Abstract 132: Final Infarct Volume is a Critical Determinant of Hospitalization Cost in Anterior Circulation Large Vessel Occlusion Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher Streib ◽  
Srikant Rangaraju ◽  
Daniel G Winger ◽  
David T Campbell ◽  
Stephanie Paolini ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Cost Effective ◽  
Large Vessel ◽  
Sensitivity Analyses ◽  
Large Vessel Occlusion ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Critical Determinant ◽  
Hospitalization Cost

Background: Anterior circulation large vessel occlusion (ACLVO) stroke, one of the most devastating stroke subtypes, is associated with substantial economic burden. Identifying predictors of increased ACLVO stroke hospitalization cost is essential to developing cost-effective treatment strategies. Methods: We utilized comprehensive patient-level cost-tracking software to calculate hospitalization costs for ACLVO stroke patients at our institution between July 2012-October 2014. Patient demographics and neuroimaging findings were analyzed. Predictors of hospitalization cost were determined using multivariable linear regression. In addition to our primary analysis (all eligible ACLVO patients), we conducted subgroup analyses by treatment (endovascular, IV tPA-only, and no reperfusion therapy) and sensitivity analyses. Results: 341 patients (median age 69 [IQR 57-80], median NIHSS 16 [IQR 13-21], median hospitalization cost $16,446 [IQR $9823-$27,165]) were included in our primary analysis; final infarct volume (FIV), parenchymal hematoma, age, obstructive sleep apnea, and baseline NIHSS were significant predictors of hospitalization cost (Figure). FIV alone accounted for 20.51% of the total variance in hospitalization cost. Notably, FIV was consistently the most robust predictor of increased cost across primary, subgroup, and sensitivity analyses. Over the observed range of FIVs in our cohort, each additional 1cc of infarcted brain tissue increased hospitalization cost by $122.35. Conclusion: FIV is a critical determinant of increased hospitalization cost in ACLVO stroke. Therapies resulting in reduced FIV may not only improve clinical outcomes, but prove cost-effective.

Abstract 31: Penumbra Consumption Rates Based on T Max Delay and Reperfusion Status: A Post-Hoc Analysis of the Defuse-3 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eytan Raz ◽  
Seena Dehkharghani ◽  
Howard Riina ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Secondary Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Consumption Rates ◽  
Definition Of ◽  
Post Hoc ◽  
New Generation

Introduction: In patients with acute large vessel occlusion, the definition of penumbral tissue based on T max delay perfusion imaging is not well established in relation to late-window endovascular thrombectomy (EVT). In this study, we sought to evaluate penumbra consumption rates for T max delays in patients treated between 6 and 16 hours from last known normal. Methods: This is a secondary analysis of the DEFUSE-3 trial, which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6-16 hours of last known normal. The primary outcome is percentage penumbra consumption defined as (24 hour infarct volume-core infarct volume)/(Tmax volume-baseline core volume). We stratified the cohort into 4 categories (untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates. Results: We included 143 patients, of which 66 were untreated, 16 had TICI 0-2a, 46 had TICI 2b, and 15 had TICI 3. In untreated patients, a median (IQR) of 48% (21% - 85%) of penumbral tissue was consumed based on Tmax6 as opposed to 160.6% (51% - 455.2%) of penumbral tissue based on Tmax10. On the contrary, in patients achieving TICI 3 reperfusion, a median (IQR) of 5.3% (1.1% - 14.6%) of penumbral tissue was consumed based on Tmax6 and 25.7% (3.2% - 72.1%) of penumbral tissue based on Tmax10. Conclusion: Contrary to prior studies, we show that at least 75% of penumbral tissue with Tmax > 10 sec delay can be salvaged with successful reperfusion and new generation devices. In untreated patients, since infarct expansion can occur beyond 24 hours, future studies with delayed brain imaging are needed to determine the optimal T max delay threshold that defines penumbral tissue in patients with proximal anterior circulation large vessel occlusion.

Abstract TP74: Aspects Scoring Applied to CTA Source Images is Predictive of Final Infarct Volume and Good Functional Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joseph F Carrera ◽  
Joseph H Donahue ◽  
Prem P Batchala ◽  
Andrew M Southerland ◽  
Bradford B Worrall
Keyword(s):  
Linear Regression ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Univariate Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
The Impact

