Abstract P819: Individualized Patients’ Risk of Post Rt-pa ICH in Acute Ischemic Stroke by Using a Simple Predictive Model

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Waitayaporn Pengtong ◽  
Mananchaya Kongmuangpak ◽  
Niraya Noitamyae ◽  
Nongnapas Hiranshayangoon ◽  
Pimchanok Sriprayoon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Predictive Model ◽  
External Validation ◽  
Predictive Score ◽  
Individual Risk ◽  
Point Score ◽  
Independent Variables

Background and Purpose: A simple and reliable prediction of post intravenous recombination tissue plasminogen activator (rt-PA) intracerebral hemorrhage (ICH) is useful for stroke team to inform individual risk and improve hospitalization care. We aim to develop and validate a simple predictive score model to assess the 24-hour risk of ICH post rt-PA. Methods: This retrospective study included 739 acute ischemic stroke patients who received intravenous rt-PA between October 2005 and June 2020 at Siriraj Hospital, Bangkok, Thailand. Multiple logistic regression was used to evaluate the value of independent variables associated with any ICH and symptomatic intracerebral hemorrhage (SICH) measure by the European Cooperative Acute Stroke Study II (ECASS II) definition. Adjusted ORs of independent variables were converted to point score, summated of point score provide a probability of ICH and SICH. The predictive scores were internal validated in 95 patients and performance tested with an area under a receiver operating characteristic curve (AUC-ROC). Results: From a total of 739 patients, 19.2% had an ICH in which 5.9% was SICH. The predictive model of ICH included hyperdense middle cerebral artery sign (HDMCA) (3 points), initial blood glucose > 180mg/dl (3 points), coronary artery disease (CAD) (2 points), international normalized ratio (INR) > 1.0 (2 points) and 10 year increase of age ( 1 point per 10 year increase; age ≤ 20 year = 1). The performance of the predictive model showed AUC-ROC was 0.72 (95% confidence interval, 0.60 - 0.82) in the derivative cohort and AUC-ROC was 0.74 (95% confidence interval, 0.66 - 0.85) in the validation cohort. Conclusions: This simple predictive model provides a better prediction of a 24-hour risk of ICH post rt-PA in AIS among Thai patients. An individualized ICH risk post rt-PA can assist frontline physicians and relatives in rt-PA decision making process. Further external validation and prospectively confirmed in a larger cohort is recommend.

Abstract P212: Comparison Of Vascular Risk Factors And Serum Fatty Acids At Admission Between Intracerebral Hemorrhage And Acute Ischemic Stroke

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka ◽  
Yuichi Miyazaki
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Area Under The Curve ◽  
Density Lipoprotein ◽  
Correlation Coefficients ◽  
Roc Curves ◽  
Threshold Values ◽  
Independent Variables ◽  
Average Blood Pressure

Introduction: Dietary triglycerides influence fatty acid (FA) serum concentrations and weight percentages (wt%), which may be associated with the onset of intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). Hypothesis: There are significant differences between FAs at the admission of ICH and AIS. Methods: We included patients admitted between 2016 and 2019 within 24 h of ICH or AIS onset and calculated correlation coefficients between their ages, serum FA concentrations, and FA wt% values. We evaluated differences in age, average blood pressure (ABP), glucose, A1c, serum lipids, and FAs between two groups. Excluding variables with multicollinearity, we performed multiple logistic regression (MLR) analysis to identify independent variables distinguishing ICH from AIS. We estimated the threshold values of independent variables using the area under the curve values derived from the receiver operating characteristic (ROC) curves. Results: Our inclusion criteria were met by 141 of ICH patients and 525 of AIS patients. In the ICH group, age, A1c, and eicosapentaenoic acid (EPA) levels were smaller than those in the AIS group. ABP, high-density lipoprotein cholesterol (HDL-C), myristic acid (MyA), linoleic acid (LiA) concentrations, and MyA wt% were higher than those in the AIS group. MLR analysis between two groups indicated that age, ABP, A1c, HDL-C were independent variables. Serum FA levels were not independent. ROC curves showed that the threshold values of age, ABP, A1c, and HDL-C for ICH onset were ≤ 69 years, ≥ 126.6 mmHg, ≤ 6.0%, and ≥ 1.62 mmol/L, respectively. In 27 patients with age ≤ 69 , ABP ≥ 126.6, A1c ≤ 6.0%, and HDL-C ≥ 1.62 and 87 patients with age > 69 , ABP< 126.6, A1c > 6.0, and HDL-C < 1.62, there were 19 (70.4%) and 9 (10.3%) patients with ICH, the MyA concentrations were 108 and 73 μmol/L (p < 0.001), the LiA concentration were 2,900 and 2,410μmol/L (p < 0.001), and the EPA wt% were 1.4 and 2.0% (p=0.059), respectively. Conclusions: Younger patients with higher ABP, lower A1c, and higher HDL-C suffered from not AIS but ICH, and their MyA and LiA concentrations were higher than older patients without them.

