Abstract 1122‐000123: Association of 24‐hour Blood Pressure Parameters Post‐Thrombectomy with Functional Outcomes According to Collateral Status

Introduction : Higher blood pressure (BP) most post mechanical thrombectomy (MT) can restore perfusion to the ischemic brain tissue depending on collateral status. We aim to determine the association of 24‐hour post‐MT BP parameters with the functional outcome depending on the pre‐MT collateral status. Methods : We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into two groups (good versus bad) depending on collateral status. A board‐certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified‐Tan>50% to designate good collaterals on the pre‐MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin‐A1C, intravenous‐alteplase, with the 24‐hour post‐MT BP parameters as the predictors. The outcomes were good functional outcome (3‐month mRS≤2) and mortality. Results : 220 patients met the inclusion criteria. 24‐hour BP parameters of standard deviation (SD) SBP (OR, 1.16; 95% CI,1.01‐1.33; P 0.047) and maximum DBP (OR, 1.05; 95% CI,1.01‐1.09; P 0.036) had an association with a good functional outcome, while SD SBP (OR, 1.15; 95% CI,1.01‐1.31; P 0.045), coefficient variation (CV) SBP (OR, 1.19; 95% CI,1.01‐1.41; P 0.043), SBP range (OR, 1.04; 95% CI,1.01‐1.07; P 0.046), maximum DBP (OR, 0.95; 95% CI,0.91‐0.99; P 0.016), pulse pressure (OR, 1.09; 95% CI,1.02‐1.16; P 0.022) and SBP ≥140 (OR, 5.85; 95% CI,1.11‐30.85; P 0.038) had an association with mortality in patients with good collaterals according to Mass grading. 24‐hour BP parameters of SD SBP (OR, 1.13; 95% CI,1.04‐1.24; P 0.007), CV SBP (OR, 1.18; 95% CI,1.05‐1.32; P 0.006), SBP range (OR, 1.04; 95% CI,1.01‐1.06; P 0.008) and maximum DBP (OR, 0.97; 95% CI,0.94‐1; P 0.02) had an association with mortality in patients with good collaterals according to modified‐Tan grading. There was no such association in patients with bad collaterals Conclusions : Various 24‐hour BP parameters post‐MT are associated with a functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.

Download Full-text

Abstract 1122‐000093: Association of Pre‐Mechanical Thrombectomy Collateral Scores with Functional‐Outcome in Short Versus Extended Window for Thrombectomy

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000093 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Taha Nisar ◽

Osama Abu‐Hadid ◽

Konrad Lebioda ◽

Toluwalase Tofade ◽

Priyank Khandelwal

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Retrospective Chart Review ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Inclusion Criteria ◽

Anterior Circulation ◽

Good Functional Outcome ◽

Ct Angiogram ◽

Comprehensive Stroke Center

Introduction : We aim to determine the utility of pre‐mechanical‐thrombectomy (MT) collateral scores in the short (<6 hours from onset) versus extended (6‐24 hours from onset) window for MT with respect to a good functional‐outcome. Methods : We performed a retrospective chart review of patients who underwent MT for anterior circulation LVO at a comprehensive stroke center from 7/2014 to 12/2020. A board‐certified neuroradiologist, who was blinded to the clinical‐outcomes, used collateral grading scales of Miteff (ordinal), Mass (ordinal), and modified‐Tan (dichotomous) to designate collateral scores on the pre‐MT CT Angiogram. The patients were divided into short (<6 hours from onset) versus extended (6‐24 hours from onset) groups depending on their timing of presentation to the emergency department. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, recanalization time, mean arterial pressure, blood glucose, location of occlusion, atrial fibrillation, LDL, hemoglobin‐A1C, and administration of intravenous‐alteplase, with the pre‐MT collateral grading scores as predictors. The primary outcome was a good functional‐outcome (3‐month mRS≤2) Results : 162 patients met our inclusion criteria for patients who presented in the short window. The pre‐MT scales of Mass (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) and modified‐Tan (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) were associated with a good functional‐outcome, unlike the Miteff scale (OR, 0.46; 95% CI, 0.18‐1.18; P 0.103). 58 patients met our inclusion criteria for patients who presented in the extended window. The pre‐MT scales of Mass (OR, 0.75; 95% CI, 0.23‐2.48; P 0.63), Miteff scale (OR, 0.78; 95%CI, 0.17‐3.64; P 0.746) and modified‐Tan (OR, 1.14; 95%CI, 0.1‐12.98; P 0.918) were not associated with a good functional‐outcome. Conclusions : Our study demonstrates that good collateral grades on Mass and modified‐Tan scales are associated with a good functional outcome for patients who present to the ED in the short window for MT. We did not find an association of any pre‐MT collateral scores with a good functional‐outcome for patients presenting in the extended window for MT.

