Abstract WP230: Safety of Intravenous Thrombolysis in Telestroke and Impact of an Acute Stroke Training Curriculum

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the COVID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

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In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02727-8 ◽

2020 ◽

Author(s):

Juha-Pekka Pienimäki ◽

Jyrki Ollikainen ◽

Niko Sillanpää ◽

Sara Protto

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Mechanical Thrombectomy ◽

Clinical Laboratory ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Ordinal Logistic Regression Analysis ◽

Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

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Abstract TP9: Safety of Endovascular Treatment in Acute Stroke Patients Taking Oral Anticoagulants

Stroke ◽

10.1161/str.47.suppl_1.tp9 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Timo Uphaus ◽

Oliver C Singer ◽

Joachim Berkefeld ◽

Christian H Nolte ◽

Georg Bohner ◽

...

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Acute Stroke ◽

Positive Impact ◽

Therapeutic Option ◽

Oral Anticoagulants ◽

Intravenous Thrombolysis ◽

Vessel Occlusion ◽

Stroke Treatment ◽

Male Patients

Introduction: The endovascular treatment (EVT) of cerebral ischemia in the case of large vessel occlusion has been established over recent years. Randomized trials showed a positive impact on the clinical outcome of endovascular treatment in addition to thrombolysis with respect to clinical outcome and safety, so that this therapeutic option will be implemented in future guidelines. The role of EVT in patients treated with oral anticoagulants remains uncertain. Hypothesis: We assessed the hypothesis that application of EVT is safe with regard to the occurrence of intracranial bleeding and clinical outcome in patients taking anticoagulants. Methods: The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria launched in January 2011. An online tool served for data acquisition of pre-specified variables concerning endovascular stroke therapy. Results: Data from 815 patients (median age 70, 57% male) undergoing EVT and known anticoagulation status were analyzed. A total of 85 (median age 76, 52% male) patients (10.4%) took oral anticoagulants prior to EVT. Anticoagulation status as measured with INR was 2.0-3.0 in 24 patients (29%), <2.0 in 52 patients (63%) and above 3.0 in 7 patients (8%) of 83 patients with valid INR data prior to EVT. Patients taking anticoagulants were significantly older (median age 76 vs. 69, p < 0.001). Comparing those patients taking anticoagulants and those not, there were no differences concerning NIHSS at admission (with anticoagulants Median-NIHSS 17 vs. without Median-NIHSS 15, p = 0.492, Mann Whitney Test) and the rate of intracranial hemorrhage after intervention (with anticoagulants 11.8% vs. without 12.2%, p = 0.538). After adjustment for age and NIHSS at admission there were no significant differences between the two groups with regard to good clinical outcome, as measured with the modified ranking scale (mRS, 90d-mRS 0-2, 39.2% of patients not receiving anticoagulants; 25.9% of those receiving anticoagulants). Conclusion: The application of endovascular treatment in patients taking oral anticoagulants is safe and should be considered in acute stroke treatment as an important alternative to contraindicated intravenous thrombolysis.

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Abstract 3268: Ct Perfusion As A Tool To Predict The Risk Of Hemorrhagic Transformation In Ischemic Stroke Treated With Tissue Plasminogen Activator: A Single Center Experience.

Stroke ◽

10.1161/str.43.suppl_1.a3268 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Tareq Kass-Hout ◽

