Abstract WMP6: Delayed Device Access to the Occluded Target Vessel Predicts Worse Recanalization Rates and Poor Outcomes in Endovascular Therapy for Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marc Ribo ◽  
Brian Jankowitz ◽  
Syed Zaidi ◽  
Mouhammad Jumaa ◽  
Jennifer Oakley ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Infarct Volume ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Improved Outcomes ◽  
Poor Outcomes ◽  
Left Hemisphere Stroke ◽  
The Impact

During embolectomy for acute stroke, transfemoral access to occluded vessel may be technically difficult. We aim to study the impact of difficult catheter access to target artery. Methods: Single center review of anterior circulation stroke patients enrolled in prospective trials/registries (MR Rescue, MERCI, DEFUSE) requiring recording of time from groin puncture to first device deployment(Tdep). Patients were divided according to Tdep quartiles (Q): patients in Q4 were considered as difficult access. We recorded recanalization (TICI≥2a), complete recanalization (TICI≥2b), infarct volume(24h DWI), day 5 NIHSS, and favorable outcome (3 months mRS≤2). Results: We included 196 patients, mean age 66±14, median NIHSS 16(IQR:12-21). Overall outcomes were: median Tdep 52 min (36-77), recanalization 89.1%, complete recanalization 59.4%, favorable outcome 43.8%. We observed a positive correlation between Tdep and day 5 NIHSS (r=0.27; p=0.01) or 3 months mRS (r=0.26; p<0.01). Patients with difficult access (Q4: Tdep>77 min) had similar baseline NIHSS (16 Vs 17 p=0.58), time from symptom to procedure start (433 Vs 371min; p=0.28) and occlusion location (ICA/M1/M2: 46.7/42.2/11.1% Vs 39.1/54.3/6.5%; p=0.31). However, patients in Q4 had: longer IA procedures (153 vs 112 min;p<0.01), lower complete recanalization (41% Vs 66%;p<0.01), larger infarcts (87 Vs 53cc; p<0.01), higher day 5 NIHSS (15 Vs 9;p<0.01), and less favorable outcome (29.2% Vs 49%; p=0.02). After adjusting by age and time to reperfusion, a regression model identified admission NIHSS (OR% 1.12: 95%CI 1.02-1.21; p<0.01), age (OR% 1.03: 95%CI 1.01-1.06; p=0.01) and Tdep (OR% 1.02 95%CI 1.01-1.03; p=0.01) as independent predictors of poor outcome. In univariate analysis age>69, male gender and left hemisphere stroke were associated with difficult access. The combined presence of the 3 factors increased by 3.5 fold the likelihood of difficult access (OR:3.55 95%CI 1.5-8.6: p<0.01) Conclusion: Delayed device access to target occluded artery independently predicts poor outcome. Identification of difficult access using clinical scores or imaging may lead to alternative strategies; brachial, radial or cervical approaches that could result in shortened procedural times and improved outcomes

Abstract TP74: Aspects Scoring Applied to CTA Source Images is Predictive of Final Infarct Volume and Good Functional Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joseph F Carrera ◽  
Joseph H Donahue ◽  
Prem P Batchala ◽  
Andrew M Southerland ◽  
Bradford B Worrall
Keyword(s):  
Linear Regression ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Univariate Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
The Impact

Introduction: CTP and MRI are increasingly used to assess endovascular thrombectomy (EVT) candidacy in large vessel occlusion stroke. Unfortunately, availability of these advanced neuroimaging techniques is not widespread and this can lead to over-triage to EVT-capable centers. Hypothesis: ASPECTS scoring applied to computed tomography angiography source images (CTA-SI) will be predictive of final infarct volume (FIV) and functional outcome. Methods: We reviewed data from consecutive patients undergoing EVT at our institution for anterior circulation occlusion between 01/14 - 01/19. We recorded demographics, comorbidities, NIHSS, treatment time parameters, and outcomes as defined by mRS (0-2 = good outcome). Cerebrovascular images were assessed by outcome-blinded raters and collateral score, TICI score, FIV, and both CT and CTA-SI ASPECTS scores were noted. Patients were grouped by ASPECTS score into low (0-4), intermediate (5-7), and high (8-10) for some analyses. FIV was predicted using a linear regression with NIHSS, good reperfusion (TICI 2b/3), collateral score, CT to groin puncture, CT and CTA-SI ASPECTS as independent variables. After excluding those with baseline mRS≥2, a binary logistic regression was performed including covariates of age, NIHSS, good reperfusion, and diabetes (factors significant at p<0.05 on univariate analysis) to assess the impact of CTA-SI ASPECTS group on outcome. Results: Analysis included 137 patients for FIV and 102 for outcome analysis (35 excluded for baseline mRS≥ 2). Linear regression found CTA-SI ASPECTS (Beta -10.8, p=0.002), collateral score (Beta -42.9, p=0.001) and good reperfusion (Beta 72.605, p=0.000) were independent predictors of FIV. Relative to the low CTA-SI ASPECTS group, the high CTA-SI ASPECTS group was more likely to have good outcome (OR 3.75 [95% CI 1.05-13.3]; p=0.41). CT ASPECTS was not predictive of FIV or good outcome. Outcomes: In those undergoing EVT for anterior circulation occlusion, CTA-SI ASPECTS is predictive of both FIV and functional outcome, while CT ASPECTS predicts neither. CTA-SI ASPECTS holds promise as a lower-cost, more widely available option for triage of patients with large vessel occlusion. Further study is needed comparing CTA-SI ASPECTS to CTP parameters.

