Abstract WP35: Outcomes of Mechanical Embolectomy in Patients Treated Beyond 8 hours From Stroke Onset: a Subanalysis of the North American SOLITAIRE Stent-retriever Acute Stroke Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Alex Abou-Chebl ◽  
Alicia Castonguay ◽  
Franklin A Marden ◽  
Raul G Nogueira ◽  
Robin Novakovic ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Stroke Onset ◽  
Anterior Circulation ◽  
Stroke Registry ◽  
The North ◽  
Primary Endpoints ◽  
Increased Risk ◽  
Stent Retrievers ◽  
Baseline Demographic

Background and Purpose: Endovascular therapy (EVT) with stent-retrievers is safe and effective within 6-8hours of acute ischemic stroke onset; however a large proportion of patients present beyond 8hrs. There is a paucity of data on the safety and effectiveness of EVT in this latter population. Methods: We reviewed demographic, clinical, procedural and clinical outcomes data from consecutive patients treated with the Solitaire™ FR device in the investigator-initiated NASA Registry. Patients were divided into early (≤8hrs) and late (>8hrs) presenting groups. Primary outcomes (90-day mRS 0-2, mortality, and symptomatic ICH) were compared. Results: Three hundred and fifty-four patients from 24 centers were enrolled in NASA. Sixty-three (18%) patients presented >8hrs from onset and were treated. Baseline demographic and procedural factors were comparable between the early and late groups, except for time-to-treatment (271.9±97.3min vs. 754±269.3min, p<0.0001), IV tPA utilization (52.6% vs. 11.1%, <0.0001), baseline diastolic BP (77.9±16.8mmHg vs. 83.8±20.2mmHg, p=0.03), and frequency of vertebrobasilar occlusions (7.1% vs. 19.1%, p=0.0034). Procedural aspects were similar except for time to recanalization (early 73.8±84.5min vs. late 53.6±32min, p=0.0074). Recanalization success (TICI≥2b) was comparable (early 74.4% vs. late 76.2%, p=0.76). The primary outcome measures including symptomatic ICH (11.6% vs. 4.8%, p=0.11), mortality (29.9% vs. 29.3%, p=0.93), and mRS 0-2 (44.4% vs. 34.5%, p=0.17) were similar between the early and late groups, respectively. When only anterior circulation strokes were included (N=301), the data did not change significantly and the primary endpoints of symptomatic ICH (12.1% vs. 5.9%, p=0.2), mortality (27.9% vs. 27.7%, p=0.97) and mRS 0-2 (44.6% vs. 36.2%, p=0.29) remained comparable between the early and late groups, respectively. Conclusions: The NASA Registry has demonstrated that clinical outcomes of patients treated >8hrs from stroke onset are favorable and comparable to the outcomes of patients treated earlier. Later treatment in these selected patients was not associated with an increased risk of symptomatic ICH. Future trials should prospectively evaluate the benefit of EVT beyond 8hrs.

scholarly journals 270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Stephanie Wo ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
John Papadopoulos ◽  
Shin-Pung Jen
Keyword(s):  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Protective Factor ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Penicillin G ◽  
Eligibility Criteria ◽  
Extended Spectrum Beta Lactamase ◽  
Increased Risk ◽  
Viridans Group Streptococci

Abstract Background Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017). Conclusion Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration. Disclosures All Authors: No reported disclosures

Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites

2016 ◽  
Vol 9 (6) ◽  
pp. 535-540 ◽  
Author(s):  
Ruchi Kabra ◽  
Timothy J Phillips ◽  
Jacqui-Lyn Saw ◽  
Constantine C Phatouros ◽  
Tejinder P Singh ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Stroke Onset ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Patient Demographics ◽  
Organizational Differences ◽  
Tertiary Hospitals ◽  
Pretreatment Time

ObjectiveTo audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.MethodsA database of 100 MT cases was maintained throughout May 2010—February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.ResultsThrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0–2). In a subgroup analysis of 76 patients with premorbid mRS 0–1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0–2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).ConclusionsOutcomes similar to randomized controlled trials are attainable in ‘real-world’ settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.

Abstract WMP113: Headache At Stroke Onset Is Present In Half Of All Older Children With Arterial Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lori L Billinghurst ◽  
Adam Kirton ◽  
Steven Pavlakis ◽  
Jo Ellen Lee ◽  
Luigi Titomanlio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Right Hemisphere ◽  
Female Gender ◽  
Stroke Onset ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Anterior Circulation ◽  
Stroke Registry ◽  
Young Infants ◽  
Individual Site

