Abstract WP268: Evaluation and Validation of Prehospital Acute Stroke Severity Scale to Predict Large Vessel Occlusion in Patients with Proven Large Vessel Occlusion; Single Center Study in US

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Muhammad H Niazi ◽  
Mohammad El-Ghanem ◽  
Alicia Richardson ◽  
Kathy Morrison ◽  
Reichwein Raymond ◽  
...  
Keyword(s):  
Hospital Setting ◽  
High Sensitivity ◽  
Final Analysis ◽  
Large Vessel ◽  
P Value ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Single Center Study

Background: In 2015 guidelines regarding endovascular treatment (ET) of Large Vessel Occlusion (LVO) in acute ischemic stroke (AIS) were changed, leading to more patients being transferred to comprehensive stroke centers (CSC) for ET in selected patients, sometimes bypassing primary stroke centers. In the era of ET, there is a need for a simple yet sensitive pre-hospital tool to triage appropriate patients to CSCs. Many prehospital stroke scales predicting LVO are not in widespread clinical use because they are complex and not reliable. A recently published Denmark study demonstrated the PASS tool (Score range 0-3) for detecting LVO where a score of ≥2 was considered to be optimal in predicting LVO with sensitivity of 0.66. Methods: A retrospective analysis of AIS patients with confirmed anterior circulation LVO by catheter-based cerebral angiography between January 2015 and June 2016 was conducted. PASS scores were calculated and correlated with NIHSS to assess for severity of the stroke. Results: Fifty-four patients received ET during the study period. Those who had posterior circulation LVO were excluded, leaving 44 patients for final analysis. Only 5 (11.4%) patients had PASS score of <2 while 39 patients (88.6 %) had a score of ≥2 showing sensitivity of 0.89 for those patients with LVO. Average NIHSS scores were 11 (95% CI 6.6-15) for PASS <2 and 20 (95% CI 18.5-22.5) for PASS ≥2 (p value 0.005). Conclusion: The PASS tool is simple, quick, and easy to perform and has high sensitivity in AIS patients with LVO. To assess its value and efficacy in real time it should be implemented into EMS systems and be performed in the pre-hospital setting.

Abstract TP185: Impact of Age on Revascularization and Early Outcomes Post Mechanical Thrombectomy in Acute Ischemic Strokes with Large Vessel Occlusion; A Single Center Real World Data Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Muhammad H Niazi ◽  
Mohammad El-Ghanem ◽  
Kevin Cockroft ◽  
Kathy Morrison ◽  
Alicia Richardson ◽  
...  
Keyword(s):  
Final Analysis ◽  
Large Vessel ◽  
P Value ◽  
Randomized Control Trials ◽  
Large Vessel Occlusion ◽  
Real World Data ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Definitive Answer ◽  
Randomized Control

Background: Recently, five randomized control trials have demonstrated superiority of endovascular therapy (ET) to medical management in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO). Some concerns have arisen in subset and meta analyses of the pivotal trials regarding the negative effect of advanced age (>80 years) on outcomes after ET. Methods: A retrospective analysis of patients with proven LVO who underwent ET was conducted from January 2015 to June 2016. Patients were divided in two groups based on age (≤80 and >80 years) and were analyzed for degree of revascularization (TICI score) and functional status at discharge using the modified Rankin Scale (mRS). Results: Fifty-four patients received ET during the study period. Those who had posterior circulation LVO and/or treated after 6 hours from last known normal were excluded, leaving 34 patients for final analysis. Twenty-two (64%) patients were ≤80 and 12 (36%) were >80. Seventy-seven percent of patients ≤ 80 had favorable recanalization (TICI ≥ 2b) while 66 % of patients > 80 had TICI ≥ 2b ( p value 0.69). Of patients >80 years, 0 % had a mRS ≤2 at discharge versus 36.3% ≤80 years ( p value 0.03). Similarly, 25% of patients > 80 and 54.5% of ≤80 had mRS 3 or 4 ( p value 0.15). Only 9% of ≤ 80 had mRS >4, as compared to >80 at 75% ( p value <0.01). No statistically significant differences were found in the average time to revascularization, admitting NIHSS or administration of tPA. Conclusion: Age above 80 is a predictor of poor outcome after ET irrespective of successful recanalization. Our results confirm the questions raised in previous subset analyses. The reason octogenarians do poorly remains unclear, but our data suggests factors other than TICI score and time to revascularization. Although ET has shown superiority in AIS with LVO, further consideration and careful selection is recommended in patients above age of 80. More focused randomized control trials are needed to get a definitive answer.