Download Full-text

Abstract WP126: Association of 24-Hour Blood Pressure Parameters Post-Intravenous Alteplase With Symptomatic Intracerebral Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.wp126 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Toluwalase Tofade ◽

Ava Liberman ◽

Priyank Khandelwal

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Treatment Time ◽

Tertiary Care ◽

Significant Risk ◽

Binary Logistic Regression Analysis ◽

Symptomatic Intracerebral Hemorrhage ◽

Intravenous Alteplase ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Higher blood pressure (BP) at presentation is associated with a higher risk of symptomatic intracerebral hemorrhage (sICH) post-intravenous alteplase (IV-rtPA). We investigated the association of different BP parameters post-IV-rtPA with the development of sICH at a tertiary care center. Methods: We performed a retrospective chart review of adult patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the BP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the BP parameters as the predictors. The primary outcome was the development of sICH. SICH was defined as an intracerebral hemorrhage (ICH) that causes worsening of NIHSS score by ≥4 points post-IV-rtPA. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 5 (5.95%) patients developed sICH. In our cohort, the BP parameters of higher maximum systolic blood pressure (SBP) (195.8±9 vs.172.22±17; OR, 1.14; 95% CI, 1.03-1.26; P 0.016), higher maximum diastolic blood pressure (DBP) (120.2±18 vs.104.76±15; OR, 1.08; 95% CI, 1.01-1.17; P 0.04), wider SBP range (79.4±20 vs.58.75±18; OR, 1.06; 95% CI, 1.01-1.12; P 0.033), wider DBP range (74.2±27 vs.47.27±15; OR, 1.11; 95% CI, 1.03-1.2; P 0.008), and coefficient variation (CV) DBP (17.7±6 vs.12.65±4; OR, 1.19; 95% CI, 1.01-1.42; P 0.048) were significantly associated with a risk of sICH post IV-rtPA. Conclusions: Our study demonstrates significant risk of sICH with higher maximum SBP and DBP, wider SBP and DBP ranges, and CV DBP post-IV-rtPA.

Download Full-text

Abstract 1122‐000175: Comparison of Transradial Artery Versus Transfemoral Artery Access Mechanical Thrombectomy at a Comprehensive Stroke Center

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000175 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Taha Nisar ◽

Jimmy Patel ◽

Amit Singla ◽

Priyank Khandelwal

Keyword(s):

Mechanical Thrombectomy ◽

Retrospective Chart Review ◽

Functional Independence ◽

Binary Logistic Regression Analysis ◽

Transfemoral Approach ◽

Outcome Parameters ◽

Significant Difference ◽

First Pass ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction : The transradial approach (TRA) is being increasingly adopted by neuro‐interventionists and has emerged as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to compare various time, technical and outcome parameters in patients who undergo MT via TRF vs. TRA approach. Methods : We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2016 to 12/2020. We compared patients who underwent MT via TRA vs. TRF with respect to time from angio suite arrival to puncture, first pass, second pass and recanalization; time from puncture to first pass, second pass and recanalization; time from arrival to the emergency department (ED) to puncture, first pass, second pass and recanalization; the number of passes, rate of switching, achievement of TICI≥2b score, functional independence (3‐month mRS≤2), 3‐month mortality and neurological improvement (improvement in NIHSS by ≥4 points) on day 1 and 3. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, type of anesthesia (general vs. moderate), laterality, and location of clot (internal carotid or middle cerebral artery), ASPECTS≥6, presenting mean arterial pressure, blood glucose, Hb A1C, LDL, intravenous alteplase. Results : 217 patients met our inclusion criteria. The mean age was 64.09±14.4 years. 42 (19.35%) patients underwent MT through the TRA approach. There was a significantly higher rate of conversion from TRA approach to TRF approach (11.90% vs.2.28%; OR, 105.59; 95% CI,5.71‐1954.67; P 0.002), but no difference in various time, technical and outcome parameters, as shown in the table. Conclusions : Our study demonstrates no significant difference between TRA and TRF approaches with respect to various time, technical and outcome parameters, with a notable exception of a significantly higher rate of conversion from TRA to TRF approach.

Download Full-text

Abstract P511: Optimal Blood Pressure Targets Following Successful Revascularization With Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p511 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Phong T Vu ◽

Swarna Rajagopalan ◽

Jessica Frey ◽

Emily Hone ◽

Casey Jelsema ◽

...

