Abstract WMP63: The Yield of Inpatient Cardiac Telemetry in Ischemic Stroke Patients With Ipsilateral Large Artery Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amador Delamerced ◽  
Anusha Boyanpally ◽  
Sleiman El Jamal ◽  
Tina Burton ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Artery Stenosis ◽  
Initial Presentation ◽  
Cardiac Monitoring ◽  
Categorical Variables ◽  
Large Artery ◽  
Continuous Variables ◽  
Artery Disease ◽  
Student’S T

Introduction: The detection of atrial fibrillation (AF) is a crucial component of ischemic stroke secondary prevention. Inpatient cardiac telemetry is part of the structured inpatient workup for ischemic stroke but the yield of telemetry is unknown when ipsilateral, hemodynamically-significant large artery atherosclerosis is identified at the time of initial presentation. Methods: We performed a single-center, retrospective, cohort study utilizing data from an institutional quality improvement database. We identified consecutive patients with acute ischemic stroke presenting between July 2015 and September 2017. We included patients with hemodynamically-significant (>50%) large artery stenosis in the arterial territory subserving the region of infarct. We excluded patients with a known history of AF. We determined the yield of an electrocardiogram, inpatient telemetry and outpatient cardiac event monitoring in detecting new AF. Groups with and without AF were compared using unpaired student’s T-test for continuous variables and Chi 2 test for categorical variables. Results: We identified 1435 patients presenting to our institution during the study period of whom 209 (14.6%) met inclusion criteria. Patients were aged 69.37±12.6 years and 33% were female. Of these patients, 19 (9.1%) were found to have new AF during their hospitalization and a further 2 (1%) were found to have AF on extended cardiac monitoring. Thirty seven patients had 30-day cardiac monitoring performed after hospitalization and the yield on this was 5.4% for the detection of AF. Patients with AF were older (76.29±11.31 years vs. 68.60±12.58 years, p=0.008) and had higher rates of hypertension (94% vs. 75%, p=0.04) and hyperlipidemia (72% vs. 52%, p=0.09). In all patients, anticoagulation was planned after the discovery of AF. Discussion: Inpatient cardiac telemetry detects new atrial fibrillation in 9.1% of patients known to have hemodynamically-significant large artery disease at the time of initial presentation. The yield of further outpatient cardiac monitoring is lower (5%). This hypothesis-generating study is limited by its retrospective nature and the potential for selection bias.

Burden of dementia in atrial fibrillation hospitalizations- analysis of national inpatient sample 2016-2018

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
H Thyagaturu ◽  
K Shah ◽  
S Li ◽  
S Thangjui ◽  
B Shrestha
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Primary Diagnosis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
National Inpatient Sample ◽  
Chi Square ◽  
Student’S T

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation is a common disorder in the elderly population and a known risk factor for stroke and dementia. Purpose  To study the burden of dementia in Afib hospitalizations and identify the predictors of in-hospital mortality in Afib with dementia hospitalizations. Methods We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of Afib. Hospitalizations of Afib with dementia was compared with Afib without dementia. We used the Chi-square test for differences between categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders. Results  We identified 1,236,540 weighted Afib hospitalizations across three years. Of which, 79,405 (6.4%) of them were associated with dementia. Afib with dementia hospitalizations were associated with older age (mean age 83.2 vs 70.0 yrs; P < 0.01), higher rate of chronic Afib (15.3% vs 7.5%; P < 0.01), higher rate of comorbidity (% of >3 Elixhauser comorbidity score 91.8% vs 83.6%; P < 0.01). After adjusting for patient and hospital-level characteristics, we observed that Afib with dementia hospitalizations was associated with higher odds of in-hospital mortality compared to Afib without dementia [Odds Ratio (OR): 1.6 (1.4 – 1.9); P < 0.01]. We also observed statistically significant association with increased LOS [4.7 vs 3.2 days; P < 0.01], repeated falls [OR: 2.8 (2.5 – 3.1); P < 0.01] and protein calorie malnutrition [OR: 1.9 (1.7 – 2.0); P < 0.01] in Afib with dementia group. Conclusion Afib with dementia hospitalizations are not only associated with higher mortality, but they are also associated with higher repeated fall rates, and skilled nursing facility discharge dispositions. Co-morbidities like hypertension, CKD, obesity, HFrEF, HFpEF, OSA are associated with higher in-hospital mortality. Our study findings emphasize the burden of dementia in Afib hospitalizations and the need for prevention of poor outcomes in this population.