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.

Abstract W MP60: Atrial Fibrillation is Associated with Worse Collaterals in Acute Stroke: Angiography in the ENDOSTROKE Registry

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Christian H Nolte ◽  
Georg Bohner ◽  
Tobias Neumann-Haefelin ◽  
Erich Hofmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Endovascular Therapy ◽  
Cardioembolic Stroke ◽  
Baseline Risk ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Stroke Etiology ◽  
The Impact

Background: Risk factors for stroke may alter hemodynamics or invoke ischemic preconditioning, yet the impact of such factors on response to acute stroke treatment and the potential relationship with collateral circulation remains unknown. Methods: Consecutive cases enrolled in the International Multicenter Registry for Mechanical Recanalization Procedures in Acute Stroke (ENDOSTROKE) were analyzed with respect to collateral status on baseline angiography before endovascular therapy. ASITN/SIR collateral grade (0-1/2/3-4) was scored by the core lab, blind to all other data. Collateral grade was analyzed with respect to numerous baseline risk factors, demographics and outcomes after endovascular intervention. Results: 109 patients (median age 69 years (25 th , 75 th percentiles: 56, 77); 51% women; median baseline NIHSS 15 (13, 18)) with complete (TICI 0) anterior circulation occlusions (M1, n=71; ICA, n=28; M2, n=10) at baseline were evaluated based on collateral grade (0-1, n=12; 2, n=41; 3-4, n=56). Worse collaterals were noted in patients with atrial fibrillation (ASITN grades 0-1/2/3-4: 21%/30%/49%) as compared to patients without atrial fibrillation (5%/42%/53%, p=0.024), yet cardioembolic stroke etiology was unrelated. Other baseline features such as age, gender, time to presentation, other co-morbidities and labs were unrelated to collateral grade. Post-procedure reperfusion (TICI 2b-3) was significantly associated with better collaterals (OR 2.58 (1.343-4.957, p=0.004). Similarly, final infarct size was significantly smaller in those with better collaterals. Good clinical outcomes (mRS 0-2 at day 90) were less frequent in those with poorer collaterals (OR 0.403 (0.199-0.813, p=0.011). Conclusions: Atrial fibrillation, but not cardioembolic stroke etiology, is associated with worse collaterals. Hemodynamic implications, such as diminished cardiac output due to atrial fibrillation, may result in less favorable outcomes after endovascular therapy for acute stroke.

Abstract P164: The Impact of the Expanded EVT Window on Acute Stroke Services: A Large Northwest Telestroke Network Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Theodore Lowenkopf ◽  
Leslie Corless ◽  
Elizabeth Baraban
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Treatment Time ◽  
Time Window ◽  
Tertiary Care ◽  
The United States ◽  
Geographic Region ◽  
Anterior Circulation ◽  
Stroke Subtypes ◽  
The Impact

