Abstract 162: 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Erwin Chiquete ◽  
Guillermo Ramirez-Garcia ◽  
Valeria Sandoval-Rodriguez ◽  
Fernando Flores-Silva ◽  
Jose L Ruiz-Sandoval ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Disability ◽  
Brain Infarction ◽  
Cox Proportional Hazards Model ◽  
Seizure Recurrence ◽  
Factors Associated ◽  
Acute Seizures

Background and purpose: Acute ischemic stroke (AIS) is the leading cause of adult-onset epilepsy. In the context of current guidelines, AIS patients presenting with seizures are considered at high risk for seizure recurrence and as a consequence, this patients are deemed as nowadays affected by epilepsy. We aimed to describe the factors associated with acute seizures, epilepsy and seizure recurrence after AIS, as well as their impact on the functional outcome at 12-month follow-up. Methods: This is a cohort study on 1,246 non-epileptic patients with AIS included in a multicenter Mexican registry; who received 12-month follow-up after a first-ever or recurrent AIS. Multivariate analyses were performed to evaluate factors associated with acute seizures and the functional outcome at 12 months of follow-up. Results: The frequency of acute seizures (within 7 days after stroke onset) after AIS was 8.1% [95% confidence interval (CI): 6.7% to 9.8%]. In all, 12-month seizure recurrence rate was 4.8% (95% CI: 3.7% to 6.1%). In a binary logistic regression model, risk factors significantly associated with seizures were >10 scoring of the National Institutes of Health Stroke Scale (NIHSSS, US) [odds ratio (OR): 2.21, 95% CI: 1.40-3.47], recurrent ischemic stroke (OR: 2.17, 95% CI: 1.34-3.53) and age <65 years (OR: 1.69, 95% CI: 1.09-2.62). After a Cox-proportional hazards model and Kaplan-Meier actuarial analyses, the presence of acute seizures was significantly associated with the risk of functional disability or death (a modified Rankin scale >3) at 12 months of follow-up [hazard ratio (HR): 1.37, 95% CI: 1.04-1.83], as well as NIHSS >10 (HR: 4.47, 95% CI: 3.53-5.65), age ≥65 years (HR: 1.74, 95% CI: 1.38-2.20), heart failure (HR: 1.61, 95% CI: 1.22-2.13) and atrial fibrillation (HR: 1.35, 95% CI: 1.05-1.74). Conclusions: The frequency of provoked seizures after acute ischemic stroke in this cohort was 8%. Age <65 years and severity of the brain infarction are the main factors associated with seizures, which in turn represent an important risk factor for functional disabilities or death one year after the acute event.

Abstract T P10: Hounsfield Unit Value and Clot Length in the Acutely Occlude Vessel and Time Required to Achieve Thrombectomy, Complications and Outcome

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alejandro Spiotta ◽  
Jan Vargas ◽  
Harris Hawk ◽  
Raymond Turner ◽  
Imran Chaudry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Hounsfield Unit ◽  
Hounsfield Units ◽  
Unit Value ◽  
Procedural Complications ◽  
Noncontrast Ct ◽  
Time Required

Introduction: Intra-arterial therapy for acute ischemic stroke (AIS) now has an established role. We investigated if Hounsfield Units (HU) quantification on noncontrast CT is associated with ease and efficacy of mechanical thrombectomy and outcomes. Methods: We retrospectively studied a prospectively maintained database of cases of acute ischemic stroke that underwent intra-arterial therapy between May 2008 and August 2012. Functional outcome was assessed by ninety-day follow up modified Rankin Scale (mRS). Patients were dichotomized base on time to recanalization. Hounsfield units were calculated on head CT. Thrombus location and length were determined on CT angiography. Simple linear regression was used to analyze the association between clot length, average HU, and other clinical variables. Results: 141 patients were included. There was no difference in clot length or average HU among patients with good recanalization achieved within an hour compared to those in which procedures extended beyond an hour. There was no relationship between clot length or density and recanalization. The thrombus length and density were not significantly different between patients with procedural complications and those without. The presence of post procedure intracranial hemorrhage was not associated with thrombus length or density. Ninety day mRS was not associated with thrombus length or density. Conclusions: We have not found any significant associations between either thrombus length or density and likelihood of recanalization, time to achieve recanalization, intraprocedural complications, postprocedural hemorrhage or functional outcome at ninety days. These results do not support a predictive value for thrombus quantification in the evaluation of AIS.

scholarly journals Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness

Stroke ◽  
2021 ◽  
Author(s):  
Manon Kappelhof ◽  
Manon L. Tolhuisen ◽  
Kilian M. Treurniet ◽  
Bruna G. Dutra ◽  
Heitor Alves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Infarct Volume ◽  
Treatment Allocation ◽  
Common Odds Ratio

Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

2018 ◽  
Vol 56 (2) ◽  
pp. 350-355 ◽  
Author(s):  
Tian Xu ◽  
Peng Zuo ◽  
Yuqin Wang ◽  
Zhiwei Gao ◽  
Kaifu Ke
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Logistic Model ◽  
Critical Role ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Multivariable Logistic Regression Model ◽  
Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

scholarly journals Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke

2019 ◽  
Vol 76 (2) ◽  
pp. 194 ◽  
Author(s):  
Anna M. M. Boers ◽  
Ivo G. H. Jansen ◽  
Scott Brown ◽  
Hester F. Lingsma ◽  
Ludo F. M. Beenen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Infarct Volume ◽  
The Relationship

scholarly journals Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

2020 ◽  
Author(s):  
Huiqing Hou ◽  
Xianglong Xiang ◽  
Yuesong Pan ◽  
Hao Li ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Fibrinogen Level ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome ◽  
Stroke Registry

Abstract Background: Fibrinogen is involved in acute stroke. This study aimed to investigate the association between fibrinogen and prognosis in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Using data from the CNSR-Ⅲ (Third China National Stroke Registry), this sub-study included 10 518 (69%) consecutive patients who had fibrinogen levels measured. The primary outcome was a poor functional outcome defined as modified Rankin Scale score of 3 to 6 within 90 days. The secondary outcomes were stroke recurrence, ischemic stroke recurrence, composite vascular events, and poor functional outcome during the 1-year follow-up and a new vascular event at 90 days. Multivariate logistic regression and Cox regression analyses were used to assess the associations between fibrinogen and prognosis of patients. Results: In total, 1446 (13.9%) patients had a poor functional outcome at 90 days. High fibrinogen levels were associated with poor functional outcome (adjusted odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12-1.64) at 90 days after adjustment for confounding risk factors. High fibrinogen levels also independently predicted poor functional outcome during the 1-year follow-up. Stroke recurrence occurred in 657 (6.3%) patients at 90 days. High fibrinogen levels were associated with stroke recurrence, ischemic stroke recurrence, and composite vascular events in the crude model, but further adjustment eliminated these associations in the multivariate models. Conclusion: Our study showed that high fibrinogen level was independently associated with poor functional outcome but not with stroke recurrence in patients with acute ischemic stroke or TIA.

scholarly journals Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

2018 ◽  
Vol 10 (12) ◽  
pp. 1137-1142 ◽  
Author(s):  
Anna M M Boers ◽  
Ivo G H Jansen ◽  
Ludo F M Beenen ◽  
Thomas G Devlin ◽  
Luis San Roman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Imaging Modality ◽  
Infarct Volume ◽  
Pooled Analysis ◽  
Acquisition Time ◽  
Anterior Circulation ◽  
Multivariable Regression Models

BackgroundFollow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement.ObjectiveTo examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality.MethodsData of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (≤48 hours vs >48 hours) was evaluated.ResultsOf 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14–120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of ≥133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15–131) vs 22 mL (IQR 8–71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (ρ=0.60(95% CI 0.56 to 0.64) and ρ=0.55(95% CI 0.50 to 0.60), respectively).ConclusionsIn patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI.

Abstract 75: Hemorrhagic Transformation After Acute Ischemic Stroke Due to a Large Vessel Occlusion is Associated With Less Treatment Benefit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Katinka R van Kranendonk ◽  
Manon Kappelhof ◽  
Vicky Chalos ◽  
Kilian M Treurniet ◽  
Wim van Zwam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Vessel Occlusion ◽  
Treatment Benefit ◽  
Natural Progression ◽  
Before And After

Introduction: Intracranial hemorrhage after acute ischemic stroke patients manifests as natural progression or as a complication of treatment with potential subsequent neurological deterioration. Currently it is unclear whether these hemorrhagic transformations (HT) contribute to the poorer functional outcomes observed in patients with large infarcts. The purpose of this study is to assess the association of HT with follow-up infarct volume (FIV) and functional outcome at 90 days after AIS. Additionally, we determined whether the development of HT was associated with a diminished endovascular therapy (EVT) effect. Methods: All patients from the HERMES collaboration with follow-up imaging were included. HERMES is pooled data from seven randomized controlled trials that assessed the efficacy and safety of EVT compared to usual care. Patients with HT were identified according to the ECASS classification and FIV was assessed on CT or MRI. Infarct and hemorrhage were included in the FIV. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with adjustment for potential confounders was used to determine the association of HT and FIV with functional outcome. Results: Of all included patients with follow-up imaging (n=1665), 42% had HT (n=698). Before and after adjustment for confounders HT and FIV were associated with a shift in the direction of poorer functional outcome (aOR:0.71,95%CI:0.58-0.86 and aOR:0.99,95%CI:0.99-0.99). EVT was beneficial in patients with and without HT, but effect was greater in patients without (aOR:1.70,95%CI:1.27-2.28 vs. aOR:2.51,95%CI:1.97-3.20)(figure 1.) Conclusions: In this analysis, patients with HT after AIS were less likely to have good functional outcome compared to those without HT, independent of the FIV. While the EVT effect was slightly diminished in patients who developed HT, EVT was always of significant benefit.

