scholarly journals Effect of COVID‐19 on Acute Ischemic Stroke Hospitalizations and Treatments: Population‐Level Experience

2021 ◽  
Author(s):  
Youngran Kim ◽  
Anjail Sharrief ◽  
Swapnil Khose ◽  
Rania Abdelkhaleq ◽  
Sergio Salazar‐Marioni ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Control Period ◽  
Population Level ◽  
Population Based ◽  
Admission Rates ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Treatment Use

Abstract BACKGROUND Several studies have reported changes in the volume and type of acute ischemic stroke (AIS) hospitalizations during the early stage of the COVID‐19 pandemic. However, population‐based assessments, which include lower volume centers and more comprehensive geographic areas, are limited. Here, we evaluate an entire state‐level experience during the first peak COVID pandemic and compare against a 1‐year prior historical period. METHODS We conducted a retrospective population‐based study using the Texas Inpatient Public Use Data File, capturing all discharges from hospitals in the State of Texas, except federal hospitals. AIS admission volumes, patient characteristics, proportions of large vessel occlusion (LVO), admission rates to comprehensive stroke centers, use of intravenous tissue plasminogen activator and endovascular treatment, and patient outcomes were compared between April 1, 2019 and June 30, 2019 (historical control period) and April 1, 2020 and June 30, 2020 (pandemic period). RESULTS A total of 9277 hospitalized AIS cases were identified during the pandemic period, a decrease of 12% (10 524) compared with the control period. Cases without LVO dropped by 15%, whereas LVO cases dropped by only 5%. There were no significant differences in age or race and ethnicity of patients. While admission rates to comprehensive stroke centers (39.6% versus 39.4%, P =0.81) and endovascular treatment use in LVO (17.0% versus 16.3%, P =0.45) were not different between the 2 periods, the use of intravenous tissue plasminogen activator (15.0% versus 13.6%, relative risk [RR], 0.90; 95% CI, 0.84–0.97; P =0.004) decreased. The percentage of patients who died or were discharged to hospice increased from 7.2% to 8.25% (RR, 1.17; 95% CI. 1.06–1.29; P =0.001). CONCLUSIONS This study from a statewide population‐level analysis confirms smaller hospital‐based cohorts observing decreasing numbers of milder AIS admissions, and lower use of thrombolysis. Although LVO admissions and endovascular treatment use were largely unchanged, these findings suggest missed treatment opportunities for patients with AIS in the pandemic.

scholarly journals Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke

Stroke ◽  
1998 ◽  
Vol 29 (1) ◽  
pp. 18-22 ◽  
Author(s):  
David Chiu ◽  
Derk Krieger ◽  
Carlos Villar-Cordova ◽  
Scott E. Kasner ◽  
Lewis B. Morgenstern ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Abstract WP280: Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregg C Fonarow ◽  
Eric E Smith ◽  
Xin Zhao ◽  
Eric D Peterson ◽  
Ying Xian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Ct Scanner ◽  
Critical Pathways ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Methods: We surveyed 304 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle times in the 1/2008-2/2010 timeframe (prior to the initiation of Target: Stroke). The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter DTN times and further refined after pilot testing. Categorical responses are reported as frequencies. Results: Hospitals participating in the survey were 50% academic, median 163 (IQR 106-247) ischemic stroke admissions per year, median 10 (IQR 6-17) tPA treated patients per year, and had median 79 minute (IQR 71-89) DTN times. By survey, 214 of 304 hospitals (70%) reported initiating or revising strategies to reduce DTN times in the prior 2 years. Reported use of the different strategies varied in frequency, with use of ischemic stroke critical pathways, CT scanner located in the Emergency Department, and tPA being stored in the Emergency Department being the strategies least frequently employed (Table). As part of Target: Stroke participation, 279 of 304 hospitals (91.5%) indicated they planned to have a dedicated team focused on reducing DTN times. Conclusions: While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists. Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care.

A Pregnant Woman with Aphasia and Right-Sided Weakness

2017 ◽  
Author(s):  
M. Angela O’Neal
Keyword(s):  
Ischemic Stroke ◽  
Pregnant Woman ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Intravenous Tissue Plasminogen Activator ◽  
Common Causes ◽  
Tissue Plasminogen ◽  
Multiple Trials ◽  
Iv Tpa ◽  
In Pregnancy

This chapter discusses the evaluation and management of acute ischemic stroke in pregnancy. Stroke in pregnancy is rare, but is a significant cause of morbidity. The etiologies of stroke in pregnancy are diverse. The most common causes in hospital-based studies are cardioembolic or related to eclampsia. The use of intravenous tissue plasminogen activator (IV tPA) as well as intra-arterial clot retrieval in stroke have been validated by multiple trials. Small case series support the safety of both therapies in pregnancy. Therefore, the management of stroke in pregnancy should be based on the mechanism and severity of the stroke, not on obstetrical issues.

scholarly journals Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA

CJEM ◽  
2006 ◽  
Vol 8 (01) ◽  
pp. 54-57 ◽  
Author(s):  
David J. Gladstone ◽  
Richard I. Aviv ◽  
Babak Jahromi ◽  
Sandra E. Black ◽  
Devra Baryshnik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Treatment Approach ◽  
Novel Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Investigational Treatment ◽  
Tissue Plasminogen ◽  
Proximal Middle Cerebral Artery ◽  
Emergency Revascularization

ABSTRACT Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (IV) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined IV–IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.

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