Abstract P150: Effects of State Mandated Stay-At-Home Orders on Timely Presentation of Ischemic Stroke Patients During the Covid-19 Pandemic

Introduction: The ability to treat an acute ischemic stroke depends on the patient’s timely presentation to the hospital from their last known well time. During the coronavirus disease 2019 (COVID-19) pandemic, individual state governments enacted stay-at-home orders to slow the transmission of the disease. We collected data from hospitals across four state-based networks where we provide stroke telemedicine coverage to ascertain the effects of these mandates. Objectives: We sought to evaluate the effects of stay-at-home orders on the number of patients evaluated and treated for ischemic stroke during the COVID-19 pandemic, and to evaluate the difference in treatment rate while states were under state-at-home orders versus while they were not. Methods: We retrospectively examined stroke alerts from March 1 st to May 30 th , 2020. We tabulated total number of stroke alerts, number of IV alteplase and intra-arterial (IA) treatment recommendations, number of less severe strokes (NIHSS 0-6) and more severe strokes (NIHSS 7-41). Treatment rates were calculated and compared by state-based network before, during, and after the stay-at-home orders. Results: We found that the total number of alerts per week fell by 27.33% during the stay-at-home orders across all state networks. The total number of patients treated with alteplase and total number of patients treated with IA therapy per week also dropped by 29.31% and 13.69%, respectively. The alteplase and IA treatment rate increased by 10.57% and 13.85%, respectively, during the stay-at- home orders. The percentage of total strokes considered more severe slightly increased during these orders, by 5.54%. Conclusion: During the government mandated stay-at-home orders, the total number of patients evaluated for stroke alerts decreased, as did the total number of patients treated either with alteplase or IA therapy. However, with the decrease in number treated, the rate at which patients were treated with alteplase, IA, or both, increased. The percentage of total strokes that were considered more severe slightly increased. In conclusion, while stay-at-home orders kept many stroke patients home, the most severe stroke patients continued to present to the hospital and were treated in a timely manner via telemedicine.

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Abstract 3313: Outcomes of “Drip-and-Ship” Paradigm Among Patients with Acute Ischemic Stroke. Results of a State Wide Study

Stroke ◽

10.1161/str.43.suppl_1.a3313 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Gustavo J Rodriguez ◽

M. Fareed K Suri ◽

Adnan I Qureshi

Keyword(s):

Ischemic Stroke ◽

Recombinant Tissue Plasminogen Activator ◽

Population Based ◽

Primary Diagnosis ◽

Hospital Charges ◽

Stroke Patients ◽

Frequency Distributions ◽

Number Of Patients ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: “Drip-and-ship” denotes patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 hours to a comprehensive stroke center. Although drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population based level. Methods: State-wide estimates of thrombolysis, associated in-hospital outcomes and mortality were obtained from 2008-2009 Minnesota Hospital Association (MHA) data. Patient numbers and frequency distributions were calculated for state-wide sample of patients hospitalized with a primary diagnosis of ischemic stroke. Patients outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n=473) or drip-and-ship paradigm (n=129). The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with drip-and-ship paradigm (8.5% versus 3.1, p=0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or drip-and-ship paradigm (5.9% versus 7.0%). The mean hospital charges were $65,669 for primary ED arrival and $47,850 for drip-and-ship treated patients (p<0.001). Conclusions: The results of drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this state-wide study.

