scholarly journals Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke

2018 ◽  
Vol 24 (5) ◽  
pp. 520-528 ◽  
Author(s):  
Seunguk Jung ◽  
Cheolkyu Jung ◽  
Jae Hyoung Kim ◽  
Byung Se Choi ◽  
Yun Jung Bae ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Independent Predictor ◽  
Metastatic Cancer ◽  
Cryptogenic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Stroke Patients ◽  
Patients With Cancer ◽  
Endovascular Recanalization ◽  
Significant Difference

Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed. CRS patients are described as those who had (a) cryptogenic stroke with advanced or metastatic cancer; (b) no other possible causes of stroke such as cardioembolism (CE) and large artery atherosclerosis (LAA); and (c) elevated D-dimer levels or diffusion-restricted lesions in multiple vascular territories. We compared procedural and clinical outcomes at discharge among CRS, CE, and LAA patients. Results A total of 329 patients were finally enrolled in this study; of these, 19 were CRS patients. The rate of successful recanalization, defined as modified treatment in cerebral infarction grade 2b or 3, was lower in the CRS group than in the LAA and CE groups (63% versus 84% versus 84%, p = .06). CRS subtype was an independent predictor for successful recanalization after ERT in the multivariate analysis (odds ratio, 0.317; 95% confidence interval, 0.116–0.867; p < .001). No significant difference in the rate of good clinical outcomes at discharge was observed among groups. Conclusions Although clinical outcomes at discharge were similar for CE and LAA patients, complete recanalization seemed more difficult to achieve in CRS patients than in conventional stroke patients.

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership

2018 ◽  
Vol 46 (3-4) ◽  
pp. 170-175 ◽  
Author(s):  
Penelope van Veenendaal ◽  
Bernard Yan ◽  
Leonid Churilov ◽  
Richard Dowling ◽  
Steven Bush ◽  
...  
Keyword(s):  
Service Delivery ◽  
Clinical Outcomes ◽  
Artery Occlusion ◽  
Large Artery ◽  
Service Model ◽  
Good Clinical Outcome ◽  
Hub And Spoke ◽  
Significant Difference ◽  
The Difference ◽  
Regional Hospitals

Background: Endovascular clot retrieval (ECR) improves outcomes for acute ischaemic stroke with large artery occlusion. However, the provision of ECR requires resource-intensive comprehensive stroke centres (CSC), which are impractical to establish in regional hospitals. An alternative is a “hub-and-spoke” model, whereby ischaemic strokes are triaged at the regional primary centres and where eligible, transferred to a CSC. We aimed to compare the outcomes of patients directly admitted to a CSC with patients treated in the “hub-and-spoke” model. We hypothesize that there are no significant differences in clinical outcomes between the 2 systems. Methods: We included patients undergoing ECR at a CSC. Patients were categorised into 2 groups; the first group included patients directly admitted to the CSC and the second group included patients in the “hub-and-spoke” model. Good clinical outcome was defined as modified Rankin Scale 0–2 and the difference between the 2 groups was tested by logistic regression. Results: Of 178 patients, 50 (28%) presented directly to CSC and 128 (72%) were transferred from a referring hospital. The median age was 70 (interquartile range 58–77) and 61% were male. Thrombolysis in ischaemic cerebral-infarction 2b/3 recanalisation was achieved in 79% of patients. Of the direct group, 63% (95% CI 48–77%) achieved good clinical outcomes compared to 52% (95% CI 43–61%) in the “hub-and-spoke” group (p = 0.233). Conclusion: This state-wide service model demonstrates comparable clinical outcomes to that described in clinical trials. We found no significant difference in outcome between patients directly admitted to CSC and those with “hub-and-spoke” service delivery.

scholarly journals Endovascular therapy in patients with large vessel occlusion due to cardioembolism versus large-artery atherosclerosis

