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.

scholarly journals Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

2021 ◽  
Vol 10 (3) ◽  
pp. 151-161
Author(s):  
Novi Fatni Muhafidzah ◽  
◽  
Sobaryati Mansur ◽  
Emmy Hermiyanti Pranggono ◽  
Yusuf Wibisono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Size ◽  
Acute Stroke ◽  
Primary Data ◽  
Neurogenic Pulmonary Edema ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Abstract WP330: Protocol Approaches Negate the “Weekend Effect” for Endovascular Stroke Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Scott B Raymond ◽  
Feras Akbik ◽  
Joshua A Hirsch ◽  
Christopher J Stapleton ◽  
Ramon G Gonzalez ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Care Delivery ◽  
Working Hours ◽  
Weekend Effect ◽  
Complication Rates ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Therapeutic Procedures ◽  
The Impact

Background: Endovascular management of stroke from acute large vessel occlusion (LVO) requires complex, emergent diagnostic and therapeutic procedures. The “weekend effect” (worsened outcomes from stroke presenting on weekends or evenings) is a recognized phenomenon, attributed to non-uniform availability of services throughout the week. We assessed the impact of institutional protocols for stroke patients undergoing endovascular therapy during off hours. Methods: We analyzed a prospective observational stroke database for consecutive patients with anterior circulation stroke undergoing endovascular therapy between 6/2012 and 10/2015. Patients were grouped and analyzed based on day of the week and time of presentation to the emergency department. Off-hours were considered between 1900hrs and 0700hrs on weekdays and 1900hrs on Friday to 0700hrs on Mondays for weekends. Functional outcome was assessed prospectively by 3 month modified Rankin scale (mRS), dichotomized into good (mRS 0-2) versus poor (mRS 3-6). Results: In a cohort of 129 patients, 75 (58%) patients were treated off-hours. Patients treated off-hours demonstrated equivalent imaging to groin puncture times (78 vs 72 min, p = 0.4) and procedure durations (75 vs 68 min, p = 0.3). Reperfusion rates (TICI 2b or 3) were 68% off hours and 76% during working hours (p = 0.4). Complication rates were similar between the two groups. Outcome at 90 days was no different in the patients treated off hours, with 35 of 75 treated off-hours achieving a good outcome (mRS 0-2) compared to 22 of 54 treated during working hours (p = 0.6). With protocol adherence, temporal improvement was noted in imaging to groin times. Discussion/Conclusions: Following recent evidence of benefit from endovascular therapy for LVOs there is increased attention to care delivery. Our findings demonstrate that under the guidance of protocols, the “weekend effect” was negated. Evaluation and treatment times, and 90 day outcomes were equivalent in patients treated off- vs business hours, with improving treatment times as familiarity with protocols increased. Our findings highlight the importance of establishing institutional and regional protocols in the optimized management of these patients.

scholarly journals Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
H. Handelsmann ◽  
L. Herzog ◽  
Z. Kulcsar ◽  
A. R. Luft ◽  
S. Wegener
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Patient Characteristics ◽  
Posterior Circulation ◽  
University Hospital ◽  
Outcome Predictors ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
The University ◽  
Median Admission

AbstractDistinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.

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 Sex Differences in the Association Between Liver Fibrosis and Clinical Outcomes in Acute Cardioembolic Stroke Population With Nonvalvular Atrial Fibrillation

2021 ◽  
Author(s):  
Lei Yang ◽  
Ke Gao ◽  
Xin-Ye Yao ◽  
Yong-lan Tang ◽  
Wan-Ying Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Fibrosis ◽  
Clinical Outcomes ◽  
Cardioembolic Stroke ◽  
Advanced Fibrosis ◽  
Short Term ◽  
Nonvalvular Atrial Fibrillation ◽  
Severe Stroke ◽  
Advanced Liver Fibrosis ◽  
The Impact

Abstract Background: Liver cirrhosis is a confirmed risk factor for worse clinical outcomes of stroke, however the contribution of liver fibrosis to cardioembolic stroke (CES) and its short-term outcomes are poorly understood. This study aimed to investigate whether liver fibrosis is associated with more severe stroke, worse short-term clinical outcomes of acute CES, due to nonvalvular atrial fibrillation (NVAF), as well as the impact of sex on the association. Methods: Using data of 522 patients with NVAF admitted within 48 hours after acute symptom of CES onset. We calculated Fibrosis-4 score (FIB-4) and defined liver fibrosis as: likely advanced fibrosis (FIB-4>3.25), indeterminate (FIB-4, 1.45-3.25), unlikely advanced fibrosis (FIB-4<1.45). We invested the impact of liver fibrosis degree on stroke severity on admission, major disability at discharge and all cause death at 90 days stratified by sex. Results: Among 522 acute CES patients with NVAF, the mean FIB-4 on admission reflected intermediate fibrosis, whereas liver enzymes were largely normal. After adjusting for possible confounders, multivariate analyses revealed that likely advanced liver fibrosis was associated with severe stroke (OR=2.21, 95% CI: 1.04-3.54), major disability at discharge (OR=4.59, 95% CI: 1.88-11.18), and 90-days mortality (HR=1.25, 95% CI: 1.10-1.56). Further grouped by sex, these associations were stronger in males but not significant in females.Conclusions: In patients with largely normal liver enzyme, likely advanced liver fibrosis is associated with severe stroke, major disability and all cause death after acute CES due to NVAF; the association unfolded more obvious in males, but not for females.

