Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study

2016 ◽  
Vol 12 (5) ◽  
pp. 502-509 ◽  
Author(s):  
Jessica Barlinn ◽  
Johannes Gerber ◽  
Kristian Barlinn ◽  
Lars-Peder Pallesen ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracranial Hemorrhage ◽  
Stroke Center ◽  
Favorable Functional Outcome

Background Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. Aim We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. Methods Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center. We compared baseline characteristics, onset-to-treatment times, symptomatic intracranial hemorrhage, in-hospital mortality, reperfusion (modified Treatment in Cerebral Infarction 2b/3), and favorable functional outcome (modified Rankin scale ≤ 2) at discharge between patients transferred from spoke hospitals and those directly admitted. Results We studied 151 patients who underwent emergent endovascular treatment for anterior circulation stroke: median age 70 years (interquartile range, 62–75); 55% men; median National Institutes of Health Stroke Scale score 15 (12–20). Of these, 48 (31.8%) patients were transferred after teleconsultation and 103 (68.2%) were primarily admitted to our emergency department. Transferred patients were younger (p = 0.020), received more frequently intravenous tissue plasminogen activator (p = 0.008), had prolonged time from stroke onset to endovascular treatment initiation (p < 0.0001) and tended to have lower rates of symptomatic intracranial hemorrhage (4.2% vs. 11.7%; p = 0.227) and mortality (8.3% vs. 22.6%; p = 0.041) than directly admitted patients. Similar rates of reperfusion (56.2% vs. 61.2%; p = 0.567) and favorable functional outcome (18.8% vs. 13.7%; p = 0.470) were observed in telestroke patients and those who were directly admitted. Conclusions Telestroke networks may enable delivery of endovascular treatment to selected ischemic stroke patients transferred from remote hospitals that is equitable to patients admitted directly to tertiary hospitals.

scholarly journals Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1781-1789 ◽  
Author(s):  
Robert-Jan B. Goldhoorn ◽  
Rob A. van de Graaf ◽  
Jan M. van Rees ◽  
Hester F. Lingsma ◽  
Diederik W.J. Dippel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Oral Anticoagulants ◽  
Common Odds Ratio ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose— The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC. Methods— Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors. Results— Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38–1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47–0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74–1.13]). Conclusions— Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.

Abstract WP19: Transfer Selection for Endovascular Therapy of Ischemic Stroke within A Collaborative Network: Off-site Versus On-site Neurology Service

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Simon M Winzer ◽  
Kristian Barlinn ◽  
Johannes Gerber ◽  
Timo Siepmann ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Comprehensive Stroke Center ◽  
Favorable Functional Outcome ◽  
Selection Of Patients ◽  
Selection Of

Introduction: Selection of patients for endovascular therapy (EVT) may depend on the hospital providing first line assessment. In our collaborative stroke network, we aimed to compare clinical characteristics and outcomes in ischemic stroke patients undergoing EVT who were transferred from telestroke hospitals following teleconsultation and in those transferred from hospitals providing on-site neurology service. Methods: We analyzed prospectively collected data from consecutive ischemic stroke patients who underwent emergent EVT at our comprehensive stroke center (01/2010 to 12/2014) after acute transfer from either telestroke hospitals or non-telestroke hospitals with on-site neurology service. We compared baseline characteristics, onset-to-EVT time, symptomatic intracranial hemorrhage (sICH), favorable functional outcome (mRS 0-2) at discharge and in-hospital mortality. Results: Among 133 transferred patients who underwent emergent EVT: median age 67 years (IQR, 15); 56% men; median NIHSS score 17 (21); 52% had anterior and 48% posterior circulation stroke. Sixty-five patients (49%) were transferred from telestroke and 68 (51%) from non-telestroke hospitals. Telestroke patients were less severely affected (median NIHSS scores: 15 [7] vs. 22 [20]; p=.0005) and more likely to have anterior circulation stroke (69% vs. 35%; p<.0001) compared with non-telestroke patients. No between-group differences were present with regard to demographics, vascular risk factors, intravenous tPA rate and onset-to-EVT time. In-hospital mortality was lower among telestroke compared with non-telestroke patients (11% vs. 26%; p=.026). There were no differences in sICH (5% vs. 4%; p=1.0) and favorable functional outcome (17% vs. 18%; p=1.0). Conclusions: Patients transferred from telestroke hospitals were twice as often treated for anterior circulation stroke than those from non-telestroke neurological hospitals within our stroke network. This might be explained by more conservative selection of patients potentially amenable for EVT in hospitals harboring on-site neurology service but no EVT-capability. As our data was acquired prior to evidence from the positive EVT trials, further research is warranted to elaborate these findings.

