Abstract WP43: Body Mass Index and Clinical Outcomes in Large Vessel Occlusion Acute Ischemic Stroke After Endovascular Therapy: The Obesity Paradox

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Hilarie Perez ◽  
Letícia C Rebello ◽  
Diogo C Haussen ◽  
Jonathan A Grossberg ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Endovascular Therapy ◽  
Obesity Paradox ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Body Mass Index and Clinical Outcomes in Large Vessel Occlusion Acute Ischemic Stroke after Endovascular Therapy

2019 ◽  
Vol 8 (2-6) ◽  
pp. 144-151 ◽  
Author(s):  
Mehdi Bouslama ◽  
Hilarie J. Perez ◽  
Clara M. Barreira ◽  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Endovascular Therapy ◽  
Normal Weight ◽  
Large Vessel ◽  
Obese Patients ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Glucose Levels

Background and Purpose: Several reports have described lower mortality rates in overweight or obese patients as compared to normal weight ones. In the past decade, several studies have investigated the phenomenon, commonly known as the obesity paradox, with mixed results thus far. We sought to determine whether outcomes differ between patients with large vessel occlusion strokes (LVOS) after endovascular therapy (ET) according to their body mass index (BMI). Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution. All patients that underwent ET for acute LVOS were categorized according to their BMI into 4 groups: (1) underweight (BMI < 18.5), (2) normal weight (BMI = 18.5–25), (3) overweight (BMI = 25–30), and (4) obese (BMI > 30). Baseline characteristics, procedural radiological as well as outcome parameters where compared. Results: A total of 926 patients qualified for the study, of which 20 (2.2%) were underweight, 253 (27.3%) had a normal weight, 315 (34%) were overweight, and 338 (36.5%) were obese. When compared with normal weight (reference), overweight patients were younger, had higher rates of dyslipidemia and diabetes and higher glucose levels, while obese patients were younger, less often smokers, and had higher rates of hypertension and diabetes and higher glucose levels. Other baseline and procedural characteristics were comparable. The rates of successful reperfusion (modified treatment in cerebral ischemia, 2b–3), parenchymal hematomas, 90-day good clinical outcomes (modified Rankin scale, 0–2), and 90-day mortality were comparable between groups. On multivariate analysis, BMI was not associated with good outcomes nor mortality. Conclusion: In patients treated with mechanical thrombectomy, BMI is not associated with outcomes. However, patients who are overweight or obese have more comorbidities and a higher stroke risk and, thus, should strive for a normal weight.

Abstract TP19: Clinical Outcomes In Patients With Acute Ischemic Stroke Due To Large Vessel Occlusion In The Modern Era: 2010-2011 Experience With 423 Patients.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Maxim Mokin ◽  
Tareq Kass-Hout ◽  
Omar Kass-Hout ◽  
Erol Veznedaroglu ◽  
Fadi Nahab ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Medical Management ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background and Purpose: Acute ischemic stroke due to large vessel occlusion is associated with a poor prognosis. With no consensus about the best treatment option, various treatment modalities including conservative management, intravenous tissue plasminogen activator, and endovascular approach are currently being used. Methods: Retrospective data including demographic information, baseline NIHSS score, site of occlusion (based on CTA, MRA or angiogram), type of treatment and clinical outcomes were collected from 4 centers in the United States during the period of 2010-2011. Results: A total of 423 were included in final analysis: 175 patients received conservative medical management, 54 patients received intravenous (IV) thrombolysis alone, and 194 patients had endovascular treatment (with or without prior IV tPA). Younger patients were more likely to receive endovascular treatment (p<0.001). There was no statistically significant difference among the sex and co-morbid conditions among the three groups. Proximal middle cerebral artery was the most commonly involved vessel. Strokes due to basilar artery occlusion or internal carotid artery occlusion were associated with worst outcomes in all three groups. Conservative medical management had the lowest rates of symptomatic intracerebral hemorrhage but also the highest mortality rates at 3 months. Patients who received endovascular treatment within the first 3 hrs had better outcome and lower mortality rates as compared to patients with intervention during 3-8 hours or beyond 8 hrs. Conclusions: Our study represents real world experience on the management and outcomes of acute ischemic strokes due to large vessel occlusion. Our results help understand natural history of strokes with large vessel occlusion, as well as modern trends in managing these patients with intravenous and intraarterial treatment approaches.

