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 Elevation of troponin I in acute ischemic stroke

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1866 ◽  
Author(s):  
Yu-Chin Su ◽  
Kuo-Feng Huang ◽  
Fu-Yi Yang ◽  
Shinn-Kuang Lin
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Troponin I ◽  
Clinical Deterioration ◽  
Stroke Severity ◽  
Nihss Score ◽  
Poor Outcome

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.

Abstract TP18: Endovascular Treatment in the Elderly with Acute Ischemic Stroke - Is it Safe in Clinical Practice?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Thabele M Leslie-Mazwi ◽  
Syed F Ali ◽  
Sanjeeva R Onteddu ◽  
Adewumi D Amole ◽  
Mehmet S Akdol ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
The Elderly ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Younger Patients

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

Elevated total homocysteine predicts in-hospital pneumonia and poor functional outcomes in acute ischemic stroke

2020 ◽  
Author(s):  
Shoujiang You ◽  
Lixuan Wang ◽  
Huaping Du ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Fold Increase ◽  
Short Term ◽  
Thcy Level ◽  
Poor Outcome ◽  
Total Homocysteine ◽  
The Impact

Abstract Background The impact of elevated total homocysteine (tHcy) on functional outcomes and pneumonia after acute ischemic stroke (AIS) is still not well understood. We investigated the association between tHcy levels upon hospital admission and in-hospital short-term outcomes in AIS patients. Methods A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into 4 groups according to their level of admission tHcy: Q1 (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results During hospitalization, 332 patients (15.9%) had pneumonia, 57 patients (2.7%) died from all causes and 784 (37.6%) patients experienced poor outcome at discharge. The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P -trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality(adjusted OR 3.35; 95% CI, 1.11–10.13; P -trend =0.015) and poor outcome upon discharge(adjusted OR 1.50; 95% CI, 1.06–2.12; P -trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Subgroup analyses further confirmed a significant association between higher tHcy levels and a high risk of short-term outcomes. Conclusions Having a high admission tHcy level was independently associated with in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge in AIS patients. Moreover, the association between higher tHcy and poor functional outcome was not modified by pneumonia.

scholarly journals A Score Based on Age and DWI Volume Predicts Poor Outcome following Endovascular Treatment for Acute Ischemic Stroke

2013 ◽  
Vol 10 (5) ◽  
pp. 705-709 ◽  
Author(s):  
John T. P. Liggins ◽  
Albert J. Yoo ◽  
Nishant K. Mishra ◽  
Hayley M. Wheeler ◽  
Matus Straka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Poor Outcome

Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA

2015 ◽  
Vol 8 (5) ◽  
pp. 457-460 ◽  
Author(s):  
Mark R Villwock ◽  
David J Padalino ◽  
Eric M Deshaies
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Temporal Trends ◽  
Rank Correlation ◽  
Binary Logistic Regression ◽  
Recombinant Tissue Plasminogen Activator ◽  
Therapeutic Benefit ◽  
Primary Diagnosis ◽  
Inhospital Mortality

Background and purposeMechanical thrombectomy (MT) for the treatment of acute ischemic stroke has been growing in popularity while the therapeutic benefit of MT has been increasingly debated. Our objective was to examine national trends in mortality following MT.MethodsWe analyzed the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2008–2011) for patients with a primary diagnosis of acute ischemic stroke that received MT. Temporal trends in mortality were examined using Spearman's rank correlation. To account for confounding factors, mortality was further analyzed in binary logistic regression.ResultsHospitals performing MT comprised 8% of all hospitals treating ischemic stroke. The percentage of stroke cases treated with MT increased from 0.6% of cases in 2008 to 1.1% in 2012, totaling 16 307 MT cases in a 5 year period. Inhospital mortality decreased over the study period from 25.4% in 2008 to 16.1% in 2012 (r=−0.081, p<0.001). This finding was supported by regression analysis as each incremental year reduced the odds of mortality by 20% (OR=0.832, p<0.001). Administration of recombinant tissue plasminogen activator was associated with a decrease in the odds of mortality (OR=0.805, p<0.001).ConclusionsUtilization of MT represents a small percentage of stroke cases, although the trend is increasing. Mortality following MT has been showing a steady decline over the past 5 years. This may be a result of a learning curve, improved patient selection, and/or device improvements. Randomized trials remain essential to evaluate the potential benefit of endovascular devices and identify the most appropriate patients.

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.

Abstract WP67: Ultra-early Institution of Statin Treatment is Associated With Improved Outcomes Among Acute Ischemic Stroke Patients Receiving Thrombolytic Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Ischemic Stroke ◽  
Activities Of Daily Living ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Daily Living ◽  
Recombinant Tissue Plasminogen Activator ◽  
Statin Treatment ◽  
Functional Independence ◽  
Stroke Patients ◽  
Statin Use

Background: There is preliminary evidence that early statin use may improve the outcomes of acute ischemic stroke patients following endovascular treatment. Methods: We analyzed data from subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment the Interventional Management of Stroke III trial. We compared the rates of functional independence (defined by modified Rankin scale of 0-2) and minimal impairment of activities of daily living (Barthel index at 90 days 95-100)at 3 and 12 months among subjects with ultra-early institution of statin treatment (on Day 0) with those in whom statin treatment was not initiated and in those in whom statins were initiated between Day 1-discharge (delayed institution)after adjusting for age and baseline National Institutes of Health Stroke Scale score strata, history of hyperlipidemia; and statin use at baseline Results: Of the 656 subjects who were recruited in the trial, ultra-early institution of statin treatment and delayed institution occurred in 51 and 387 subjects, respectively. At 3 months post randomization, the adjusted rates of independent functional outcome (odds ratio [OR] 2.3; 95 % confidence interval [CI] 1.2-4.5; P = 0.015) and minimal impairment of activities of daily living (OR 2.2; 95 % CI 1.1-4.3; P = 0.022) were higher among subjects with ultra-early institution of statin treatment compared with those without any statin treatment. The adjusted rates of functional independence (OR 2.7; 95 % CI 1.4-5.2; P = 0.004) continued to higher among subjects with ultra-early institution of statin treatment at 12 months post randomization. The adjusted rates of functional independence and minimal impairment of activities of daily living were higher among subjects with ultra-early institution of statin treatment compared with those without any statin treatment in subjects randomized to endovascular treatment. Conclusions: Ultra-early institution of statin treatment in acute ischemic stroke patients treated with IV rt-PA with or without endovascular treatment was associated with improved outcome at both 3 and 12 months

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.

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