Abstract WP36: National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shahram Majidi ◽  
Amol Mehta ◽  
Inder P Singh ◽  
Hazem Shoirah ◽  
Tomoyoshi Shigematsu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Favorable Outcome ◽  
Secondary Outcome ◽  
Age Group ◽  
Endovascular Thrombectomy ◽  
Younger Patients

Background: The efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in elderly is controversial as this age group is often excluded or under-represented in major randomized clinical trials. We evaluated the real-world trends in utilization and outcome of EVT in patients ≥80 years in a nationally representative database. Methods: Using nationwide inpatient sample (2014-2016), we identified patients admitted to hospitals in the United States with acute ischemic stroke who underwent EVT. Baseline demographics and clinical outcome were assessed among patients with age ≥80 years and those with age <80 years. The primary endpoint was favorable outcome defined as discharge to home or acute rehabilitation center. Hemorrhage and in-hospital mortality rates were assessed as secondary outcome measures. Multivariate analysis was performed to identify independent predictors of favorable clinical outcome in elderly. Results: A total of 6,230 patients were identified and 1,547 (24.83%) of them were ≥80. The number of patients ≥80 years who underwent EVT increased from 323 (22%) in 2014 to 695 (28%) in 2016. The rate of favorable outcome in elderly was 9% which was significantly lower than in younger patients (22%). In-hospital mortality was 19% in patients ≥80 years compared to 13% in their younger counterpart. There was no difference in the rate of hemorrhagic transformation between octogenarians and younger patients (3.2% vs 2.6%). Among patient ≥80, decreasing baseline comorbidity burden (Elixhauser Comorbidity Index) [OR; (95% CI): 1.24; (1.04-1.47)] was an independent predictor of favorable outcome. Conclusions: Two-fold increase in the number of EVT was seen from 2014 to 2016 among patients ≥80 years old. Although the rate of favorable outcome is lower in this age group, comparison to a historical control group suggests significant outcome benefit from EVT in these patients. Future prospectively designed studies are warranted for further characterization of the risks and benefit of EVT in elderly.

Mechanical Thrombectomy in Acute Ischemic Stroke Patients Performed Within and Outside Clinical Trials in the United States

Neurosurgery ◽  
2019 ◽  
Author(s):  
Adnan I Qureshi ◽  
Baljinder Singh ◽  
Wei Huang ◽  
Zhiyuan Du ◽  
Iryna Lobanova ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
The United States ◽  
Severe Disability ◽  
Secondary Outcome ◽  
Stroke Patients

Abstract BACKGROUND A better understanding of differences in outcomes of mechanical thrombectomy performed within and outside clinical trials will assist in optimal implementation of the procedure for acute ischemic stroke patients in general practice. OBJECTIVE To identify differences in demographic and clinical characteristics and outcomes related to mechanical thrombectomy in patients treated within clinical trials and those treated outside clinical trials in a large national cohort. METHODS  We compared the patient characteristics and associated in-hospital outcomes of mechanical thrombectomy in acute ischemic stroke patients performed within and outside clinical trials using the Nationwide Inpatient Sample from 2013 to 2015. We analyzed in-hospital mortality (primary outcome) and moderate to severe disability (secondary outcome) based on discharge disposition after adjusting for potential confounders. RESULTS Of 23 375 patients who underwent mechanical thrombectomy, 430 (1.8%) underwent the procedure as part of a clinical trial. After adjusting for age, gender, and the teaching status of the hospital, patients treated within a clinical trial had lower rates of in-hospital mortality (odds ratio [OR] 0.14; 95% CI .03 to .71; P < .001). Among patients discharged alive, the rate of moderate to severe disability (OR .43; 95% CI .26 to .71; P < .001) was lower among those patients treated within a clinical trial. There was no difference in odds of post-thrombectomy intracerebral or subarachnoid hemorrhage between the two groups. CONCLUSION Mechanical thrombectomy performed as part of clinical trials was associated with lower rates of in-hospital mortality and lower rates of moderate to severe disability compared with those performed outside clinical trials.

scholarly journals The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Mona Laible ◽  
Ekkehart Jenetzky ◽  
Markus Alfred Möhlenbruch ◽  
Martin Bendszus ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Stroke Severity ◽  
Post Contrast ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Impact

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or &gt;25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p &lt; 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p &lt; 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p &lt; 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

Abstract TP18: Endovascular Treatment in the Elderly with Acute Ischemic Stroke - Is it Safe in Clinical Practice?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Thabele M Leslie-Mazwi ◽  
Syed F Ali ◽  
Sanjeeva R Onteddu ◽  
Adewumi D Amole ◽  
Mehmet S Akdol ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
The Elderly ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Younger Patients

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

scholarly journals Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes

2020 ◽  
Vol 12 (11) ◽  
pp. 1045-1048 ◽  
Author(s):  
Adam de Havenon ◽  
Shadi Yaghi ◽  
Eva A Mistry ◽  
Alen Delic ◽  
Samuel Hohmann ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Unit Length ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Systemic Complications ◽  
Endovascular Thrombectomy ◽  
Lower Odds ◽  
Coronary Syndrome

BackgroundWe aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without.MethodsWe performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection.ResultsWe identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002).ConclusionIn AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.