Keyword(s):

Blood Pressure ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Hemorrhagic Transformation ◽

Adverse Outcomes ◽

Multivariable Logistic Regression Analysis ◽

Blood Pressure Targets ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Optimal Blood Pressure

Background/Objective: Blood pressure parameters for patients undergoing mechanical thrombectomy (MT) are not clearly defined. Prior studies have shown that higher maximum and mean systolic blood pressure (SBP) is associated with adverse outcomes. Our study sought to investigate the relationship of blood pressure on clinical outcomes after successful revascularization and determine optimal thresholds for BP parameters that correlated with a poor functional outcome. Methods: This was a retrospective observational study of 88 consecutive patients who received successful MT at one comprehensive stroke center. Systolic, diastolic, and mean arterial pressure values were recorded for each patient over a 48-hour period, as well as patient age and National Institutes of Health Stroke Scale (NIHSS). Outcome measures included modified Rankin Score (mRS), intracranial hemorrhage (ICH), and mortality at time of discharge and 90 days. Both univariable and multivariable logistic regression analysis was performed to identify associations between the BP covariates and functional outcomes. Results: A higher SBP standard deviation (SD) of >14mmHg (OR=1.150) and wider SBP range >64mmHg (OR=1.037) from the mean in the first 48 hours after successful MT were associated with poor MRS at 90 days. A SBP SD>14 was also associated with mortality at 90 days. A higher age (OR=1.052) and NIHSS (OR=1.096) were also associated with a poor MRS at 90 days. A higher DBP mean (OR=1.045) was associated with a higher rate of hemorrhagic transformation (HT). Conclusions: A higher SBP variability within the first 48 hours after successful MT is associated with a higher likelihood of poor 90-day functional outcome and mortality, and a higher mean DBP is associated with a higher rate of HT.

Download Full-text

Abstract P703: Association of Anemia With Functional Outcomes in Patients With Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p703 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Osama Abu-hadid ◽

Toluwalase Tofade ◽

Sara Shapouran ◽

Muhammad Zeeshan Memon ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Infarct Volume ◽

Retrospective Chart Review ◽

World Health ◽

Binary Logistic Regression Analysis ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Functional Outcome

Introduction: Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke. We aim to investigate the association of anemia upon presentation with functional outcomes in patients who undergo mechanical thrombectomy (MT). Methods: We performed a retrospective chart review of patients who underwent MT for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. Anemia was considered a dichotomous categorical variable with a cutoff point of hemoglobin <12.0 g/dL in women and <13.0 g/dL in men, as per the definition of the World Health Organization. A binary logistic regression analysis was performed, controlling for age, pre-treatment-NIHSS, ASPECTS ≥6, TICI score ≥2b, onset to recanalization time, and administration of intravenous-alteplase (IV-rtPA), with the presence of anemia as the predictor. The primary outcome was a good functional outcome at 3-months (mRS of ≤1). The secondary outcomes were 3-month mortality, sICH (ECASS-II criteria), and infarct volume on follow-up CT Head. Results: 177 patients met our inclusion criteria. The mean age was 64.34±15.16 years. 93 (52.54%) patients were men. 34 (19.21%) patients had 3-month mRS≤1. 11 (6.21%) patients developed sICH. Among men, there was a significant association of anemia with lesser chance of good functional outcome (5.89% vs.23.73%; OR, 6.1; 95% CI, 1.3-30.5; P 0.028), higher mortality (52.94% vs.30.51%; OR, 2.9; 95% CI, 1.1-7.8; P 0.038), and a larger infarct volume (106.12±109.78mls vs.73.02±74.36mls.; OR, 1.1; 95% CI, 1.1-1.1; P 0.032), but not with sICH (5.89% vs.5.26%; OR, 1.6; 95% CI, 0.2-12.2; P 0.681). Among women, there was no significant association of anemia with any outcome measures: mRS ≤1 (25% vs.31.25%; OR, 0.84; 95% CI, 0.27-2.59; P 0.754), mortality (25% vs.23.08%; OR, 1.26; 95% CI, 0.4-3.97; P 0.693), infarct volume (60.08±94.46mls vs.69.05±97.74mls.; OR, 1; 95% CI, 1-1.01; P 0.981), and sICH (9.37% vs.5.89%; OR, 1.52; 95% CI, 0.26-8.88; P 0.643). Conclusions: Our study demonstrates a gender difference in outcomes in patients with anemia at presentation who undergo MT. In our cohort, men had an association between anemia and mRS≤1, mortality, and a larger infarct volume, unlike women.

