Abstract WMP11: Interhospital Transfer versus Direct Admission of Acute Stroke Patients Undergoing Endovascular Reperfusion Therapy: A Real-World Experience in Japan

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Masayuki Sato ◽  
Masataka Yoshimura ◽  
Arihito Tsurumi ◽  
Takuya Kawai ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Real World ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Interhospital Transfer ◽  
Direct Admission

Abstract P327: Utilizing Iodine Contrast Extravasation Post Reperfusion and Dual Energy Ct Imaging to Predict Risk of Hemorrhagic Conversion in Acute Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Tri Huynh* ◽  
Niran Vijayaraghavan* ◽  
Hannah Branstetter ◽  
Natalie Buchwald ◽  
Justin De Prey ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Infarct Volume ◽  
Reperfusion Therapy ◽  
Dual Energy ◽  
Ct Imaging ◽  
Dual Energy Ct ◽  
Stroke Patients ◽  
Post Intervention ◽  
Contrast Extravasation ◽  
Post Contrast

Introduction: Hyperintense acute reperfusion marker (HARM) has been identified on post-contrast magnetic resonance imaging (MRI) to be a marker of hemorrhagic conversion (HC) post reperfusion therapy in acute stroke patients. We have previously described a case where MRI HARM was mimicked on post contrast computed topography (CT) imaging in an acute stroke patient post reperfusion. Dual-Energy (DECT) allows for differentiation between acute blood and iodine contrast extravasation (ICE), and thus can have utility when ICE is present. Here we sought to validate whether post-intervention ICE/CT hyperdensity reperfusion maker (CT HARM), and contrast subtracted on DECT is associated with HC in acute stroke patients. Method: Data was obtained from our Institutional Review Board approved stroke admission database from January 2017 to November 2019, including ischemic stroke patients that received thrombolysis or thrombectomy, had evaluable images within 24 hours of admission, and received a DECT. Ischemic volumes of the stroke was measured on diffusion-weighted image (DWI). ICE was measured on CT head and DECT using the freehand 3D region of interest tool on the Visage Imaging PACS System. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling. Results: A total of 82 patients were included, 49% women, median age 73 (interquartile range (IQR), 61- 77), admission NIHSS 12 (IQR, 7 - 21), 24 hour change in NIHSS 4 (IQR, 0 -13), glucose 125 (IQR, 106 -158), creatinine 1.0 (IQR, 0.8 - 1.2), infarct volume 50.6 ± 7.1 mL, 48% treated with thrombectomy, 7% with PH-1 or PH-2 identified on MRI, and 56% with MCA infarcts. ICE volume was 2.6 ± 1.0 mL and DECT volume was 2.2 ± 1.1mL. ICE increased the likelihood of MRI confirmed PH-1 or PH-2 hemorrhagic conversion (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 - 22.94) and decreased likelihood of increase in NIHSS at 24 hours (OR 0.20, 95% CI 0.01 to 0.40). There were no other significant associations with ICE or DECT volumes. Conclusion: Our results are supportive of our proposed association between CT HARM and risk of HC. More studies are needed to study whether quantitative of DECT can be predictive of stroke outcomes post reperfusion therapy.

Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Takayuki Matsuki ◽  
Masatoshi Koga ◽  
Shoji Arihiro ◽  
Kenichi Todo ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Reperfusion Therapy ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Multicenter Observational Study ◽  
Spot Urine ◽  
Poor Outcome ◽  
The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

scholarly journals PND77 IMPACT OF THE INTERHOSPITAL TRANSFER TIME ON THE CLINICAL OUTCOMES OF ACUTE STROKE PATIENTS TREATED WITH MECHANICAL THROMBECTOMY

2019 ◽  
Vol 22 ◽  
pp. S751
Author(s):  
A. Boltyenkov ◽  
J.J. Wang ◽  
M.G. Martinez ◽  
K. Adinarayan ◽  
A.M. Hoang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Transfer Time ◽  
Stroke Patients ◽  
Interhospital Transfer

scholarly journals Real-World Comparison of Human and Software Image Assessment in Acute Ischemic Stroke Patients’ Qualification for Reperfusion Treatment

2020 ◽  
Vol 9 (11) ◽  
pp. 3383
Author(s):  
Bartlomiej Lasocha ◽  
Roman Pulyk ◽  
Pawel Brzegowy ◽  
Pawel Latacz ◽  
Agnieszka Slowik ◽  
...  
Keyword(s):  
Real World ◽  
Ct Perfusion ◽  
Reperfusion Therapy ◽  
Computer Algorithms ◽  
Stroke Patients ◽  
Volume Measurements ◽  
Manual Methods ◽  
Rapid Processing ◽  
Image Assessment