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Abstract 24: Predictors of Occult Atrial Fibrillation in Cryptogenic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Erin Ingala ◽  
Jenny Jara ◽  
Emily Fessler ◽  
Brett L Cucchiara ◽  
Steven R Messe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Multivariate Logistic Regression Model ◽  
Cerebellar Infarction ◽  
Large Artery ◽  
Brain Images ◽  
Risk Sources ◽  
Artery Disease

Background and Purpose: Prolonged cardiac monitoring may identify paroxysmal atrial fibrillation (AF) in patients with cryptogenic stroke. We aimed to identify clinical, echocardiographic, and neuroimaging features which may increase the efficiency of detecting AF on cardiac monitoring. Methods: We studied a retrospective cohort of 227 subjects with cryptogenic ischemic stroke referred for 28 day mobile cardiac outpatient telemetry (MCOT). Patients with large artery disease or high risk sources of cardioembolism were excluded. We reviewed medical records, brain images, and echocardiograms, blinded to MCOT results. Acute and/or chronic infarctions were characterized by size, location, and as cortical, subcortical, or both; wedge-shaped; lacunar; borderzone; and/or multiple territories. Cardiac features included left atrial (LA) size, ejection fraction, aortic arch atheroma, and PFO. Variables were tested in univariate analyses and further incorporated in a multivariate logistic regression model to determine independent predictors of detecting AF. Results: The cohort age was 62.9±2.9 years, 42% were men, and 53% were white. Median CHADS was 3 and CHADS2Vasc was 5. Infarcts were >1.5 cm in 62% of subjects, predominantly cortical in 47%, subcortical in 39%. Only 9% were single, deep, and <1.5 cm. LA size was 3.6±0.7 cm and ejection fraction was 61±9%. MCOT detected AF in 30 (13%) patients. In multivariate analysis, AF was only associated with age>60 (OR 3.6 [1.2-10.4], p=0.02) and prior (chronic) cortical or cerebellar infarction (OR 3.3 [1.3-8.6], p=0.013) (C-statistic 0.72). There was no association with any other clinical, echocardiographic, or radiographic parameter. AF was detected in 32% of patients with age >60 and the presence of prior cortical or cerebellar infarction, compared to 4% with neither of these factors. Conclusion: Atrial fibrillation is detected on MCOT in a substantial minority of cryptogenic stroke patients. Age>60 and the presence of prior cortical or cerebellar strokes are predictive of detecting AF in these patients. Other brain and cardiac characteristics were not found to be helpful. These data may aid in the selection of patients for prolonged arrhythmia monitoring.

EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

2021 ◽  
pp. 174749302110059
Author(s):  
Yiu Ming Bonaventure Ip ◽  
Lisa Au ◽  
Yin Yan Anne Chan ◽  
Florence Fan ◽  
Hing Lung Ip ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrence Rate ◽  
Small Vessel Disease ◽  
Mainland China ◽  
Cardioembolic Stroke ◽  
Large Artery ◽  
Risk Factor Control ◽  
Stroke Subtypes ◽  
Artery Disease ◽  
Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joon-tae Kim ◽  
Hee-Joon Bae ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulant ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards ◽  
Large Artery ◽  
Vascular Events ◽  
Nihss Score ◽  
Composite Events

Introduction: Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far. Objective: This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD. Methods: Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke. Results: Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35). Conclusion: In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.

