Abstract WP12: Impact of the Introduction of Endovascular Treatment on Acute Ischemic Stroke Therapy in a Rural Broad Region in Japan

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Taichiro Imahori
Keyword(s):  
Ischemic Stroke ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Group 2 ◽  
Revascularization Therapy ◽  
Standard Medical Treatment ◽  
Iv Tpa ◽  
Broad Region ◽  
Group 1

Background: Endovascular treatment (EVT) has been proven to be effective for selected patients with acute ischemic stroke (AIS). We evaluated the effect of the introduction of EVT on outcome of AIS therapy in a rural broad region in Japan, covering an area within a radius of 80km by air ambulance. Methods: Between January 2014 and July 2016, 210 consecutive patients with acute large vessel occlusion (189 patients in the anterior circulation and 21 in the posterior circulation) admitted to our institute were analyzed. EVT was introduced into the AIS therapy at our institute in April 2015. We compared the outcome of the patients during the period before (group 1: standard medical treatment including intravenous [IV] tPA) and after (group 2: standard medical treatment including IV tPA with or without EVT) the introduction of EVT. Results: In the group 1, all 87 patients (median age, 81 years; NIHSS, 20; ASPECTS, 8; onset to door, 237min; IV tPA 24%) were treated medically (Table 1). In the group 2, among 123 patients (age, 82 years; NIHSS, 20; ASPECTS, 8; onset to door, 149min; IV tPA 16%), 47 patients were treated medically, and the remaining 76 patients underwent EVT (TICI 2b or 3, 84%). Although the median transfer distance increased (23km in the group 1 vs 30km in the group 2, p=0.028), the median time from call to admission was equivalent (42min vs 43min, p=0.93) because of the increase in the proportion of the helicopter transfer (30% vs 41%, p=0.14). The rates of patients who underwent revascularization therapy with IV tPA or EVT (24% vs 66%, p<0.001) and good outcome (mRS 0 to 2) at discharge (11% vs 24%, p=0.021) increased significantly after the introduction of EVT approach. Conclusions: Our study showed that the introduction of EVT improved the outcome of the AIS therapy with significant increase in the number of patients receiving revascularization therapy. EVT in collaboration with air ambulance might expand the target area for revascularization therapy in a rural broad region.

scholarly journals Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system

2020 ◽  
Vol 4 (9) ◽  
pp. 539-543
Author(s):  
D.T. Chipova ◽  
◽  
L.V. Santikova ◽  
A.Ch. Zhemukhov ◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Inflammatory Markers ◽  
Internal Carotid ◽  
Fatal Outcome ◽  
Group 2 ◽  
Group 1

Aim: to study the stroke-associated pneumonia (SAP) effect on the outcome of ischemic stroke (IS) in the internal carotid artery system. Patients and Methods: 87 patients with IS underwent the follow-up study, of which 75 had no inflammatory bronchopulmonary complications (group 1), and 12 had pneumonia manifestation (group 2). The study was performed on days 1, 5, and 9 after IS, and 6 months and 12 months after discharge from the hospital. Neurological deficit severity (NIHSS, Barthel index) and inflammatory markers (peripheral blood leukocyte composition, C-reactive protein (CRP), ESR) were studied. Results: it was found that the presence of SAP was associated with increased mortality during the acute IS period (4 (33.1%) patients died in group 1 and 10 (13.3%) — in group 2, p<0.05), greater severity of neurological deficits (63.3±5.3 and 71.5±4.0 points on the NIHSS scale, respectively, p<0.05) and incapacitation (Barthel index — 63.3±5.3 and 71.5±4.0 points, respectively, p<0.05) at the end of the inpatient treatment period. In group 2, signs of an inflammatory response were detected on day 5, and the values of the white blood cell shift index, ESR and CRP significantly (p<0.05) differed from the initial values. During examination at 6 months and 12 months, there were no significant differences in these indicators between the groups. An association was established between the probability of SAP occurrence and the presence of swallowing disorders (r=0.672; p<0.05), the age of patients (r=0.572; p<0.05) and the presence of diabetes mellitus (r=0.522; p<0.05). The studied laboratory inflammatory markers allow us to timely assume the occurrence of pulmonary pathology. Conclusion: timely diagnosis and prevention of SAP can reduce the risk of fatal outcome, facilitate rehabilitation measures, and improve early IS outcomes. KEYWORDS: ischemic stroke, cardioembolic stroke, atherothrombotic stroke, complications, acute period, inflammatory markers, strokeassociated pneumonia, long-term outcomes. FOR CITATION: Chipova D.T., Santikova L.V., Zhemukhov A.Ch. Impact of stroke-associated pneumonia on the outcome of acute ischemic stroke in internal carotid artery system. Russian Medical Inquiry. 2020;4(9):539–543. DOI: 10.32364/2587-6821-2020-4-9-539-543.