2021 ◽  
Vol 14 ◽  
pp. 175628642199901
Author(s):  
Meredeth Zotter ◽  
Eike I. Piechowiak ◽  
Rupashani Balasubramaniam ◽  
Rascha Von Martial ◽  
Kotryna Genceviciute ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endovascular Therapy ◽  
Independent Predictor ◽  
Intravenous Thrombolysis ◽  
Stent Retriever ◽  
Large Vessel ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Background and aims: To investigate whether stroke aetiology affects outcome in patients with acute ischaemic stroke who undergo endovascular therapy. Methods: We retrospectively analysed patients from the Bernese Stroke Centre Registry (January 2010–September 2018), with acute large vessel occlusion in the anterior circulation due to cardioembolism or large-artery atherosclerosis, treated with endovascular therapy (±intravenous thrombolysis). Results: The study included 850 patients (median age 77.4 years, 49.3% female, 80.1% with cardioembolism). Compared with those with large-artery atherosclerosis, patients with cardioembolism were older, more often female, and more likely to have a history of hypercholesterolaemia, atrial fibrillation, current smoking (each p < 0.0001) and higher median National Institutes of Health Stroke Scale (NIHSS) scores on admission ( p = 0.030). They were more frequently treated with stent retrievers ( p = 0.007), but the median number of stent retriever attempts was lower ( p = 0.016) and fewer had permanent stent placements ( p ⩽ 0.004). Univariable analysis showed that patients with cardioembolism had worse 3-month survival [72.7% versus 84%, odds ratio (OR) = 0.51; p = 0.004] and modified Rankin scale (mRS) score shift ( p = 0.043) and higher rates of post-interventional heart failure (33.5% versus 18.5%, OR = 2.22; p < 0.0001), but better modified thrombolysis in cerebral infarction (mTICI) score shift ( p = 0.025). Excellent (mRS = 0–1) 3-month outcome, successful reperfusion (mTICI = 2b–3), symptomatic intracranial haemorrhage and Updated Charlson Comorbidity Index were similar between groups. Propensity-matched analysis found no statistically significant difference in outcome between stroke aetiology groups. Stroke aetiology was not an independent predictor of favourable mRS score shift, but lower admission NIHSS score, younger age and independence pre-stroke were (each p < 0.0001). Stroke aetiology was not an independent predictor of heart failure, but older age, admission antithrombotics and dependence pre-stroke were (each ⩽0.027). Stroke aetiology was not an independent predictor of favourable mTICI score shift, but application of stent retriever and no permanent intracranial stent placement were (each ⩽0.044). Conclusion: We suggest prospective studies to further elucidate differences in reperfusion and outcome between patients with cardioembolism and large-artery atherosclerosis.

P5351In-Flight Stroke in Korea

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Park
Keyword(s):  
Cerebral Infarction ◽  
Old Age ◽  
Cryptogenic Stroke ◽  
Case Series ◽  
Flight Time ◽  
Stroke Onset ◽  
Large Artery ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Short Flight

Abstract Background During flight, atmospheric pressure drop, low humidity and restricted motion occur. The environmental change can evoke the stroke occurrence. However, description of in-flight stroke case series has been limited until now. We investigated the clinical and flight trip characteristics of in-flight stroke cases in Korea. Method Since the opening of Incheon international airport, which is used by about 50 million people a year, in 2001, our hospital branch has been located at the airport and all the emergency stroke patients have been referred to our hospital. We performed retrospective review of the prospectively collected stroke registry and the information about the flight from January 2001 to December 2018. Results During the study period, 31 in-flight stroke cases were identified among total 1,452 ischemic stroke patients (17 men, 62±15 years old). Twenty-six patients had cerebral infarction, and four patients had transient ischemic attack. On etiological classification of cerebral infarction, 19 large artery atherothrombosis (61.3%), 1 septic embolism, 3 cryptogenic stroke, 3 cardioembolism (9.7%) and 1 cerebral venous thrombosis were identified. Six patients had Patent Foramen Ovale. Twenty-two patients reported to experience symptom around landing. Fourteen patients had flight for six hours or longer. Compared to the patients with long flight time (≥6 hrs), those with short flight time had the higher incidence of stroke occurrence around landings (32 vs 68%) and low incidence of unclear stroke onset. Poor outcome, defined as mRS 4 or higher, was associated with old age, unclear stroke onset, and early neurologic deterioration. Conclusion In-flight stroke is uncommon, and can easily be neglected during flight, which result in poor outcome. The stroke risk seems to be relatively high around landing, especially in the travelers with short flight time. The possibility of paradoxical embolism related to motion restriction seems low for stroke occurrence. Old age and unclear stroke onset are associated with poor outcomes.

scholarly journals LONG TERM CLINICAL OUTCOMES AFTER ENDOVASCULAR RECANALIZATION IN PATIENTS WITH CHRONIC CAROTID ARTERY OCCLUSION

2017 ◽  
Vol 69 (11) ◽  
pp. 1006
Author(s):  
Mao-Shin Lin ◽  
Chi-Sheng Hung ◽  
Chih-Fan Yeh ◽  
Ching-Chang Huang ◽  
Ying-Hsien Chen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Clinical Outcomes ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Endovascular Recanalization

Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yoshiaki Shimada
Keyword(s):  
Ischemic Stroke ◽  
Antiphospholipid Syndrome ◽  
Patent Foramen Ovale ◽  
Multiple Logistic Regression Analysis ◽  
Cryptogenic Stroke ◽  
Control Group ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

scholarly journals Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 49-55
Author(s):  
Huong Bich Thi Nguyen ◽  
Thang Huy Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Limited Information ◽  
Anterior Circulation ◽  
Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

2016 ◽  
Vol 9 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Yahia Lodi ◽  
Varun Reddy ◽  
Gorge Petro ◽  
Ashok Devasenapathy ◽  
Anas Hourani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Large Artery ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Nihss Score ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Background and purposeIn recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39–68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO.MethodsBased on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS).Results18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10–23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0–12), 1 (0–12), and 0 (0–4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%.ConclusionsOur study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

scholarly journals INVESTIGATING THE EFFECT OF REFLEXOLOGY IN INTENSITY OF PAIN AND ANXIETY AMONG PATIENTS SUFFERING FROM METASTATIC CANCER IN ADULTS’ HEMATOLOGY WARD

