Abstract WP48: Impact of Rapid Complete Recanalization on Clinical Recovery in Cardioembolic Stroke Patients With M2 Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Ryutaro Kimura ◽  
Shinichiro Numao ◽  
Kazutaka Sawada ◽  
Takehiro Katano ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Data Bank ◽  
Multivariate Regression Analysis ◽  
Study Data ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Mca Occlusion ◽  
The Impact

Background and purpose: Recent study reported the impact of complete recanalization beyond significant recanalization. The main of present study is to investigate the impact of complete recanalization in stroke patients with distal (M2) middle cerebral artery (MCA) occlusion. Methods: From our prospective endovascular thrombectomy (EVT) registry and multicenter tPA trial (YAMATO study) data bank, data on M2 occlusion and treated with EVT and/or tPA were retrospectively reviewed. In the YAMATO study, all tPA patients were examined using MRA before and at 1 hour after tPA. Thus, we defined the complete recanalization as a modified TICI of 3 at the end of EVT or similar appearances of both MCA on MRA at 1 hour after tPA. Significant recanalization was TICI ≥2b or >50% recanalization of MRA. At 3 months, favorable outcome was defined as mRS ≤ 2. Result: Data on 122 patients with M2 occlusion (median age 79 [72-85] years; male, 69 [57%], NIHSS score 13 [8-19]) received tPA and/or EVT were analyzed. Onset-to-admission was calculated as 95 (52-189) minutes. Complete recanalization was achieved in 27 (22%) patients, and significant recanalization was in 75 (61%) patients. Neither EVT administration it self, tPA, combined EVT and tPA were related to the complete recanalization (p=0.383, 0,237 and 0.612). At 3 months onset, patients with complete recanalization at the end of EVT/tPA frequently had favorable outcome than those without it (75% vs. 43%, p=0.013), while significant recanalization did not statistically increase the rate of favorable outcome (52% vs. 46%, p=0.673). Age, NIHSS score, DWI-ASPECTS, and plasma levels of d-dimer and brain benign peptide were also related to the favorable outcome (0.031, <0.001, 0.005, 0.011, and 0.010). Finally, multivariate regression analysis found that complete recanalization was an independent parameter related to the favorable outcome (odd ratio, 5.0 95%CI [1.1-23.0], p=0.038) as well as DWI-ASPECTS (odds ratio, 2.1, 95%CI [1.2-3.3], p=0.001). Conclusion: Complete recanalization but not significant recanalization was a parameter associated with favorable outcome in M2 occlusion patients. The goal of recanalization therapy may be immediate and complete recanalization even in patients with distal MCA occlusion.

Abstract TP29: Endovascular Thrombectomy in In-Hospital Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kazutaka Sawada ◽  
Kazumi Kimura ◽  
Junya Aoki
Keyword(s):  
Patient Outcome ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Pulmonary Diseases ◽  
Large Artery ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Stroke Registry ◽  
Clinical Background

Background and Purpose: Outcome of in-hospital stroke (IHS) patients is reported to be poor because of having other diseases as malignancy, cardiac, kidney and pulmonary diseases. IHS accounts for 5% of all ischemic strokes. Recent endovascular thrombectomy (EVT) can dramatically improve the clinical outcome of acute large artery occlusion(LVO) patients. However, it is not clear whether EVT can improve the outcome of HIS patients with LVO. Methods: Our prospective stroke registry between 2014 and 2019 were retrospectively reviewed. Among them, we enrolled acute stroke patients with LVO treated with EVT. We classified two group; IHS group; had IHS patients and outside hospital onset stroke (OHS) group; stroke onset was outside of our hospital and were directly admitted to our hospital. We compared clinical background and patient outcome at 3 months between two groups. Favorable outcome was identified as mRS 0-2 at 3 months. Results: Among 225 EVT patients((age 79 years [68-83], male 140 [62%], NIHSS score 15 [8-21]), 27 and 198 patients were classified to the IHS group and OHS group, respectively. Age, gender, initial NIHSS score was similar between IHS and OHS group (P=0.891, 1.000, and 0.146). ICA occlusion tended to be infrequent in the IHS group (11% vs. 26%, P=0.098), while distal MCA occlusion tended to be frequent (41% vs. 25%, P=0.107). Successful reperfusion was achieved in 82% in the IHS group and in 84% in the OHS group (P=0.780). Favorable outcome at 3 months was similar between two groups (39% in the IHS group and 51% in the OHS group, P=0.457). Conclusion: Patient outcome at 3 months in IHS patients with LVO was similar to OHS patients. In hospital stroke patients with LVO, EVT should improve the patient outcome as well as OHS patients. Thus, EVT in HIS patients with LVO should be performed without hesitation.