scholarly journals Comparisons of ASPECTS 5 and 6 for endovascular treatment in anterior circulation occlusive stroke

2017 ◽  
Vol 23 (5) ◽  
pp. 516-520 ◽  
Author(s):  
Wenchen Li ◽  
Shijun Li ◽  
Meifen Dai ◽  
Shang Wang ◽  
Yunyun Xiong
Keyword(s):  
Endovascular Treatment ◽  
Functional Outcome ◽  
Chinese Patients ◽  
Large Artery ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Future Studies ◽  
Good Functional Outcome ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Symptomatic Intracranial Hemorrhage

Background Whether ASPECTS 5 and ASPECTS 6 were significantly different on clinical outcomes in acute anterior circulation ischemic stroke undergoing endovascular treatment remains unclear. We aimed to retrospectively compare the effectiveness and safety of ASPECTS 5 and ASPECTS 6 in acute anterior circulation large-artery occlusive stroke patients. Methods A total of 41 patients, 14 in the ASPECTS 5 group and 27 in the ASPECTS 6 group, were enrolled between January 2014 and June 2016. Modified Rankin Scale 0–2 was considered as good functional outcome. Symptomatic intracerebral hemorrhage at 72 hours and mortality at 90 days were recorded. Results Good functional outcome at 90 days in the ASPECTS 5 group (0% (0/14)) was significantly lower than that in the ASPECTS 6 group (25.9% (7/27)) ( p = 0.04). Rates of symptomatic intracranial hemorrhage (21.4 (3/14) vs 18.5% (5/27), p = 0.83) and mortality (64.3% (9/14) vs 44.4% (12/27), p = 0.23) within 90 days were not significantly different. There is a trend for a lower rate of successful reperfusion in the ASPECTS 5 group (71.4% (10/14) for ASPECTS 5 vs 92.6% (25/27) for ASPECTS 6, p = 0.07). Conclusions ASPECTS 5 has very little chance to reach good functional outcome in Chinese patients with anterior circulation large-artery occlusive stroke. Future studies with large sample sizes are needed.

scholarly journals Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Chinese Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2690-2696 ◽  
Author(s):  
Xiaohao Zhang ◽  
Yi Xie ◽  
Huaiming Wang ◽  
Dong Yang ◽  
Teng Jiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Collateral Circulation ◽  
Risk Model ◽  
Stepwise Logistic Regression ◽  
Large Artery ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Derivation Cohort ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Symptomatic intracranial hemorrhage (sICH), potentially associated with poor prognosis, is a major complication of endovascular thrombectomy (EVT) for ischemic stroke patients. We aimed to develop and validate a risk model for predicting sICH after EVT in Chinese patients due to large-artery occlusions in the anterior circulation. Methods: The derivation cohort recruited patients with EVT from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China. sICH was diagnosed according to the Heidelberg Bleeding Classification within 24 hours of EVT. Stepwise logistic regression was performed to derive the predictive model. The discrimination and calibration of the risk model were assessed using the C index and the calibration plot. An additional cohort of 503 patients from 2 stroke centers was prospectively enrolled to validate the new model. Results: We enrolled 629 patients who underwent EVT as the derivation cohort, among whom 87 developed sICH (13.8%). In the multivariate adjustment, Alberta Stroke Program Early CT Score (odds ratio [OR], 0.85; P =0.005), baseline glucose (OR, 1.13; P =0.001), poor collateral circulation (OR, 3.06; P =0.001), passes with retriever (OR, 1.52; P =0.001), and onset-to-groin puncture time (OR, 1.79; P =0.024) were independent factors of sICH and were incorporated as the Alberta Stroke Program Early CT Score, Baseline Glucose, Poor Collateral Circulation, Passes With Retriever, and Onset-to-Groin Puncture Time (ASIAN) score. The ASIAN score demonstrated good discrimination in the derivation cohort (C index, 0.771 [95% CI, 0.716–0.826]), as well as the validation cohort (C index, 0.758 [95% CI, 0.691–0.825]). Conclusions: The ASIAN score reliably predicts the risk of sICH in Chinese ischemic stroke patients treated by EVT.

