Abstract WP238: Thrombolytic Use in Stroke Mimics via Telestroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Michael A Sperl ◽  
Aditi Gupta ◽  
Jayashree Ravichandran ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Stroke Mimics ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Acute Rehabilitation

Background: It has been established that safety and outcomes of intravenous thrombolysis (IVT) to stroke patients via telestroke (TS) is similar to those presenting to stroke centers. Little is known on the accuracy of TS diagnosis among those receiving IVT. We sought to compare the rate of stroke mimic (SM) patients receiving IVT in our TS network to those who present to our comprehensive stroke center (CSC). Methods: Consecutive patients receiving IVT between August 2014 and June 2015 were identified at our CSC and TS network. The rates of SM patients in each cohort were calculated. Outcomes measured included rates of symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and discharge to home or an acute rehabilitation unit (ARU). Results: During the study period, 132 patients (mean age 71±15 years, 49% women) receiving IVT were included in the analysis (75 CSC, 57 TS). Rates of SM patients receiving IVT were similar (CSC 12% vs TS 7%, p=0.39). One stroke patient developed sICH, and three other stroke patients experienced in-hospital mortality; neither outcome was found in the SM cohort. Discharge to home or ARU was similar between stroke (76.5%) and SM (76.9%) patients (p=1). Patients with SMs had significantly higher diagnoses of migraine (p=0.045) and psychiatric disorders (p=0.0002) compared to stroke patients. Conclusion: The rate of IVT among SM patients via TS is low and similar to those who present directly to a stroke center. Continued efforts should be made to further minimize IVT in SM patients despite the low rate of complications.

How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

2021 ◽  
pp. 174749302098526
Author(s):  
Juliane Herm ◽  
Ludwig Schlemm ◽  
Eberhard Siebert ◽  
Georg Bohner ◽  
Anna C Alegiani ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

Stroke mimic in an acute rehabilitation unit patient with associated hypomagnesaemia

2021 ◽  
Vol 14 (4) ◽  
pp. e239777
Author(s):  
Mia X Shan ◽  
Andrew Hanna ◽  
Emmanuel G Villalpando ◽  
Dixie Aragaki
Keyword(s):  
Emergency Department ◽  
Comprehensive Evaluation ◽  
Rehabilitation Unit ◽  
Stroke Mimics ◽  
Laboratory Results ◽  
Acute Infarct ◽  
Facial Numbness ◽  
Stroke Mimic ◽  
Acute Rehabilitation ◽  
Work Up

This case report describes a patient who presented with acute left facial numbness and eyelid weakness prompting work-up, which demonstrated low suspicion for new stroke but revealed hypomagnesaemia as a potential differential diagnosis. Patient initially presented to the emergency department with left upper extremity weakness and was diagnosed with right basal ganglia infarction. Two weeks after transfer to the acute rehabilitation unit, patient suddenly complained of left facial numbness and eyelid weakness. However, brain imaging did not show any new acute infarct. Instead, laboratory results showed hypomagnesaemia at 1.50 mg/dL. Patient was therefore treated with intravenous magnesium leading to resolution of his symptoms. Up to 30% of acute stroke presentations are stroke mimics. Although hypomagnesaemia is less frequently seen as a mimic, its neuromuscular manifestations may present with similar symptoms. Patients will always benefit from a comprehensive evaluation for stroke symptoms, but it is important to consider the mimics as well.