Introduction: Headache at stroke onset occurs in up to a quarter of adults and is associated with younger age, female gender, right hemisphere and cerebellar infarcts. Little is known about headache at stroke onset in children. Methods: Children (29 days-18 years) with clinical and radiographic confirmation of arterial ischemic stroke were prospectively enrolled in the International Pediatric Stroke Study from 2003-2014. Details regarding demographics, stroke presentation and infarct location were obtained from the multi-center, pediatric stroke registry. Headache at stroke presentation was classified and annotated in the registry by the individual site investigators as present, absent or unclear. Results: We analyzed 2103 children. Half of all subjects ≥ 6 yo reported headache at stroke onset (N=509/1047, 49%; Figure). Headache was less prevalent in children < 6 yo (N=112/1056, 11%; p<0.001), though headache presentation was more commonly classified as unclear (10% vs 32%; p<0.001). In children ≥ 6 yo, headache was significantly associated with papilledema (p = 0.03) and vertigo (p = 0.01), but not with hemiparesis (p = 0.11), visual field deficit (p = 0.90), aphasia (p = 0.35), dysarthria (p = 0.44), or ataxia (p = 0.50). Headache was more common in posterior than anterior circulation infarcts (p<0.001). There was a significant association between headache and right or bilateral hemisphere infarcts (p = 0.04) but not with gender (p = 0.76). Conclusion: Headache is more prevalent in children than adults at stroke ictus and shares similar associations, including infarcts involving the posterior circulation and right hemisphere. Headache may be under-reported in young infants and children due to pre-verbal stages of development. These findings have implications for early identification and treatment of pediatric stroke and warrant further investigation in prospective studies to distinguish stroke from more common benign mimics, including migraine.

scholarly journals Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Zongjie Shi ◽  
Shunyuan Guo ◽  
Jie Pan ◽  
Chao Xu ◽  
Yu Geng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Fasting Glucose ◽  
Independent Predictor ◽  
Secondary Outcome ◽  
Vessel Occlusion ◽  
Glucose Levels ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage

Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment.Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses.Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment.Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.

Abstract T P26: Predictors of Clinical and Angiographic Outcomes in Acute Stroke Treatment: Subgroup Analysis From the Star Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Vitor Mendes Pereira ◽  
Rene Chapot ◽  
Antoni Davalos ◽  
Alain Bonafé ◽  
Carlos Castano ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Outcomes ◽  
Subgroup Analysis ◽  
Conscious Sedation ◽  
High Volume ◽  
Anaesthetic Management ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Stent Retrievers ◽  
Acute Stroke Treatment

Endovascular acute stroke treatment (AIS) has changed dramatically last years. Stent retrievers are progressively substituting other devices and old practices like intra-arterial thrombolysis. We present the subgroup analysis of the largest prospective multicentre study using stent retrievers on the treatment of AIS. The study was realized in 14 high volume and experienced stroke centres in Europe, Canada and Australia. 202 patients harbouring anterior circulation occlusions were included within 8 hours after onset. All procedures were performed with balloon guiding catheter. We observed that the occlusion location did not change the successful (TICI 2b or 3) recanalization rates (ICA - 76.5% and MCA - 86.4%: p=0.187) or good clinical outcomes (mRS 0-2) (ICA - 47.2% and MCA - 61.3%: p=0.137). However, it was significant when we considered excellent (mRS 0-1) outcomes only (ICA - 25% and MCA - 47.5%: p=0.016). There were no differences concerning the previous use of rtPA on the angiographic (TICI scores) (p=1.0) or clinical (mRS) (p=0.564) outcomes. The anaesthetic management also did not influence the revascularization (p=0.7) or patient’s status (p=0.343). Angiographic collateral status determined using the ASITN/SIR grading system was significantly correlated to good clinical outcomes (Grades 0-2 and Grades3-4, p=0.034). Also the time from the stroke onset to groin puncture influence clinical progress (0-3h, 3-4.5h, over 4.5h: p=0.002). Multivariate regression analysis on prediction of good outcomes was significant for age (OR-0.93 (0.89, 0.97)), baseline NIHSS (OR-0.87(0.79, 0.96)), absence of haemorrhage (OR-5.01 (1.65, 15.16)), time to treatment (OR-0.62(0.45-0.83)) procedure performed under conscious sedation (OR4.83(1.78,13.11)) and successful recanalization (OR-3.37(1.12,10.14)). Early and efficient revascularization is ideal situation for AIS. Conscious sedation can save time for endovascular procedure using a stent retriever in experienced centers.

Abstract P579: Fluid Attenuated Inversion Recovery Correlates With Time of Onset of Arterial Ischemic Stroke in Childhood

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dennis Shaw ◽  
Dwight Barry ◽  
Michael G Abraham ◽  
Dana D Cummings ◽  
Mark T MacKay ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Brain Mri ◽  
Inversion Recovery ◽  
Stroke Onset ◽  
Childhood Stroke ◽  
Arterial Ischemic Stroke ◽  
Anterior Circulation ◽  
Increased Risk ◽  
Fluid Attenuated Inversion Recovery ◽  
Highest Density Interval

