Abstract WP46: FLAIR Vascular Hyperintensity ASPECTS (FVH-ASPECTS) Pattern Predicts Outcome in Endovascular Therapy in Acute M1-MCA Occlusion

Introduction: In acute arterial occlusion, the FLAIR vascular hyperintensity (FVH) sign have been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH-ASPECTS pattern and outcome in acute M1-MCA occlusion patients with endovascular treatment. Methods: We included acute M1-MCA occlusion patients treated with endovascular therapy. All patients had DWI and FLAIR before endovascular therapy. Distal FVH ASPECT score was evaluated according to distal MCA-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. Presence of FVH inside DWI positive lesion and outside DWI positive lesion was separately analyzed. We analyzed clinical outcome after endovascular therapy based on these different FVH-ASPECTS patterns. Results: Among 101 patients that met inclusion criteria for the study, mean age was 66.2±17.8 and median NIHSS was 17.0 (IQR 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (mRS 0-2), (8.0 vs 4.0, p<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (OR 1.3, p=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhage transformation (OR 1.3, p=0.019). Conclusion: Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing endovascular therapy. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhage transformation. FVH pattern, not number, can predict outcome of acute M1-MCA occlusion patients after endovascular therapy.

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Study Criteria Applied to Real Life—A Multicenter Analysis of Stroke Patients Undergoing Endovascular Treatment in Clinical Practice

Journal of the American Heart Association ◽

10.1161/jaha.120.017919 ◽

2021 ◽

Cited By ~ 1

Author(s):

Hannes Leischner ◽

Caspar Brekenfeld ◽

Lukas Meyer ◽

Gabriel Broocks ◽

Tobias Faizy ◽

...

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

Daily Practice ◽

Inclusion Criteria ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

Mr Clean

Background Randomized controlled clinical trials (RCT) have demonstrated the efficacy of endovascular treatment in anterior circulation large vessel occlusions. However, outcome of patients treated in daily practice differs from the results of the clinical trials. We hypothesize that this is attributable to the study criteria and that application of the criteria on patients undergoing endovascular therapy in daily routine would improve their outcome. Methods and Results Data from a multicenter prospective registry of GSR‐ET (German Stroke Registry – Endovascular Treatment) was used. Inclusion criteria and selectivity of SWIFT‐PRIME (Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment trial), MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands trial), ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times trial), DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake‐Up and Late Presenting Strokes Undergoing Neurointervention with Trevo trial) and DEFUSE‐3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke trial) trials were analyzed. Baseline characteristics, procedural and outcome data of patients from GSR‐ET before and after selection were compared with the results of the RCTs. Furthermore, outcome of patients who underwent endovascular treatment despite not fulfilling the RCT criteria was analyzed. A total of 2611 patients were included (median age, 75 years; 49.6% women; median National Institute of Health Stroke Scale, 16). A minority of patients met all inclusion criteria, ranging from 3% (DEFUSE‐3 criteria) to 35% (MR CLEAN criteria). Of the patients fulfilling the MR CLEAN criteria, 41% of patients had a good clinical outcome, compared with 34% of patients that did not fulfill MR CLEAN criteria. Conclusions The RCTs represent a selected population with higher rates of good clinical outcome compared with daily practice. The good outcomes of RCTs can be reproduced in clinical routine in patients who fulfill the RCT inclusion criteria. Furthermore, patients who did not meet the criteria of the RCT still had substantial rates of good clinical outcome.

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Abstract P122: The Impact of Center Certification Status on Acute Stroke Care Within a Multi-Hospital System in Western United States

Stroke ◽

10.1161/str.52.suppl_1.p122 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Radoslav I Raychev ◽

CrystalAnn Moreno ◽

Leslie Corless ◽

Jason W Tarpley ◽

John F Zurasky ◽

...

