Abstract TP380: Significant Factors of Early Independent Gait in Acute Ischemic Stroke Patients

Introduction: Acute stroke patients have problems with gait disturbance. Independent gait in hospitalized patients is important for early discharge to home. Therefore, we must find factors of disturbing independent gait following acute stroke and intensively treat them. Hypothesis: Impaired trunk control and cognitive function are factors of disturbing early independent gait. Methods: We included acute ischemic stroke patients who were admitted in our hospital from June 2017 to May 2018 and excluded patients with disturbed level of consciousness. We defined a score of 6 (modified Independence) or 7 (complete independence) in the Functional Independence Measure (FIM) as gait independence. We evaluated association of stroke subtypes, Brunnstrom recovery stage (BRS) of upper limbs, fingers and lower limbs, trunk control test (TCT) score and Mini-Mental State Examination (MMSE) score with early gait independence on the 7th day of a stroke onset. Results: One hundred twenty- six patients met our inclusive criteria and we analyzed them. Stroke subtypes had no relation to early gait independence. In gait independent and dependent patients on the 7th day, median BRS score of upper limbs was 5 and 5 (ns), median BRS score of fingers was 5 and5 (ns), median BRS score of lower limbs was 6 and 5 (p<0.01), TCT score was 100and 75 (p<0.01) and MMSE score was 28.5 and 24.5 (p<0.01), respectively. Multiple logistic regression analysis that TCT (p<0.01) and BRS lower limbs (p<0.01) were independent factors for early independent gat. Receiver operating characteristic curve (ROC) for early gait independence demonstrated that cut-off values of TCT score and BRS of lower limbs and were 100 and 5. Conclusions: Impaired trunk control and muscle weakness of lower limbs were significant factors of disturbing early gait independence.

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Abstract WP471: Significant Factors for Early Independent Toilet Activities in Acute Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.wp471 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Yuki Sawada ◽

Takahisa Mori ◽

Yuna Hosaka

Keyword(s):

Cognitive Function ◽

Acute Stroke ◽

Mmse Score ◽

Multiple Logistic Regression Analysis ◽

Early Discharge ◽

Functional Independence ◽

Lower Limbs ◽

Stroke Patients ◽

Trunk Control ◽

Significant Factors

Introduction: Acute stroke patients have problems with toilet activities. Independent toilet activity in hospitalized patients is important for dischargee to home. Hypothesis: Lower limbs function, trunk control and cognitive function are important factors of early independent toilet activities and discharge to home within 7 days. Methods: We included acute ischemic stroke patients who 1) were admitted from June 2017 to May 2018 and 2) received early rehabilitation treatment. Patients with disturbed level of consciousness were excluded. Functional independence measure (FIM) scale of 6 or 7 was defined as independence and FIM scale of 5 or less as dependence. We evaluated Brunnstrom Recovery Stage (BRS) of arms, fingers and lower limbs, trunk control test (TCT), Mini-Mental State Examination (MMSE) and investigated significant factors of early independent toilet activities and discharge to home within 7 days. Results: One-hundred twenty-four patients met our inclusive criteria. Their average age was 75.8 years, male gender of 63.7%, median BRS of arms, fingers and lower limbs was 5, 5 and 5, median TCT score and MMSE score were 94 and 24.7, respectively. Fifty-three patients were independent in toilet activity and 73 patients were dependent. All patients with independent toilet activity discharged to home within 7 days. In independent and dependent toilet activity patients, an average age was 73.6 and 77.4 (p<0.05), median BRS of arms was 5 and 5 (p<0.01), median BRS of fingers was 6and 5 (p<0.01), median BRS of lower limbs was 5 and 5 (p<0.01), median TCT score was 100 and 61 (p<0.01), and median MMSE score was 27.8 and 22.5 (p<0.01), respectively. Multiple logistic regression analysis showed that MMSE score (p<0.01), TCT score (p<0.01), and BRS of lower limbs (p<0.05) were independent factors for independent toilet activity and discharge to home. Receiver operating characteristic (ROC) curve for early discharge to home demonstrated that cut-off values of MMSE score, TCT score and MRS of lower limbs were 27 or more, 87 or more and 5 or more, respectively. Conclusion: BRS as lower limbs function, TCT as trunk control and MMSE as cognitive function were important factors of early independent toilet activities and early discharge to home.

