Abstract TP64: Intravenous Thrombolysis in Chinese Patients with Mild Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiqi Chen ◽  
Yuesong Pan ◽  
Xingquan Zhao ◽  
Liping Liu ◽  
Hao Li ◽  
...  
Keyword(s):  
Conditional Logistic Regression ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Subtype ◽  
Stroke Registry ◽  
Good Outcome ◽  
Mild Stroke

Objectives: Thrombolysis treatment for patients with mild stroke is controversial. The aim of this study is to investigate whether patients with mild stroke or its specific etiologic subtype could benefit from recombinant tissue plasminogen activator (rt-PA) therapy. Methods: Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database and (2) the China National Stroke Registry database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype. Good functional outcome was defined as modified Rankin Scale 0-1 at 3 months. Odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated using conditional logistic regression in total patients and by etiologic subtype, respectively. Results: A total of 134 rt-PA treated patients were matched to 249 non-rt-PA treated patients in the study. Among them, 104 (76%) rt-PA-treated patients with mild stroke had good outcome after 3 months compared with 173 (69.5%) non-rt-PA-treated matching cases (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.91-2.43; P=0.12). Compared with non-rt-PA treatment group, rt-PA-treated patients had good outcome after 3 months in those with stroke subtype of large-artery atherosclerosis (LAA) (80.5% vs 65.1%; OR, 2.19; 95%CI, 1.14-4.21; P=0.02). Conclusions: For patients with mild stroke, intravenous rt-PA treatment may be effective. Patients with stroke subtype of LAA could benefit more from intravenous rt-PA treatment.

Abstract WMP61: Drip-and-Ship versus Front-Door Strategy of Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy; An Analysis From the Clinical Research Center for Stroke-5th division Registry in Korea

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hong-Kyun Park ◽  
Seong-Ho Park ◽  
Moon-Ku Han ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Standard Dose ◽  
Intravenous Thrombolysis ◽  
Estimating Equation ◽  
Bivariate Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Registry ◽  
Front Door

Background: The widespread use of drip-and-ship strategy in acute ischemic stroke (AIS) is confined by the safety concerns during transfer. However, recent development of endovascular therapy (EVT) might add the advantage of higher recanalization rate to this strategy. We evaluated the effectiveness and safety of drip-and-ship versus conventional (front-door) strategy of preceding intravenous thrombolysis (IVT) in large artery occlusion stroke patients receiving EVT. Method: From a prospective multicenter stroke registry (CRCS-5) database, we identified AIS patients treated with IVT and EVT within 8 h of onset and admitted to the 14 participating centers between 2008 and 2013. Safety outcomes were symptomatic intracranial hemorrhage (sICH), and 3-month mortality. Effectiveness outcome was a 3-month modified Rankin Scale (mRS) score. We performed multivariable logistic regression analysis using generalized estimating equation to estimate adjusted odds ratio (OR) and 95% confidence interval (CI) of the drip-and-ship versus the front-door. Results: Of 16929 AIS patients registered during 64 months, 480 were treated with IVT and EVT within 8 h, and 61 (13%) were categorized into drip-and-ship group. Mean onset to IVT and IVT to EVT times were 117±51 and 187±69 minutes in drip-and-ship strategy and 127±59 and 75±38 minutes in front-door strategy, respectively. Forty-eight drip-and-ship cases were matched to 146 front-door cases by age and initial NIH stroke scale (NIHSS). Compared to the front-door cases, the drip-and-ship cases were more likely to be a habitual smoker, and treated with standard dose alteplase. sICH developed in 5.5% of the front-door strategy and 10.4% of the drip-and-ship strategy (p=0.146). After adjustment for age, initial NIHSS, pre-stroke mRS score, and variables with p<0.1 from bivariate analysis, the ORs (95% CIs) of the drip-and-ship strategy were 2.48 (0.73 - 8.44) for sICH, 0.95 (0.50 - 1.81) for shift to lower score of 3-month mRS, and 1.15 (0.37 - 3.62) for 3-month mortality. Conclusion: The drip-and-ship strategy did not improve functional recovery at 3 months, and the safety issues might still exist in patients receiving EVT. However, there is a possible underestimation of initial stroke severity in drip and ship patients.

scholarly journals Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Ischemic Stroke with Minor Symptom

2021 ◽  
Vol 39 (1) ◽  
pp. 10-18
Author(s):  
Dae-Hyun Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Intravenous Thrombolysis ◽  
Treatment Decision ◽  
Recombinant Tissue Plasminogen Activator ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Mild Stroke

More than 50% of all patients with ischemic stroke initially present with mild symptoms. Despite the mild clinical presentation, a high percentage of these patients develop stroke progression with consequent disability, recurrent stroke, or death at follow-up. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours has been proven to be an effective treatment for acute ischemic stroke, but the risk-benefit ratio of this therapeutic approach remains still unclear in patients with mild stroke. Many patients with mild stroke are frequently excluded from thrombolysis. Large artery occlusion is an important predictor of early neurological deterioration or poor outcomes in patients with mild ischemic stroke. However, current guidelines do not recommend endovascular thrombectomy in patients with National Institutes of Health Stroke Scale score of <6 points. Some previous retrospective cohort studies have reported that endovascular thrombectomy showed promising results in cases of acute mild ischemic stroke with large vessel occlusion. Treatment decisions in patients with mild ischemic stroke should be individualized depending on clinical and radiological features. In this review, we discuss the prognosis of mild strokes, efficacy of intravenous thrombolysis and endovascular thrombectomy, and the role of neurovascular imaging in treatment decision making in this patient population.

