Abstract P292: Characteristics of Asian Americans With Acute Ischemic Stroke Treated at a Tertiary/Quaternary Stroke Center

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Claude Nguyen ◽  
David Grosvenor ◽  
Ilana Spokoyny ◽  
Charlene Chen ◽  
Christine S Wong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
San Francisco ◽  
Asian Americans ◽  
Asian American ◽  
Similar Proportion ◽  
Chi Square ◽  
Stroke Center ◽  
To Receive

Background: Asian Americans comprise a rapidly increasing segment of the population, but little is known of their outcomes after acute ischemic stroke. We compared Asians and whites presenting to a San Francisco Bay Area tertiary/quaternary stroke center that uniquely serves a high proportion of Asian American patients, and reviewed the treatment rates and outcomes of Asian Americans presenting with acute ischemic stroke compared to whites. Methods: We performed a retrospective study of ischemic stroke patients presenting to our center between 1/2014-7/2020, conducting univariate analyses of demographics, comorbidities, and clinical outcomes in those designated as Asian compared with white patients. Odds ratios and chi-square analyses were conducted between groups. Asians were defined as those of Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese descent. Results: Between 1/2014 and 7/2020, 3958 patients presented with ischemic stroke; 852 (21.5%) were Asian and 2107 (53.2%) were white. Asians were older and more likely to have hypertension, hyperlipidemia, and diabetes, and less likely to have atrial fibrillation (Table 1). More Asians presented directly to our center, while more whites were transferred in. IV rt-PA rates are described in Table 1. Overall, Asians were less likely to receive endovascular treatment (Table 1). Asians had a higher NIHSS at discharge, although there was no difference in the proportion who expired or who were discharged home. Conclusions: Asians with ischemic stroke tended to have more comorbid conditions than whites. Though there was a trend towards similar IV rt-PA rates between Asians and whites presenting to the ED, Asians were less likely to receive endovascular treatment, and had worse NIHSS on discharge with similar proportion going home. This may have to do with local geographic/socioeconomic distribution, or differences in stroke etiology. Further analyses are needed to better elucidate these disparities.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

scholarly journals Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 923-930 ◽  
Author(s):  
Esmee Venema ◽  
Adrien E. Groot ◽  
Hester F. Lingsma ◽  
Wouter Hinsenveld ◽  
Kilian M. Treurniet ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Independence ◽  
Modified Rankin Scale ◽  
Interhospital Transfer ◽  
Primary Stroke Center ◽  
Transferred Patients ◽  
Stroke Center

Background and Purpose— To assess the effect of inter-hospital transfer on time to treatment and functional outcome after endovascular treatment (EVT) for acute ischemic stroke, we compared patients transferred from a primary stroke center to patients directly admitted to an intervention center in a large nationwide registry. Methods— MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, observational study in all centers that perform EVT in the Netherlands. We included adult patients with an acute anterior circulation stroke who received EVT between March 2014 to June 2016. Primary outcome was time from arrival at the first hospital to arterial groin puncture. Secondary outcomes included the 90-day modified Rankin Scale score and functional independence (modified Rankin Scale score of 0–2). Results— In total 821/1526 patients, (54%) were transferred from a primary stroke center. Transferred patients less often had prestroke disability (227/800 [28%] versus 255/699 [36%]; P =0.02) and more often received intravenous thrombolytics (659/819 [81%] versus 511/704 [73%]; P <0.01). Time from first presentation to groin puncture was longer for transferred patients (164 versus 104 minutes; P <0.01, adjusted delay 57 minutes [95% CI, 51–62]). Transferred patients had worse functional outcome (adjusted common OR, 0.75 [95% CI, 0.62–0.90]) and less often achieved functional independence (244/720 [34%] versus 289/681 [42%], absolute risk difference −8.5% [95% CI, −8.7 to −8.3]). Conclusions— Interhospital transfer of patients with acute ischemic stroke is associated with delay of EVT and worse outcomes in routine clinical practice, even in a country where between-center distances are short. Direct transportation of patients potentially eligible for EVT to an intervention center may improve functional outcome.