Background: Telestroke has led the technological revolution in providing acute medical services to rural areas in the United States since the beginning of this century. In January 2018 the American Stroke Association made a level IA recommendation to expand the treatment time window for endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from 6 to 24 hours for anterior circulation stroke based on perfusion imaging. Our study is the first to our knowledge to report the effect of the expanded time window on acute stroke consult and treatment volumes in a large rural supporting telestroke network. Methods: Stroke registry data from two tertiary care facilities from a 22 hospital telestroke network supporting a large (> 78,000 mi 2 ) primarily rural Northwest geographic region were used. Data included stroke patients arriving within 24 hours of last known well (LKW) between January 2017 and March 2019. Patients arriving January 2017 to December 2017 were grouped into the PRE-expanded time window and those arriving April 2018 to March 2019 into the POST-expanded time window. Stroke subtypes, transfers, telestroke consults (via phone or video), and EVT treatments were compared across time periods. Analyses were performed using Pearson’s chi square test, corrected for multiple comparisons. Results: A total of 1117 patients arrived with stroke symptoms within 24 hours of LKW, 567 (50.8%) in PRE and 550 (49.2%) in POST-window. The percentage of all stroke subtypes were not significantly different in the PRE and POST patient groups (p=.720). However, the percent of telestroke consults increased by 12.1% from 62.3% to 74.4% (p<.001) but the percent of video consults remained similar (25.9% vs 25.8%). The total number of transfers (142 vs 141) and percentage of transfers among AIS patients (25.0% vs 25.6%) from partner to hub did not change. The percentage of thrombectomies among transfers rose by 8.7% with the expanded time window, but was not statistically significant [p=0.118]. Conclusions: In a large Northwest telestroke rural network the expanded EVT treatment time window led to a marked increase in all telestroke consults but did not impact video consults, transfer, or percentage of patients treated.

scholarly journals Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

2017 ◽  
Vol 01 (03) ◽  
pp. 139-143 ◽  
Author(s):  
Yosuke Tajima ◽  
Michihiro Hayasaka ◽  
Koichi Ebihara ◽  
Masaaki Kubota ◽  
Sumio Suda
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Complete Revascularization ◽  
Anterior Circulation ◽  
Clinical Imaging ◽  
Good Outcome ◽  
Poor Outcome ◽  
Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

Abstract W P11: A Clinical Scale to Predict Futile Arterial Recanalization in Acute Stroke Patients with Anterior Circulation Arterial Occlusion Treated with Endovascular Therapies.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Natalia Perez de la Ossa ◽  
Maria Hernández-Pérez ◽  
Monica Millán ◽  
Meritxell Gomis ◽  
Elena López-Cancio ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Arterial Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
History Of ◽  
Stent Retrievers ◽  
Arterial Recanalization

Introduction: Futile arterial recanalization (FAR), considered as a lack of functional recovery despite complete recanalization, is observed in up to 30-50% of acute stroke patients treated with endovascular therapy. We aimed to develop a prognostic scale based on baseline clinical and radiological factors to predict FAR. Methods: Prospective analysis of consecutive stroke patients with anterior circulation occlusion treated with endovascular therapy (97% mechanical thrombectomy with stent-retrievers). Complete recanalization was considered as a TICI 2b-3. FAR was defined as a modified Rankin scale >2 at 90 days in patients with complete recanalization. Baseline factors associated with FAR were detected on univariate analysis and were used to compose the predictive scale. Results: From a total of 229 patients with anterior arterial occlusion, 166 (72.5%) achieved complete recanalization. FAR was observed in 80/166 (48.2%). Factors significantly associated with FAR were included to compose the predictive scale as follow: Age (scoring 0 if ≤70 and 1 if >70 years old), history of diabetes mellitus (0 if absent, 1 if present), history of hypertension (0 if absent, 1 if present), NIHSS (1 if NIHSS ≤10, 2 if NIHSS 10-19, 3 if NIHSS>19), ASPECTS (1 if ASPECTS 9-10, 2 if ASPECTS 7-8, 3 if ASPECTS<7) and i.v tPA use (0 if yes, 1 if not). The higher the scale score, the higher the risk of FAR (Figure). The scale showed a good predictive value of FAR (c-statistics 0.71). A scale score <5 was associated with a low rate of FAR (25%) whereas a score >7 increased FAR up to 86%. Conclusion: We developed a simple scale that can easily predict futile arterial recanalization (FAR) in stroke patients with large arterial occlusion treated with endovascular therapies. A larger validation study is necessary to confirm the utility of this predictive scale.

Abstract TP50: A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy: A Single-Center Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aaron P Wessell ◽  
Helio De Paula Carvahlo ◽  
Elizabeth Le ◽  
Gregory Cannarsa ◽  
Matthew J Kole ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Procedure Time ◽  
Golden Hour ◽  
Poor Outcome ◽  
Multivariable Logistic Regression ◽  
Scale Scores ◽  
The Impact