Abstract TP198: The Impact of Regular Employments on Hyper-Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takeo Sato ◽  
Kenichiro Sakai ◽  
Ryoji Nakada ◽  
Tomotaka Shiraishi ◽  
Teppei Komatsu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Positive Impact ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Factors Associated ◽  
The Impact

Background and Purpose: We aimed to investigate the differences in weekly variations of stroke occurrence between hyper-acute ischemic stroke patients with and without regular employments (RE), and the impact of RE on outcome. Methods: Consecutive symptomatic ischemic stroke patients with < 4.5 h from onset to door between October 2012 and May 2018 were enrolled. All the situations of employment on admission were obtained from interviews with the participant or substitute guardians. First, we divided the patients into with and without RE to evaluate the differences in weekly variations of stroke occurrence. Second, we divided the same patients into with and without favorable outcome (mRS score of 0 to 2 at 3 months from the onset) to evaluate the impact of RE on outcome. Results: We screened 1,249 consecutive symptomatic ischemic stroke patients, including 385 patients (292 (76%) male, median age 67 years) with hyper-acute ischemic stroke. Of all, 251 patients (65%) were included in RE group. In the multivariate analysis, patients with RE were more likely to develop strokes on Monday compared to that on Sunday and public holiday (OR 2.841, 95% CI 1.145-7,049, p = 0.024, Figure A). In the multivariate analysis, the factors associated with favorable outcome were low NIHSS score on admission (OR 0.909, 95% CI 0.857-0.964, p = 0.001), not receiving endovascular therapy (OR 0.175 95% CI 0.069-0.444, p <0.001), and having RE (OR 2.506, 95% CI 1.049-5.986, p = 0.039, Figure B). Conclusions: There were dramatic differences in weekly variations of hyper-acute ischemic stroke occurrence between patients with and without RE. Monday seems to be “a black day” for ischemic stroke patients with RE. RE had a positive impact on outcome in hyper-acute ischemic stroke.

In Hyperacute Recanalization Therapy, Early Hospital Arrival Improves Outcome in Patients with Large Artery Occlusion

2018 ◽  
Vol 79 (5-6) ◽  
pp. 335-341
Author(s):  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Satoshi Suda ◽  
Seiji Okubo ◽  
Masahiro Mishina ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Outcome ◽  
Multivariate Regression ◽  
Intravenous Thrombolysis ◽  
Multivariate Regression Analysis ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Large Artery ◽  
Independent Factor ◽  
Hospital Arrival

Background: It is unknown whether the effect of onset-­­to-door (OTD) time on clinical outcomes differs between ­patients with and without large artery occlusion (LAO) who undergo hyperacute recanalization therapy. Methods: Hyperacute recanalization therapy includes intravenous thrombolysis tissue-plasminogen activator (tPA), and endovascular therapy (EVT). Favorable clinical outcome was defined as modified Rankin Scale of ≤2 at discharge. Results: Among 164 patients, 117 (71%) patients received tPA, 86 (52%) received EVT, and 39 (24%) received tPA and EVT. One hundred and fifteen patients (70%) were classified into the LAO group and 49 (30%) into the non-LAO group. In the total cohort, multivariate regression analysis showed OTD time (OR 0.809 [95% CI 0.693–0.944], p = 0.007) was an independent factor related to the favorable outcome. Similarly, among patients with LAO, OTD was an independent negative factor for the favorable outcome (0.779 [0.646–0.940], p = 0.009). On the contrary, OTD was not associated with the favorable outcome (1.5 [0.7–2.5] vs. 1.7 [1.1–3.2], p = 0.155) in patients without LAO. This was confirmed with multivariate regression analysis, which did not show OTD to be an independent factor for the favorable outcome (0.900 [0.656–1.236], p = 0.516). Conclusion: The effect of early hospital arrival on clinical outcome differed between patients with and without LAO.