Medication Adherence of Statin Users after Acute Ischemic Stroke

2018 ◽  
Vol 80 (1-2) ◽  
pp. 106-114 ◽  
Author(s):  
Pil-Wook Chung ◽  
Byung-Woo Yoon ◽  
Yeong-Bae Lee ◽  
Byoung-Soo Shin ◽  
Hahn Young Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Medication Adherence ◽  
Acute Ischemic Stroke ◽  
Multiple Logistic Regression Analysis ◽  
Statin Treatment ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Subtype ◽  
Modifiable Factors ◽  
Statin Adherence

Although statins are established therapy for the secondary prevention of ischemic stroke, factors associated with adherence to statin treatment following ischemic stroke are not well known. To address this, we assessed the 6-month statin adherence using 8-item Morisky Medication Adherence Scale-8 in patients with acute ischemic stroke. Of 991 patients, 65.6% were adherent to statin at 6-month after discharge. Multiple logistic regression analysis showed that patients’ awareness of hyperlipidemia (OR 1.62; 95% CI 1.07–2.43), large artery stroke subtype (versus non-large artery stroke, OR 1.79; 95% CI 1.19–2.68), and alcohol drinking habits (OR 1.64; 95% CI 1.06–2.53) were positively associated, while high statin dose (versus low dose, OR 0.6; 95% CI 0.40–0.90) and higher daily number of medication pills (OR 0.93; 95% CI 0.88–0.97) were found to have a negative association with self-reported good adherence to statin medication after acute ischemic stroke. However, stroke severity and diagnosis of hyperlipidemia were not associated with adherence. These results suggest that educational and motivational interventions may enhance statin adherence because modifiable factors were associated with statin adherence.

Characteristics and management of stroke in Korea: 2014–2018 data from Korean Stroke Registry

2019 ◽  
Vol 15 (6) ◽  
pp. 619-626 ◽  
Author(s):  
Han-Yeong Jeong ◽  
Keun-Hwa Jung ◽  
Heejung Mo ◽  
Chan-Hyuk Lee ◽  
Tae Jung Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Reperfusion Therapy ◽  
Lifestyle Changes ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Aging Populations ◽  
Care Patterns ◽  
Ischemic Attack

Background Lifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population. Aims We aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time. Methods This study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis. Results A total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060–1.131), p < 0.001). Conclusions This study provided analysis of nationwide, hospital-based, quality-controlled data from the Korean Stroke Registry database regarding changes in the characteristics, risk factors, and treatments of strokes in Korea.

scholarly journals Intravenous Thrombolysis Benefits Mild Stroke Patients With Large-Artery Atherosclerosis but No Tandem Steno-Occlusion

2020 ◽  
Vol 11 ◽  
Author(s):  
Dapeng Wang ◽  
Lulu Zhang ◽  
Xiaowei Hu ◽  
Juehua Zhu ◽  
Xiang Tang ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Large Artery ◽  
Stroke Patients ◽  
Mild Stroke

Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

2016 ◽  
Vol 9 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Yahia Lodi ◽  
Varun Reddy ◽  
Gorge Petro ◽  
Ashok Devasenapathy ◽  
Anas Hourani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Large Artery ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Nihss Score ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Background and purposeIn recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39–68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO.MethodsBased on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS).Results18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10–23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0–12), 1 (0–12), and 0 (0–4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%.ConclusionsOur study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

scholarly journals Intravenous Thrombolysis for Acute Mild Ischemic Stroke Patients: Higher ABCD2 Score Associated with Better Outcome

2019 ◽  
Author(s):  
Runnan Li ◽  
Chunyan Han ◽  
Xiuying Cai ◽  
Yan Kong ◽  
Lulu Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Final Diagnosis ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Duration Of Symptoms ◽  
Excellent Outcome ◽  
Abcd2 Score