Abstract 1: Antegrade Flow Across an Intracranial Occlusion Can be Reliably Assessed on Ct Perfusion Source Images and it Predicts Recanalization With Intravenous Tpa

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sachin Mishra ◽  
Muneer Eesa ◽  
Mohammed Almekhlafi ◽  
Emmad Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sensitivity And Specificity ◽  
Ct Perfusion ◽  
Large Vessel ◽  
Perfusion Study ◽  
Static Mode ◽  
Group 2 ◽  
Antegrade Flow ◽  
Group 1

Background: We aimed to see if antegrade flow observed on CT Perfusion Source Images (CTPSi) across an intracranial occlusion correlated with first run of DSA and predicted recanalization on DSA or repeat CTA. Methods: Patients with acute ischemic stroke and large vessel intracranial occlusion on CTA who had a CT Perfusion study followed by DSA or repeat CTA 4-6 hours later were included. CT Perfusion parameters were 8 cm coverage in static mode, acquisitions at 5 mm thickness, 5 seconds delay after contrast & 24 passes over 66 seconds. Antegrade flow was defined as the presence of ‘clot enhancement’ sign on the 1st pass of CTPSi and increasing density of contrast permeating the clot and filling the vessel distal to the occlusion on the 2nd and 3rd passes of CTPSi (Fig 1 & 2). This was correlated with the first run of DSA and recanalization was assessed on DSA (Group 1) or repeat CTA (Group 2). Results: Total 56 patients were included. In group 1(n=35), antegrade flow on CTPSI was present in 14/35 patients (40%). All these patients had antegrade flow on DSA and 12 of them showed early recanalization (TICI 2a, 2b or 3). IV t-PA was received by 29/35 patients. The sensitivity and specificity of CTPSi to predict antegrade flow when compared to DSA was 86.7% (95% CI, 59.5 - 98.3) and 95% (95% CI, 75.1 - 99.9) respectively. In Group 2 (n=21), antegrade flow was seen on CTPSI in 13 patients (62%) and all of them recanalized with IV t-PA. Six out of 8 patients without antegrade flow on CTPSi did not recanalize. Conclusion: Antegrade flow across an occlusion can be reliably assessed on initial passes of CTPSi and it predicts recanalization with IV t-PA.

Abstract TP39: Comparative Effectiveness of Endovascular Treatment for Acute Ischemic Stroke: A Population-Based Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Charlotte Zerna ◽  
Edwin Rogers ◽  
Doreen M Rabi ◽  
Andrew M Demchuk ◽  
Noreen Kamal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Population Based ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Population Based Study ◽  
Nihss Score

Background: A heterogeneous patient population receives endovascular treatment (EVT) for acute ischemic stroke due to proximal large vessel occlusion every day. We aimed to conduct a population-based study of EVT in the province of Alberta, Canada, to understand the effectiveness in a complete population and how the magnitude of effect differs from the artificial world of clinical trials. Methods and Results: Within a three year period (April 2015 - March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. Primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at pre-morbid living situation without increase in level of care within 90 days of index stroke event. Median age of patients was 70 years (interquartile range (IQR) 59 - 81) and 47.8% were female. Median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13 - 20). EVT was associated with an increased 90-day home-time by an average of 8.5 days compared to medical treatment alone using Cragg hurdle regression (p = 0.009). Age and higher NIHSS score were associated with decreased 90-day home-time (both p = 0.001). Multivariable logistic regression showed no association between EVT and mortality at 90 days (odds ratio 0.76, 95% confidence interval 0.47 - 1.24). Conclusions: EVT for acute ischemic stroke due to proximal large vessel occlusion was effective in our province-wide population-based study and results in increased 90-day home-time by ~8.5 days. Home-time is a novel and patient-centered outcome that reflects health circumstances that are easy to understand and meaningful to patients and their caregivers.

scholarly journals Routine CT Angiography in Acute Stroke Does Not Delay Thrombolytic Therapy