Maxim Mokin ◽

Omar Kass-Hout ◽

Emad Nourollahzadeh ◽

David Wack ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Brain Tissue ◽

Cerebral Blood Volume ◽

Ct Perfusion ◽

Intravenous Thrombolysis ◽

Hemorrhagic Transformation ◽

Stroke Therapy ◽

Two Phase ◽

The Mean

Objective: To use the Computed Tomography Perfusion (CTP) parameters at the time of hospital admission, including Cerebral Blood Volume (CBV) and Permeability Surface area product (PS), to identify patients with higher risk to develop hemorrhagic transformation in the setting of acute stroke therapy with intravenous thrombolysis. Methods: Retrospective study that compared admission CTP variables between patients with Hemorrhagic Transformation (HT) acute stroke and those with no hemorrhagic transformation. Both groups received standard of care intravenous thrombolysis with tPA. Twenty patients presented to our stroke center between the years 2007 - 2011 within 3 hours after stroke symptoms onset. All patients underwent two-phase 320 slice CTP which creates CBV and PS measurements. Patients were divided into two groups according to whether or not they had HT on a follow up CT head without contrast, done within 36 hours of the thrombolysis therapy. Clinical, demographic and CTP variables were compared between the HT and non-HT groups using logistic regression analyses. Results: HT developed in 8 (40%) patients. Patients with HT had lower ASPECT score ( P =.03), higher NIHSS on admission ( P= .01) and worse outcome ( P= .04) compared to patients who did not develop HT. Baseline blood flow defects were comparable between the two groups. The mean PS for the HT group was 0.53 mL/min/100g brain tissue, which was significantly higher than that for the non-HT group of 0.04 mL/min/100g brain tissue ( P <.0001). The mean area under the curve was 0.92 (95% CI). The PS threshold of 0.26 mL/min/100g brain tissue had a sensitivity of 80% and a specificity of 92% for detecting patients with high risk of hemorrhagic transformation after intravenous thrombolysis. Conclusions: Admission CTP measurements might be useful to predict patients who are at higher risk to develop hemorrhagic transformation after acute ischemic stroke therapy.

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Abstract TP10: Selection Criteria, Is The Clue To Successful Thrombectomy?

Stroke ◽

10.1161/str.44.suppl_1.atp10 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Pedro Cardona ◽

Helena Quesada ◽

Luis Cano ◽

Lucia Aja ◽

De Miquel MA. ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Selection Criteria ◽

Intravenous Thrombolysis ◽

Correct Selection ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Stroke Treatment

In our comprehensive stroke center we analyze correct selection criteria to use self-expandable retrievable intracranial stents for acute stroke treatment. The criteria for intervention were the onset of neurological symptoms, a National Institute of Health Stroke Scale Score (NIHSS) ≥9 at presentation, large vessel occlusion stroke demonstrated by angio-CT, and failure of intravenous thrombolysis or exclusion criteria to administrate it. METHODS: We performed an retrospective analysis of 512 consecutive patients with acute ischemic stroke candidates for thrombectomy, from April of 2010 to June of 2012, that met inclusion criteria for intervention. Experienced vascular neurologists selected 171 patients to undergoing endovascular therapy using retrievable stents (Solitaire,Trevo). Successful recanalization results were assessed by follow-up angiography immediately after the procedure (TIMI 2-3/TICI 2b-3 score), and good functional outcome was considered when ≤2 mRankin score (mRS) was achieved at 90 days. RESULTS: A total of 171 patients were treated, 87% with anterior circulation stroke. The mean age was 67.5 years (range 32-87); 58% men. The median NIHSS at presentation was 17 (range 6-26). Recanalization (TICI 2b-3) was achieved in 73% of patients. Symptomatic hemorrhage occurred in 8%. Ninety-day mortality was 19, 5% and good 90-day functional outcome (mRS ≤2) was achieved by 45%. Unsuccessful recanalization (TICI 0-2a) was a significant predictor of poor outcome (mRS≤2: 9%). When we analyzed these patients according to inclusion criteria of IMS trial, 101 patients who met strict criteria achieved good neurological outcome more frequently (51% versus 34%) and significant lower mortality rates (17% vs 28%) compared with the group of 70 patients with IMS exclusion criteria. CONCLUSIONS: Efficacy in recanalization, safety of thrombectomy and its consequent good clinical outcome is sufficiently established. It is important an experienced vascular neurologist to select possible candidates (proportion of evaluated/treated patients 3:1). Inclusion criteria for acute stroke trials do not always represent real population of stroke patients as well as their clinical results.

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Abstract TP64: Negative-FLAIR Vascular Hyperintensities Serves as a Marker of Chronic Major Arterial Occlusion in Acute Stroke

Stroke ◽

10.1161/str.47.suppl_1.tp64 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Junya Aoki ◽

Kentaro Suzuki ◽

Yuki Sakamoto ◽

Arata Abe ◽

Satoshi Suda ◽

...