Abstract P25: Safety of Ticagrelor in Moderate to Severe Acute Ischemic Stroke: A Single-Center Retrospective Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Stephen W English ◽  
David Landzberg ◽  
Nirav Bhatt ◽  
Michael Frankel ◽  
Digvijaya Navalkele
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Major Bleeding ◽  
Mechanical Thrombectomy ◽  
Categorical Variables ◽  
Severe Bleeding ◽  
Large Artery ◽  
Inpatient Stay ◽  
Increased Risk

Introduction: Ticagrelor with aspirin has been recently shown to reduce the risk of stroke or death compared to aspirin alone in patients with high risk TIAs and mild strokes. However, this benefit is offset by increased risk of severe bleeding. We sought to evaluate the safety of ticagrelor in patients with moderate to severe ischemic stroke. Methods: This was a retrospective cohort study of adults discharged on ticagrelor after presenting with acute ischemic stroke and NIHSS > 5 from January 2016 to December 2019 at a large, urban, academic comprehensive stroke center. Patients were excluded if they underwent carotid or intracranial angioplasty and/or stenting, or carotid endarterectomy during admission. Baseline clinical characteristics, imaging, and outcomes were reviewed. Data was organized into continuous and categorical variables. Results: Sixty-one patients met inclusion and exclusion criteria. Median age was 61 (IQR, 52-68) years; 33 (54%) were men, and 33 (54%) were African American. Median NIHSS was 11 (IQR, 8-15). Fourteen (23%) patients received IV Alteplase and 35 (57%) patients underwent mechanical thrombectomy. Five (8%) patients received both IV Alteplase and mechanical thrombectomy. Median ticagrelor start date was hospital day 1 (IQR, 0-3). Large artery atherosclerosis was presumed etiology in 53 (87%) patients. No patients experienced neurologic worsening, recurrent stroke, sICH, or major bleeding during inpatient stay. Sixty (98%) patients were on aspirin and ticagrelor at discharge. Follow-up information was available for 53 (87%) patients for a median duration of 3 (IQR, 2-6) months. Following discharge, 3 (5%) patients experienced recurrent ischemic stroke despite being compliant. One (2%) patient experienced major bleeding—gastrointestinal hemorrhage requiring transfusion—two months after hospital discharge. Conclusions: This study highlights the potential expanding role for ticagrelor in secondary stroke prevention in patients with moderate to severe stroke. Early ticagrelor use did not result in sICH during inpatient stay—and only 1 major bleeding event on follow-up—in our cohort. While further research in this area is needed, these findings present an exciting opportunity for future prospective studies.

Abstract W P224: Higher Pre-Hospital Blood Pressure Prolongs Door to Needle Thrombolysis Times

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Digvijaya Navalkele ◽  
Chunyan Cai ◽  
Mohammad Rahbar ◽  
Renganayaki Pandurengan ◽  
Tzu-Ching Wu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Sample Size ◽  
Heart Association ◽  
Small Sample ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Intravenous Tissue Plasminogen Activator ◽  
Number Of Patients

Background: Per American Heart Association guidelines, blood pressure (BP) should be < 185/110 to be eligible for intravenous tissue plasminogen activator (tPA). It is shown that door to needle (DTN) time is prolonged in patients who require anti-hypertensive medications prior to thrombolysis in the emergency department (ED). To our knowledge, no studies have focused on pre-hospital BP and its impact on DTN times. We hypothesize that DTN times are longer for patients with higher pre-hospital BP. Methods: We conducted a retrospective review of acute ischemic stroke patients who presented between 1/2010 and 12/2010 to our ED through Emergency Medical Services (EMS) within 3-hrs of symptom onset. Patients were identified from our registry and categorized into two groups: Pre-hospital BP ≥ 185/110 (Pre-hsp HBP) and < 185/110 (Pre-hsp LBP). BP records were abstracted from EMS sheets. Two groups were compared using two-sample t-test or Wilcoxon rank sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. Results: A total of 107 consecutive patients were identified. Out of these, 75 patients (70%) were treated with tPA. Among the patients who received thrombolysis, 35% had pre-hospital BP ≥ 185/110 (n= 26/75). Greater number of patients required anti-hypertensive medications in ED in high BP group compared to low BP group (Pre-hsp HBP n= 14/26, 54%; Pre-hsp LBP n= 13/49, 27%, p < 0.02). Mean door to needle times were significantly higher in Pre-hsp HBP group. (mean ± SD 87.5± 34.2 Vs. 59.7±18.3, p<0.0001). Analysis of patients only within the Pre-hsp HBP group (n= 26) revealed that DTN times were shorter if patients received pre-hsp BP medications compared to patients in the same group who did not receive pre-hsp BP medication (n= 10 vs 16; mean ± SD 76.5 ± 25.7 Vs. 94.3 ± 37.7, p = 0.20) Conclusion: Higher pre-hospital BP is associated with prolonged DTN times and it stays prolonged if pre-hospital high BP remains untreated. Although the later finding was not statistical significant due to small sample size, pre-hospital blood pressure control could be a potential area for improvement to reduce door to needle times in acute ischemic stroke.