scholarly journals Rescue Therapy in Endovascualr Treatment for Acute Ischemic Stroke Due to Large Artery Atherosclerosis

2019 ◽  
Author(s):  
Mingli Liu ◽  
Minghui Chen ◽  
Yang Liu ◽  
Lin Lin ◽  
Yongli Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Rescue Therapy ◽  
Large Artery ◽  
Procedure Time ◽  
Excellent Outcome ◽  
Logistic Analysis ◽  
Tandem Occlusion ◽  
Stroke Center

Abstract Background and purpose Safety and predictors of rescue therapy in patients with acute ischemic stroke due to large artery atherosclerosis still remain unclear. This study aimed to test safety of rescue therapy and evaluate predictors of it after failed mechanical thrombectomy.Methods This retrospective study enrolled consecutively 245 patients with acute ischemic stroke treated by endovascular treatment from March 2016 to April 2019 in a single stroke center. We analyzed the clinical data and laboratory test for safety and predictors of rescue therapy. Binary logistic analysis was applied to confirm the independently relationship.Results There were totally 145 patients enrolled among 245 patients. Rescue therapy was independently associated with the excellent outcome [p=0.048, adjusted OR: 2.655, 95%CI: 1.008 – 6.989] and longer procedure time of endovascular treatment [p=0.004, adjusted OR: 3.722, 95%CI: 1.519-9.122], but there was no significance on complications and mortality. Prestrike incidence [p=0.004, adjusted OR:4.427, 95%CI:1.618-12.114], use of rt-PA [p=0.003, adjusted OR:4.792, 95%CI:1.688-13.602], tandem occlusion [p=0.001, adjusted OR:0.021, 95%CI:0.002-0.194], PLT [p=0.012, adjusted OR:3.234, 95%CI:1.289-8.113], P-LCR>42.3% [p=0.031, adjusted OR:0.132, 95%CI:0.021-0.827] were independent predictors of rescue therapy.Conclusions Rescue therapy for acute ischemic stroke due to large artery atherosclerosis costs more procedure time of endovascular treatment, but it can successfully recanalize the occlusive large artery and is independently related to the excellent clinical outcome without increasing ICH, sICH, reocclusion and others. Prestroke incidence, use of rt-PA, tandem occlusion, PLT and P-LCR may be independent predictors of rescue therapy in acute ischemic stroke due to large artery atherosclerosis.

The association between computed tomography angiography timing and workflow times in patients with acute ischemic stroke

2020 ◽  
pp. 174749302096223
Author(s):  
Femke M Dessens ◽  
Adrien E Groot ◽  
Bas van der Veen ◽  
Kilian M Treurniet ◽  
Charles BLM Majoie ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Intravenous Thrombolysis ◽  
Median Difference ◽  
Adjusted Analysis ◽  
Stroke Center

Background In most hospitals, computed tomography angiography (CTA) is nowadays routinely performed in patients with acute ischemic stroke. However, it is unclear whether CTA is best performed before or after start of intravenous thrombolysis (IVT), since acquisition of CTA before IVT may prolong door-to-needle times, while acquisition after IVT may prolong door-to-groin times in patients undergoing endovascular treatment. Methods We performed a before-versus-after study (CTA following IVT, period I and CTA prior to IVT, period II), consisting of two periods of one year each. This study is based on a prospective registry of consecutive patients treated with IVT in two collaborating high-volume stroke centers; one primary stroke center and one comprehensive stroke center. The primary outcome was door-to-needle times. Secondary outcomes included door-to-groin times. Quantile regression analyses were performed to evaluate the association between timing of CTA and workflow times, adjusted for prognostic factors. Results A total of 519 patients received IVT during the study period (246 in period I, 273 in period II). In the adjusted analysis, we found a nonsignificant 1.13 min median difference in door-to-needle times (95% confidence interval: 1.03–3.29). Door-to-groin times was significantly shorter in period II in both unadjusted and adjusted analysis with the latter showing a 19.16 min median difference (95% confidence interval: 3.08–35.24). Conclusions CTA acquisition prior to start of IVT did not adversely affect door-to-needle times. However, a significantly shorter door-to-groin times was observed in endovascular treatment eligible patients. Performing CTA prior to start of IVT seems the preferred strategy.