2012 ◽  
Vol 39 (4) ◽  
pp. 499-501 ◽  
Author(s):  
Simerpreet Bal ◽  
Bijoy K. Menon ◽  
Andrew M. Demchuk ◽  
Michael D. Hill ◽  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Linear Regression Analysis ◽  
Computed Tomographic Angiography ◽  
University Hospital ◽  
Computed Tomographic ◽  
Multivariable Linear Regression Analysis ◽  
Group 2 ◽  
Contrast Ct ◽  
Group 1

Introduction:Lack of additional utility over non-contract computed tomography (NCCT) in decision making and delay in door to needle time are arguments used against routine computed tomographic angiography (CTA) use in acute ischemic stroke management. We compare interval times during a CTA based acute ischemic stroke protocol with an earlier non-CTA based protocol at our center.Methods:We reviewed 850 stroke thrombolysis patients in a university hospital in Canada from April 1996 to December 2009. Time to treatment was divided into the following interval times: onset-to-door, door-to-needle and onset-to-needle. Patients were categorized into: Group 1 (April 1996-Dec 2002) (Non-contrast CT Scan based thrombolysis) n=297, Group 2 (Jan 2004-Dec 2009) (CTA based thrombolysis) n=504. The period from Jan to Dec 2003 (n=49) was considered a washout period as we had started the CTA protocol that year. Interval times were compared between the two groups.Results:Interval times in Group 1 and Group 2 were: median onset-to-door times in Group 1 [55 minutes (IQR 48),] and Group 2 [61 minutes (IQR 57)] (p=0.019); median door-to-needle times in Group 1 [67 minutes(IQR 43)] and Group 2 [62.5 minutes (IQR 52)] (p=0.519); median onset-to-needle times in Group 1 (139 minutes (IQR 73)] and Group 2 (141.5 min (IQR 109.5) (p=0.468). In multivariable linear regression analysis, age and onset-to-door time influenced the door-to-needle time. For every decade of age, door-to-needle times were 5.4 minutes faster.Conclusions:CTA based thrombolytic approach for acute ischemic stroke does not significantly delay thrombolysis in routine clinical practice.

Abstract T P382: Urgent Primary Care Physician Follow up is Associated with Reduced Stroke Readmission after Acute Ischemic Stroke Hospitalization

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
William Neil ◽  
Jane Rosete ◽  
Jennifer Seibel ◽  
David Buccigrossi ◽  
Kerry Forde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hospital Readmission ◽  
Care Physician ◽  
Stroke Patients ◽  
Group 2 ◽  
Group 1

Introduction: Readmission after acute ischemic stroke is common and costly, with an average rate of 14.8% within 30 days of discharge1. In 2010, as part of a hospital performance improvement strategy, ischemic stroke patients who were discharged to home had an urgent (within 7 days) appointment with Primary Care Physician (PCP) scheduled. We compared 30-day readmission rates for those who kept and did not keep their appointment. Methods: Data from an electronic medical record system was retrospectively evaluated. The cohort included all patients with hospital admission for ICD 9 diagnosis of ischemic stroke (433, 434, 435) during the years 2010 - 2013. Only those with a discharge disposition of home were included. Group 1 included patients discharged to home who kept follow up appointment. Group 2 included those who did not keep their scheduled appointment. Significant predictors of readmission such as age, heart failure, diabetes, LACE score were compared. Fisher’s Exact test was used for categorical variables. Results: A total of 349 ischemic stroke patients were discharged to home during the study period. Of these, 250 had appointments scheduled, and 167 (66.8%) kept these appointments (Group 1). The average age was 69.2 and 68.3 with average LACE of 9.7 and 9.5 for groups 1 and 2 respectively. There was no significant difference in rates of diabetes or heart failure between groups. There were 7 (3.6%) readmissions in group 1 and 19 of 83 (22.9%) in group 2. Five patients were readmitted prior to appointment time in group 2, so were not entered into final calculation; this left readmission rate of 14/83 (16%); p =0.004. Conclusion: Urgent follow up with PCP may prevent hospital readmission in those with mild strokes. Reverse causation, from missing appointment due to hospital readmission did not account for these results. Although NIHSS was not compared, our cohort consisted of those with mild symptoms, given home disposition. Further study is needed to determine which elements of the PCP follow up visit are most effective in reducing hospital readmission. Reference: 1. Lichtman, JH. Leifheit-Limson, EC. Predictors of Hospital Readmission after Stroke: A Systematic Review Stroke. 2010; 41(11): 2525-2533.