JET 7 XTRA Flex reperfusion catheter related complications during endovascular thrombectomy

2020 ◽  
pp. neurintsurg-2020-016826
Author(s):  
Shahram Majidi ◽  
Devin V Bageac ◽  
Islam Fayed ◽  
Benjamin Yim ◽  
Reade De Leacy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Technological Advancement ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Device Malfunction ◽  
Inner Diameter

Endovascular thrombectomy has revolutionized the management of acute ischemic stroke from emergent large vessel occlusion. Continued technological advancement in the field, as evidenced by successive introduction of large bore aspiration catheters with enhanced trackability and large inner diameter, has played a major role in achieving fast and robust recanalization and improved clinical outcome. Here, we present three patients with intraprocedural device malfunction related to the JET 7 XTRA Flex reperfusion catheter.

CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

2015 ◽  
Vol 8 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Lucas Elijovich ◽  
Nitin Goyal ◽  
Shraddha Mainali ◽  
Dan Hoit ◽  
Adam S Arthur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
Favorable Outcome ◽  
Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

Abstract WMP50: Age-Specific Female-Male Disparities in Endovascular Thrombectomy Use for Acute Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hamidreza Saber ◽  
Amytis Towfighi ◽  
David S Liebeskind ◽  
Jeffrey L Saver
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Age Groups ◽  
Reperfusion Therapy ◽  
The United States ◽  
National Inpatient Sample ◽  
Endovascular Thrombectomy ◽  
Age Related ◽  
The Us ◽  
Age And Sex

Introduction: Studies have suggested sex-related and age-related variations in frequency of reperfusion therapy, but have been limited by constrained geographic scope, data from before the modern thrombectomy era, and incomplete exploration of sex-related differences in discrete age ranges. We therefore analyzed sex-, age-, and sex-age interaction in the frequency of endovascular thrombectomy (EVT) for acute ischemic stroke in the US National Inpatient Sample. Methods: In the National Inpatient Sample , we identified all adult ischemic stroke EVT hospitalizations from 2010-2016, using ICD-9-CM and ICD-10-CM codes. Patient age was categorized as: <50y, 50-59y, 60-69y, 70-79y and ≥80ys. Rates of use of EVT were assessed standardized to the 2010 US Census population. Results: Among 50,573 EVT hospitalizations, 50.1% were female. The number of EVTs increased from 4091 in 2010 to 12,875 in 2016. Over the entire 7y time period, a sex-age interaction was noted: 49% in <50y; 37% in 50-59y; 35% in 60-69y; 53% in 70-79y; and 66% in ≥80y. This sex-age interaction was present as well for EVT rates per 100,000 individuals in the population, with the total ratio of female to male rate of EVT per 100,000: 0.93 for in <50y; 0.52 in 50-59y; 0.58 in 60-69y; 0.91 in 70-79y; and 1.1 in ≥80y. EVT utilization rates increased substantially over time in both men and women in all age groups. However, the ratio of women to men per 100,000 receiving EVT changed for only one age range, decreasing among <50y from 0.98 in 2010 to 0.79 in 2016 (P<0.05). Conclusion: While half of all endovascular thrombectomies in the US are performed in women, there are major age-related sex-specific variations in EVT rates, with rates of EVT much lower among women than men in 50-70 age group. Determinants of these age-specific female-male disparities in EVT treatment merit detailed investigation. Figure: Age- and sex-specific female to male thrombectomy utilization rates.

Abstract WP30: Trends and Outcomes of Endovascular Revascularization Therapy for the ASIAN KR Registry

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yang-Ha Hwang ◽  
Yong-Won Kim ◽  
Jeong-Ho Hong ◽  
Chang-Hyun Kim ◽  
Hyuk Won Chang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Rapid Evolution ◽  
Favorable Outcome ◽  
Anterior Circulation ◽  
Revascularization Therapy ◽  
Multicenter Registry ◽  
Over Time

Background and Purpose: The rapid evolution of endovascular therapy (EVT) in acute ischemic stroke has benefited its performance in real clinical practice. The aim of this study is to describe the annual trends of EVT performance after the introduction of the stentriever in Korea. Methods: Data were retrospectively collected from the ASIAN KR (Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective) registry between January 2011 and December 2015. The ASIAN KR registry is an observational multicenter registry of consecutive patients treated with EVT for acute ischemic stroke. Trends in EVT performance were described and analyzed. Results: A total of 649 patients were included for analysis. The target arterial occlusive lesions included 584 in the anterior circulation (including 158 ICA terminuses and 293 MCA M1s) and 65 in the posterior circulation. Overall, successful reperfusion (mTICI 2b-3, post-procedure) and favorable outcome (mRS 0-2 or equal to prestroke mRS, at 3-month) was achieved in 500 patients (77.0%) and 332 patients (51.2%), respectively. A trend for increase in successful reperfusion and favorable outcome over time was observed (73.9% in 2011 vs. 83.1% in 2015, p =0.040; 48.7% in 2011 vs. 58.1% in 2015, p =0.074). Utilization of a stentriever as a first-chosen device for EVT increased over time from 12.8% in 2011 to 46.9% in 2015 ( p <0.001). This was accompanied by a significant trend for shorter time regarding arrival to groin puncture and groin puncture to end of EVT procedure (median 119 minutes in 2011 vs. 86 minutes in 2015, p <0.001; 68 minutes in 2011 vs. 54.5 minutes in 2015, p <0.001). After adjustment for age, onset to groin puncture time, and successful reperfusion, a trend for better clinical outcome over time following EVT remained statistically significant (odds ratio 1.13, 95% CI 1.01-1.27; p =0.033) Conclusions: A upward trend in successful reperfusion and better clinical outcome was observed along with improvement in intra-hospital workflow and utilization of up-to-date thrombectomy devices over time, which emphasizes the role of EVT experience, quality improvement of workflow, and use of newer EVT devices.

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