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Abstract WP130: Association of Large Inter-arm Blood Pressure Difference With Mortality And Systemic Atherosclerosis In Acute Stroke Patients

Stroke ◽

10.1161/str.44.suppl_1.awp130 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jinkwon Kim ◽

Tae-Jin Song ◽

Dongbeom Song ◽

Seung Hun Oh ◽

Ok Joon Kim ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Prognostic Value ◽

Ankle Brachial Index ◽

Lower Limbs ◽

Absolute Difference ◽

Peripheral Arteries ◽

Stroke Patients

Backgrounds: Large inter-arm difference of blood pressure (IAD) is associated with development of cardiovascular events and increased mortality in the general population and in patients with cardiovascular risk factors. However, it is unknown whether the presence of large IAD has prognostic value in acute stroke patients and whether it is associated with atherosclerosis on other vascular beds (cerebral, coronary, and peripheral arteries, and aorta). We evaluated the prognostic value of large IAD measured in acute ischemic stroke, and the association between large IAD and atherosclerosis on multiple arterial beds (cerebral, coronary, and peripheral arteries, and aorta). Methods: We included 836 consecutive patients with acute ischemic stroke. Large IAD was defined by more than 10 mmHg absolute difference of systolic blood pressure between the arms. The presence of systemic atherosclerosis was determined based on cerebral angiography, coronary CT angiography, transesophageal echocardiograpghy and ankle-brachial index examination. Results: Large IAD was observed in 7.4 % of patients. During a mean study period of 419.4 ± 250.2 days, 48 patients (5.7 %) died (including 34 cardiovascular deaths). The Kaplan-Meier survival curves showed significantly higher mortality in the group with large IAD than those without (Figure, a log-rank test, (A) p<0.001 in all-cause death, (B) p<0.001 in cardiovascular death). In multivariate Cox regression, large IAD was associated with increased all-cause mortality (adjusted HR is 3.040, p=0.002), and cardiovascular mortality (adjusted HR is 3.612, p=0.002). The presence of large IAD was associated with peripheral artery disease in the lower limbs (p=0.005), but not with atherosclerosis in the cerebral artery, coronary artery or the aorta. Conclusions: The presence of large IAD is a strong independent prognostic marker in acute ischemic stroke.

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Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.10 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Amy K Starosciak ◽

Italo Linfante ◽

Gail Walker ◽

Osama O Zaidat ◽

Alicia C Castonguay ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Predictive Power ◽

Rescue Therapy ◽

Univariate Analysis ◽

Stroke Patients ◽

Good Outcome ◽

Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

Journal of Cerebrovascular and Endovascular Neurosurgery ◽

10.7461/jcen.2013.15.3.131 ◽

2013 ◽

Vol 15 (3) ◽

pp. 131 ◽

Cited By ~ 14

Author(s):

Hye-Young Shin ◽

In-Hye Jeong ◽

Chang-Ki Kang ◽

Dong-Jin Shin ◽

Hyeon-Mi Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Left Atrial ◽

Stroke Patients ◽

Left Atrial Enlargement ◽

Stroke Subtypes ◽

Atrial Enlargement

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The Predictive Value of the Boston Acute Stroke Imaging Scale (BASIS) in Acute Ischemic Stroke Patients among Chinese Population

PLoS ONE ◽

10.1371/journal.pone.0113967 ◽

2014 ◽

Vol 9 (12) ◽

pp. e113967

Author(s):