Abstract 15353: Apixaban Failure in Prevention of Ischemic Cerebrovascular Accidents in Non-valvular Atrial Fibrillation Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohammad Zmaili ◽  
Jafar Alzubi ◽  
Mohamed Gad ◽  
Ahmed Abu-Haniyeh ◽  
Walid I Saliba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Clinical Characteristics ◽  
Low Dose ◽  
Carotid Artery Disease ◽  
Cleveland Clinic ◽  
Inappropriate Use ◽  
Multivariable Analyses ◽  
Artery Disease

Introduction: Apixaban has been increasingly used over the past decade for the prevention of ischemic strokes in atrial fibrillation (AF) patients. Nonetheless, some patients may experience ischemic strokes despite apixaban therapy. There is scarce information about factors underlying apixaban failure in AF patients. Methods: A system wide search was employed at the Cleveland Clinic Health System using electronic records. All patients 18 years of age or older, who were diagnosed with AF, and developed an ischemic stroke while being treated with apixaban (January 2013 through May 2019) were included. A matched controls series (no stroke on apixaban) was included accounting for antiplatelet and statin therapy, and carotid artery disease. Multivariable analyses were performed to assess for associations between clinical characteristics and stroke on apixaban. Results: A total of 137 patients with stroke while on apixaban were identified and matched to 137 controls. Cases and controls were comparable in a large number of clinical characteristics. There was an association between apixaban dosing and risk of stroke. About 40% of the lower (2.5 mg BID) dose of apixaban was prescribed for patients who would have qualified for full dose. Being on inappropriately low dose of apixaban was associated with a higher risk of ischemic strokes compared to appropriately prescribed doses with an adjusted OR 3.37 [1.37-8.32]. Among appropriately prescribed doses, the 5 mg BID dose showed a statistically nonsignificant lower risk of ischemic stroke compared to the 2.5 mg BID dose, adjusted OR 0.55 [0.21-1.41]. Compared to the inappropriate use of the 2.5 mg dose, the appropriate prescription of the 2.5 mg dose was associated with a lower risk of stroke adjusted OR 0.34 [0.07-1.64]. Conclusion: In this series, there was a statistically significant association between being on an inappropriately low dose of apixaban and the odds of stroke while on apixaban therapy.

Abstract 147: Outcomes of the Stroke Thromboembolism Registry of Imaging and Pathology: A Multicenter International Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
Sean Fitzgerald ◽  
David F Kallmes ◽  
Kennith Layton ◽  
Ricardo Hanel ◽  
...  
Keyword(s):  
Inverse Correlation ◽  
Categorical Variables ◽  
Histopathological Analysis ◽  
Large Artery ◽  
Imaging Features ◽  
Continuous Variables ◽  
Imaging Findings ◽  
Clinical Registry ◽  
Stroke Etiology ◽  
Platelet Content