Abstract W P329: Oxygen Desaturation Index by Apnea Link as Prognostic Factor in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Fernando Gongora-Rivera ◽  
Walter Muruet ◽  
Beatriz Chavez ◽  
Hector Jorge Villarreal-Montemayor ◽  
Hector Jorge Villarreal-Velazquez
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Respiratory Disorders ◽  
Desaturation Index ◽  
Oxygen Desaturation Index ◽  
Significant Difference

Objective: To determine the association between the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI) with the functional outcome in Acute Ischemic Stroke Patients and describe the prevalence of sleep respiratory disorders in this population. Methods: Patients with Acute Ischemic Stroke and NIHSS≤20, within 5 days of admission were tested with Apnea Link device. We analyzed demographic, clinical, and functional characteristics (mRS, NIHSS and Barthel) at outcome, 3 and 6 months after discharge. Results: We included 111 patients, 62% male, with 64.4 ± 12 years-old and Body Mass Index (BMI) of 27 (18-60). NIHSS was ≤12 in 82% of patients. 30% had an AHI ≥30. Patients were divided in 2 groups according to mRS score (0-3 and ≥4) at discharge, 3 and 6 months follow-up. No statistically significant difference was found between groups regarding demographic, clinical and risk factors with symptoms associated with sleep disorders. At 6 months, ODI were associated with a worse functional outcome (p=0.017), but not with AHI (p=0.157). Multivariate analysis revealed that NIHSS (p=0.01) and the ODI (p=0.021) were associated with a mRS ≥4 at 6 months follow-up after adjusting for age, gender and BMI. Conclusions: There is a high prevalence of sleep respiratory disorders in our population. The correlation found between ODI and the mRS at the 6 months follow-up suggests a prognostic potential in Ischemic Stroke.

scholarly journals Serum albumin level as prognostic indicator of acute ischemic stroke in tertiary care hospital admitted patients

2020 ◽  
Vol 7 (6) ◽  
pp. 948
Author(s):  
Prafulla Kumar Dash ◽  
Smrutiranjan Behera ◽  
Nirmal Chandra Sahoo ◽  
Roma Rattan ◽  
Saroj Kumar Tripathy
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Serum Albumin ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Osmotic Gradient ◽  
Care Hospital

Background: Serum Albumin level is an important multifunctional protein in the blood for maintaining the normal permeability across vessel wall by osmotic gradient, in inhibiting platelet aggregation and in reducing blood viscosity.  Serum albumin level as a novel parameter for predicting outcome and assessment of severity of coronary artery disease is established. Keeping in mind the scarcity of studies regarding albumin level in ischemic Cerebrovascular Accident (CVA), present study was undertaken to correlate serum albumin level with clinical outcome in acute ischemic stroke (AIS) patients.Methods: One hundred patients of diagnosed AIS were included in the study. Thorough clinical examination and risk factor profile assessment was done. Severity of stroke was assessed using National Institute of Health Stroke Scale (NIHSS) Score and then followed up to 1 week and 3 months post-admission with serum albumin level and assessment was done using modified Rankin Scale (mRS) score. Institutional ethics committee cleared the study.Results: In 100 patients with AIS, 58% were male and 42% were female. Mean age was 65±8.160. Motor weakness (85%) was the commonest presenting symptom. Around 75% of patients revealed infarction in middle cerebral artery (MCA) territory. Hypertension (HTN) (74%) was the most frequently associated comorbid condition. Patients with low serum albumin level at admission time were directly proportional to severity of stroke at presentation and poor clinical outcome. 1 week and 3 months follow up mean albumin level (g/dl) was 3.8±0.25 and 3.7±0.23 in patients with poor functional outcome respectively. Significant co-relation between mean serum albumin level and clinical outcome was observed.Conclusions: Serum albumin level is inversely correlated with severity of stroke at presentation and functional outcome in patients on follow up.

Sign in / Sign up

Export Citation Format

Share Document