Abstract WP378: Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christian D Cerecedo Lopez ◽  
Alejandra Cantu Aldana ◽  
Nirav J Patel ◽  
Mohammad A Aziz-Sultan ◽  
Kai U Frerichs ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glycemic Control ◽  
Acute Ischemic Stroke ◽  
Glucose Control ◽  
Meta Analysis ◽  
Severe Hypoglycemia ◽  
Tight Glycemic Control ◽  
Tight Glucose Control ◽  
Random Effects Models

Background: The role of tight glycemic control in the management of acute ischemic stroke remains uncertain. Objective: Our goal is to evaluate the effects of tight glucose control with insulin therapy after acute ischemic stroke. Methods: We searched PubMed, CENTRAL, and EMBASE for randomized controlled trials (RCTs) that evaluated the effects of tight glycemic control (70 - 135 mg/dL) in acute ischemic stroke. Analysis was performed using fixed- and random-effects models. Outcomes were death, independence and modified Rankin Scale (mRS) score at ≥90 days follow-up, and symptomatic or severe hypoglycemia during treatment. Results: Twelve RCTs including 2,734 patients were included. When compared to conventional therapy or placebo, tight glycemic control was associated with similar rates of mortality at ≥90 days follow-up (pooled odds ratio [pOR], 0.99 [95% CI, 0.79 - 1.22], I 2 0%), independence at ≥90 days follow-up (pOR, 0.95 [0.79 - 1.14], I 2 0%) and mRS scores at ≥90 days follow-up (standardized mean difference, 0.014 [-0.15 - 0.17], I 2 0%). In contrast, tight glycemic control was associated with increased rates of symptomatic or severe hypoglycemia during treatment (pOR 5.2 [1.87 - 14.42], I 2 20%). Conclusion: Tight glucose control after acute ischemic stroke is not associated with improvements in mortality, independence or mRS score and leads to higher rates of symptomatic or severe hypoglycemia.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Brain microbleeds, anticoagulation, and hemorrhage risk

Neurology ◽  
2017 ◽  
Vol 89 (23) ◽  
pp. 2317-2326 ◽  
Author(s):  
Andreas Charidimou ◽  
Christopher Karayiannis ◽  
Tae-Jin Song ◽  
Dilek Necioglu Orken ◽  
Vincent Thijs ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Brain Mri ◽  
Stroke Patients ◽  
Nonvalvular Atrial Fibrillation ◽  
Random Effects Models ◽  
Level Data ◽  
Hemorrhage Risk

Objectives:To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants.Methods:This was a meta-analysis of cohort studies with >50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models.Results:We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19–6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07–14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04–0.55) among CMB-negative patients to 0.81% (95% CI 0.17–1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2–6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke.Conclusions:The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.

scholarly journals Dementia Risk Following Ischemic Stroke: A Systematic Review and Meta-Analysis of Factors Collected at Time of Stroke Diagnosis

2021 ◽  
Author(s):  
Reem Waziry ◽  
Jacqueline J Claus ◽  
Albert Hofman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Hospital Setting ◽  
Incidence Rates ◽  
Previous Stroke ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Stroke Diagnosis