Our aim was to compare human and computer accuracy in reading medical images of acute stroke patients. We analyzed data of patients who underwent assessment of Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion (CTP) via Rapid Processing of Perfusion and Diffusion (RAPID) software RAPID ASPECTS, and RAPID CTP), compared to radiologist reports and manual measurements. We compared volumes calculated by RAPID CTP software with those selected by scanner-equipped software (GE). For reference, follow-up images were manually assessed in accordance with the Alberta Stroke Program Early CT Score (ASPECTS) territories retrospectively. Although exact ASPECTS score agreement between the automatic and manual methods, and between each method and follow-up, was poor, crossing of the threshold for reperfusion therapy was characterized by an 80% match. CT perfusion analyses yielded only slight agreement (kappa = 0.193) in the qualification of patients for therapy. Either automatic or manual scoring methods of non-contrast images imply similar clinical decisions in real-world circumstances. However, volume measurements performed by fully automatic and manually assisted systems are not comparable. Thresholds devised and validated for computer algorithms are not compatible with measurements performed manually using other software and should not be applied to setups other than those with which they were developed.

Abstract WP36: Post-ischemic Hyperperfusion After Reperfusion Therapy Predicts Hemorrhagic Transformation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shuhei Okazaki ◽  
Takeshi Yoshimoto ◽  
Hiroshi Yamagami ◽  
Katsufumi Kajimoto ◽  
Mikito Hayakawa ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Three Dimensional ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Regional Cerebral Blood ◽  
Stroke Patients ◽  
Mca Occlusion ◽  
Blood Flow Ratio ◽  
The Relationship

Background and Purpose: Post-ischemic hyperperfusion has been considered as a risk factor of hemorrhagic transformation and poor prognosis. To date, however, there is a lack of data about the pathological significance of hyperperfusion after reperfusion therapy. In this study, we evaluated the relationship between hemorrhagic transformation and post-ischemic hyperperfusion after reperfusion therapy by using arterial spin labeled perfusion MRI (ASL) and 123 I IMP-SPECT. Methods: We retrospectively collected data of acute stroke patients with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis and/or endovascular therapy, and underwent pulsed ASL using Q2TIPS-FAIR with 3D-TGSE readout and 123 I IMP-SPECT using dual-table ARG method within 14 days of stroke onset from November 2015 to June 2016. Ipsilateral-contralateral regional cerebral blood flow ratio (IC ratio) was calculated by using three-dimensional stereotactic ROI template (3DSRT) software. Results: Among 47 consecutive acute stroke patients with the MCA occlusion who received reperfusion therapy, 21 underwent only ASL and 10 underwent both ASL and SPECT after reperfusion therapy. The IC ratio of ASL was well correlated with that of SPECT in the MCA territory (r=0.65, p <0.001). Hemorrhagic transformation was observed in 7 patients. IC ratio was higher in patients with hemorrhagic transformation after reperfusion therapy than those without hemorrhagic transformation (2.19±0.35 vs 0.99±0.19, p=0.005). Focal post-ischemic hyperperfusion (IC ratio >1.5) was detected in 7 of 31 patients (23%). The presence of post-ischemic hyperperfusion was significantly associated with hemorrhagic transformation after reperfusion therapy (odds ratio 9.3, 95% confidence interval 1.4 to 64.0, p=0.03). Conclusions: Post-ischemic hyperperfusion detected by ASL predicts hemorrhagic transformation after reperfusion therapy. ASL hyperperfusion may indicate the disruption of blood brain barrier after reperfusion therapy.

Abstract P85: Impact of Covid-19 Pandemic on Hospitalizations and Outcomes of Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (pcnasp)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Sallyann Coleman King ◽  
Erika Odom ◽  
Quanhe Yang
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
The United States ◽  
Emergency Department Visits ◽  
National Institutes Of Health ◽  
Hospital Death ◽  
Stroke Patients ◽  
Stroke Treatment

