ◽  
Stroke Treatment

<b><i>Background:</i></b> It has been 50 years since the first explorations of the physiology of cerebral ischemia by measuring cerebral blood flow (CBF), and 25 years since the approval of tissue plasminogen activator for treating acute ischemic stroke. My personal career began and matured during those eras. Here, I provide my perspective on the evolution of acute stroke research and treatment from 1971 to the present, with some in-depth discussion of the National Institutes of Neurologic Disease and Stroke (NINDS) tissue-type plasminogen activator (tPA) stroke trial and development of mobile stroke units. <b><i>Summary:</i></b> Studies of CBF and metabolism in acute stroke patients revealed graded tissue injury that was dependent on the duration of ischemia. Subsequent animal research unraveled the biochemical cascade of events occurring at the cellular level after cerebral ischemia. After a decade of failed translation, the development of a relatively safe thrombolytic allowed us to achieve reperfusion and apply the lessons from earlier research to achieve positive clinical results. The successful conduct of the NINDS tPA stroke study coupled with positive outcomes from companion tPA studies around the world created the specialty of vascular neurology. This was followed by an avalanche of research in imaging, a focus on enhancing reperfusion through thrombectomy, and improving delivery of faster treatment culminating in mobile stroke units. <b><i>Key Messages:</i></b> The last half century has seen the birth and evolution of successful acute stroke treatment. More research is needed in developing new drugs and catheters to build on the advances we have already made with reperfusion and also in evolving our systems of care to get more patients treated more quickly in the prehospital setting. The history of stroke treatment over the last 50 years exemplifies that medical “science” is an evolving discipline worth an entire career’s dedication. What was impossible 50 years ago is today’s standard of care, what we claim as dogma today will be laughed at a decade from now, and what appears currently impossible will be tomorrow’s realities.

Sign in / Sign up

Export Citation Format

Share Document