Background: We performed a multicenter prospective clinical registry across 11 centers to study the association between histopathological characteristics of retrieved clots and imaging, stroke etiology and clinical outcomes. Materials and Methods: Following IRB approval at the 11 centers, patients were enrolled in the STRIP registry. All retrieved emboli were sent for histopathological analysis with H&E and MSB staining. Demographic variables, comorbidities, stroke etiology, imaging findings and procedural details were collected for each case. We studied the association between clot histopathology and imaging findings, stroke etiology and and revascularization outcomes. Student’s t-test was used for continuous variables and chi-squared testing for categorical variables. Results: To date, 1022 patients have been included. There was a significant correlation between platelet rich clots and the absence of hyperdensity on non-contrast CT [p=0.321, p=0.003) and a significant inverse correlation between the percentage of platelets and mean HU on NCCT (p=-0.243, p=0.025). The proportion of platelet-rich clots (55.0% versus 21.2%, p=0.005) and the percentage of platelet content (22.1% versus 13.9%, p=0.03) was significantly higher in patient with large artery atherosclerosis compared to those with a cardioembolic etiology. There was no correlation between RBC density, WBC density, fibrin density or platelet density and revascularization outcomes with stent-retrievers. However, we have found that with aspiration alone, patients with platelet rich clots are less likely to be fully revascularized (i.e. TICI 2c/3) than non-platelet rich clots (OR=0.36, 95%CI=0.12-0.81, P<.0001). Meanwhile, patients with RBC rich clots are more likely to be completely revascularized with aspiration alone than those with RBC poor clots (OR=2.71, 95%CI=1.25-3.24, P=0.02). Conclusions: Interim analysis of the STRIP registry suggests that the platelet content of a clot may be the most revealing factor in determining a clot’s etiology, imaging features and revascularization outcome. Platelet rich clots are less dense on NCCT, are associated with a large artery atherosclerosis source and are less likely to be completely revascularized with aspiration alone.

Abstract TP159: Correlation Between Arterial Stiffness And The Severity Of Acute Cerebral Infarction

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
YEONG-BAE LEE ◽  
Joo-Hwan Park ◽  
Eunja Kim ◽  
Ki-Tae Kim ◽  
Ju Kang Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Stiffness ◽  
Acute Ischemic Stroke ◽  
Pulse Wave ◽  
Small Vessel Disease ◽  
Large Artery ◽  
Significant Difference ◽  
Initial Severity ◽  
Artery Disease ◽  
Toast Classification

Arterial stiffness is an independent predictor of cardiovascular disease and stroke and can be evaluated by measuring pulse wave velocity(PWV) between 2 sites in the arterial tree, with a higher PWV indicating stiffer arteries. Recent studies have demonstrated that arterial stiffness is associated with intracranial large artery disease and the severity of cerebral small vessel disease. The aim of this study is to clarify whether pulse wave velocity value predict initial severity of acute ischemic stroke. We enrolled consecutive patients with acute ischemic stroke. Demographic factors, laboratory data, brain imaging, neurological exam and arterial stiffness measured by brachial ankle PWV (baPWV) were evaluated on admission in all subjects. The subtype of acute ischemic stroke was classified according to the TOAST classification. All patients were categorized into two groups based on the initial severity of stroke, indicated by modified Rankin Scale(mRS). Severe group was defined as a mRS ≥ 3 at admission. Unpaired student’s t-test or Mann-whitney U-test were used to compare maximal and meanbaPWV values between two groups. We enrolled 78 patients. According to the TOAST classification, the etiology of stroke was large artery disease (LAD) in 34 patients, small vessel disease (SVD) in 23 patients, and other subtypes in 12 patients. There were 28 patients with good outcome and 41 patients with poor outcome. The maximal and mean baPWV values were significantly increased in inpatients with high mRS score (2120.17± 527.75, 1999.21 ± 437.46) compared with those with low mRS score (1751.96 ± 363.49, 1723.14 ± 353.02)(p=0.001, p=0.007). In patients with SVD subtype, there was significant difference in maximal and mean baPWVvalues between two groups (p=0.030, p=0.047), whereas there was no significant difference in baPWV in patients with LAD subtype (p=0.141, p=0.172). The main finding of our study is that arterial stiffness indicated by baPWV is associated with the initial severity of acute ischemic stroke. Because initial stroke severity is strongly associated with functional outcome of stroke, this findings suggest that measurement of baPWV may predict long-term outcome in patients with stroke especially in those with TOAST classification confirmed as SVD.

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