Abstract WP13: Stroke Severity and Revascularization are the Strongest Predictors of Outcome in Large Vessel Occlusion Strokes: Post-Hoc Analysis of the TREVO 2 Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Helmi L Lutsep ◽  
Raul G Nogueira ◽  
Rishi Gupta ◽  
Tudor G Jovin ◽  
Gregory W Albers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Hemisphere ◽  
Symptom Onset ◽  
Univariate Analysis ◽  
Large Vessel ◽  
P Value ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Good Outcome

Introduction.: The Trevo Retriever showed higher recanalization rates and better outcomes than the Merci Retriever in patients with ischemic stroke due to large vessel occlusion (LVO) in TREVO 2. Hypothesis.: We assessed the hypothesis that except for device-related variables, predictors of good outcome would be similar in TREVO 2 and single arm Merci Retriever studies. Methods.: The study evaluated predictors of good outcome, modified Rankin Scale (mRS) 0-2 at 90 days, in TREVO 2 including those with ischemic stroke due to LVO aged 18-85 years with a National Institutes of Health Stroke Scale Score (NIHSS) 8-29 and a first device treatment pass within 8 hours of symptom onset. A secondary analysis investigated mortality predictors. Variables included baseline characteristics of age, sex, NIHSS, IV tPA use, occlusion side, most proximal occlusion site, stroke etiology, body mass index, systolic blood pressure (BP), diastolic BP, glucose; history including hypertension, diabetes, dyslipidemia, smoking, congestive heart failure (CHF), atrial fibrillation, previous coronary or cerebral ischemia; and procedural characteristics of time from symptom onset to arterial puncture, time to TICI ≥2 or end of procedure, device allocation, intubation status, rescue therapy usage and post device revascularization success TICI ≥ 2 per core lab. Variables were assessed with univariate analysis for association with mRS 0-2 and mortality and those with a p-value of <0.15 were eligible for the multivariate model. Results.: TREVO 2 data were available for 168 patients. Variables significant on multivariate analysis for an association with good outcome were baseline NIHSS (OR 0.76, 95% CI 0.67, 0.86), post device revascularization success per core lab (OR 117.6, 95% CI 8.40, 1645), diabetes (OR 0.12, 95% CI 0.03, 0.41), intubation (OR 0.11, 95% CI 0.03, 0.41) and left hemisphere involvement (OR 5.11, 95% CI 1.77, 14.71). Predictors of mortality included baseline NIHSS and left hemisphere involvement but also age and CHF. Conclusions.: While age did not appear as a predictor of good outcome and diabetes was negatively associated with it for the first time in a Merci analysis, predictors of favorable outcome in TREVO 2 were similar to those previously reported for the Merci Retriever.

scholarly journals Retrospective Validation of Prehospital Acute Stroke Severity Scale to Predict Large Vessel Occlusion in Acute Stroke Patients - Single Center study in China

2019 ◽  
Author(s):  
Xiaoli Si ◽  
Yuanjian Fang ◽  
Wenqing Xia ◽  
Tianwen Chen ◽  
Huan Huang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Predictive Value ◽  
Large Vessel ◽  
Motor Deficits ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Consciousness Disorder ◽  
Gaze Palsy

Abstract Background and Purpose - To date, identifying emergent large vessel occlusion (ELVO) patients in the prehospital stage is important but still challenging. We aimed to retrospectively validate a simple prehospital stroke scale——Prehospital Acute Stroke Severity (PASS) scale to identify ELVO. Methods - We retrospectively evaluated our consecutive cohort of acute ischemic stroke (AIS) who underwent CT angiography (CTA), MR angiography (MRA) or digital subtraction angiography (DSA). PASS scale was calculated based on National Institutes of Health Stroke Scale (NIHSS) items retrospectively. The comparison of diagnostic parameters between PASS scale and NIHSS scale were performed. Results - Finally, a total of 605 patients were enrolled. ELVO patients with PASS≥2 had a median NIHSS score of 14. The best predictive value of PASS≥2 showed a similar predictive value compared with NIHSS≥9. Cortical symptoms such as consciousness disorder and gaze palsy were more specific indicators for ELVO than motor deficits. Consciousness disorder was more serious in posterior circulation infarct (PIC) while gaze palsy was more common in anterior circulation infarct (AIC). Conclusions - PASS scale had both good discrimination and calibration in our retrospective cohort. It could reflect acute stroke severity well and predict ELVO in an effective and simple way. Moreover, cortical symptoms had high specificities to predict ELVO on their own.

Abstract TP251: Pomona Large Vessel Occlusion Scale for Pre-hospital and Emergency Room Settings

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kessarin Panichpisal ◽  
Nazli Janjua ◽  
Karen Tse-Chang ◽  
Kimberly.A.Jones A Jones ◽  
Katrina Woolfolk ◽  
...  
Keyword(s):  
Emergency Room ◽  
Acute Stroke ◽  
High Sensitivity ◽  
Screening Tools ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Historical Cohort ◽  
Lower Accuracy