Background: Previous studies have demonstrated the importance keeping thrombectomy procedure times ≤60 min., termed the ‘golden hour’. In the current study, we further investigate the significance of the ‘golden hour’ and the impact of procedural timing on clinical outcomes after mechanical thrombectomy. Methods: We performed an analysis of 319 consecutive mechanical thrombectomy patients at a single Comprehensive Stroke Center from April 2012 through February 2019. Bivariate analyses compared patients grouped according to procedure time ≤60 min. or >60 min. and time of stroke onset-to-endovascular therapy (OTE) ≤6 hours or >6 hours. Logistic regression was used to determine independent predictors of poor outcome at 90-days defined by modified Rankin Scale (mRS) scores of 3-6. Results: A procedure time ≤60 min. was associated with increased revascularization rates (88% vs. 67%; p<0.001) and a greater percentage of good outcomes at 90-days (47% vs. 31%; p=0.003). Multivariable logistic regression revealed that greater age (OR 1.03, 95% CI 1.004-1.051; p=0.023), higher admission NIHSS score (OR 1.10, 95% CI 1.038-1.159; p=0.001), and history of diabetes mellitus (OR 1.94, 95% CI 1.049-3.580; p=0.035) were independently associated with a greater odds of poor outcome. Modified TICI scale scores of 2C (OR 0.12, 95% CI 0.047-0.313; p<0.001) and 3 (OR 0.19, 95% CI 0.079-0.445; p<0.001) were associated with a reduced odds of poor outcome. Although not statistically significant on univariate analysis, OTE ≤6 hrs. was independently associated with a reduced odds of poor outcome (OR 0.41, 95% CI 0.212-0.809; p=0.010) in the final multivariate model (AUC 0.800). Procedure time ≤60 min. did not have a significant independent association with clinical outcome on multivariate analysis (p=0.095). Conclusions: Thrombectomy procedure times beyond 60 min. are associated with lower overall revascularization rates and worse 90 day functional outcomes when compared to faster thrombectomy procedures. However, thrombectomy procedure time was not predictive of outcome on multivariable logistic regression analysis. Our study emphasizes the significance of achieving revascularization despite the requisite procedure time.

Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Takayuki Matsuki ◽  
Masatoshi Koga ◽  
Shoji Arihiro ◽  
Kenichi Todo ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Reperfusion Therapy ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Multicenter Observational Study ◽  
Spot Urine ◽  
Poor Outcome ◽  
The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial

2021 ◽  
pp. 1-5
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Fabio A. Frisoli ◽  
Megan S. Cadigan ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Ruptured Aneurysm ◽  
Poor Outcome ◽  
Increased Risk ◽  
Grade Ii ◽  
Grading Scale ◽  
Poor Outcomes ◽  
Grade Iii

OBJECTIVEThe SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.METHODSThe records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups.RESULTSA total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5–4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2–6.2; p < 0.001) follow-ups.CONCLUSIONSHigh SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.

Abstract 37: Refining of the Association of Fever with Functional Outcome in SAH

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marianna Pegoli ◽  
Christopher L Kramer ◽  
Jay Mandrekar ◽  
Giuseppe Lanzino ◽  
Alejandro Rabinstein
Keyword(s):  
Functional Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Core Body Temperature ◽  
Univariate Analysis ◽  
Great Majority ◽  
Icu Stay ◽  
Poor Outcome ◽  
Fever Onset ◽  
Fisher Grade ◽  
The Impact

Background: Fever has been associated with worse clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). However, the impact of the cause, severity, and duration of fever is not clear. We conducted this study to evaluate the impact of fever and subfebrile load and fever characteristics on functional outcome. Methods: We collected detailed information on fever onset, cause, severity, and duration during the ICU stay in a cohort of 586 consecutive patients with aSAH. Fever was defined as core body temperature ≥ 38.3°C. Subfebrile measurements were those between 37 and 38.2°C. Febrile and subfrebile loads were defined as number of hours with fever or subfebrile measurements. Poor outcome was defined as modified Rankin score (mRS) > 2. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: 532/586 patients (90.9%) had fever for a mean of 2.1±3.0 days. Fever started within 24 hours in 69 (11.8%) and within 72 hours in 110 (18.8%). Poor outcome occurred in 175 patients (29.9%). On univariate analysis, days of fever, febrile load, fever onset within 24 hours, and fever onset within 72 hours were associated with poor outcome (all p<0.001), but subfebrile load was not (p=0.58). On multivariate model constructed with all variables associated with outcome on univariate analyses (including age, WFNS grade, modified Fisher grade) days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95% CI 1.06-1.22; p=0.0006) displacing all other fever measures from the final model. Conclusions: The great majority of patients with aSAH are febrile during their ICU stay. Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, the number of hours with elevated but subfebrile temperature does not influence clinical outcome. These data suggest that prolonged fever should be avoided, but subfebrile temperatures do not justify intervention.

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