Abstract 3314: The Role of Bridging with Intravenous Thrombolysis in Endovascular Therapy of Acute Ischemic Stroke.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Omar Kass-Hout ◽  
Tareq Kass-Hout ◽  
Maxim Mokin ◽  
David Orion ◽  
Shadi Jahshan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Combined Therapy ◽  
Large Vessel ◽  
P Value ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Nihss Score

Background: Large vessel occlusions with a high clot burden are less likely to improve with the FDA-approved IV strategy. Endovascular therapy within the first 3 h of stroke symptom onset provides an effective alternative treatment in patients with large vessel occlusion. It is not clear if combination of IV thrombolysis and endovascular approach is superior to endovascular treatment alone. Methods: We retrospectively reviewed all cases of acute ischemic stroke with large vessel occlusion treated within the first 3 h stroke onset during the 2005-2010 period. First group received endovascular therapy within the first 3 h of stroke onset. Second group consisted of patients who received IV thrombolysis within the first 3 h followed by endovascular therapy. We compared the following outcomes: revascularization rates, NIHSS score at discharge, mRS at discharge and 3months, symptomatic hemorrhage rates and mortality. Results: Among 104 patients identified, 42 received combined therapy, and 62 received endovascular therapy only. The two groups had similar demographic (age and sex distribution) and vascular risk factors distribution, as well as NIHSS score on admission (14.8±4.7 and 16.0±5.3; p=0.23). We found no difference in TIMI recanalization rates (Thrombolysis in Myocardial Infarction scale score of 2 or 3) following combined or endovascular therapy alone (83.3% and 79.0%; p=0.59). A preferred outcome, defined as a mRS of 2 or less at 90 days also did not differ between the combined therapy group and the endovascular only group (37.5% and 34.5%; p=0.76). There was no difference in mortality rate (22.5% and 31.0%; p=0.36) and the rate of symptomatic intracranial hemorrhage (9.5% and 8.1%; p=0.73). There was a significant difference in mean time from symptom onset to endovascular treatment between the combined group (227±88 min) and endovascular only group (125±40 min; p<0.0001).Patients with good TIMI recanalization rate of 2 or 3 showed a trend of having a better mRS at 90 days in both bridging (16.67% vs. 41.18%, p-value: 0.3813) and endovascular groups (25% vs. 34.78%, p-value: 0.7326).When analyzing the correlation of mRS at 90 days with the site of occlusion, patients in the bridging group showed a trend of a better outcome when the site of occlusion was ICA (33.3% vs 30%) and MCA (66.67% vs. 27.59%) and worse outcome when the site of occlusion was in the posterior circulation (26.32% vs. 50%), however, these results were not statistically significant (p-values: 0.1735& 0.5366). Conclusion: Combining IV thrombolysis and endovascular therapy achieves similar rates of clinical outcomes, revascularization rates, complications and mortality rates, when compared with endovascular treatment alone. The combined therapy, however, significantly delays initiation of endovascular treatment. A randomized prospective trial comparing both treatment strategies in acute ischemic stroke is warranted

Endovascular Therapy for Acute Ischemic Stroke in Patients with Large-Vessel Occlusion due to Atherosclerotic Stenosis

2021 ◽  
Vol 30 (10) ◽  
pp. 105960
Author(s):  
Manabu Shirakawa ◽  
Hidetoshi Matsukawa ◽  
Nobuyuki Sakai ◽  
Hiroshi Yamagami ◽  
Kanta Tanaka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Atherosclerotic Stenosis