Introduction: CTP and MRI are increasingly used to assess endovascular thrombectomy (EVT) candidacy in large vessel occlusion stroke. Unfortunately, availability of these advanced neuroimaging techniques is not widespread and this can lead to over-triage to EVT-capable centers. Hypothesis: ASPECTS scoring applied to computed tomography angiography source images (CTA-SI) will be predictive of final infarct volume (FIV) and functional outcome. Methods: We reviewed data from consecutive patients undergoing EVT at our institution for anterior circulation occlusion between 01/14 - 01/19. We recorded demographics, comorbidities, NIHSS, treatment time parameters, and outcomes as defined by mRS (0-2 = good outcome). Cerebrovascular images were assessed by outcome-blinded raters and collateral score, TICI score, FIV, and both CT and CTA-SI ASPECTS scores were noted. Patients were grouped by ASPECTS score into low (0-4), intermediate (5-7), and high (8-10) for some analyses. FIV was predicted using a linear regression with NIHSS, good reperfusion (TICI 2b/3), collateral score, CT to groin puncture, CT and CTA-SI ASPECTS as independent variables. After excluding those with baseline mRS≥2, a binary logistic regression was performed including covariates of age, NIHSS, good reperfusion, and diabetes (factors significant at p<0.05 on univariate analysis) to assess the impact of CTA-SI ASPECTS group on outcome. Results: Analysis included 137 patients for FIV and 102 for outcome analysis (35 excluded for baseline mRS≥ 2). Linear regression found CTA-SI ASPECTS (Beta -10.8, p=0.002), collateral score (Beta -42.9, p=0.001) and good reperfusion (Beta 72.605, p=0.000) were independent predictors of FIV. Relative to the low CTA-SI ASPECTS group, the high CTA-SI ASPECTS group was more likely to have good outcome (OR 3.75 [95% CI 1.05-13.3]; p=0.41). CT ASPECTS was not predictive of FIV or good outcome. Outcomes: In those undergoing EVT for anterior circulation occlusion, CTA-SI ASPECTS is predictive of both FIV and functional outcome, while CT ASPECTS predicts neither. CTA-SI ASPECTS holds promise as a lower-cost, more widely available option for triage of patients with large vessel occlusion. Further study is needed comparing CTA-SI ASPECTS to CTP parameters.

scholarly journals Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study

2017 ◽  
Vol 10 (6) ◽  
pp. 525-529 ◽  
Author(s):  
Amélie Carolina Hesse ◽  
Daniel Behme ◽  
André Kemmling ◽  
Antonia Zapf ◽  
Nils Große Hokamp ◽  
...  
Keyword(s):  
High Volume ◽  
Stent Retriever ◽  
Large Vessel ◽  
Combined Approach ◽  
Large Vessel Occlusion ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
First Pass

Background and purposeThrombectomy has become the standard of care for acute ischaemic stroke due to large vessel occlusion. Aim of this study was to compare the radiological outcomes and time metrics of the various thrombectomy techniques.MethodsIn this retrospective, multicenter study we analysed the data of 450 patients with occlusion of the anterior circulation, treated in five high-volume center from 2013 to 2016. The treatment techniques were divided in three categories: first-pass use of a large-bore aspiration-catheter; first-pass use of a stent-retriever; and primary combined approach (PCA) of an aspiration-catheter and stent-retriever. Primary endpoints were successful reperfusion and groin to reperfusion time. Secondary endpoints were the number of attempts and occurrence of emboli in new territory (ENT). The primary analysis was based on the intention to treat groups (ITT).ResultsThe ITT-analysis showed significantly higher reperfusion rates, with 86% of successful reperfusion in the PCA-group compared with 73% in the aspiration group and 65% in the stent-retriever group. There was no significant difference in groin to reperfusion time regarding the used technique. The secondary analysis showed an impact of the technique on the number of attempts and the occurrence of ENTs. Lowest ENT rates and attempts were reported with the combined approach.ConclusionsThe combined first-pass deployment of a stent-retriever and an aspiration-catheter was the most effective technique for reperfusion of anterior circulation large vessel occlusion. Our results correlate with the latest single-centrere studies, reporting very high reperfusion rates with PCA variations.

scholarly journals Infarct Volume Predicts Hospitalization Costs in Anterior Circulation Large-Vessel Occlusion Stroke

2018 ◽  
Vol 40 (1) ◽  
pp. 51-58 ◽  
Author(s):  
C.D. Streib ◽  
S. Rangaraju ◽  
D.T. Campbell ◽  
D.G. Winger ◽  
S.L. Paolini ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Hospitalization Costs

Abstract WP8: Minor Stroke With Large Vessel Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hazem Shoirah ◽  
Alhamza R Al-Bayati ◽  
Cynthia L Kenmuir ◽  
Amin Aghaebrahim ◽  
Tudor G Jovin ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Therapy Group ◽  
Large Vessel ◽  
Favorable Outcome ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Iv Tpa

Background and Rationale: Minor stroke symptoms (NIHSS </= 8) with large vessel occlusion (LVO) comprise an important population that has not been thoroughly studied in the recent intra-arterial therapy (IAT) trials. A subset of patients with mild symptoms may benefit from IAT. We attempt to characterize those patients. Methods: We retrospectively reviewed patients who presented with minor stroke symptoms and LVO between the years of 2002 and 2015. In our primary analysis, we divided patients who underwent IAT based on 90 day modified Rankin Scale (mRS) into favorable (mRS 0-2) vs unfavorable outcome (mRS >2). Using unpaired t-test, we compared demographics, comorbidities, NIHSS at presentation, use of IV tPA, stent retrievers, IAT within 8 hours from last known well and location of LVO. In our secondary analysis, we compared the two cohorts with matched patients who received tPA only without IAT. Results: Risk of complication of patients undergoing IAT was low (4%). The overall good outcome in patients undergoing IAT was 62.5%. Patients with favorable outcome tended to have anterior circulation occlusion (70% vs 41.6%, p = 0.03) and tandem occlusions (32.5% vs 8.3%, p = 0.03) with higher rates of TICI 2b/3 recanalization (90% vs 62.5%, p = 0.008). There was no difference in favorable outcome between patients who received IV tPA only vs IAT +/- IV tPA (68.5% vs 62.5%, p = 0.5). However, the medical therapy group had higher rates of distal occlusions (46% vs 17.2%, p = 0.001) and the IAT group had higher rates of vertebrobasilar occlusion (20.4% vs 40.6%, p = 0.02). Conclusion: This study highlights good safety profile in patients undergoing IAT for strokes with minor symptoms. Favorable outcomes were observed in patients with successful recanalization, anterior circulation occlusions and tandem lesions. A randomized clinical trial is warranted to investigate the benefit of IAT in patients with low NIHSS over medical therapy alone and our findings can assist in patient selection.