Introduction: Studies suggest a significant reduction in emergency department visits and hospitalizations for acute ischemic stroke (AIS) during the COVID-19 pandemic in the United States. Few studies have examined AIS hospitalizations, treatments, and outcomes during the pandemic period. The present study compared the demographic and clinical characteristics of patients hospitalized with AIS before and during the COVID-19 pandemic (weeks 11-24 in 2019 vs. 2020). Method: We identified 42,371 admissions with a clinical diagnosis of AIS, from 370 participating hospitals who contributed data during weeks 11-24 in both 2019 and 2020 to the Paul Coverdell National Acute Stroke Program (PCNASP). Results: During weeks 11-24 of the COVID-19 period, AIS hospitalizations declined by 24.5% compared to the same period in 2019 (18,233 in 2020 vs. 24,138 in 2019). In 2020, the percentage of individuals aged <65 years who were hospitalized with AIS was higher compared with the same period in 2019 (34.6% vs. 32.7%, p<0.001); arriving by EMS were higher in 2020 compared with 2019 (47.7% vs. 44.8%, p<0.001). Individuals admitted with AIS in 2020 had a higher mean National Institutes of Health Stroke Scale (NIHSS) score compared with 2019 (6.7 vs. 6.3, p<0.001). In 2020, the in-hospital death rates increased by 16% compared to 2019 (5.0% vs. 4.3%, p<0.001). However, there were no differences in rates of alteplase use, achievement of door to needle in 60 minutes, or complications from reperfusion therapy between the two time periods. Conclusion: A higher percentage of younger (<65 years) individuals and more severe AIS cases were admitted to the participating hospitals during weeks 11 to 24 of the COVID-19 pandemic in 2020 compared to the same period in 2019. The AIS in-hospital death rate increased 16% during the pandemic weeks as compared to the same weeks in 2019. Additional studies are needed to examine the impacts of the COVID-19 pandemic on stroke treatment and outcomes.

Histologic features of acute thrombi retrieved from stroke patients during mechanical reperfusion therapy

2016 ◽  
Vol 11 (9) ◽  
pp. 1036-1044 ◽  
Author(s):  
Seong Hwan Ahn ◽  
Ran Hong ◽  
In Sung Choo ◽  
Ji Hoe Heo ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Stroke Subtypes ◽  
The Rich ◽  
Undetermined Etiology

Background The histologic features of thrombus may differ according to the stroke subtypes. However, in acute reperfusion therapy, fibrin-specific thrombolytics are used based on the assumption that all thrombi are alike. Aims The histologic characteristics of thrombi were compared between patients with different stroke etiologies. Methods Between April 2010 and March 2012, we analyzed thrombi retrieved from acute stroke patients during mechanical thrombectomy. All thrombi were analyzed using component-specific stains such as Martius scarlet blue for fibrins and immunostaining with CD42b antibody for platelets. The stroke subtypes were determined based on the Trial of ORG 10172 in Acute Stroke Treatment classification. Results Among 36 patients, 22 were diagnosed with cardioembolism, 8 with atherothrombosis, and 6 with undetermined etiology. In arteriogenic thrombi, red blood cells were most abundant (56.9 ± 12.2%), and the platelets covered the fibrin layers or were localized at the edge or periphery of the thrombus. In cardiogenic thrombi, fibrin was most abundant (39.5 ± 13.5%), and platelets were clustered within the rich fibrin. Red blood cells proportion was greater in arteriogenic thrombi than in cardiogenic thrombi ( p < 0.001), whereas fibrin proportion was greater in cardiogenic thrombi than in arteriogenic thrombi ( p = 0.003). Of six patients with undetermined etiology, the thrombi in five showed histologic features and composition similar to that of cardiogenic thrombi. Conclusions Acute thrombi showed different histologic features according to the stroke etiology. The distribution of platelets and proportion of red blood cells and fibrin were major distinguishing factors between stroke subtypes.

scholarly journals Current status of aspiration thrombectomy for acute stroke patients in China: data from ANGEL-ACT Registry

2021 ◽  
Vol 14 ◽  
pp. 175628642110077
Author(s):  
Xu Tong ◽  
Yilong Wang ◽  
Clayton T. Bauer ◽  
Baixue Jia ◽  
Xuelei Zhang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Real World ◽  
Current Status ◽  
Stroke Patients ◽  
First Line ◽  
Vessel Occlusion ◽  
Clinical Trial Registration ◽  
Aspiration Thrombectomy ◽  
Rescue Treatment ◽  
Significant Difference