Abstract P483: Immediate Feedback to Emergency Medical Services Reduce Door to Angiogram and Transfer Time for Endovascular Treatment of Large Vessel Occlusion Ischemic Strokes

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kimberley Stephania Yescas Garibay ◽  
Nguyen Vo ◽  
Syung Jung ◽  
Sun Lee
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Transfer Time ◽  
Large Vessel Occlusion ◽  
Immediate Feedback ◽  
Vessel Occlusion ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: The morbidity of acute ischemic Stroke (AIS) caused by a large vessel occlusion (LVO) can be significantly reduced with endovascular intervention. However, delay in diagnosis can exclude a patient from therapy.Rapid Arterial Occlusion evaluation (RACE) score of five or more have an 85% chance of being LVO acute ischemic stroke. Pre-arrival notification of potential LVO cases by EMS (Emergency Medical Service) is an important factor to reduce door-to-transfer time from a Primary Stroke Center (PSC) to a Comprehensive Stroke center (CSC). We hypothesize that immediate feedback to EMS teams on their pre-hospital RACE score reporting will improve prehospital recognition of LVO strokes. Therefore, reducing the Door to Needle CTA (CT Angiogram) and/or Door to Transfer Time for endovascular treatment. Methods: Our inclusion criteria included patients with a diagnosis of AIS brought in by EMS with a RACE score of five or more, was given IV thrombolytics, or transferred to a comprehensive stroke center for endovascular treatment. A 5-item feedback form was developed for each case and was reviewed biweekly with our EMS liaison. Feedback included compliance with RACE score reporting, presence of IV access, CTA time, and TPA/Transfer time. Direct feedback was verbally given to the EMS transport team. Results: Comparison of data from a twelve-month preintervention period (n=29) to a four-month postintervention period (n=12) was conducted through direct comparison. This showed a decrease in mean Door-to-CTA time from 212.14 (CI ±83.3) to 97.08 (CI ±54.92) minutes with a p-value of 0.0126 in a one-tailed t-Test, a 54% reduction and a reduction in door to transfer time (305 minutes to 132 minutes, a 56.7 % reduction ). Conclusion: A pilot project focused on providing immediate feedback to EMS regarding accurate prehospital notification of RACE score showed a statistically significant improvement in door to CTA time and door to transfer time. Extension of the post study period is needed to confirm the significance of transfer time. This study demonstrates the importance of collaboration between a PSC and EMS to ensure prompt diagnosis and transfer for endovascular treatment of AIS caused by LVO.

Endovascular Treatment in Acute Ischemic Stroke - Three Years Clinical Experience

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
S. Andonova ◽  
E. Kalevska ◽  
Ch. Bachvarov ◽  
Tz. Dimitrova ◽  
M. Petkova ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Experience

Choosing to be the Hero, the Joker, the Villain: An Interview with Arthur Dong

2020 ◽  
Vol 73 (3) ◽  
pp. 41-46
Author(s):  
Oliver Wang
Keyword(s):  
High School ◽  
San Francisco ◽  
Asian Americans ◽  
Asian American ◽  
Short Film ◽  
Recent Experience ◽  
West Hollywood

Oliver Wang interviews documentary filmmaker Arthur Dong. Originally from San Francisco, Dong began his career as a student filmmaker in the 1970s before releasing the Oscar-nominated short film, Sewing Woman in 1982. Since then, his films have focused on the role of Chinese and Asian Americans in entertainment industries as well as on anti-LGBQ discrimination. In the interview, Wang and Dong discuss Dong's beginnings as a high school filmmaker, his decision to turn the story of his seamstress mother into Sewing Woman, his struggle to bring together the Asian American and queer film communities and his recent experience in staging a “Hollywood Chinese” exhibit inside a renovated bar in West Hollywood.

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