Objective: To assess incidence rates and predictors of dementia after ischemic stroke. Methods: A search was conducted on Embase and Medline for reports published up to November 2019. Studies were included if they: 1) assessed dementia incidence among patients with ischemic stroke diagnosis and 2) excluded patients with prevalent dementia at baseline. The main analysis included: 1) absolute risk; 2) incidence rates (per 100 person-years) and 3) patient-level predictors (demographics, CVD history and major cardiac events, previous stroke and TIA, stroke location, disability post-stroke, chronic brain change and stroke mechanism). Additional predictors assessed included study setting (clinic or registry), method of dementia diagnosis (Diagnostic and Statistical Manual of Mental Disorders (DSM), National Institute of Neurological Disorders and Stroke (NINDS) or both) and inclusion of patients with recurrent or first-ever stroke. A random effects meta-analysis was undertaken. Risk of bias in included studies was assessed in terms of selection, comparability and outcome. Results: 4,325 studies were screened in the title and abstract phase after removing duplicates and 280 eligible studies were screened for full text. A total of 21 studies met the inclusion criteria and were included in the meta-analysis, representing 55,183 patients with ischemic stroke, with average age of 70 years (range 65-80 years) and average follow-up of 29 months. The majority of included studies were conducted in a hospital setting (n=17/21). The overall rate of dementia after ischemic stroke was 13.0 per 1000 person-years (95% CI 6.0, 36.0). Incidence rates were eight times higher in hospital-based studies (17.0, 95% CI 8.0, 36.0) compared to registry-based studies (1.8, 95% CI 0.8, 4.0). Absolute dementia risk after stroke was 20% at 5 year, 30% at 15 years and 48% at 25 years of follow-up. Incidence rates were 1.5 times higher in studies that included patients with recurrent ischemic stroke compared to estimates from studies that included first-time ever stroke patients only. There was 33% difference in dementia incidence in the later study periods (2007-2009) compared to (1996-2006). Statistically significant predictors of dementia after ischemic stroke included female gender (OR=1.2, 95% CI 1.1, 1.4), hypertension (1.4, 95% 1.1, 2.0), diabetes mellitus (1.6, 95% 1.3, 2.1), atrial fibrillation (1.9, 95% 1.2, 3.0), previous stroke (2.0, 95% CI 1.6, 2.6), presence of stroke lesion in dominant hemisphere (2.4, 95% 1.3, 4.5), brain stem/cerebellum (0.5, 95% CI 0.3, 0.9) or frontal lobe (3.7, 95% CI 1.2, 12.0), presence of aphasia (7.9, 95% CI 2.4, 26.0), dysphasia (5.8, 95% CI 3.0, 11.3), gait impairment (1.7, 95% CI 1.1, 2.7), presence of white matter hyperintensities (3.2, 95% CI 2.0, 5.3), medial temporal lobe atrophy (3.9, 95% CI 1.9, 8.3) and transient ischemic attack (TIA) as the predisposing aetiology for ischemic stroke (0.44, 95% CI 0.22, 0.88). Conclusion: Factors routinely collected at time of admission guide informed monitoring of patients at highest risk of progression to dementia after acute ischemic stroke. Predictors of dementia after acute ischemic stroke should be assessed as distinct features from those established for general dementia.

Abstract WP371: Role of Troponin as a Biomarker for Predicting Outcome After Ischemic Stroke: A Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adel A Alhazzani ◽  
Amit Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Biomarker ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Cochrane Central Register ◽  
Central Register ◽  
Predicting Outcome

Background: After acute ischemic stroke, a higher level of troponin has been considered as an important biomarker for predicting mortality. The aim of the study was to quantitatively assess the prognostic significance of the effect of baseline troponin levels on mortality in patients with acute ischemic stroke using a meta-analysis approach. Design: The following electronic databases, PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials , TRIP Database, ClinicalTrials.govwas used for getting the relevant article from literuare. Data were extracted in standardized data collection by two independent investigators. Any disagreements were resolved by consensus. All the statistical analyses were performed in STATA software. Results: 18 studies were included in the present meta-analysis involving a total of 8723 patients. The pooled results suggested that the elevated serum troponin level was associated with in -hospital mortality (RR 2.39, 95% CI 1.37 to 3.41), at the end of last follow up mortality (RR 1.75; 95% CI 1.38 to 2.11) and for overall mortality (RR 1.82; 95% CI 1.47 to 2.17). Sensitivity analysis by removing a single study by turns indicated that there was no obvious impact of any individual study on the pooled risk estimate. No significant publication bias was observed. Conclusion: Our findings indicate that a higher level of troponinmight be an important prognostic biomarker for in hospital and follow up mortality in patients with acute ischemic stroke. The study might have clinical implications by using troponin as a prognostic biomarker for patient stratification and early intervention.

Subjecting Acute Ischemic Stroke Patients to Continuous Tube Feeding and an Intensive Computerized Protocol Establishes Tight Glycemic Control

2009 ◽  
Vol 12 (1) ◽  
pp. 62-68 ◽  
Author(s):  
N. D. Kruyt ◽  
G. J. Biessels ◽  
T. M. Vriesendorp ◽  
J. H. DeVries ◽  
J. B. L. Hoekstra ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glycemic Control ◽  
Acute Ischemic Stroke ◽  
Tube Feeding ◽  
Tight Glycemic Control ◽  
Stroke Patients

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Sign in / Sign up

Export Citation Format

Share Document