Background and Aims: Although noninferior to stent retriever (SR) as first-line approach for endovascular treatment (EVT) of acute large vessel occlusion (LVO) stroke, little is known about the current status of direct aspiration (DA) as first-line thrombectomy in China. This analysis of a prospective, nationwide registry (ANGEL-ACT) aimed to investigate the prevalence and comparative effectiveness of DA-first thrombectomy in a real-world practice in China. Methods: All patients receiving thrombectomy were screened from a prospective cohort of LVO patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and divided into two groups based upon which type of thrombectomy was attempted first (“DA-first” and “SR-first”). The following outcome measures were compared using logistic regression models with adjustment: successful recanalization after first-device alone and all procedures, use of rescue treatment, intracranial hemorrhage (ICH) within 24 h, and modified Rankin Scale (mRS) score at 90 days. Results: A total of 1225 patients, 102 (8.3%) in DA-first group and 1123 (91.7%) in SR-first group, were included. Patients receiving DA-first had less often successful recanalization after first-device alone [30.4 versus 66.4%; odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.15–0.37], more frequent rescue treatment (62.8 versus 27.0%; OR = 4.55, 95% CI = 2.92–7.08) and ICH (35.4 versus 22.1%; OR = 1.78, 95% CI = 1.12–2.83) than those receiving SR-first; however, no significant difference was found in successful recanalization after all procedures (84.3 versus 90.3%; p = 0.18) and 90-day mRS (median: 3 versus 3 points; p = 0.90) between both groups. Conclusion: This real-world registry suggested that DA-first thrombectomy for acute stroke patients lagged behind in China during the study period. Far fewer DA-first than SR-first thrombectomies were performed, and DA-first was associated with lower first-device recanalization, more frequently requiring rescue treatment, and increased ICH risk. Clinical Trial Registration: ClinicalTrials.gov , NCT03370939.

Abstract 123: Temporal Variation Affect Stroke Unit Admission Rates, Observations From the National Swedish Stroke Register

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David Darehed ◽  
Mathias Blom ◽  
Eva-Lotta Glader ◽  
Johan Niklasson ◽  
Bo Norrving ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Temporal Variation ◽  
Admission Rate ◽  
Organizational Factors ◽  
Temporal Variations ◽  
Study Cohort ◽  
Stroke Patients ◽  
Admission Rates ◽  
Direct Admission ◽  
Stroke Register

Introduction: It is firmly established that management of acute stroke at dedicated stroke units (SU) improves functioning and survival. Although guidelines recommend SU admission as 1 st level of care for all patients with acute stroke, quality registers show that many patients are treated at non-SU wards. Previous studies have shown that there are different patterns of time that impose an effect on a multitude of outcomes for acute stroke patients. The primary objective of this study was to investigate if there were any temporal variations on direct SU admissions as 1 st destination from the emergency department (ED). Patients and methods: This register study comprised data on patients with acute stroke admitted to any of the 72 Swedish hospitals that register stroke patients in the Swedish stroke register. Patients with transitory ischemic attacks (TIA) were excluded. The study period lasted from January 1, 2011 to December 31, 2015. Unadjusted analyses were followed by logistic regression analyses where we adjusted for the effects of confounding factors (age, sex, consciousness level, hospital, stroke type, thrombolysis, previous stroke, ADL-dependency, diabetes, hypertension and smoking). Results: The study cohort comprised a total of 117 804 patients with acute stroke. In total, 76.0% (89 502 of 117 804) of the patients were directly admitted to a SU from the ED. Unadjusted analyses revealed differences in direct SU admission as a function of time of week; while 83.4% (4033 of 4833) of the patients admitted on Friday mornings were directly admitted to a SU, only 68.4% (483 of 706) of patients admitted Sunday night were directly admitted to a SU. Analyses also revealed a direct admission rate during office hours of 79.9% (41 796 of 52 340) compared to 74.4% (45 812 of 61 605) during off-hours. Finally, monthly variation in direct admission rates ranged from 74.4% (7 803 of 10 483) in January to 77.3% (7 323 of 9 473) in June. Results from the adjusted analyses showed an OR of 2.570 (95% CI 2.132-3.099) for direct admission on Friday morning versus Monday night. Off-hours exhibited an OR of 0.725 (95% CI 0.704-0.747) versus office-hours. June exhibited an OR for direct admission of 1.212 (95% CI 1.127-1.303) compared to January. Discussion: There are several patterns of time affecting admission rates to a SU from the ED. Some of the variation seen in this study could possibly be explained by healthcare organizational factors such as hospital crowding. More studies are however needed to elucidate the mechanisms behind temporal variations as well as the magnitude of these effects on the quality of stroke care. Finally, we believe quality improvement efforts should focus on reducing temporal variation.

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