Abstract P695: Rural-Urban Differences in Functional Outcomes After Acute Therapy for Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Shen ◽  
Deepika Budhraja ◽  
Seeta Shah ◽  
Kimberly Martin ◽  
Chen Lin
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Rural Areas ◽  
Functional Outcomes ◽  
Regression Models ◽  
Older Age ◽  
Stroke Therapy ◽  
Acute Therapy ◽  
Acute Stroke Therapy

Introduction: The Southeastern United States, known as the “the stroke belt,” has the highest stroke mortality rate in the country. One possible reason is the high proportion of its residents living in rural areas. Studies suggest stroke care is worse for patients living in rural areas, and they are less likely to receive acute stroke therapy (intravenous thrombolysis or endovascular therapy), leading to worse outcomes. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received acute stroke therapy. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Southeastern US, the University of Alabama at Birmingham. Patients admitted with imaging-confirmed ischemic stroke and had acute stroke therapy between 2014 and 2018 were included for analysis. Individuals were classified as rural or urban dwelling based on US Department of Agriculture’s 2010 Rural-Urban Commuting Area Codes. Clinical and demographic characteristics were collected from the chart. Stepwise logistic regression models were performed with these variables to compare good (mRS 0-1) vs poor (mRS 2-6) functional outcomes. Results: There were 232 patients included in the study (185 urban, and 47 rural). There were no significant differences between groups in age (urban 64.5±15.1; rural 66.2±14.7), gender (urban: 56% male 44% female, rural: 51% male 49% female), or proportion of African-Americans (33% of urban group and 25% of rural group). Mean baseline NIH stroke scale was higher in rural patients than urban (17.0 vs 14.8 respectively, p-value=0.03.). In logistical regression models for good functional outcome (mRS 0-1) at 90-days, analysis of factors including rural/urban status, gender, age, insurance, transfer, and acute stroke therapy, revealed only older age as a significant factor (OR 0.97, 95% CI 0.95-0.99). Conclusions: Our study demonstrated no significant differences in functional outcome between patients from urban and rural locations after receiving acute therapy for treating ischemic stroke. Importantly, only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas can recover similarly to those from urban areas.

Abstract TP323: The Role of Ejection Fraction in 90 Day Functional Outcome in Acute Ischemic Infarction Patients Receiving Acute Stroke Therapy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tamra Ranasinghe ◽  
Brett Meyer ◽  
Richard Lane ◽  
Dawn Meyer
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Pearson Correlation ◽  
Recombinant Tissue Plasminogen Activator ◽  
Continuous Variables ◽  
Stroke Therapy ◽  
Stroke Registry ◽  
The Relationship ◽  
Acute Stroke Therapy ◽  
Iv Tpa

Background: Cardiovascular disease is associated with unfavorable outcomes following acute ischemic stroke (AIS). Left ventricularejection fraction (LVEF) alone has not been reported as a significant predictor of unfavorable outcomes in observational studies of AIS.The purpose of this study was to evaluate the relationship between LVEF and 90 day functional outcome in AIS patients who received acute stroke therapy with IV recombinant tissue plasminogen activator (rt-PA), endovascular therapy (EVT), or combination IV rt-PA+EVT. Methods: This was a retrospective review of prospectively collected data from the University of California San Diego (UCSD) Stroke registry from October 2014-June 2019. Analysis included all patients for whom a stroke code was activated and who had a transthoracic echocardiogram (TTE) during stroke admission or within the previous 30 days prior to AIS. Acute stroke therapy was defined as 1) IV tPA only; 2) EVT only; or 3) IV tPA + EVT. LVEF function was defined as: low <35%, moderately low 36 -49% and normal >50% on TTE. Primary outcome was modified ranking scale(mRS) at 90 days post stroke. Data was examined for frequencies and distribution. Continuous variables were assessed by Pearson correlation and t test. Kruskal-Wallis or ANOVA were used to evaluate group differences. ANCOVA was used for adjusted analysis. Results: In the 227 patients identified, low EF patients were more likely to have atrial fibrillation (61.9%, p=.004) and lower mean admission systolic blood pressure (132.6, p=0.009). LVEF was not significantly associated with 90 day outcome in all treated patients in both unadjusted (p=0.992) and adjusted (p=0.62). LVEF was not significantly associated with 90 day outcome for individual acute stroke therapy groups both unadjusted and adjusted. mRS at 90 days was significantly associated with baseline NIHSS (p<0.001), age (p=0.002), and treatment with IV tPA (p=0.01). Conclusion: In this study, LVEF was not independently associated with 90 day functional outcome in AIS patients who received acute stroke therapy. Further studies in more heterogenous samples are warranted to assess the relationship between LVEF and outcome in all stroke populations.