Keyword(s):

Logistic Regression ◽

Clinical Outcome ◽

Regression Models ◽

Process Of Care ◽

Chi Square ◽

Hospital System ◽

Logistic Regression Models ◽

Stroke Center ◽

The Impact ◽

Iv Tpa

Introduction: We aimed to investigate the impact of certification status on process of care metrics and clinical outcome in a large multi-center hospital system. Methods: We analyzed data obtained from the Providence Stroke Registry between January 2016 and December 2019. Key process of care metrics and clinical outcome were compared among patients with a discharge diagnosis of stroke and stratified based on site certification: comprehensive stroke center (CSC), thrombectomy-capable stroke center (TSC), primary stroke center (PSC) and no certification (NC). Donner’s adjusted chi-square tests were used to compare proportions for each metric grouped by certification. Generalized linear mixed effects logistic regression models were used to adjust for mode of patient arrival, age, sex, admit NIHSS, and medical history. Results: Data included 45,278 patients. Results from the analyses are summarized in the table. Donner’s adjusted chi-square analyses showed significant differences for metrics across certification groups. Results from the logistic regression models indicated significant differences in IV TPA and EVT treatment, as well as IV TPA treatment times across certification groups. There were no significant differences between TSC and CSC. Conclusions: Patients presenting with acute ischemic stroke at NC and PSC were significantly less likely to receive IV TPA or EVT with significantly less efficient IV tPA treatment times as compared to CSC. However, CSC and TSC sites performed similarly.

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The impact of age, gender, acuteness and etiology on short-term clinical outcome in patients with subdural hematomas - international dual-center study

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh171016024k ◽

2018 ◽

Vol 146 (9-10) ◽

pp. 538-542

Author(s):

Ivo Kehayov ◽

Aleksandar Kostic ◽

Borislav Kitov ◽

Vesna Nikolov ◽

Hristo Zhelyazkov ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Clinical Outcome ◽

Logistic Regression Analysis ◽

Predictive Factors ◽

Subdural Hematoma ◽

Short Term ◽

Subdural Hematomas ◽

The Impact ◽

Positive Effect

Introduction/Objective. Subdural hematoma is one of the most common intracranial types of bleeding with high risk of disability and mortality. The aim of this study was to determine the influence of age, sex, acuteness, and etiology of subdural hematoma on short-term clinical outcome in these patients. Methods. We retrospectively studied 288 patients who were diagnosed and operated on for subdural hematomas (SDH) with different etiology (traumatic and spontaneous) and acuteness (acute, subacute, and chronic) for a period of five years. Patients scored ? 5 points on the Glasgow Coma Scale at hospital admission were not included in this study. Clinical outcome was assessed by the modified Rankin Scale (mRS) score at hospital discharge. Descriptive statistics and logistic regression analysis were used to determine the effect of the investigated factors on short-term clinical outcome. Results. Logistic regression analysis was conducted to predict degree of recovery (good = mRS ?1 vs. poor = mRS ? 2 or death) using sex, age, acuteness, and etiology of SDH as predictive factors. It was established that the following three factors made a significant contribution to the outcome: age (p = 0.004), acuteness (p < 0.001), and etiology of a hematoma (p = 0.023), with acuteness being the strongest predictive factor. Sex was not a significant predictor, while age under 70 years and spontaneous origin of SDH were associated with lower mRS scores and had a positive effect on recovery chances. Conclusion. Age, acuteness, and etiology of hematoma are important predictive factors that influence the short-term clinical outcome in patients with SDH. These parameters should be taken into account when giving prognosis for recovery chances to a patient?s family and relatives.

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P1908Left common pulmonary vein in atrial fibrillation ablation with cryoballoon. A meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0655 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Gionti ◽

M C Negro ◽

M Longobardi ◽

C Storti

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Pulmonary Vein ◽

Meta Analysis ◽

Cochrane Library ◽

Cryoballoon Ablation ◽

Inclusion Criteria ◽

Af Ablation ◽

The Impact ◽

Common Pulmonary Vein

Abstract Background Conflicting results regarding the impact of left common pulmonary (LCPV) vein on clinical outcome of atrial fibrillation (AF) ablation with cryoballoon technology have been reported. In the present study, we sought to investigate the performance of the 28 mm cryoballoon advance (CB-A) on left common pulmonary vein (LCPV) in terms of post procedural outcome. Methods We systematically searched on PubMed and Cochrane library for the articles that compared the recurrence rate of AF after cryoballoon ablation between patients with four separate and distinct pulmonary vein ostia and with LCPV. Results A total of 5 studies with 1052 patients met our predefined inclusion criteria. Recurrence of AF after CB-A ablation was similar in both groups (Log OR 0.45; 95% CI: −0.03, 0.94; I=48%, p=0.08), Fig 1. Figure 1 Conclusion LCPV doesn't affect clinical outcome of AF ablation with cryoballoon technology.