scholarly journals Association between comorbid cancer and outcomes among admissions for acute ischemic stroke receiving systemic thrombolysis

2018 ◽  
Vol 14 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Erin R Weeda ◽  
Nicole Bohm
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Data Sets ◽  
Systemic Thrombolysis ◽  
The Impact ◽  
Multivariable Adjustment

Background The impact of cancer on outcomes was not assessed in major trials of systemic thrombolysis in acute ischemic stroke. Aims To evaluate the association between comorbid cancer and hospital outcomes among patients receiving systemic thrombolysis for the treatment of acute ischemic stroke. Methods The 2013 and 2014 United States National Inpatient Sample was used to identify adult patients hospitalized for acute ischemic stroke who received systemic thrombolysis. Identified admissions were stratified into two cohorts based on the presence or absence of comorbid cancer. Multivariable logistic regression was performed to determine the association between comorbid cancer and the odds of in-hospital mortality and intracerebral hemorrhage after adjustment for age ≥75 years and comorbid atrial fibrillation. Results A total of 13,993 acute ischemic stroke admissions were treated with systemic thrombolysis. Of these, 3.0% ( n = 416) had comorbid cancer. The overall incidence of in-hospital mortality was 7.0% and intracerebral hemorrhage occurred in 7.6% of patients. Upon multivariable adjustment, comorbid cancer was not associated with an increased odds of in-hospital mortality (odds ratio = 1.24; 95% confidence interval = 0.88–1.76). However, the adjusted odds of intracerebral hemorrhage were higher among those with comorbid cancer (odds ratio = 1.60; 95% confidence interval = 1.17–2.17). Conclusions In this retrospective study of admissions for acute ischemic stroke receiving thrombolysis, comorbid cancer was not associated with a higher odds of in-hospital mortality but was associated with an increased odds of intracerebral hemorrhage. Factors driving this observed association should be explored in data sets containing clinical variables.

Nomogram to Predict Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in an Asian Population.

2021 ◽  
Vol 19 ◽  
Author(s):  
Xiaohua Xie ◽  
Jie Yang ◽  
Lijie Ren ◽  
Shiyu Hu ◽  
Wancheng Lian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Calibration Curve ◽  
Intravenous Thrombolysis ◽  
Asian Population ◽  
Individual Risk ◽  
Clinical Effects ◽  
Symptomatic Intracranial Hemorrhage

Background: Symptomatic intracranial hemorrhage (sICH) is a serious hemorrhagic complication after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients. Most existing predictive scoring systems were derived from Western countries Objective: To develop a nomogram to predict the possibility of sICH after IVT in an Asian population. Methods: This retrospective cohort study included AIS patients treated with recombinant tissue plasminogen activator (rt-PA) in a tertiary hospital in Shenzhen, China, from January 2014 to December 2020. The end point was sICH within 36 hours of IVT treatment. Multivariable logistic regression was used to identify risk factors of sICH, and a predictive nomogram was developed. Area under the curve of receiver operating characteristic curves (AUC), calibration curve, and decision curve analyses were performed. The nomogram was validated by bootstrap resampling Results: Data on a total of 462 patients were collected, of whom 20 patients (4.3%) developed sICH. In the multivariate logistic regression model, the National Institute of Health stroke scale scores (NIHSS) (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06–1.23, P < 0.001), onset to treatment time (OTT) (OR, 1.02; 95% CI, 1.01–1.03, P < 0.001), neutrophil to lymphocyte ratio (NLR) (OR, 1.22; 95% CI, 1.09–1.35, P < 0.001), and cardioembolism (OR, 3.74; 95% CI, 1.23–11.39, P = 0.020) were independent predictors for sICH and were used to construct a nomogram. Our nomogram exhibited favorable discrimination ability [AUC, 0.878; specificity, 87.35%; and sensitivity, 73.81%]. Bootstrapping for 500 repetitions was performed to further validate the nomogram. The AUC of the bootstrap model was 0.877 (95% CI: 0.823–0.922). The calibration curve exhibited good fit and calibration. The decision curve revealed good positive net benefits and clinical effects Conclusion: The nomogram consisted of the predictors NIHSS, OTT, NLR, and cardioembolism could be used as an auxiliary tool to predict the individual risk of sICH in Chinese AIS patients after IVT. Further external verification among more diverse patient populations is needed to demonstrate the accuracy of the model’s predictions.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

Abstract T P307: Similar Rates of Early Cognitive Dysfunction after Intracerebral Hemorrhage and Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
M. Carter Denny ◽  
Suhas S Bajgur ◽  
Kim Y Vu ◽  
Rahul R Karamchandani ◽  
Amrou Sarraj ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Cognitive Dysfunction ◽  
Hospital Setting ◽  
Stroke Severity ◽  
Regression Analyses ◽  
Post Stroke ◽  
Poor Outcome