Background: Early detection of acute stroke with large vessel occlusion (LVO) in both pre-hospital and emergency room settings results in favorable clinical outcomes. There is still no universal guideline for LVO screening. Method: We proposed that the presence of any of the following signs (Pomona scale): gaze deviation, expressive aphasia or neglect has a high sensitivity and accuracy to predict LVO. We reviewed a historical cohort of all acute stroke activation patients at Pomona Valley Hospital during February 2014 to January 2016. We tested Pomona scale in both groups. The predictive performance of Pomona scale was compared with different NIHSS cutoffs ( ≥4, ≥6, ≥8, ≥10), Los Angeles Motor Scale (LAMS), Cincinnati Prehospital Stroke Severity (CPSS) scale, Vision Aphasia and Neglect scale (VAN) and Prehospital Acute Stroke Severity (PASS) scale. Results: LVO was detected in 129 of the 777 acute stroke activation (17%). Two hundred and forty-two patients had nonLVO stroke (31%). NIHSS ≥4 and Pomona scale had highest sensitivity (0.99 and 0.98 respectively) to predict LVO. LAM scale had lowest sensitivity (0.68). Pomona scale had moderate accuracy (0.61) which was comparable with VAN (0.66) and PASS (0.67). NIHSS ≥4 had the least accuracy (0.28). When Pomona scale was combined with arm weakness, it had highest accuracy (0.77) and high sensitivity (0.92) to predict LVO in acute ischemic stroke subgroup. Using various NIHSS cut off to screen for LVO had lower accuracy than using other LVO screening tools. Conclusion: Pomona scale is very sensitive to predict LVO. It may be used as a screening tool for LVO in emergency room setting. Combination of arm weakness and Pomona scale may be used as a Pre-hospital LVO screening with moderately high accuracy.

scholarly journals P.135 Willisian collateral and cervical carotid stenosis during large vessel occlusion stroke: Observations from computed tomography angiography

2021 ◽  
Vol 48 (s3) ◽  
pp. S58-S58
Author(s):  
R Kiwan ◽  
S Lownie
Keyword(s):  
Ophthalmic Artery ◽  
Carotid Arteries ◽  
Large Vessel ◽  
Stroke Severity ◽  
Collateral Flow ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Point Increase ◽  
Ophthalmic Arteries

Background: The circle of Willis (CoW) and cervical carotid arteries are important sources of collateral flow during acute large vessel occlusion (LVO) in the anterior circulation. We examined the anatomical components of the circle and the cervical carotid arteries to determine relationship to acute stroke severity. Methods: Consecutive patients with acute LVO who underwent EVT were assessed. Measurements were made of the luminal diameters of 16 anatomical vascular components. Admission NIHSS, ASPECTS and mCTA collateral scores were statistically analyzed for any relationship to vascular measurements. Results: 100 patients were studied. No relationship was found between the collateral Willisian pathways and measures of stroke severity. However, the ophthalmic arteries exhibited a relationship to stroke severity. In adjusted analysis, 1-mm increases in the ipsilateral and contralateral ophthalmic artery diameter were independently associated with a 4.80-point decrease and a 6.31-point increase in the NIHSS scale, respectively. Similarly, a 1.53-point increase and a 2.62-point decrease in the ASPECTS. In the neck a majority showed 0-55% stenosis, with no stenosis between 55% and 95%, and 14% at 95% to 100%. Conclusions: Stroke severity and collateral during LVO is unrelated to Willisian collateral. Ophthalmic artery calibers are related. Acute progression of 55-95% stenoses to complete occlusion occurs in LVO stroke

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.

scholarly journals Progression of cerebral infarction before and after thrombectomy is modified by prehospital pathways

2021 ◽  
pp. neurintsurg-2020-017155
Author(s):  
Alexander M Kollikowski ◽  
Franziska Cattus ◽  
Julia Haag ◽  
Jörn Feick ◽  
Alexander G März ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Before And After ◽  
Transferred Patients ◽  
Stroke Center

BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001), resulting in lower ASPECTS at stroke center presentation (mothership 9 (7–10) vs drip and ship 7 (6–9), p<0.0001) and on follow-up imaging (mothership 7 (4–8) vs drip and ship 6 (3–7), p=0.001) compared with mothership patients. Infarct progression was significantly higher in transferred patients (points lost, mothership 2 (0–3) vs drip and ship 3 (2–6), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT.

scholarly journals Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hai-fei Jiang ◽  
Yi-qun Zhang ◽  
Jiang-xia Pang ◽  
Pei-ning Shao ◽  
Han-cheng Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Vessel ◽  
Susceptibility Weighted Imaging ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis

2021 ◽  
pp. 1-9
Author(s):  
Jong-Hoon Kim ◽  
Young-Jin Jung ◽  
Chul-Hoon Chang
Keyword(s):  
Functional Outcomes ◽  
Medical Center ◽  
Large Vessel ◽  
Intracranial Atherosclerosis ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stent Retrieval ◽  
First Pass ◽  
Solitaire Fr

OBJECTIVEThe optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.METHODSThe authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group.RESULTSA total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5–79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset–to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017).CONCLUSIONSThis study’s findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

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