Keyword(s):

Acute Stroke ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Multivariate Regression Analysis ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

National Institutes Of Health ◽

Chronic Occlusion ◽

Fluid Attenuated Inversion Recovery

Introduction: Because acute fluid-attenuated inversion recovery vascular hyperintensities (FVH) represent disordered blood flow, FVH has been considered as a marker of major arterial occlusions. Contrary, the role of absence of FVH (negative-FVH) is unknown. Hypothesis: We hypothesized that negative-FVH may indicate chronic occlusion. Thus, we investigated the clinical characteristics and neuroimaging findings in patients with negative-FVH and major arterial occlusion. Methods: Consecutive acute stroke patients within 24 hours of onset and major arterial occlusion on magnetic resonance angiography (MRA) were studied. All patients were examined using serial angiography to evaluate the presence of recanalization. Patients were classified into two groups (NF: group without FVH, F: group with FVH). Results: Seventy-two patients (49 [68%] males, 76 [66-83] years) were enrolled. Thirty-six (50%) patients were treated with acute recanalization therapy, including the intravenous thrombolysis or endovascular therapy. On admission, 10 patients were NF group and 62 were F group. Initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (2-8) in NF group and 10 (4-21) in F group (p=0.012). The rate of internal carotid artery occlusion was similar between NF and F group (20% vs. 29%, p=0.716). Serial angiography studies revealed that recanalization was achieved in only 1 (10%) of the 10 patients with NF group and 49 (79%) of the 62 patients with F group during hospitalization (p<0.001). When all patients divided into 2 groups based on the presence or absence of recanalization, patients with recanalization were younger (p=0.023), had higher NIHSS (p=0.008), earlier admission (p=0.014), higher prevalence of atrial fibrillation (p=0.010), and frequently treated with acute recanalization therapy (p=0.040). When multivariate regression analysis was conducted, that Negative-FVH (odds ratio 0.061, 95% CI 0.06-0.620, p=0.018) was a negative independent factor associated with recanalization during hospitalization. Conclusions: Negative-FVH was independently associated with no recanalization during hospitalization. Negative-FLAIR may present not acute occlusion but chronic occlusion.

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Idarucizumab for Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Stroke: A Case Report

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2019.09.040 ◽

2020 ◽

Vol 58 (3) ◽

pp. e113-e116

Author(s):

Yu-Ting Lin ◽

Yen-Jun Lai ◽

Tzu-Hsien Lai

Keyword(s):

Case Report ◽

Acute Stroke ◽

Intravenous Thrombolysis ◽

Endovascular Thrombectomy

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Addressing a real‐life problem: treatment with intravenous thrombolysis and mechanical thrombectomy in acute stroke patients with an extended time window beyond 4.5 h based on computed tomography perfusion imaging

European Journal of Neurology ◽

10.1111/ene.14051 ◽

2019 ◽

Vol 27 (1) ◽

pp. 168-174 ◽

Cited By ~ 4

Author(s):

K. Feil ◽

P. Reidler ◽

W. G. Kunz ◽

C. Küpper ◽

J. Heinrich ◽

...

Keyword(s):

Computed Tomography ◽

Acute Stroke ◽

Perfusion Imaging ◽

Mechanical Thrombectomy ◽

Time Window ◽

Real Life ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Computed Tomography Perfusion ◽

Computed Tomography Perfusion Imaging

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Isolated Wrist Drop Presenting as Acute Stroke: Rare Case Report with Review of Literature

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_115_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 647-649

Author(s):

Khushbu Goel ◽

Saraj Kumar Singh ◽

Himanshu Agarwal ◽

Joy Dev Mukherji ◽

Mukesh Kumar

Keyword(s):

Magnetic Resonance ◽

Acute Stroke ◽

Brain Mri ◽

Intravenous Thrombolysis ◽

Acute Onset ◽

Cerebral Stroke ◽

Rare Presentation ◽

Rare Case Report ◽

Magnetic Resonance Imaging Mri ◽

Wrist Drop

ABSTRACTIsolated wrist drop is very unusual clinical presentation due to cerebral stroke. It is highly confused with peripheral neuropathy. However, timely detection of acute stroke as one of the causes of wrist drop is necessary as it changes the line of treatment and prognosis significantly. Here we are presenting a 62 year-old diabetic and hypertensive male patient who came with acute onset weakness of right hand. Initial Magnetic resonance imaging (MRI) of the brain showed hyperacute infarct in the splenium of corpus callosum. Magnetic resonance angiography (MRA) was normal. Repeat brain MRI on next day showed acute infarct at hand area of motor strip in posterior frontal region. The patient underwent intravenous thrombolysis and thereafter improved significantly. Isolated hand palsy is a rare presentation of stroke, often mistaken for peripheral lesion.

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