Yuanqi Zhao ◽

Min Zhao ◽

Xiaomin Li ◽

Xiancong Ma ◽

Qinghao Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Predictive Value ◽

Chinese Population ◽

Stroke Patients ◽

Stroke Imaging ◽

Acute Stroke Imaging

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Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.52.suppl_1.p201 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

RAJAN R GADHIA ◽

Farhaan S Vahidy ◽

Tariq Nisar ◽

Destiny Hooper ◽

David Chiu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Combined Treatment ◽

Stroke Patients ◽

Stroke Treatment ◽

Intravenous Tissue Plasminogen Activator ◽

Significant Difference ◽

Acute Stroke Treatment ◽

Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

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Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp267 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Kerrin Connelly ◽

Rishi Gupta ◽

Raul Nogueira ◽

Arthur Yancey ◽

Alexander Isakov ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Transport Protocol ◽

Stroke Patients ◽

Stroke Registry ◽

The Public ◽

State Office ◽

Stroke Center ◽

Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

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Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽

10.1161/str.45.suppl_1.wp287 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Laurie Paletz ◽

Shlee Song ◽

Nili Steiner ◽

Betty Robertson ◽

Nicole Wolber ◽

...

Keyword(s):

Ischemic Stroke ◽

Quality Of Care ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Turnaround Time ◽

Joint Commission ◽

Stroke Patients ◽

Number Of Patients ◽

The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

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Abstract WMP58: The Smoker’s Paradox After Acute Ischemic Stroke, is it Real or a Cloud of Smoke?

Stroke ◽

10.1161/str.51.suppl_1.wmp58 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam H de Havenon ◽

Eva Mistry ◽

Shadi Yaghi ◽

Pooja Khatri ◽

Shyam Prabhakaran

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Tobacco Use ◽

Neurologic Outcome ◽

Stroke Patients ◽

Logistic Regression Models ◽

Neurological Outcomes ◽

Good Outcome ◽

Adjusted Model

Background: Although tobacco use, the majority of which is cigarette smoking, increases the risk of incident stroke, there are inconsistent data regarding the effect of tobacco use on neurological outcomes after acute ischemic stroke. Several prior studies have suggested that smoking could be protective after stroke, which has been termed the "smoker’s paradox." Methods: We pooled three data sources to explore the effect of tobacco use on neurologic outcome in acute stroke patients. The first was the Blood Pressure after EVT in Stroke (BEST) study, the second was the NINDS tPA trial, and the third was the Interventional Management of Stroke (IMS) III trial. The primary outcome is 90-day mRS 0-2 (good outcome). We fit logistic regression models to good outcome, both unadjusted and adjusted for patient age, NIHSS, and sICH. Results: Our pooled cohort had 1,671 acute stroke patients, of which 480 (28.7%) used tobacco. In an unadjusted model, tobacco use was associated with good outcome (OR 1.42, 95% CI 1.15-1.76, p=0.001). However, in the adjusted model, this association was no longer significant (aOR 0.98, 95% CI 0.76-1.25, p=0.868). If we stratify by placebo-treated (n=310), tPA-treated (n=513), and EVT-treated (n=836), we continue to find that tobacco use is not associated with good neurologic outcome in adjusted analyses specific to these subgroups. An additional subgroup analysis of the EVT-treated patients that adjusted for successful procedural recanalization (TICI 2b-3) was not significant. Patients who used tobacco were younger (mean age, 60.5 vs. 69.2 years, p<0.001). Adjusting for age alone rendered the association between tobacco use and good outcome insignificant (aOR 1.05, 95% CI 0.84-1.32, p=0.666). Conclusions: This is the first adjusted analysis to examine the association between tobacco use and neurologic outcome in EVT-treated patients. We find that tobacco use is not protective after acute ischemic stroke that is untreated or treated with tPA or EVT. The univariate association of tobacco use with good outcome is accounted for by tobacco users being younger.

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