Abstract Background: Up to 30% of patients with mild ischemic stroke suffer neurologic deterioration. However, optimal medical approaches of such patients remain controversial given the efficacy and safety of intravenous thrombolysis (IVT). The purpose of this study was to evaluate whether patients with acute mild stroke stratified with ABCD2 score (the risk of stroke on basis of age, blood pressure, clinical features, duration of symptoms, and presence of diabetes mellitus) could benefit from IVT. Methods: Among 3321 patients with a final diagnosis of acute ischemic stroke, we retrospectively included 224 patients identified with acute mild neurologic deficits (National Institution of Health Stroke Scale, NIHSS ≤5) treated with or without IVT. Odds ratios (OR) with their confidence intervals (CI) for outcomes between groups were assessed by using multivariable binary logistic regression analyses. And the heterogeneity of treatment effect magnitude for excellent outcome at 90d (modified Rankin Scale [mRS] 0-1) was estimated in different subgroups. Results: A total of 224 cases were enrolled, 106 receiving IVT and 118 treated with secondary stroke prevention strategies alone. At 7d, 30 (28.3%) patients with IVT treatment versus 16 (13.6%) patients not receiving IVT achieved significant improvement (≥4-point NIHSS score decrease or complete resolution; OR, 2.448; 95%CI, 1.204-4.977; P=0.013). At 90d, excellent outcome was achieved in 83 (78.3%) patients treated with IVT versus 77 (65.35%) patients without IVT treatment (OR, 3.156; 95%CI, 1.526-6.528; P=0.002), especially in those with ABCD2 score ≥5 (OR, 2.768; 95%CI, 1.196-6.406; P=0.017) and with stroke subtype of large artery atherosclerosis (OR, 5.616; 95%CI, 1.080-29.210; P=0.040). Besides, 7(6.6%) IVT-treated patients versus 2 (1.7%) non-IVT-treated patients developed intracranial hemorrhage (ICH; P=0.359), among these only 1 (0.9%) was symptomatic ICH in IVT group. Conclusions: For acute mild ischemic stroke patients, we reassured the safety and especially the efficacy of IVT at 7- and 90-days. Patients with 5 or more of ABCD2 score and stroke subtype of large artery atherosclerosis might benefit more from IVT.

Abstract 122: Quality of Care for Patients With Acute Ischemic Stroke as a Function of Hospital Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator Capability: Insights From China National Stroke Registry II

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Zhenzhen Rao ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yilong Wang ◽  
Yongjun Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Care Quality ◽  
Composite Score ◽  
Stroke Patients ◽  
Stroke Registry

Background: Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator (rt-PA) availability at Chinese hospitals varies and may affect care quality for acute ischemic stroke patients. Limited research has shown whether there were differences in quality of care at China National Stroke Registry (CNSR II) hospitals based on rt-PA capability. Methods: For acute ischemic stroke patients admitted to CNSR II hospitals between 2012 and 2013, care quality at hospitals with or without Intravenous rt-PA capability was examined by evaluating conformity with performance and quality measures. The primary outcome was guideline-concordant care, defined as compliance with 10 predefined individual guideline-recommended performance metrics and composite score. A composite score was defined as the total number of interventions actually performed among eligible patients divided by the total number of recommended interventions among eligible patients. Propensity score matching was used to balance the baseline characteristics. We used cox model with shared frailty model and logistic regression with generalized estimating equation to compare the relationship between hospitals with rt-PA capability and hospitals without rt-PA on quality measures. Results: This study included 19604 acute ischemic stroke patients admitted to 219 CNSR II hospitals. Before matching, there were 7928 patients admitted to 86 (40.4%) hospitals with rt-PA capability and 11676 patients admitted to 133 (59.6%) hospitals without rt-PA capability. After matching, 7606 pairs of patients in rt-PA-capable hospitals and rt-PA-incapable hospitals were analyzed. Before matching, the composite score of guideline-concordant process of care was higher at hospitals with rt-PA capability than hospitals without rt-PA capability (74% versus 73%, P=0.0126). Hospitals with rt-PA capability were more likely to perform deep vein thrombosis prophylaxis within 48 hours of admission, dysphagia screening, assessment or receiving of rehabilitation, discharge antithrombotic, anticoagulation for atrial fibrillation and medications for lowering low-density lipoprotein (LDL) ≥100mg/dL. But hospitals with rt-PA capability were less likely to perform antithrombotic medication within 48 hours of admission and hypoglycemic therapy at discharge for patients with diabetes. After matching, differences of stroke care quality between hospitals with rt-PA capability and without rt-PA capability still exist after adjusting covariates. Conclusions: The CNSR II hospitals were associated with better performance in some of the hospitals but not all of them. The difference in conformity between rt-PA-capable hospitals and rt-PA-incapable hospitals was modest for performance measures of stroke care. However, more room for improvement still exists in key quality performance measures and further studies should be explored.

scholarly journals Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Latha Ganti Stead ◽  
Rachel M. Gilmore ◽  
M. Fernanda Bellolio ◽  
Anunaya Jain ◽  
Alejandro A. Rabinstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Subtype ◽  
Academic Center ◽  
Ischemic Stroke Subtype ◽  
Study Population ◽  
Toast Criteria

Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence.Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality.Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center.Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year).Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity.

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