Rapid Clot Removal for Acute Stroke Therapy: Technical Case Report

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-E86-ONS-E86
Author(s):  
Scott E. Olson ◽  
R. Sean Pakbaz ◽  
Charles W. Kerber
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
International Normalized Ratio ◽  
Inclusion Criteria ◽  
Stroke Therapy ◽  
Clot Removal ◽  
Retrieval Device ◽  
Acute Stroke Therapy

Abstract Objective: Endovascular therapy for acute ischemic stroke offers hope to those patients who do not meet the strict inclusion criteria for intravenoust issue plasminogen activator. Because no approach or device can be optimal for every patient, it is desirable to have options. This case is the first report on a novel retrieval device which proved to be very effective in our patient. Clinical Presentation: A 69-year-old woman with an acute ischemic stroke was excluded from treatment with intravenoust issue plasminogen activator because of an elevated international normalized ratio. Intervention: We successfully treated this patient endovascularly using a device newly approved by the Food and Drug Administration. We achieved rapid recanalization and an excellent clinical outcome. Conclusion: Using a new retrieval device, we were able to rapidly and successfully treat an acute ischemic stroke in a patient not eligible for intravenoust hrombolysis. This may offer another alternative in endovascular acute stroke therapy.

scholarly journals Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?

2009 ◽  
Vol 2 (1) ◽  
pp. 67-70 ◽  
Author(s):  
C Nichols ◽  
J Carrozzella ◽  
S Yeatts ◽  
T Tomsick ◽  
J Broderick ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcomes ◽  
Stroke Therapy ◽  
Acute Stroke Therapy

scholarly journals 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and summary of discussions

2019 ◽  
Vol 14 (4) ◽  
pp. 439-441 ◽  
Author(s):  
Sunil A Sheth ◽  
Victor Lopez-Rivera ◽  
Songmi Lee ◽  
Sean I Savitz ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
International Symposium ◽  
Acute Stroke ◽  
Systems Of Care ◽  
Stroke Therapy ◽  
Full List ◽  
Online Supplement ◽  
Key Points ◽  
14Th International Symposium ◽  
Acute Stroke Therapy

The 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy (TTST) took place in Houston, Texas on 21–22 October 2018. Attended by 150+ invited global experts, the objectives of TTST 2018 were to explore the changing landscape of acute ischemic stroke therapy and to address current controversies in thrombolysis and thrombectomy, including expanding access and systems of care with global relevance. This article summarizes the proceedings of TTST 2018. The key points of each session are listed below, the full text of presentations and discussion are available in the online supplement, and the full list of contributing authors appear in the Appendix at the end of this article.

Abstract 3268: Ct Perfusion As A Tool To Predict The Risk Of Hemorrhagic Transformation In Ischemic Stroke Treated With Tissue Plasminogen Activator: A Single Center Experience.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tareq Kass-Hout ◽  
Maxim Mokin ◽  
Omar Kass-Hout ◽  
Emad Nourollahzadeh ◽  
David Wack ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Brain Tissue ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Stroke Therapy ◽  
Two Phase ◽  
The Mean