Background: In adults, time since stroke onset correlates with efficacy and risk of recanalization therapies; beyond this temporal window there is increased risk of adverse events in particular hemorrhage with thrombolysis and decreased benefit of recanalization due to irreversible tissue injury. In adults the appearance of fluid attenuated inversion recovery (FLAIR) signal is a proxy for time, and is typically present by 6 hours. The time to FLAIR signal hyperintensity in childhood stroke is unknown but is of interest with potential utility due to the often greater uncertainty as to timing symptom onset. Methods: Time to FLAIR signal hyperintensity on brain MRI performed on children within 24 hours of stroke onset was studied with logistic regression. Results: A total of 68 MRIs with FLAIR imaging were available from 54 children (27 female), age 0.8 to 17.9 years, median 12.0 years. Seventy-four percent (40/54) of children and 72% (49/68) of scans had anterior circulation stroke. Interquartile range for time to FLAIR presence was 7.8 to 19.1 hours. The 90% probability of FLAIR change was reached at 11.2 hours for all strokes (Figure, dotted line; 80% highest density interval (HDI): 1.2-11.2 hours), and 9.3 hours for anterior circulation only strokes (Figure, solid line; 80% HDI: 3.3-9.3 hours), though nearly all had FLAIR change by 6 hours. FLAIR change was absent in 4 children after 6 hours, two with anterior circulation stroke (16 year-old at 6.1 hours, 10 year-old at 7.0 hours) and 2 with posterior circulation stroke (15 year-old at 7.3 hours, 9 month-old at 18.2 hours). Conclusion: Similar to adults, FLAIR hyperintensity can be used to estimate time since stroke ictus in childhood stroke. Children may have somewhat delayed time to FLAIR signal change compared with adults, suggesting that they may have a longer window for effective recanalization therapies.

Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke

Neurology ◽  
2019 ◽  
Vol 93 (18) ◽  
pp. e1675-e1685 ◽  
Author(s):  
Chongke Zhong ◽  
Guangli Wang ◽  
Tan Xu ◽  
Zhengbao Zhu ◽  
Daoxia Guo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Primary Outcome ◽  
Tissue Inhibitor ◽  
Vascular Events ◽  
Baseline Serum ◽  
Hazard Ratios ◽  
Increased Risk

ObjectiveTo prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsA total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06–1.29) for the primary outcome, 1.13 (1.02–1.25) for major disability, 1.49 (1.19–1.87) for death, and 1.34 (1.11–1.62) for the composite outcome of death and vascular events. The addition of serum TIMP-1 to conventional risk factors model significantly improved risk prediction of the primary outcome (net reclassification index 9.0%, p = 0.02; integrated discrimination improvement 0.2%, p = 0.03). Participants with both higher TIMP-1 and matrix metalloproteinase-9 levels simultaneously had the highest risk of all study outcomes.ConclusionsHigher TIMP-1 levels were associated with increased risk of mortality and major disability after acute ischemic stroke. Our findings provided evidence supporting the important prognostic role of extracellular matrix biomarkers after acute ischemic stroke.

Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

2020 ◽  
pp. neurintsurg-2020-016720
Author(s):  
Feras Akbik ◽  
Ali Alawieh ◽  
C Michael Cawley ◽  
Brian M Howard ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Intracranial Hemorrhage ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Anterior Circulation ◽  
Increased Risk ◽  
First Pass

BackgroundAtrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).ObjectiveTo determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.MethodsWe performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).ConclusionsIn patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

scholarly journals Plasma S100A8/A9 Concentrations and Clinical Outcomes of Ischemic Stroke in 2 Independent Multicenter Cohorts

2020 ◽  
Vol 66 (5) ◽  
pp. 706-717
Author(s):  
Daoxia Guo ◽  
Zhengbao Zhu ◽  
Tan Xu ◽  
Chongke Zhong ◽  
Aili Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
High Plasma ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Vascular Events ◽  
Hazard Ratios ◽  
Increased Risk

Abstract Background S100A8/A9 is implicated in inflammation mechanisms related to atherosclerosis and plaque vulnerability, but it remains unclear whether S100A8/A9 is associated with the prognosis of ischemic stroke. The aim of this study was to investigate these associations in 2 independent multicenter cohorts. Methods Plasma S100A8/A9 concentrations at baseline were measured among 4785 patients with ischemic stroke from 2 independent cohorts: Infectious Factors, Inflammatory Markers, and Prognosis of Acute Ischemic Stroke (IIPAIS) and China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a composite outcome of death or major disability at 3 months after ischemic stroke. Secondary outcomes were major disability, death, and a composite outcome of death or vascular events. Results Among the combined participants of IIPAIS and CATIS, the adjusted odds ratios associated with the highest quartile of plasma S100A8/A9 were 2.11 (95% CI, 1.66–2.68) for the primary outcome and 1.62 (95% CI, 1.27–2.07) for the secondary outcome of major disability; adjusted hazard ratios were 4.14 (95% CI, 2.10–8.15) for the secondary outcome of death and 2.08 (95% CI, 1.38–3.13) for the composite outcome of death or vascular events. Each SD increase of log-transformed S100A8/A9 was associated with 28% (95% CI, 18%–39%; P &lt; 0.001) increased risk of the primary outcome. Multivariable-adjusted spline regression analyses showed a linear association between plasma S100A8/A9 concentrations and primary outcome (P &lt; 0.001 for linearity). Subgroup analyses further confirmed these associations. Conclusions High plasma S100A8/A9 concentrations at baseline were independently associated with increased risks of adverse clinical outcomes at 3 months after ischemic stroke, suggesting that S100A8/A9 might have a role as a prognostic marker of ischemic stroke.

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