Abstract TMP5: The Smoking-Thrombolysis Paradox in Large Vessel Occlusion Acute Ischemic Stroke Undergoing Endovascular Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Leticia C Rebello ◽  
Diogo C Haussen ◽  
Jonathan A Grossberg ◽  
Shannon Doppelheuer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Posterior Circulation ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background and Purpose: The smoking-thrombolysis paradox has been well described in myocardial infarction. However, its existence in the stroke population remains elusive. In the past decade, several studies have investigated the phenomenon with mixed results. We sought to determine whether clinical outcomes differ between smokers and non-smokers with acute ischemic stroke undergoing endovascular therapy. Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution. All patients who underwent endovascular therapy for acute large vessel occlusion acute ischemic stroke were categorized into current smokers and non-smokers. Baseline characteristics, procedural radiological as well as outcome parameters where compared. Results: A total of 968 patients qualified for the study of which 189 (19.5%) were current smokers. Smokers were younger (60.78±11.95 vs. 66.41±15.05 years, p<0.001), had higher rates of dyslipidemia (49.7% vs 31.7%, p<0.001) and posterior circulation strokes (13.2% vs 7.8%, p=0.02,) and lower rates of atrial fibrillation (21.1% vs 37.9%, p<0.001). There were no statistically significant differences between groups in terms of stroke severity (as assessed by NIHSS), baseline CT perfusion core and hypoperfusion volumes, CT angiogram collateral scores as well as procedural variables. On univariate analysis, smokers had higher rates of good outcomes at 90 days (modified Rankin scale, mRS 0-2: 53.8% vs 42.8%, p=0.01) and similar rates of successful reperfusion (mTICI 2b-3) (92.1% vs 87.7%, p=0.09), parenchymal hematomas (4.2% vs 4%, p=0.84) and mortality at 90 days (20.2% vs 25.7%, p=0.14). Multivariate analysis showed that smoking was not independently associated with good outcomes. Stratifying for (1) stroke etiology and (2) anterior vs. posterior circulation topology yielded similar results. Conclusion: In stroke patients treated with mechanical thrombectomy, smoking does not seem to be associated with outcomes regardless of stroke subtype or location.

Abstract 1122‐000119: Impact of Diabetes on Pass‐Number in Intracranial Thrombectomy for Large Vessel Occlusion Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Juan Carlos Rodriguez Quintero ◽  
Juan Carlos Martinez‐Gutierrez ◽  
Sergio A Salazar‐Marioni ◽  
Rania Abdelkhaleq ◽  
Arash Niktabe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Serum Glucose ◽  
Large Vessel ◽  
Diabetic Patients ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Alternative Means ◽  
Admission Glucose

Introduction : Admission hyperglycemia is associated with poor functional outcomes, greater hemorrhagic risk and mortality after endovascular therapy (EVT) for large vessel occlusion (LVO) acute ischemic stroke (AIS). Diabetes is also linked with intracranial atherosclerosis. In this study, we examine whether underlying diabetes is associated with increased pass number requirements, as a possible etiology for worsened clinical outcomes in these patients. Methods : From our prospectively maintained multi‐institutional registry across 4 comprehensive stroke centers, we identified patients with LVO AIS undergoing EVT, for whom admission glucose, HbA1c as well as complete procedural details and 90 day outcome measures (mRS) had been captured. Diabetes was defined using HbA1c cutoff of ≥ 6.5% consistent with American Diabetes Association definitions. Admission hyperglycemia was defined as serum glucose on admission of >140 mg/dL. The primary outcome was number of EVT passes required for TICI ≥2b in diabetic vs. non‐diabetic patients. Results : Among 512 patients that met inclusion criteria, median age was 68 [IQR 58‐78], 254 (49.6%) were female, and median NIHSS was 16 [IQR 11‐20]. Median HbA1c was 5.8% (range 2.5‐14%), and 136 (26.6%) were diabetic. Mean admission glucose was greater in diabetic patients (122±30.7 vs. 199±79.8 mg/dL, non‐diabetic vs. diabetic, p<0.01). Admission hyperglycemia and HbA1≥6.5 were associated with lower rates of 90 day mRS 0–2 (24.0% vs 42.7%, hyperglycemia vs. no hyperglycemia, p<0.01; 28.7% vs. 39.1%, diabetes vs. no diabetes, p = 0.03). However, diabetics and patients presenting with hyperglycemia did not appear to require a higher number of passes to achieve TICI 2b or greater (1.83 vs 1.88, p = 0.69, 1.82 vs 1.88, p = 0.56, respectively) and had comparable first pass recanalization rates (56 vs 53%, p = 0.50, 56 vs 54, p = 0.72). Conclusions : Presentation hyperglycemia and diabetes were both associated with worsened clinical outcomes, but not with increased pass numbers or procedural time in EVT. These findings suggest alternative means by which clinical outcomes are worsened in this population.

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