Abstract T P29: The Impact of Contrast Based CTA/CTP Brain Attack Protocol on Kidney Function

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamie Folsom ◽  
Nnadozie Ezerioha ◽  
Pratik Chhatbar ◽  
Swaroop Pawar ◽  
Christina Holmstedt ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Creatinine Level ◽  
Endovascular Therapy ◽  
Kidney Injury ◽  
Complete Information ◽  
Absolute Increase ◽  
Stroke Imaging ◽  
Clinical Consequences ◽  
Stage Renal Disease ◽  
The Impact

Background: We aimed to evaluate the occurrence of acute kidney injury (AKI) associated with contrast based CTA/CTP Brain Attack (BAT) Protocol in a cohort of patients who presented to an academic stroke center with acute stroke symptoms. Methods: Consecutive patients who presented to the Emergency Department with acute stroke symptoms from 01/12 to 12/12 and received CTA/CTP contrast-based BAT protocol were identified and their medical records reviewed. Clinicodemographic information was retrieved. Serum creatinine values at baseline, at discharge, and at a follow-up visit, as well as the highest in-hospital value were recorded. AKI was defined as a 0.3 absolute increase in creatinine level from baseline. A logistic regression was fit to identify the potential predictors for AKI. Results: Of 348 patients had complete information. 37(11%) patients experienced AKI during hospitalization. Of 38 patients, 16 (43%) patients had persistent elevated creatinine at hospital discharge (5 patients also received endovascular therapy); 11(38%) patients returned to baseline, and the rest 10(26%) patients’ creatinine improved but did not return to baseline. No patient develops end stage renal disease requiring hemodialysis. Baseline creatinine level (p<0.002), comorbidity index (p=0.05) and endovascular therapy (p=0.01) were the three main predictors of AKI. Race, gender and age were not predictors of AKI. Conclusion: Contrast based CTA/CTP BAT protocol may incur a small risk of AKI in patients but clinical consequences are minimal. Risks seem greater in patients with higher presenting creatinine level, more comorbidities and those receiving additional contrast from endovascular therapy. More data are required to understand the clinical impact of contrast-based CT stroke imaging protocols.

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 TP10: Selection Criteria, Is The Clue To Successful Thrombectomy?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Helena Quesada ◽  
Luis Cano ◽  
Lucia Aja ◽  
De Miquel MA. ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Selection Criteria ◽  
Intravenous Thrombolysis ◽  
Correct Selection ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment

In our comprehensive stroke center we analyze correct selection criteria to use self-expandable retrievable intracranial stents for acute stroke treatment. The criteria for intervention were the onset of neurological symptoms, a National Institute of Health Stroke Scale Score (NIHSS) ≥9 at presentation, large vessel occlusion stroke demonstrated by angio-CT, and failure of intravenous thrombolysis or exclusion criteria to administrate it. METHODS: We performed an retrospective analysis of 512 consecutive patients with acute ischemic stroke candidates for thrombectomy, from April of 2010 to June of 2012, that met inclusion criteria for intervention. Experienced vascular neurologists selected 171 patients to undergoing endovascular therapy using retrievable stents (Solitaire,Trevo). Successful recanalization results were assessed by follow-up angiography immediately after the procedure (TIMI 2-3/TICI 2b-3 score), and good functional outcome was considered when ≤2 mRankin score (mRS) was achieved at 90 days. RESULTS: A total of 171 patients were treated, 87% with anterior circulation stroke. The mean age was 67.5 years (range 32-87); 58% men. The median NIHSS at presentation was 17 (range 6-26). Recanalization (TICI 2b-3) was achieved in 73% of patients. Symptomatic hemorrhage occurred in 8%. Ninety-day mortality was 19, 5% and good 90-day functional outcome (mRS ≤2) was achieved by 45%. Unsuccessful recanalization (TICI 0-2a) was a significant predictor of poor outcome (mRS≤2: 9%). When we analyzed these patients according to inclusion criteria of IMS trial, 101 patients who met strict criteria achieved good neurological outcome more frequently (51% versus 34%) and significant lower mortality rates (17% vs 28%) compared with the group of 70 patients with IMS exclusion criteria. CONCLUSIONS: Efficacy in recanalization, safety of thrombectomy and its consequent good clinical outcome is sufficiently established. It is important an experienced vascular neurologist to select possible candidates (proportion of evaluated/treated patients 3:1). Inclusion criteria for acute stroke trials do not always represent real population of stroke patients as well as their clinical results.

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

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