Download Full-text

Abstract WP125: Association of 24-Hour Systolic Blood Pressure Parameters Post-Intravenous Alteplase With Functional Outcomes at Discharge

Stroke ◽

10.1161/str.51.suppl_1.wp125 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Toluwalase Tofade ◽

Ava Liberman ◽

Priyank Khandelwal

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Functional Outcome ◽

Pulse Pressure ◽

Compensatory Mechanism ◽

Good Outcome ◽

Poor Outcome ◽

Intravenous Alteplase ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Elevation of post-stroke systolic blood pressure (SBP) can be a part of a compensatory mechanism to restore cerebral perfusion to the ischemic brain tissue, but comes at a risk of reperfusion injury. The ideal SBP in the 24-hour range post-IV-rtPA has been understudied. We investigated the association of different SBP parameters post-intravenous-alteplase (IV-rtPA) with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the SBP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the SBP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of ≤2 and a poor outcome as mRS of ≥3, upon discharge. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 25 (29.76%) patients had a good outcome (mRS≤2) at discharge. In our cohort, the parameters of higher mean SBP (144.9±14 vs.135.5±18; OR, 1.06; 95% CI, 1.02-1.11; P 0.004), higher maximum SBP (176.56±17 vs.166.7±18; OR, 1.06; 95% CI, 1.02-1.1; P 0.005) and wider pulse pressure (65.5±12 vs.57.8±13; OR,1.08; 95% CI, 1.03-1.14; P 0.007) were significantly associated with a poor outcome at discharge. Parameters of SBP variability like standard deviation SBP (13.5±5 vs.11.5±4; OR, 1.17; 95% CI, 1-1.36; P 0.058), coefficient variation SBP (9.36±4 vs.8.49±3; OR, 1.11; 95% CI, 0.94-1.32; P 0.242), and SBP range (62.22±20 vs.54.68±15; OR, 1.04; 95% CI, 1-1.07; P 0.08) were not significantly associated with a poor outcome at discharge. Conclusions: Our study demonstrates an association between higher mean SBP, higher maximum SBP, and wider pulse pressure over a period of 24-hours post-IV-rtPA, and poor functional outcome upon discharge.

Download Full-text

How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

International Journal of Stroke ◽

10.1177/1747493020985260 ◽

2021 ◽

pp. 174749302098526

Author(s):

Juliane Herm ◽

Ludwig Schlemm ◽

Eberhard Siebert ◽

Georg Bohner ◽

Anna C Alegiani ◽

...

Keyword(s):

Functional Outcome ◽

Odds Ratio ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Stroke Registry ◽

Primary Stroke Center ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

Download Full-text

Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000012321 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012321

Author(s):

Wagih Ben Hassen ◽

Caroline Touloupas ◽

Joseph Benzakoun ◽

Gregoire Boulouis ◽

Martin Bretzner ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Binary Logistic Regression ◽

Unfavorable Outcome ◽

Binary Logistic Regression Analysis ◽

Strongly Correlated ◽

Vessel Occlusion

Objective:To determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS LVO).Methods:Data were extracted from two pooled multicentric prospective registries of consecutive anterior AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2016-2019. Patients with pretreatment and 24 hours post-treatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale (eTICI) scores 2b, 2C or 3 were included. ENT were assessed and IG measured by voxel-based segmentation after DWI co-registration. Associations between number of CRA, ENT, IG and 3-month outcome were analyzed.Results:Four hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ=0.73, p=10-4). In multivariable linear analysis, IG was independently associated with CRA (β=1.6 per retrieval attempt, 95% CI = [0.97–9.74], p=0.03) and ENT (β=2.7, [1.21-4.1], p=0.03). Unfavorable functional outcome (3-month modified Rankin Score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (OR=1.05 [1.02-1.07] per 1 mL IG increase, p=10-4) in binary logistic regression analysis.Conclusion:Increasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved.Classification of evidence:This study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of clot retrieval attempts is associated with poorer functional outcome.