Abstract WP29: Temporal Trends of Intravenous Recombinant Tissue Plasminogen Activator Infusion and Endovascular Treatment for Acute Ischemic Stroke in Japan: J-ASPECT Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ai Kurogi ◽  
Daisuke Onozuka ◽  
Akihito Hagihara ◽  
Akiko Kada ◽  
Kunihiro Nishimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Recombinant Tissue Plasminogen Activator ◽  
Treatment Groups ◽  
Poor Outcome ◽  
Using Data

Objective: This study aimed to investigate recent nationwide trends in the epidemiology of acute ischemic stroke (AIS) in Japan. Methods: We analyzed 328,147 acute ischemic stroke patients in 350 certified training hospitals in Japan using data obtained from the Japanese Diagnosis Procedure Combination Database. Data between the period April 1, 2010 and May 31, 2014 were used. We divided patients into three treatment groups: medical treatment only (group M), intravenous t-PA infusion only (group IVT), and endovascular treatment (group ET). Outcome was assessed by in-hospital mortality and modified Rankin Scale (mRS) score at discharge, and poor outcome was defined as a mRS score of 3-6. Results: The patient proportion in groups M, IVT, and ET changed from 94.3%, 3.2%, and 1.6% in 2010 to 90.9%, 4.3%, and 3.7% in 2014, respectively (P<0.0001). In all AIS patients, in-hospital mortality significantly decreased from 6.5% in 2010 to 5.3% in 2014 (p<0.0001) and poor outcome at discharge also decreased from 42.7% in 2010 to 41.6% in 2014 (p<0.0001). In groups M and IVT, in-hospital mortality significantly decreased from 6.3% and 12.0% in 2010 to 5.0% and 9.1% in 2014, respectively (p<0.0001), and poor outcome at discharge also decreased from 42.1% and 60.7% in 2010 to 40.7% (P<0.0001) and 55.4% (p<0.005) in 2014, respectively. In contrast, in group ET, both in-hospital mortality (from 11% in 2010 to 9.5% in 2014) and poor outcome at discharge (from 53.4% in 2010 to 54.0% in 2014) were not significantly different between the two time points. Conclusion: In Japan, during the 5-year period before the guidelines concerning proper use of ET for AIS were revised in 2015, a significant improvement in in-hospital mortality and functional outcomes of AIS patients undergoing medical treatment and intravenous rt-PA infusion was observed. This was probably due to a gradual increase in the proportion of patients undergoing IVT; the outcomes of ET, however, remained the same.

scholarly journals The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke

2019 ◽  
Vol 8 (2) ◽  
pp. 190 ◽  
Author(s):  
Pei-Hsun Sung ◽  
Kuan-Hung Chen ◽  
Hung-Sheng Lin ◽  
Chi-Hsiang Chu ◽  
John Chiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mitral Regurgitation ◽  
Acute Ischemic Stroke ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valvular Regurgitation ◽  
P Values ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

Despite left ventricular (LV) dysfunction increases the risk of incidental acute ischemic stroke (AIS), the association between LV function and severity of neurological deficits after AIS remains unclear. Between November 2015 and October 1017, a total of 99 AIS patients were prospectively enrolled and categorized into two groups based on National Institute of Health Stroke Scale (NIHSS). The AIS patients with NIHSS <6 were allocated into Group 1 (n = 50) and those with NIHSS ≥6 were into Group 2 (n = 49). Echocardiography was performed within 5 days after AIS to assess chamber size, left ventricular ejection fraction (LVEF) and valvular regurgitation. Besides, two inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were evaluated on admission. The results showed Group 2 had significantly higher value of NLR and PLR (all p-values < 0.01) but lower LVEF (p = 0.001) and frequency of mitral regurgitation (p = 0.021) than Group 1. The NIHSS and modified Rankin scale were significantly negatively correlated with LVEF, whereas both were significantly positively correlated with NLR and PLR (all p-values < 0.02). Multivariate analysis showed LVEF <65%, aging and inflammation were significantly associated with NIHSS ≥6 (all p-values < 0.01). In conclusion, the AIS patients with NIHSS ≥6 had lower LVEF but more clinically dominant mitral regurgitation and higher NLR and PLR compared to those with NIHSS <6.

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