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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 3730: Length Of Hospitalization And Discharge Disposition Among Acute Ischemic Stroke Patients With Moderate To Severe Stroke by Treatment

Stroke ◽

10.1161/str.43.suppl_1.a3730 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Steven A Koehler ◽

Maxim Hammer ◽

Vivek Reddy ◽

Houhammad Jumaa ◽

Syed Zaidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Treatment Modality ◽

Cerebral Arteries ◽

Stroke Patients ◽

Term Care ◽

Severe Stroke ◽

Discharge Disposition ◽

Significant Difference

Background: Data regarding length of stay and discharge disposition in patients with moderate to severe stroke are scarce. We sought to determine Length of Stay (LoS) in a consecutive group of patients admitted at a large academic center and assess for any possible difference in LoS at discharge by treatment modality received and by vessels occlusion status. Methods: Retrospective review of a database comprising acute ischemic stroke patients admitted to our center between 1/1/2009-3/31/2011. Patient Demographics, treatment modality (IV thrombolytic tissue plasminogen activator (IVtPA), Endovascular (IA), no thrombolytic (NT), LoS, occlusion of major cerebral arteries and discharge disposition were collected. Inclusion criteria were AIS with admission NIHSS ≥10. Results: A total of 744 patients 361 (48.5%) male, mean age 69.9 years were identified. Treatment modalities: 174 (23%) IVtPA, 177 (24%) IA, 393 (53%) NT. Median NIHSS 16.5 and not significant among the 3 groups (P=.603). Mean LoS was 7.38 days (SD 7.4) with no significant difference between the 3 groups (P=.056). Occlusion to one of the 3 cerebral arteries (ICA, MCA, BA) was: 84% in IVtPA, 100% in IA, 87% in NT. Discharge disposition and LoS by treatment and occlusions are shown in the Table . Among patients treated with IVtPA (n=174) mean LoS was 6.33 days (range 1-27). LoS was significantly longer among those without occlusion vs with any occlusion (P=.001). Among patients that received IA (n=177) mean LoS was 8.21 days (range 0-74). Among patients received NT (n=393) the mean LoS was 7.47 days (range 0-64). Conclusions: Thrombolytic therapy (IV or EV) in patients with strokes is not associated with longer hospitalizations duration. A significant difference between death rates in patients receiving IA thrombolytic (22%) compared to IV (32%) or NT (30%) was found with fewer death among those that received IA (P= .008). Patients discharged to long term care facilities have regardless of treatment longer LoS (12.41v 6.14) (P>.000).

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POSITIVE: Perfusion imaging selection of ischemic stroke patients for endovascular therapy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017315 ◽

2021 ◽

pp. neurintsurg-2021-017315

Author(s):

J Mocco ◽

Adnan H Siddiqui ◽

David Fiorella ◽

Michael J Alexander ◽

Adam S Arthur ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Therapy ◽

Perfusion Imaging ◽

Medical Management ◽

Primary Outcome ◽

Functional Improvement ◽

Positive Trial ◽

Stroke Patients ◽

Number Of Patients ◽

Selection Of

BackgroundThe PerfusiOn imaging Selection of Ischemic sTroke patIents for endoVascular thErapy (POSITIVE) trial was designed to evaluate functional outcome in patients with emergent large vessel occlusion (ELVO) presenting within 0–12 hours with pre-specified bifurcated arms of early and late window presentation, who were selected for endovascular thrombectomy with non-vendor specific commercially available perfusion imaging software. Recent trials demonstrating the benefit of thrombectomy up to 16–24 hours following ELVO removed equipoise to randomize late window ELVO patients and therefore the trial was halted.MethodsUp to 200 patients were to be enrolled in this FDA-cleared, prospective, randomized, multicenter international trial to compare thrombectomy and best medical management in patients with ELVO ineligible for or refractory to treatment with IV tissue plasminogen activator (IV-tPA) selected with perfusion imaging and presenting within 0–12 hours of last seen normal. The primary outcome was 90-day clinical outcome as measured by the raw modified Rankin Scale (mRS) with scores 5 and 6 collapsed (mRS shift analysis).ResultsThe POSITIVE trial suspended enrollment with the release of results from the DAWN trial and was stopped after the release of the DEFUSE 3 trial results. Thirty-three patients were enrolled (21 for medical management and 12 for thrombectomy). Twelve of the 33 patients were enrolled in the 6–12 hour cohort. Despite the early cessation, the primary outcome demonstrated statistically significant superior clinical outcomes for patients treated with thrombectomy (P=0.0060). The overall proportion of patients achieving an mRS score of 0–2 was 75% in the thrombectomy cohort and 43% in the medical management cohort (OR 4.00, 95% CI 0.84 to 19.2).ConclusionPOSITIVE supports the already established practice of delayed thrombectomy for appropriately selected patients presenting within 0–12 hours selected by perfusion imaging from any vendor. The results of the POSITIVE trial are consistent with other thrombectomy trials. The statistically significant effect on functional improvement, despite the small number of patients, reinforces the robust benefits of thrombectomy.Clinical trial registrationNCT01852201