Lessons Learned Over More than 500 Stroke Thrombectomies Using ADAPT With Increasing Aspiration Catheter Size

Neurosurgery ◽  
2018 ◽  
Author(s):  
Ali Alawieh ◽  
A Rano Chatterjee ◽  
Jan Vargas ◽  
M Imran Chaudry ◽  
Jonathan Lena ◽  
...  
Keyword(s):  
South Carolina ◽  
Standard Of Care ◽  
Multivariate Regression Analysis ◽  
Lessons Learned ◽  
Stent Retriever ◽  
Complication Rates ◽  
Procedure Time ◽  
University Of South Carolina ◽  
Endovascular Thrombectomy ◽  
The Impact

Abstract BACKGROUND Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes. METHODS We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05). CONCLUSION Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.

Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Procedure ◽  
Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

Abstract TP47: Mitral Regurgitation Might Prevent the Neurological Recovery After Endovascular Thrombectomy in Patients With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Ryutaro Kimura ◽  
Shinichiro Numao ◽  
Kazutaka Sawada ◽  
Takehiro Katano ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Regurgitation ◽  
Multivariate Regression Analysis ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
Right Atrial ◽  
Laboratory Findings ◽  
Endovascular Thrombectomy ◽  
Clinical Background ◽  
Atrial Area

Hypothesis: Some of hyperacute stroke patients had unfavorable outcome even when the occlusive artery was successfully opened. We hypothesized that moderate-to-sever mitral regurgitation (significant MR) might inhibit cerebral reperfusion, and thus decrease the rate of good clinical outcome after endovascular thrombectomy (EVT) in patients with atrial fibrillation (AF). Method: From our prospective EVT registry, patients received transthoracic echocardiography (TTE), were retrospectively analyzed. Only patients with AF were included. Based on the presence of the moderate-to-sever MR, all patient were divided into group with and without significant MR (MR group, and non-MR group). Clinical background, laboratory findings, and TTE parameters were compared between the 2 groups. Favorable outcome was defined as mRS 0-1 at 3 months. Result: From 2014 September to 2018 December, 316 patients treated with EVT, and 246 received TTE. Among them, data on 127 patients with AF were analyzed. TTE found 25 (20%) patients had significant MR. Patients in MR group were older (p=0.05) and had higher plasma level of brain natriuretic peptide (p=0.05). NIHSS, DWI-APSECTS, TICI ≥2b reperfusion, onset-to-reperfusion time, ICA occlusion (p=0.96, 0.26, 0.52, 0.33, and 0.80) were similar between the 2 groups. Regarding TTE parameters, although ejection fraction was similar (p=0.28), left atrial area (p=0.02), right atrial area (p<0.01), and tricuspid regurgitation area (p<0.01) were elevated in the MR group. At 3 months, favorable outcome was seen in only 9% in the MR group, while 26% had it in the non-MR group (p=0.04), Group with favorable outcome had higher rate of TICI ≥2b reperfusion (p=0.04), lower NIHSS score (p=0.04), however, above mentioned TTE parameter except significant MR, were not associated favorable outcome. When we conduct multivariate regression analysis, moderate-to-sever MR the negative independent parameter of favorable outcome (odds ratio 0.17, 95%CI [0.03-0.89], p=0.04). Conclusion: The presence significant MR was related to the unfavorable outcome independent of the neurological symptom and reperfusion status on cerebral angiography.MR might prevent the clinical recovery in patients with atrial fibrillation.

scholarly journals The Impact of Basel III Capital Regulation on Credit Risk: A Hybrid Model

2020 ◽  
Vol 9 (2) ◽  
pp. 56-71
Author(s):  
NADIM ANASS ALFOUHAILI ◽  
Frédéric GAUTIER ◽  
Iyad ZAAROUR
Keyword(s):  
Regression Analysis ◽  
Credit Risk ◽  
Hybrid Model ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Capital Regulation ◽  
Basel Iii ◽  
Spearman Correlation ◽  
Spearman Correlation Test ◽  
The Impact