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Abstract WMP6: Stenting Placement During Endovascular Treatment in VBAO Was Not Associated With 90-Day Outcome in the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) Trial

Stroke ◽

10.1161/str.51.suppl_1.wmp6 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Qiliang Dai ◽

Gelin Xu ◽

Xinfeng Liu ◽

Raul Nogueira

Keyword(s):

Logistic Regression ◽

Endovascular Treatment ◽

Artery Occlusion ◽

Favorable Outcome ◽

Basilar Artery Occlusion ◽

Intracranial Stenting ◽

Safety Outcome ◽

Vertebrobasilar Artery ◽

Standard Medical Treatment ◽

The Impact

Background: The impact of intracranial stenting placement during endovascular treatment for acute vertebrobasilar artery occlusion (VBAO) remains elusive. We aim to investigate the influence of intracranial stenting on 90-day outcomes in the BEST trial. Methods: All patients who underwent endovascular treatment in BEST trial were included in the analysis. The primary efficacy and safety outcome measures were the 90-day rate of favorable outcome (mRS 0-3) and mortality, respectively. Logistic regression was used to investigate the association between stenting placement and outcome. Results: All 77 patients who received endovascular treatment in the trial were included (e.g. full As-Treated population). Baseline and procedural characteristics are summarized in Table 1 . Stenting was performed in 26% (20/77) of the patients. Favorable outcome was achieved in 46.8% patients and mortality rate was 29.9%. Multivariable logistic regression showed that stenting placement in VBAO was not a predictor of either 90-day favorable outcome (adjusted OR, 0.91; 95% CI, 0.31 to 2.65, p=0.86) or 90-day mortality (adjusted OR, 0.91; 95% CI, 0.28 to 3.00, p=0.88). Conclusion: Stenting placement in VBAO during endovascular treatment did not impact outcomes in the BEST trial. Our data suggest that stent placement is a reasonable option for selected VBAO patients. Table 1: Baseline Characteristics and Outcomes Measures in as-treated population.

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The Impact of Group Prenatal Care on Interpregnancy Interval

American Journal of Perinatology ◽

10.1055/s-0041-1739413 ◽

2021 ◽

Author(s):

Justine M. Keller ◽

Jessica A. Norton ◽

Fan Zhang ◽

Rachel Paul ◽

Tessa Madden ◽

...

Keyword(s):

Logistic Regression ◽

Prenatal Care ◽

Maternal Education ◽

Stepwise Logistic Regression ◽

Group Prenatal Care ◽

Interpregnancy Interval ◽

Inclusion Criteria ◽

Postpartum Contraception ◽

Infant Birth ◽

The Impact

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

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Endovascular therapy of wake-up strokes in the modern era of stent retriever thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011586 ◽

2015 ◽

Vol 8 (3) ◽

pp. 240-243 ◽

Cited By ~ 14

Author(s):

Maxim Mokin ◽

Peter Kan ◽

Sananthan Sivakanthan ◽

Erol Veznedaroglu ◽

Mandy J Binning ◽

...

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

First Generation ◽

Good Clinical Outcome ◽

Aspiration Thrombectomy ◽

Stent Retrievers ◽

Favorable Clinical Outcome ◽

Solitaire Fr ◽

Modern Era

BackgroundEndovascular treatment of wake-up strokes (WUS) has been previously described, mostly with the use of pharmacological thrombolysis or first generation thrombectomy devices.ObjectiveTo describe outcomes of WUS treated with modern endovascular therapy since the Food and Drug Administration approval of stent retrievers, and to identify predictors of good clinical outcome in this population of stroke patients.MethodsWe performed a multicenter retrospective analysis of consecutive patients with WUS who underwent thrombectomy with stent retrievers Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire FR (Covidien, Irvine, California, USA), or primary aspiration thrombectomy. We correlated favorable clinical outcomes with demographic, clinical, and technical characteristics.Results52 patients were included in this study; 46 (88%) cases were treated with stent retrievers and 6 (12%) were treated with primary aspiration thrombectomy alone. Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b/3) was achieved in 36 (69%) patients. Favorable clinical outcome at 3 months, defined as a modified Rankin Scale score of 0–2, was achieved in 25 (48%) patients. Duration of intervention <30 min and its success, defined as TICI 2b/3 recanalization, were strong predictors of favorable clinical outcome at 90 days (p<0.001 and p<0.0001, respectively).ConclusionsOur study indicates that endovascular treatment of WUS with stent retrievers and aspiration thrombectomy is safe and effective.