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Abstract 183: Time to Alteplase and Symptomatic Intracranial Hemorrhage Complication Rates

Stroke ◽

10.1161/str.51.suppl_1.183 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Muhammad U Farooq ◽

Kathie Thomas

Keyword(s):

Ischemic Stroke ◽

Intracranial Hemorrhage ◽

American Heart ◽

Phase Iii ◽

P Value ◽

Complication Rates ◽

Stroke Patients ◽

Number Of Patients ◽

Symptomatic Intracranial Hemorrhage ◽

Get With The Guidelines

Background/Objective: The American Heart Association’s Target Stroke initiative focuses on reducing door-to-needle time for faster treatment with Alteplase and improved patient outcomes. The concern for reducing door-to-needle time is that there will be an increase in complication rates, specifically the rate of symptomatic intracranial hemorrhage (ICH). This study sought to review whether reduced door-to-needle times were associated with increased rates of complications in Midwest hospitals. Methods: A retrospective review of acute ischemic stroke patients treated with Alteplase was conducted from 2010-2018 in 13 Midwestern states (IN, IL, KS, KY, MI, MN, NO, ND, OH, SD, and WI) using the American Stroke Association’s Get With The Guidelines (GWTG) Stroke database. Percentage of eligible patients treated with Alteplase, treatment times, and complication rates were reviewed. Results: From 2010-2018 the rate of ischemic stroke patients treated with Alteplase in the approved 3-hour window increased from 68.9% to 88.5%. The number of patients treated with Alteplase in 60 minutes increased from 24.1% in 2010 to 74.9% in 2018. The median time to treatment for Alteplase was reduced from 80 minutes in 2010 to 46 minutes in 2018. The rate of complications associated with thrombolytics was 6.5% in 2010 and dropped to 4.5% in 2018. This is statistically significant at a p-value of .05. Conclusions: In the Midwest Region, a reduction in door-to-needle times was not associated with increased complication rates. Interestingly, a reduction in door-to-needle times was associated with a reduction in complication rates. This supports the American Heart Association’s new Target Stroke Phase III initiative which seeks to further reduce door-to-needle times.

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A Study of Comorbidities Among Stroke Patients Admitted In A Tertiary Level Hospital

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44419 ◽

2019 ◽

Vol 10 (3) ◽

pp. 152-155

Author(s):

Mohammad Iqbal Hossain ◽

Ahmed Manadir Hossain ◽

Quazi Shihab Uddin Ibrahimi

Keyword(s):

Ischemic Stroke ◽

Recurrent Stroke ◽

Cross Sectional Study ◽

Comorbid Condition ◽

Stroke Patients ◽

Stroke Event ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Number Of Patients