Abstract P513: Effect of Premorbid Antiplatelet Medication on Infarct Volume at 24 Hours After Late Window Presentation With Anterior Circulation Large Vessel Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Soren Christensen ◽  
Maarten G Lansberg ◽  
Michael Mlynash ◽  
Gregory W Albers ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Infarct Volume ◽  
Secondary Analysis ◽  
Large Vessel ◽  
Clot Lysis ◽  
Linear Regression Models ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Antiplatelet Medication

Introduction: We sought to evaluate the effect of premorbid antiplatelet medication on 24 hour infarct volume in late presenting patients with anterior circulation large vessel occlusion. Methods: This is a secondary analysis of the DEFUSE 3 trial. The primary outcome is infarct volume on a 24-hour MRI scan (volume of DWI positive tissue). The primary predictor is premorbid use of an antiplatelet medication. We fit linear regression models to 24-hour infarct volume and adjusted for admission infarct volume, age, sex, treatment arm, anticoagulant use, time from stroke onset to presentation, hypoperfusion intensity ratio, tPA administration, admission NIH Stroke Scale, glucose, and systolic blood pressure. In a sensitivity analysis, we included recanalization status in the model (no vs. partial vs. complete recanalization). All models had variance inflation factors <2, indicating acceptable multicollinearity. Results: We included 149 patients, of which 51 (34.2%) took premorbid antiplatelet medication. The mean±SD 24-hour infarct volume was 51.7±50.1 in antiplatelet versus 80.4±93.6 ml in control patients (p=0.04). In the adjusted regression model, taking an antiplatelet medication had a beta coefficient of -31.2 (95% CI, -55.0, -7.4; p=0.011). The other significant predictors of 24-hour infarct volume were admission glucose, baseline infarct volume, and HIR. In the sensitivity analysis with recanalization status in the model (n=132), premorbid antiplatelet use remained associated with 24-hour infarct volume (beta=-29.6, 95% CI -55.8, -3.4, p=0.027). Conclusion: For patients with late window anterior circulation large vessel occlusion stroke, premorbid use of an antiplatelet medication was associated with a ~30 mL smaller 24-hour infarct volume on MRI. Possible explanations for this finding include reduced clot burden, improved clot lysis, the anti-inflammatory effects of antiplatelet medications, or the results could be due to chance.

Abstract TP154: Infarct Volume and Prolonged Intubation are Critical Determinants of Inpatient Rehabilitation Cost in Anterior Circulation Large Vessel Occlusion Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher Streib ◽  
Srikant Rangaraju ◽  
Ashutosh Jadhav ◽  
Tudor Jovin
Keyword(s):  
Infarct Volume ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Inpatient Rehabilitation ◽  
Large Vessel ◽  
P Value ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion

Introduction: Anterior circulation large vessel occlusion (ACLVO) stroke is one of the most devastating stroke subtypes. Significant recent advances, including endovascular thrombectomy, have markedly improved ACLVO stroke outcomes. The economic burden of ACLVO stroke treatment is now an important consideration. Our study investigates the critical determinants of acute inpatient rehabilitation (AIR) cost in ACLVO stroke. Methods: We utilized comprehensive patient-level cost-tracking software to calculate AIR costs for ACLVO stroke patients at our institution between July 2012-October 2014. Cost was calculated from the hospital perspective. Patient demographics, clinical course, neurologic exam, and imaging findings were analyzed. Variables with p-value <0.20 in univariate analysis were included in multivariable analysis to determine significant predictors of AIR cost (p<0.05). Results: 65 patients were included in our analysis (median age 61 [IQR 54-73], median AIR admit NIHSS 12 [6-16]). Univariate analysis results are shown (Figure). In our multivariable analysis the only statistically significant predictors of AIR cost were the patient’s final infarct volume (p<0.001) and intubation >48 hours during the hospitalization (p=0.044). AIR costs increased by $66.46 for every 1 cubic centimeter increase in infarct volume. Conclusion: Infarct volume and intubation >48 hours were significant predictors of AIR cost in ACLVO stroke patients at our institution. ACLVO stroke interventions that limit infarct volume may decrease AIR costs, in addition to avoidance of intubation and aggressive pursuit of extubation when feasible.

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