Objective: To use the Computed Tomography Perfusion (CTP) parameters at the time of hospital admission, including Cerebral Blood Volume (CBV) and Permeability Surface area product (PS), to identify patients with higher risk to develop hemorrhagic transformation in the setting of acute stroke therapy with intravenous thrombolysis. Methods: Retrospective study that compared admission CTP variables between patients with Hemorrhagic Transformation (HT) acute stroke and those with no hemorrhagic transformation. Both groups received standard of care intravenous thrombolysis with tPA. Twenty patients presented to our stroke center between the years 2007 - 2011 within 3 hours after stroke symptoms onset. All patients underwent two-phase 320 slice CTP which creates CBV and PS measurements. Patients were divided into two groups according to whether or not they had HT on a follow up CT head without contrast, done within 36 hours of the thrombolysis therapy. Clinical, demographic and CTP variables were compared between the HT and non-HT groups using logistic regression analyses. Results: HT developed in 8 (40%) patients. Patients with HT had lower ASPECT score ( P =.03), higher NIHSS on admission ( P= .01) and worse outcome ( P= .04) compared to patients who did not develop HT. Baseline blood flow defects were comparable between the two groups. The mean PS for the HT group was 0.53 mL/min/100g brain tissue, which was significantly higher than that for the non-HT group of 0.04 mL/min/100g brain tissue ( P <.0001). The mean area under the curve was 0.92 (95% CI). The PS threshold of 0.26 mL/min/100g brain tissue had a sensitivity of 80% and a specificity of 92% for detecting patients with high risk of hemorrhagic transformation after intravenous thrombolysis. Conclusions: Admission CTP measurements might be useful to predict patients who are at higher risk to develop hemorrhagic transformation after acute ischemic stroke therapy.

Abstract 96: CTP-Mismatch Maps Improve Interobserver Agreement

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Waimei A Tai ◽  
Archana Purushotham ◽  
Matus Straka ◽  
Rebecca M Sugg ◽  
Naveed Akhtar ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Interobserver Reliability ◽  
Observer Agreement ◽  
Absolute Difference ◽  
Stroke Therapy ◽  
Adequate Quality ◽  
Ischemic Core ◽  
Observer Disagreement ◽  
Acute Stroke Therapy

Introduction: The use of mismatch between the ischemic core and penumbra to select patients who are likely to benefit from acute stroke therapy has gained popularity. Interpretation of the ischemic core and penumbra on standard CT-perfusion (CTP) maps is subjective. This may lead to variability among physicians in the decision if a patient is a good candidate for acute stroke therapy. A CTP-Mismatch map with outlines of the ischemic core and penumbra could limit this variability. The goal of this study was to determine if inter-observer agreement regarding a patient’s suitability for acute stroke therapy improves with the use of a CTP-Mismatch map. The figure shows a typical CTP-Mismatch map. Methods: Ninety-six consecutive patients evaluated with CTP prior to intra-arterial therapy at St. Lukes Hospital in 2008-09 were included. 79 patients had adequate quality CTP for this analysis. Standard CTP maps (CBV, CBF, MTT, and Tmax) and a CTP-Mismatch map were generated with a fully automated program for processing of CTP source images (RAPID). RAPID assessed the ischemic core using a CBF threshold <30% of the contralateral hemisphere (rCBF<30%). The ischemic penumbra was defined by a Tmax threshold of >6 sec (Tmax>6s). The standard CTP maps and the CTP-Mismatch map were independently analyzed by two vascular neurologists in a blinded fashion. The raters assessed a patient's suitability for intra-arterial therapy based on the following mismatch criteria: (1) a ratio between (Tmax>6s) and (rCBF<30%) volumes >1.8 and (2) an absolute difference between (Tmax>6s) and (CBF<30%) volumes >15ml. Interobserver reliability was assessed with Cohen’s kappa. Results: When assessment of suitability for intra-arterial therapy was based on interpretation of standard CTP maps, the two raters agreed in 58 of 79 patients (kappa=0.46; 95% CI=0.24-0.60). The agreement between observers improved when suitability was determined using CTP-Mismatch maps (agreement in 76 of 79 cases; kappa=0.92; 95% CI=0.75-0.92; p<0.001 for difference between kappa values). The 3 cases with inter-observer disagreement had artifact on the CTP-Mismatch map. Following concensus adjudication of these 3 cases, 40 of the 79 patients (51%) were deemed suitable candidates for acute stroke therapy. Conclusion: CTP-Mismatch maps with estimates of ischemic core and penumbra volumes markedly improve inter-observer agreement regarding assessment of suitability for acute stroke therapy. Such maps, which can be generated automatically, may help standardize decision making algorithms for evaluation of potential intra-arterial therapy candidates.

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