National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Akiko Kada ◽  
Kuniaki Ogasawara ◽  
Takanari Kitazono ◽  
Kunihiro Nishimura ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Temporal Trends ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

scholarly journals Acute administration of tirofiban versus aspirin in emergent carotid artery stenting

2018 ◽  
Vol 25 (2) ◽  
pp. 219-224 ◽  
Author(s):  
Philipp Gruber ◽  
Martin Hlavica ◽  
Jatta Berberat ◽  
Benjamin Victor Ineichen ◽  
Michael Diepers ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Intravenous Thrombolysis ◽  
Similar Efficacy ◽  
Intracranial Bleeding ◽  
Acute Administration ◽  
Efficacy And Safety ◽  
Stroke Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Carotid artery stenting requires antiplatelet therapy for prevention of in-stent thrombosis. Patients suffering from acute ischemic stroke undergoing intravenous thrombolysis and emergent carotid artery stenting (eCAS) are at high risk for intracranial bleeding. We assessed efficacy and safety of acute administration of intravenous tirofiban versus aspirin in these patients. Methods A retrospective, single center, cohort study was carried out of 32 patients who underwent eCAS (18 received tirofiban, 14 received aspirin) at our comprehensive stroke center (2008–2016). Results Of our 32 consecutive eCAS patients, favorable clinical outcomes (modified Rankin scale ≤ 2) were achieved in eight (47%) tirofiban patients and six (46%) aspirin patients ( p = 0.96). Overall rates were similar for symptomatic intracranial bleeding (tirofiban 22%, aspirin 29%, p = 0.68) and mortality (tirofiban 18%, aspirin 23%, p = 0.71). Conclusions Tirofiban and aspirin demonstrated similar efficacy and safety in thrombolyzed stroke patients who underwent eCAS in our cohort. Intravenous tirofiban with its short half-life might represent an alternative to aspirin in select patients.

scholarly journals Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: results of a nationwide Dutch clinical audit

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Laurien S. Kuhrij ◽  
◽  
Perla J. Marang-van de Mheen ◽  
Renske M. van den Berg-Vos ◽  
Frank-Erik de Leeuw ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Audit ◽  
Intravenous Thrombolysis ◽  
Natural Spline ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Abstract Background Intravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT. Methods Patients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT. Results Included were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98). Conclusions Even though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.

Abstract T P211: Continued Participation in a Telestroke Program Improves Time to Intravenous Thrombolysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamal N Muthana ◽  
James J Conners ◽  
Shawna Cutting ◽  
Sarah Y Song ◽  
Elizabeth Diebolt ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Nihss Score ◽  
Period 2 ◽  
Intravenous Tissue Plasminogen Activator ◽  
Educational Partnership ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Mean Time ◽  
Iv Tpa

Background: Improved clinical outcomes after intravenous tissue plasminogen activator (IV tPA) are time dependent. Participation in a telestroke program allows the spoke hospitals 24/7 access to a vascular fellowship trained neurologist for a telestroke consult, as well as educational partnership with the hub site, shared protocols, and access to quality improvement feedback. We sought to assess the effects of continued participation in a telestroke program on times to administration of IV tPA. Methods: Our institutional telestroke program began in March 2011 and consists of an academic hub (comprehensive stroke center) that serves 8 community spoke hospitals. We retrospectively reviewed acute ischemic stroke patients treated with IV tPA via the telestroke program. We compared 2 cohorts of patients: Period 1 (July 2011 to June 2013) and Period 2 (July 2013 to July 2014). We collected data on demographics, National Institutes of Health Stroke Scale (NIHSS), and times from initiation of telestroke consult to IV tPA administration. Results: Among 259 consecutive stroke patients (mean: 69.6 years, 56% female) treated with IV tPA via telestroke, the median NIHSS score was 11.8, and 41.7% of patients were transferred to the hub. The mean time from initiation of telestroke consult to IV tPA administration was 42.2 minutes. Period 1 included 129 patients and Period 2 included 130 patients, and the two groups did not differ by age (p=0.2), gender (p=0.3), or NIHSS score (p=0.3). Time from initiation of telestroke consult to IV tPA administration improved from Period 1 to Period 2 (35 vs. 49.9 minutes, p<0.0001). This improvement was due to faster mean time from initiation of telestroke consult to IV tPA advised (12.5 vs. 17.4 minutes, p<0.0001) and faster mean time from IV tPA advised to administration (22.5 vs. 33.1 minutes, p<0.0001). Conclusions: Maturation of a telestroke program is associated with improvement in the timeliness of IV tPA delivery, possibly due to a learning effect that continues the longer the sites participate in the program. This improvement is due to faster responses in both the hub site (recommending IV tPA earlier) and spoke site (administering IV tPA quicker). Further studies aimed at improving delivery of IV tPA in telestroke program are warranted.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