This research examined the impact of Basel III capital regulation (BCR) on credit risk (CR) using a sample of 25 commercial banks in Lebanon over the period 2012–2017. BCR is measured using the capital adequacy ratio (CAR) and the common equity tier one ratio (CET1 ratio), CR is measured using net provision for credit losses /total assets. To analyze the data, we constructed a hybrid model based on 3 statistical approaches. First, we modelled the dual impact of BCR and CR using probabilistic inference in the framework of Bayesian Belief Network formalism (BBN). Second, to highlight more about the correlation between BCR and CR, we used Spearman correlation test as a nonparametric approach. Third to study the simultaneous effect of CAR and CET1 ratio on CR we applied multivariate regression analysis. By analyzing the probabilistic inference for the first approach we concluded that there is an effect of BCR on CR especially for the high level of CET1 ratio, but when we investigated more if this effect is significant using the Spearman correlation test and the multivariate regression analysis, we concluded that there is no effect statistically significant of Basel III capital regulation (BCR) on credit risk (CR).

scholarly journals Prolonged SARS-CoV-2 Viral Shedding in Patients with COVID-19 was Associated with Delayed Initiation of Arbidol Treatment: a retrospective cohort study

2020 ◽  
Author(s):  
Yaya Zhou ◽  
Xinliang He ◽  
Jianchu Zhang ◽  
Yu’e Xue ◽  
Mengyuan Liang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Virus Shedding ◽  
Illness Onset ◽  
Factors Associated ◽  
Viral Shedding ◽  
Union Hospital ◽  
Delayed Initiation ◽  
The Impact

AbstractObjectivesEvaluate the risk factors of prolonged SARS-CoV-2 virus shedding and the impact of arbidol treatment on SARS-CoV-2 virus shedding.MethodsData were retrospective collected from adults hospitalized with COVID-19 in Wuhan Union Hospital. We described the clinical features and SARS-CoV-2 RNA shedding of patients with COVID-19 and evaluated factors associated with prolonged virus shedding by multivariate regression analysis.ResultsAmong 238 patients, the median age was 55.5 years, 57.1% were female, 92.9% (221/238) used arbidol, 58.4% (139/238) used arbidol combination with interferon. The median time from illness onset to start arbidol was 8 days (IQR, 5-14 days) and the median duration of SARS-CoV-2 virus shedding was 23 days (IQR, 17.8–30 days). SARS-CoV-2 RNA clearance was significantly delayed in patients who received arbidol >7 days after illness onset, compared with those in whom arbidol treatment was started≤7 days after illness onset (HR, 1.738 [95% CI, 1.339–2.257], P < .001). Multivariate regression analysis revealed that prolonged viral shedding was significantly associated with initiation arbidol more than seven days after symptom onset (OR 2.078, 95% CI [1.114-3.876], P .004), more than 7 days from onset of symptoms to first medical visitation (OR 3.321, 95% CI[1.559-7.073], P .002), illness onset before Jan.31, 2020 (OR 3.223, 95% CI[1.450-7.163], P .021). Arbidol combination with interferon was also significantly associated with shorter virus shedding (OR .402, 95% CI[.206-.787], P .008).ConclusionsEarly initiation of arbidol and arbidol combination with interferon as well as consulting doctor timely after illness onset were helpful for SARS-CoV-2 clearance.

Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children

2020 ◽  
Author(s):  
Robert C Duguid ◽  
Mohammed Al Reesi ◽  
Adam W Bartlett ◽  
Pamela Palasanthiran ◽  
Brendan J McMullan
Keyword(s):  
Staphylococcus Aureus ◽  
Regression Analysis ◽  
Infectious Diseases ◽  
Multivariate Regression ◽  
Complete Response ◽  
Multivariate Regression Analysis ◽  
Source Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract Background To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. Methods A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. Results There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P &lt; .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P &lt; .01), dose (54/55 = 98.2% vs 36/45 = 80%, P &lt; .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P &lt; .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P &lt; .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. Conclusions Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.

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