2018 ◽  
Vol 11 (6) ◽  
pp. 401 ◽  
Author(s):  
Simin Jahani ◽  
Fatemeh Salari ◽  
Nasrin Elahi ◽  
Bahman Cheraghian
Keyword(s):  
Cancer Patients ◽  
Metastatic Cancer ◽  
Test Group ◽  
Control Group ◽  
Anxiety Management ◽  
Patients With Cancer ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
And Control

Objective: Findings suggest dissatisfaction of half of the cancer patients regarding pain and anxiety management. This study aimed to determine the effect of reflexology on the intensity of pain and anxiety among patients with metastatic cancer hospitalized inadulthematology ward.  Methods: In this study, the samples were selected from adult hematology ward in Baghaei 2 hospital in Ahwaz, Iran, according to the inclusion criteria. They were then assigned into treatment and control groups. In the treatment group, reflexology protocol was performed following manual reflexology method by Fr Josef Eugster based on Ingham method on the patient’s bed. In the control group, sole touching was used as the placebo. Reflexology was performed for three days, 30 min per day. Spielberger questionnaire were provided to the samples and completed in the first and third days, and Spielberger questionnaire was provided to the samples and completed. The data obtained from this study were then analyzed by SPSS 20.Results: The two groups did not show a significant difference in terms of demographic characteristics (p>0.05). Based on the obtained results, it was found that in the test group, there was a significant difference between the mean intensity of pain before and after the treatment across all 3 days as well as the mean anxiety of the 1st and 3rd days (p<0.05). However, in the control group, there was no significant difference in terms of mean pain intensity before and after the treatment across 3 days (p>0.05). No significant difference was observed between the mean anxiety of the 1st and 3rd days either (p>0.05).Conclusion: Considering the findings of this research, it can be concluded that reflexology has a positive effect on mitigating the intensity of pain and anxiety in metastatic cancer patients. Therefore, it is recommended that nurses employed in cancer centers benefit from the findings of this research to further help patients with cancer. It is also suggested that further research be conducted on the effect of reflexology on the pain and anxiety of other patients.

D-dimers increase in acute ischemic stroke patients with the large artery occlusion, but do not depend on the time of artery recanalization

2009 ◽  
Vol 29 (4) ◽  
pp. 477-482 ◽  
Author(s):  
David Školoudík ◽  
Michal Bar ◽  
Daniel Šaňák ◽  
Petr Bardoň ◽  
Martin Roubec ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Stroke Patients

Abstract WP65: Relationship Between Neurological Severity and CBF Grade of Mr Perfusion in Acute Stroke Patients With the Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yuji Takahashi ◽  
Kazuhiro Yoshioka ◽  
Shigen Kasakura ◽  
Yuhei Tanno ◽  
Tomonori Iwata ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Mr Perfusion ◽  
Stroke Patients ◽  
Statistical Significant Difference ◽  
Time To Peak ◽  
Significant Difference ◽  
Grade Groups

Introduction: It remains unclear how strongly perfusion findings are related to neurological severity (NS) and MR-DW images (DWI). Hypothesis: CBF grade based on MR perfusion (MRp) is related to NS or DWI and can identify candidates for endovascular therapy (ET). Methods: Included in our retrospective analysis were acute ischemic stroke patients 1) who were admitted to our stroke center within 24 hours of the onset between Jan 2004 and May 2015, 2) who presented NIHSS as NS of 0 or more, 3) who underwent MRA, displaying complete occlusion of the affected carotid artery. We evaluated patients’ baseline features, NIHSS, DWI-ASPECTS (ACT) at arrival and CBF grade, which was calculated by using bilateral time-intensity curves (TICs) of MR perfusion. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we regarded the affected-sided PSa divided by TPa as possible CBFa and the contralateral-sided PSc divided by TPc as possible CBFc. CBF grade 1 was defined as CBFa divided by CBFc (CBF%) less than 0.2, grade 2 as CBF% of 0.2 or more and CBF% less than 0.7 and grade 3 as CBF% of 0.7 or more. Results: During the study period, 176 patients matched our criteria for analysis. Median NIHSS was 18, and median ACT was 6. There were 30 patients with CBF grade1, 81 with grade2 and 65 with grade3. Median NIHSS in grade1, 2, and 3 patients was 23, 19, and 7 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Median ACT in grade1, 2, and 3 was 1, 5, and 8 (p<0.0001), respectively, and there was a statistical significant difference between any grade groups (p<0.016). Among 32 patients with NIHSS of 7 or less and ACT of 8 or more, there were 28 (87.5%) in grade3. Among 10 patients with NIHSS of 23 or more and ACT of 1 or less, there were 9 (90%) in grade1. Among 40 patients with NIHSS of 8 or more and ACT of 8 or more, there was 22 (55%) in grade2 and 18 (45%) in grade3. Conclusion: CBF grade defined by MRp had strong relation to NIHSS and ACT. Patients with lower NIHSS score but higher ACT score were probable candidates for ET and many among them belonged to CBF grade2.

Sign in / Sign up

Export Citation Format

Share Document