Download Full-text

Relationship between plasma homocysteine and blood pressure in hypertensive Northern-Nigerians

African Health Sciences ◽

10.4314/ahs.v20i1.38 ◽

2020 ◽

Vol 20 (1) ◽

pp. 324-337

Author(s):

Obiageli Uzoamaka Onyemelukwe ◽

Bilkisu Bello Maiha

Keyword(s):

Blood Pressure ◽

Binary Logistic Regression ◽

Plasma Homocysteine ◽

Binary Logistic Regression Analysis ◽

Healthy Controls ◽

Cross Sectional ◽

Hypertensive Patients ◽

Blood Pressure Difference ◽

Confounding Variables ◽

Blood Pressures

Aim: The study sought to determine whether there is any relationship between plasma homocysteine and blood pressure levels in Nigerians with essential hypertension. Method: It was a cross-sectional analytical study done on 120 randomly selected hypertensive patients and 120 normal healthy controls seen at the large Conference hall of the Ahmadu Bello University (ABU) Medical Centre, Zaria as well as the ABU Teaching Hospital, Zaria, Northern-Nigeria. Pearson’s Correlation and Binary Logistic Regression analysis determined the rela- tionship between homocysteine and hypertension. Results: Hyperhomocysteinaemia found in the hypertensive patients (22.8 ± 6.6 µmol/L) differed significantly (p<0.001) from controls (10.9 ± 2.8 µmol/L) with significant (p<0.001), blood pressure difference between both groups. Homocysteine signifi- cantly positively correlated with systolic (r = 0.51, p<0.001) and diastolic (r = 0.47, p<0.001) blood pressures in hypertensive subjects. The relation of plasma hcy to hypertension was statistically significant for SBP; OR: 1.08 (95% CI, 1.05-1.11) and DBP; OR: 1.08 (95% CI, 1.03-1.13) in the unadjusted model. When adjusted for confounding variables, hcy was significantly related to SBP; OR: 1.1 (95% CI, 1.04-1.18) but not DBP (p=0.25; OR: 1.06 (95 % CI, 0.96-1.18). The mean plasma folate level was high (115.2 ± 48.0 ng/mL) in the hypertensive subjects. The hyperhomocysteinaemic subjects showed a 2.8 times Odds of developing hypertension. Conclusion: This study showed higher mean plasma homocysteine levels in hypertensives than controls not accounted for by sub-optimal folate levels. Hyperhomocysteinaemia showed a positive relationship to systolic hypertension after adjusting for confounders. Keywords: Plasma homocysteine; hypertension; healthy controls; folic acid; blood pressure; Northern-Nigerians.

Download Full-text

Abstract P404: Causes of Recrudescent Stroke Symptoms in Emergent Stroke Evaluations

Stroke ◽

10.1161/str.52.suppl_1.p404 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jeffrey Quinn ◽

Mohammad Hajighasemi ◽

Laurie Paletz ◽

Sonia Figueroa ◽

Konrad Schlick

Keyword(s):

Los Angeles ◽

Medical Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Ischemic Lesion ◽

Tertiary Care Medical Center ◽

Stroke Mimic ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Rule Out

Introduction: Recrudescent symptoms of remote central nervous system lesions (primarily due to prior ischemic or hemorrhagic stroke) is a specific stroke mimic that is commonly in the differential diagnosis in patients presenting for emergent stroke evaluation. To date, best practices have yet to be established in terms of ensuring accurate diagnosis and the relative rates of causative systemic illnesses are not well described. We seek to better delineate the etiologies of recrudescent stroke symptoms seen at a tertiary care medical center via emergency stroke evaluation “Code Brain” (CB) as a first step towards clarifying diagnostic criteria for this entity. Methods: Data was obtained via retrospective chart review from consecutive patients via departmental database listing all CB consults seen at a tertiary care comprehensive stroke center in Los Angeles, California between the timeframe of January 2018- June 2020. Diagnoses for each case were adjudicated by faculty Vascular neurologists, in collaboration with Vascular neurology fellows and Neurology residents. Those cases with a diagnosis of stroke recrudescence were reviewed in detail for the extent of neuroimaging they underwent, as well as for identified causes of recrudescence. Results: Records of 3,998 consecutive CB activations were reviewed. 2.1% (n=85) were found after screening to have clinical diagnosis of recrudescence or chronic stroke. Of these 85 patients, 29.4% (n=25) were not found to have a causative etiology for recrudescent neurologic deficit. Of these 25 patients, 36.0% (n=9) did not undergo MRI to evaluate for interval ischemic lesion, as compared to 46.6% of those whom a causative etiology was identified. This difference (10.6%, 95% CI -12.30 to 30.67%, p=0.3719) was not significant. Discussion: At our comprehensive stroke center, recrudescent stroke is an uncommon diagnosis amongst all CB evaluations, despite being commonly considered. Despite a diagnosis of recrudescence, MRI brain is not always performed to rule out acute ischemic stroke. Standardized neuroimaging protocols should be considered in making the diagnosis of stroke recrudescence.

Download Full-text