Introduction: Post-stroke cognitive dysfunction (CD) affects at least 1/3 of acute ischemic stroke (AIS) patients when assessed at 3 months. Limited data exists on CD in intracerebral hemorrhage (ICH). The role of early, in-hospital cognitive screening using the brief Montreal Cognitive Assessment (mini MoCA) is being investigated at our center. Hypothesis: We assessed the rates of early CD in ICH and AIS and hypothesized that even minor deficits from these disorders causes significant CD. Methods: 1218 consecutive stroke patients admitted from 2/13 to 12/13 were reviewed; 610, 442 with AIS and 168 with ICH, with admission NIHSS and mini MoCAs were included in the final analyses. CD was defined as mini MoCA <9 (max 12). Poor outcome was defined as discharge mRS 4-6. Stroke severity was stratified by NIHSS score of 0-5, 6-10, 11-15, 16-20, 21-42 as in ECASS-I . Chi-squared tests and univariate logistic regression analyses were performed. Results: Baseline characteristics are shown in table 1. AIS and ICH groups were similar with regard to race, gender and stroke severity. ICH patients were younger, had longer stroke service lengths of stay and poorer outcomes than AIS patients (p=0.03, p<0.001, p<0.001). No difference was seen in rates of CD between AIS and ICH patients (60% vs. 57%, p=0.36, OR 1.2 (CI 0.8-1.7)). CD rates ranged from 36% for NIHSS 0-5 to 96% for 21-42 (figure 1). Older patients were twice as likely to have CD (p<0.001, OR 2.2 (CI 1.6 - 3.0)). Patients with CD had five times the odds of having a poor outcome compared to the cognitively intact (p<0.001, OR 5.2 (CI 3.4-7.7)). In univariate logistic regression analyses, age was a significant predictor of CD in AIS, but not in ICH (p= <0.001, p=0.06). Conclusion: Post-stroke CD is common across all severities and occurs at similar rates in AIS and ICH. More than 1/3 of patients with minor deficits (NIHSS 0-5) had CD in the acute hospital setting. Whether early CD is predictive of long term cognitive outcomes deserves further study.

Abstract 19892: Association Between Estimated-glomerular Filtration Rate and Clinical Outcomes at One Year After Acute Ischemic Stroke

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
xiaoqing bu ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Hao Peng ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
The Relationship

Introduction: The relationship between estimated-glomerular filtration rate (eGFR) and acute ischemic stroke outcomes remains controversial. Hypothesis: We aimed to evaluate the impact of eGFR on all-cause mortality, recurrent stroke, and vascular events in patients with acute ischemic stroke. Methods: 4036 patients with acute ischemic stroke recruited from 26 hospitals across China from August 2009 to May 2013 were included in our study. GFR was estimated by CKD-EPI equations based on serum creatinine and/or cystatin C (CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys). The Cox proportional hazards models were used to examine the relationship between declined eGFR and 1-year all-cause mortality, recurrent stroke, and vascular events. Declined eGFR was defined as <60 mL/min /1.73 m2. Results: Declined eGFR was present in 7.22% (n=281) of patients based on the CKD-EPIcr equation, 3.43% (n=119) based on the CKD-EPIcys equation, and 5.67% (n=170) based on the CKD-EPIcr-cys equation. Compared to patients with an eGFR ≥90 mL/min /1.73 m2, adjusted hazard ratios (95% confidence interval) for all-cause mortality associated with eGFR<60 mL/min /1.73 m2 were 1.68 (1.06 to 2.66, p=0.026), 2.29 (1.29 to 4.06, p=0.005), and 1.79 (1.08 to 2.98, p=0.024) using CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, respectively. For recurrent stroke, adjusted hazard ratios (95% confidence interval) were 0.90 (0.49 to 1.66, p=0.743), 0.60 (0.19 to 1.93, p=0.393), and 0.89 (0.40 to 1.95, p=0.762), respectively. For vascular events, adjusted hazard ratios (95% confidence interval) were 1.33 (0.81 to 2.19, p=0.266), 1.07 (0.46 to 2.47, p=0.880), and 1.31 (0.70 to 2.43, p=0.403), respectively. Conclusion: Our study indicates that declined eGFR is a strong independent risk factor for total mortality among patients with acute ischemic stroke. However, there is no association between low eGFR and recurrent stroke or vascular events among patients with acute ischemic stroke. In addition, the association of eGFR with all-cause mortality among patients with acute ischemic stroke is stronger when eGFR was calculated based on the CKD-EPIcys equation compared to CKD-EPIcr and CKD-EPIcr-cys equations.

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