Introduction: Stroke is an important cause of disability among adults and is one of the leading causes of death worldwide. The reported prevalence of stroke in Bangladesh is 0.3%. Stroke patients have comorbidity Comorbidity is an important factor in stroke outcomes and burden. Objectives: This study was carried out with a view to find out the common comorbidities prevalent in stroke patients. Materials and Method: This cross sectional study was carried out in Faridpur Medical College Hospital from November 2018 to April 2019 to see the comorbidities and associated factors among admitted stroke patients. A total of 390 stroke patients were included. Data were collected by detailed history from patients or their relatives followed by thorough physical examination; Results: Among total respondents, majority was male (56.4%) and ischemic stroke was the commonest type of stroke (65.6%) diagnosed. The substantial number of patients (85.6%) had one or more comorbidities. Hypertension was the predominant comorbid condition (74.1%) followed by coronary heart disease ((19.5%), diabetes mellitus (17.4%), obesity (6.2%), hyperlipidemia (6.2%), CKD (4.9%), COPD (3.3%), malignancy (0.8%), hypothyroidism (0.5%),CLD (0.5%) and parkinsonism (0.3%). Comorbidities were present in 88.28% of ischemic stroke, 81.81% of intracerebral haemorrhage and 69.23% of subarachnoid hemorrhage cases. Patients with first stroke event have comorbidities in 83.64% cases where as in 95.45% cases of recurrent stroke patients. The relationship between comorbidity and mortality risk is not clear with approximately 16% death in both with or without comorbidity. Conclusion: The results of the study concluded that the prevalence of comorbidities in stroke patients remains high in our settings and the patients with increasing age and those with recurrent stroke events have statistically significant number of comorbid conditions. KYAMC Journal Vol. 10, No.-3, October 2019, Page 152-155

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Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rapid diagnosis of stroke

Scientific Reports ◽

10.1038/s41598-020-75379-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Cassandra M. Wilkinson ◽

Jennifer I. Burrell ◽

Jonathan W. P. Kuziek ◽

Sibi Thirunavukkarasu ◽

Brian H. Buck ◽

...

Keyword(s):

Ischemic Stroke ◽

Low Cost ◽

Minor Stroke ◽

Stroke Severity ◽

Stroke Patients ◽

Low Frequencies ◽

Severe Stroke ◽

High Frequencies ◽

Detection Tool ◽

Record Data

Abstract In this study, we demonstrated the use of low-cost portable electroencephalography (EEG) as a method for prehospital stroke diagnosis. We used a portable EEG system to record data from 25 participants, 16 had acute ischemic stroke events, and compared the results to age-matched controls that included stroke mimics. Delta/alpha ratio (DAR), (delta + theta)/(alpha + beta) ratio (DBATR) and pairwise-derived Brain Symmetry Index (pdBSI) were investigated, as well as head movement using the on-board accelerometer and gyroscope. We then used machine learning to distinguish between different subgroups. DAR and DBATR increased in ischemic stroke patients with increasing stroke severity (p = 0.0021, partial η2 = 0.293; p = 0.01, partial η2 = 0.234). Also, pdBSI decreased in low frequencies and increased in high frequencies in patients who had a stroke (p = 0.036, partial η2 = 0.177). Using classification trees, we were able to distinguish moderate to severe stroke patients and from minor stroke and controls, with a 63% sensitivity, 86% specificity and accuracy of 76%. There are significant differences in DAR, DBATR, and pdBSI between patients with ischemic stroke when compared to controls, and these effects scale with severity. We have shown the utility of a low-cost portable EEG system to aid in patient triage and diagnosis as an early detection tool.

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HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.101 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Ignatius Ivan ◽

Budi Riyanto Wreksoatmodjo ◽

Octavianus Darmawan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Severe Stroke ◽

History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords: Atrial fibrillation, heart failure, ischemic stroke, myocardial infarction, National Institutes of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

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Association between Increased Matrix Metalloproteinase-9 (MMP-9) Levels with Hyperglycaemia Incidence in Acute Ischemic Stroke Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.459 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2067-2072 ◽

Cited By ~ 2

Author(s):

Ismail Setyopranoto ◽

Rusdy Ghazali Malueka ◽

Andre Stefanus Panggabean ◽

I Putu Eka Widyadharma ◽

Ahmad Hamim Sadewa ◽

...