scholarly journals Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Nourhan Abdelmohsen Taha ◽  
Hala El Khawas ◽  
Mohamed Amir Tork ◽  
Tamer M. Roushdy
Keyword(s):  
Intravenous Thrombolysis ◽  
Posterior Circulation ◽  
University Hospitals ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Time Points ◽  
Posterior Circulation Stroke ◽  
First Line Therapy ◽  
Insignificant Difference ◽  
Stroke Center

Abstract Background Intravenous thrombolysis (IVT) with alteplase is the first-line therapy for acute ischemic anterior and posterior circulation strokes (ACS and PCS). Knowledge about safety and efficacy of IVT in posterior circulation stroke is deficient as most of the Egyptian studies either assessed IVT outcome in comparison to conservative therapy or its outcome in anterior circulation stroke only. Therefore, our aim was to compare the relative frequency and outcome after intravenous thrombolysis in anterior versus posterior circulation stroke patients presenting to stroke centers of Ain Shams University hospitals (ASUH). Results A total of 238 anterior circulation stroke and 61 posterior circulation strokes were enrolled, onset-to-door and door-to-needle time were statistically insignificant. NIHSS showed comparable difference at all time points despite higher scores along anterior circulation stroke; 90-day modified Rankin Scale (mRS) showed significant improvement in both groups from mRS >2 to ≤2 with a better percentage along posterior circulation stroke patients. There was insignificant difference for either incidence of death or intracranial hemorrhage (ICH) between the two groups. Conclusion IVT significantly reduced NIHSS for both anterior and posterior circulation stroke along different studied time points. Meanwhile, a higher percentage of patients with posterior circulation stroke had a better mRS outcome at 90 days.

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

Abstract WP322: Inability to Identify Physician is Associated With Medication and Care Plan Knowledge Gaps Ii Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Fred Cohen ◽  
Jeffrey M Katz ◽  
Jackie McCarthy ◽  
Ignacio Lopez ◽  
Paul Wright
Keyword(s):  
Medication Compliance ◽  
Care Plan ◽  
Medication Regimen ◽  
Stroke Patients ◽  
General Neurology ◽  
Patient Dissatisfaction ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Knowledge Deficits ◽  
Attending Physician

Introduction: Patient dissatisfaction and medication non-compliance correlate with patient misunderstanding of their medications and care plan. We aimed to assess the degree of these gaps and their associations in hospitalized stroke patients. Methods: A 5-question survey was administered to patients hospitalized on the neuroscience ward of a comprehensive stroke center. Patient understanding of their condition leading to admission, care plan, medications, primary attending physician, and follow-up plan was assessed. If the patient was unable to communicate, then their health care representative was interviewed. Results: A total of 146 patients (55 stroke and 91 general neurology and neurosurgery (non-stroke) patients) or their representatives were interviewed. Stroke patients were less likely to properly identify their primary attending physician (33/55 (60.0%) stroke patients versus 35/91 (38.5%) non-stroke patients; p=0.011). Inability to identify the attending physician was associated with lack of medication and care plan knowledge and was more common in stroke patients, (23/33 (69.7%) stroke patients versus 14/35 (40.0%) non-stroke patients; p=0.014). Conclusion: Despite sharing a common pool of providers, the inability to identify the primary attending physician was significantly more common in stroke patients and was associated with patient knowledge deficits regarding their medication regimen and care plan. This correlation was significantly higher in stroke patients and suggests that stroke patients may require different, extra or more robust communication and education than the general neurology and neurosurgery population. Additionally, emphasis on attending physician identification may improve patient satisfaction and medication compliance.

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