Abstract WP130: Association of Large Inter-arm Blood Pressure Difference With Mortality And Systemic Atherosclerosis In Acute Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jinkwon Kim ◽  
Tae-Jin Song ◽  
Dongbeom Song ◽  
Seung Hun Oh ◽  
Ok Joon Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Ankle Brachial Index ◽  
Lower Limbs ◽  
Absolute Difference ◽  
Peripheral Arteries ◽  
Stroke Patients

Backgrounds: Large inter-arm difference of blood pressure (IAD) is associated with development of cardiovascular events and increased mortality in the general population and in patients with cardiovascular risk factors. However, it is unknown whether the presence of large IAD has prognostic value in acute stroke patients and whether it is associated with atherosclerosis on other vascular beds (cerebral, coronary, and peripheral arteries, and aorta). We evaluated the prognostic value of large IAD measured in acute ischemic stroke, and the association between large IAD and atherosclerosis on multiple arterial beds (cerebral, coronary, and peripheral arteries, and aorta). Methods: We included 836 consecutive patients with acute ischemic stroke. Large IAD was defined by more than 10 mmHg absolute difference of systolic blood pressure between the arms. The presence of systemic atherosclerosis was determined based on cerebral angiography, coronary CT angiography, transesophageal echocardiograpghy and ankle-brachial index examination. Results: Large IAD was observed in 7.4 % of patients. During a mean study period of 419.4 ± 250.2 days, 48 patients (5.7 %) died (including 34 cardiovascular deaths). The Kaplan-Meier survival curves showed significantly higher mortality in the group with large IAD than those without (Figure, a log-rank test, (A) p<0.001 in all-cause death, (B) p<0.001 in cardiovascular death). In multivariate Cox regression, large IAD was associated with increased all-cause mortality (adjusted HR is 3.040, p=0.002), and cardiovascular mortality (adjusted HR is 3.612, p=0.002). The presence of large IAD was associated with peripheral artery disease in the lower limbs (p=0.005), but not with atherosclerosis in the cerebral artery, coronary artery or the aorta. Conclusions: The presence of large IAD is a strong independent prognostic marker in acute ischemic stroke.

Abstract TP380: Significant Factors of Early Independent Gait in Acute Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yuna Hosaka ◽  
Takahisa Mori ◽  
Yuki Sawada
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Mmse Score ◽  
Lower Limbs ◽  
Upper Limbs ◽  
Stroke Patients ◽  
Trunk Control ◽  
Stroke Subtypes ◽  
Significant Factors

Introduction: Acute stroke patients have problems with gait disturbance. Independent gait in hospitalized patients is important for early discharge to home. Therefore, we must find factors of disturbing independent gait following acute stroke and intensively treat them. Hypothesis: Impaired trunk control and cognitive function are factors of disturbing early independent gait. Methods: We included acute ischemic stroke patients who were admitted in our hospital from June 2017 to May 2018 and excluded patients with disturbed level of consciousness. We defined a score of 6 (modified Independence) or 7 (complete independence) in the Functional Independence Measure (FIM) as gait independence. We evaluated association of stroke subtypes, Brunnstrom recovery stage (BRS) of upper limbs, fingers and lower limbs, trunk control test (TCT) score and Mini-Mental State Examination (MMSE) score with early gait independence on the 7th day of a stroke onset. Results: One hundred twenty- six patients met our inclusive criteria and we analyzed them. Stroke subtypes had no relation to early gait independence. In gait independent and dependent patients on the 7th day, median BRS score of upper limbs was 5 and 5 (ns), median BRS score of fingers was 5 and5 (ns), median BRS score of lower limbs was 6 and 5 (p<0.01), TCT score was 100and 75 (p<0.01) and MMSE score was 28.5 and 24.5 (p<0.01), respectively. Multiple logistic regression analysis that TCT (p<0.01) and BRS lower limbs (p<0.01) were independent factors for early independent gat. Receiver operating characteristic curve (ROC) for early gait independence demonstrated that cut-off values of TCT score and BRS of lower limbs and were 100 and 5. Conclusions: Impaired trunk control and muscle weakness of lower limbs were significant factors of disturbing early gait independence.

scholarly journals Stress hyperglycemia as a prognostic factor in acute ischemic stroke patients: a prospective observational cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mahmoud A. Mohamed ◽  
Amr E. Abd-Elhamid ◽  
Mohammed A. Nosseir
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Diabetic Patients ◽  
Stroke Patients ◽  
Stress Hyperglycemia ◽  
Discrimination Power ◽  
Observational Cohort

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

scholarly journals Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0144260 ◽  
Author(s):  
Wei Wu ◽  
Xiaochuan Huo ◽  
Xingquan Zhao ◽  
Xiaoling Liao ◽  
Chunjuan Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
China Study

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 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.

Effect of renal function status on the prognostic value of heart rate in acute ischemic stroke patients

2017 ◽  
Vol 263 ◽  
pp. 1-6
Author(s):  
Zhengbao Zhu ◽  
Chongke Zhong ◽  
Tian Xu ◽  
Aili Wang ◽  
Yanbo Peng ◽  
...  
Keyword(s):  
Heart Rate ◽  
Renal Function ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Stroke Patients

scholarly journals The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e113967
Author(s):  
Yuanqi Zhao ◽  
Min Zhao ◽  
Xiaomin Li ◽  
Xiancong Ma ◽  
Qinghao Zheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Chinese Population ◽  
Stroke Patients ◽  
Stroke Imaging ◽  
Acute Stroke Imaging

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.

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