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The influence of paramedic qualification level on the administration of analgesia in the prehospital setting

Irish Journal of Paramedicine ◽

10.32378/ijp.v4i2.187 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Bill Lord ◽

Toby Keene ◽

Cassie Luck

Keyword(s):

Logistic Regression ◽

Predictor Variables ◽

Future Research ◽

Sample Population ◽

Practice Setting ◽

Patient Records ◽

Inclusion Criteria ◽

Chi Square ◽

Chi Square Test ◽

The Impact

BackgroundUndertreatment of pain has been reported in the paramedic literature, and reasons for these disparities are not well understood.AimsAs the qualification level of the paramedic may affect analgesia administration, the primary aim of this study was to determine the impact of paramedic qualification on the provision of any analgesia for patients reporting pain.MethodsRetrospective study of de-identified patient care records from one Australian ambulance service over a period of 6 months. Inclusion criteria were age was > 17 years, initial pain severity score was > 3/10 and Glasgow Coma Score >13. Data were descriptively analysed for analgesia administration and type of analgesic by predictor variables: age, sex, pain score and case nature. Pearson’s chi-square test was used to test for associations between the outcome of interest and predictor variables. Adjusted logged odds of patients receiving analgesia was tested with binomial logistic regression.Findings3173 patient records met the inclusion criteria. ICP treated 86% of the sample population. Of those treated by an AP, 76.2% (n=340) received analgesia, whereas 71.6% (n=1952) of patients treated by an ICP received analgesia (p=0.042). Methoxyflurane was the most frequently administered analgesic, with 39.9% of the patients (n=1,264) receiving this agent; 31.1% of patients (n=988) received morphine, and 14.2% (n=452) received fentanyl. The unadjusted regression model found that AP have higher odds of administering analgesia than ICP paramedics (OR 1.264, p <0.05). However, once other covariates are included in the logistic regression, the significance no longer exists.ConclusionParamedic qualification is not associated with the administration of analgesia in this setting. This study contributes to the gap in knowledge regarding disparities in analgesia for adults experiencing pain and may inform future research that aims to identify and reduce barriers to appropriate pain management in the paramedic practice setting.

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Abstract WP92: Risk Factors for Thrombotic Events in the Endovascular Treatment of Ruptured Cerebral Aneurysms

Stroke ◽

10.1161/str.48.suppl_1.wp92 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ali Sultan-Qurraie ◽

Adam de Havenon ◽

John Lynch ◽

David Tirschwell ◽

Marc Lazzaro ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

Regression Models ◽

Platelet Transfusion ◽

Endovascular Aneurysm Repair ◽

The United States ◽

Active Smoking ◽

Logistic Regression Models

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries a high risk of morbidity and mortality. Endovascular coiling is an effective treatment option for ruptured aneurysms and offers certain advantages over microsurgical clipping. Thromboembolism is a known complication of endovascular therapy, but little has been reported regarding its causes. We hypothesized that platelet transfusion (PT) is a risk factor for thrombotic events (TE) during endovascular therapy. Methods: We retrospectively evaluated 84 patients presenting with aSAH to a Comprehensive Stroke Center in the United States between 2011 and 2015 who underwent endovascular treatment. In addition to TE related to endovascular aneurysm repair, charts were reviewed for variables including length of hospitalization, 3-month modified Rankin Scale (mRS), and smoking. Intergroup differences were evaluated with a Chi-squared and Student’s t-test. Logistic regression models were also fitted to the outcome of TE. Results: Patient demographics and clinical variables are seen in Table 1. 23% of patients incurred TE. Platelet transfusion was more common in patients with TE, but this association was not statistically significant in the logistic regression models (Table 2). In the adjusted model, active smoking and procedure length remained significantly associated with TE. Conclusion: To our knowledge, risk factors for thrombotic events in the setting of endovascular cerebral aneurysm treatment have not been previously reported. Procedure length and active smoking are associated with TE, and PT has a trend towards significance. After adjusting for potential confounders, active smoking remains the best predictor of TE (p=0.004), conferring an 11-fold risk.

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