Abstract WP305: Predictors of Early Improvement of Swallow Function in Acute Ischemic Stroke Patients With Severe Dysphagia

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Kristin Brown ◽  
Chunyan Cai ◽  
Andrew Barreto ◽  
Jade Woellner ◽  
Sean Savitz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Early Improvement ◽  
Severe Dysphagia ◽  
Swallow Function

Abstract TP93: Rapid and Appropriate Evaluation of Collateral Development by Four-Dimensional CT Angiography Covering Only 4-cm Width With a Focus on the Intracranial Internal Carotid Artery and the Middle Cerebral Artery to Identify Candidates of Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka ◽  
Nozomi Chiba
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Internal Carotid ◽  
Stroke Patients ◽  
Early Improvement ◽  
Nihss Score ◽  
Collateral Development ◽  
Neurological Improvement ◽  
Mca Occlusion

Introduction: Four-dimensional computed tomography (CT) angiography (4D-CTA) can visualize time sequential changes of bilateral internal carotid (ICA) and middle cerebral arteries (MCA). Therefore, 4D-CTA could find ICA or MCA occlusion and visualize collateral circulation in case of intracranial artery occlusion. Hypothesis: Four-dimensional CTA covering only 4-cm width with a focus on the intracranial ICA and the MCA can early visualize them because of small volumetric data and evaluate collateral development status to identify candidates of thrombectomy. Methods: We included acute ischemic stroke patients who 1) were admitted from August 2018 to July 2019 due to ICA or MCA occlusion, 2) underwent 4D-CTA covering only 4-cm width on admission and 3) underwent endovascular thrombectomy. We classified collateral status into good, moderate and poor collateral according to opacification of M2 and M3 branches distal to occlusion and evaluated successful recanalization of thrombolysis in cerebral infarction (TICI) grade 2b or 3 and improvement of NIHSS score 7 days after thrombectomy. Results: During the study period, 337 acute ischemic stroke patients were admitted, 92 patients suffered from ICA or MCA occlusion and 23 patients met our inclusive criteria. Median age was 81 years and median ASPECTS was 10. Image reconstruction time of 1,000 images was only 69 seconds and 4D-CTA with only 4-cm width demonstrated MCA occlusion in 14 patients, IC occlusion in 9 patients and collateral status as good in 4 patients, moderate in 13 patients and poor in 6 patients. Median onset-to-recanalization time was 5.2 hours, successful recanalization was achieved in 21 patients (91.3%), median NIHSS score on admission was 20, median 7-day NIHSS score decreased to 6 (p<0.0001) and median decrease of NIHSS score was 13. Two patients without successful recanalization had no early improvement of NIHSS score, whereas 20 of 21 patients with successful recanalization obtained early neurological improvement. Conclusion: Four-dimensional CTA with only 4-cm width rapidly and appropriately evaluated collateral status to identify candidates of thrombectomy for ICA or MCA occlusion and achieved early neurological improvement following successful recanalization.

Abstract P820: Fast Prediction of the Dysphagia Severity Using Clinical Signs in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ting Ye ◽  
Yi Dong ◽  
Shengyan Huang
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Tongue Movement ◽  
Stroke Patients ◽  
Volume Viscosity ◽  
Fast Prediction ◽  
Swallow Function

Objective: The purpose of this study was to compare the clinical signs in patients with acute ischemic stroke(AIS) and identify which of them was associated with the severity of dysphagia. Methods: This was a prospective observational study enrolled AIS within 14 onset days. All patients had swallowing evaluations by the modified Volume Viscosity Swallowing Test (the modified V-VST). Five clinical signs suggestive of swallow function impaired were directly observed in the patients who failed the test. We compared the performance of clinical signs between different completing volumes at three viscosity series. The area under curves (AUCs) were made to show the ability of specific clinical signs in predicting the dysphagia severity in patients with AIS. Results: 184 hospital-based AIS patients who failed the modified V-VST were enrolled from June 2017 to December 2019. 123 patients were identified as moderate swallow function impaired and 61 patients were identified as serious. Larynx movement and tongue movement were significant different clinical signs at all of three viscosities (p≤0.001). The AUC of larynx movement in predicting severity of dysphagia was 0.733( 95% CI 0.658-0.808,P<0.001). Conclusions: Larynx movement and tongue movement were easy clinical signs for medical staffs to assess the dysphagia severity quickly. Additionally, larynx movement showed stronger ability to predict the severity of dysphagia in AIS patients.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

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