Keyword(s):

Ischemic Stroke ◽

Matrix Metalloproteinase ◽

Acute Ischemic Stroke ◽

Matrix Metalloproteinase 9 ◽

Blood Levels ◽

Stroke Patients ◽

Reference Hospital ◽

The Difference ◽

Increased Activity ◽

Metalloproteinase 9

BACKGROUND: Hyperglycemia is common in acute stroke patients. Hyperglycemia can induce the production of reactive oxygen species, causing increased activity of matrix metalloproteinase-9 (MMP-9). AIM: This study aimed to determine an association between the increased levels of MMP-9 and the incidence of hyperglycemia in acute ischemic stroke patients. METHODS: This is a case-control study. Acute ischemic stroke patients admitted to the Stroke Unit of a reference hospital in Yogyakarta, Indonesia was divided into the hyperglycemic and non-hyperglycemic group. Demographic and clinical characteristics of each subject were recorded, and blood levels of MMP-9 were measured. Seventy-one patients were recruited, 40 subjects in the hyperglycemic group and 31 subjects in the non-hyperglycemic group. RESULTS: The median levels of blood MMP-9 level in the hyperglycemic and non-hyperglycemic group were 974.37 and 748.48 ng/mL, respectively, and the difference was statistically not significant (95% CI, 191.24-2849.53; p = 0.07). When the calculated cut-off point of 600.99 ng/mL was used, the proportion of patients with higher MMP-9 levels was significantly more in the hyperglycemic group compared with the ones in the non-hyperglycemic group (82.5% and 54.8%, respectively; OR = 3.88; p = 0.011). CONCLUSION: We concluded that the proportion of patients with MMP-9 level >600.99 ng/mL was significantly higher in acute ischemic stroke patients with hyperglycemia.ng/mL was significantly higher in acute ischemic stroke patients with hyperglycemia.

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Abstract WP497: Investigation of Cognitive Impairment in Ischemic Stroke Patients After Endovascular Treatment in Acute Phase and at 6 Months Follow-Up

Stroke ◽

10.1161/str.51.suppl_1.wp497 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Toru Nakagami ◽

Satoshi Suda ◽

Junya Aoki ◽

Takuya Kanamaru ◽

Kanako Muraga ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Cognitive Function ◽

Endovascular Treatment ◽

Acute Phase ◽

Cognitive Assessment ◽

Internal Carotid ◽

Stroke Patients ◽

Number Of Patients

Purpose and Objective: There have been limited reports that focused on cognitive impairment in acute ischemic stroke after endovascular treatment. The aim of this study, therefore, was to investigate cognitive function in patient after endovascular treatment in acute phase and at 6 months follow-up. Method: In this prospective study, from December 2016 to November 2018, the patients who were diagnosed as ischemic stroke with occlusion of the internal carotid artery and of the middle cerebral artery and treated with endovascular treatment were enrolled. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA-J) test within 5 days of onset and at 6 months follow-up. We defined cognitive impairment as a score of <24 in MoCA-J. Results: 150 patients were enrolled. MoCA-J was feasible in 69 patients (median 76 years; 49 female) (46%), in acute phase (Figure A). 63 patients (91%) had cognitive impairment and no significant differences were found in the naming and the abstraction domains between MoCA-J <24 group and ≧24 group. At 6 months follow-up, 48 patients (median 72 years; 12 female) were assessed with MoCA-J and 35 patients (73%) had cognitive impairment. However, only one patient scored less at 6 months follow-up than in acute phase (Figure B), which resulted in the significant increase in the median MoCA-J score (7 vs. 21, P<0.05) (Figure C) and in all the domains except for the language (P=0.078) (Figure D). Conclusion: In acute phase of ischemic stroke after endovascular treatment, MoCA-J was feasible in about 45%, in which 91% had cognitive impairment. However, at 6 months follow-up, the median MoCA-J score was significantly higher and less number of patients had cognitive impairment. The present results suggest that cognition recovers with time after endovascular treatment in ischemic stroke.

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