scholarly journals Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (8) ◽  
pp. 2147-2155 ◽  
Author(s):  
Rob A. van de Graaf ◽  
Vicky Chalos ◽  
Adriaan C.G.M. van Es ◽  
Bart J. Emmer ◽  
Geert J. Lycklama à Nijeholt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Common Odds Ratio ◽  
Intravenous Heparin ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose— Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety. Methods— Patients registered between March 2014 and June 2016 in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke), including all patients treated with endovascular treatment in the Netherlands, were analyzed. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. Secondary outcomes were successful recanalization (extended Thrombolysis in Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, and mortality at 90 days. We used multilevel regression analysis to evaluate the association of periprocedural intravenous heparin on outcomes, adjusted for center effects and prognostic factors. To account for possible unobserved confounding by indication, we analyzed the effect of center preference to administer intravenous heparin, defined as percentage of patients treated with intravenous heparin in a center, on functional outcome. Results— One thousand four hundred eighty-eight patients from 16 centers were analyzed, of whom 398 (27%) received intravenous heparin (median dose 5000 international units). There was substantial between-center variability in the proportion of patients treated with intravenous heparin (range, 0%–94%). There was no significant difference in functional outcome between patients treated with intravenous heparin and those without (adjusted common odds ratio, 1.17; 95% CI, 0.87–1.56), successful recanalization (adjusted odds ratio, 1.24; 95% CI, 0.89–1.71), symptomatic intracranial hemorrhage (adjusted odds ratio, 1.13; 95% CI, 0.65–1.99), or mortality (adjusted odds ratio, 0.95; 95% CI, 0.66–1.38). Analysis at center level showed that functional outcomes were better in centers with higher percentages of heparin administration (adjusted common odds ratio, 1.07 per 10% more heparin, 95% CI, 1.01–1.13). Conclusions— Substantial between-center variability exists in periprocedural intravenous heparin use during endovascular treatment, but the treatment is safe. Centers using heparin more often had better outcomes. A randomized trial is needed to further study these effects.

Abstract P471: Ipsilateral Asymmetrical Internal Cerebral Vein on Multiphasic Computed Tomography for Acute Anterior Circulation Ischemic Stroke Thrombectomy is an Independent Predictor of Poor Functional Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
May Zin Myint ◽  
Benjamin Yong Qiang Tan ◽  
Aloysius Sheng Ting Leow ◽  
Ei Zune The ◽  
Cunli Yang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Symptomatic Intracranial Hemorrhage

Background: National Institute of health stroke scale(NIHSS) and collateral circulation are well-established predictors for functional outcomes of endovascular thrombectomy (EVT) patients in acute ischemic stroke (AIS), nonetheless additional prognostic markers can improve the prediction of stroke outcomes. The inflow and drainage into the internal cerebral veins (ICV) can be seen consistently on multiphasic computed tomography angiography (mCTA). Thus, we hypothesize that asymmetry of ICV in the mCTA in large vessel occlusion AIS can be used as an adjunctive predictor of functional outcomes and complications. Method: We enrolled 185 consecutive anterior circulation AIS patients who underwent EVT that presented to our hospital between 2017 and 2019. The collateral circulation was defined by the university of Calgary mCTA collateral flow assessment in stroke. The ICV on the ipsilateral occlusion side was compared with the contralateral side according to a binary scale: 1 (less than contralateral or absent) or 2(equal or greater than contralateral). The primary outcome was modified Rankin scale at 3 months (mRS), and secondary outcomes included symptomatic intracranial hemorrhage and mortality. Result: Among 185 patients, 53% were men, the median age 70 years (range 29-91) and the median NIHSS score on arrival (NIHSS OA) was 19 (range 4-34). 82 patients (44.3%) had good functional outcomes at 3 months. Ipsilateral asymmetry in all three stages of mCTA were statistically significantly associated with good functional outcomes. The 1 st delay phase of mCTA showed the strongest association. On multivariate analysis, high NIHSS OA (OR 1.09, 95% CI 1.02-1.15, P = 0.007), good mCTA collateral score (OR 0.30, 95% CI .16- .53, P < .001), ipsilateral asymmetrical ICV on the 1 st delay phase of mCTA (OR 2.64, 95% CI 1.17-5.96, P = 0.01) were independent predictors of poor functional outcome. Ipsilateral asymmetry was not associated with mortality or symptomatic intracranial hemorrhage on multivariate analysis. Conclusion: Ipsilateral assymetrical ICV is a novel radiological marker associated with functional outcomes after thrombectomy even after correction for the collateral circulation. Further studies should be done to validate this finding in different datasets.

scholarly journals Mechanical thrombectomy of acute ischemic stroke with a new intermediate aspiration catheter: preliminary results

2018 ◽  
Vol 10 (10) ◽  
pp. 975-977 ◽  
Author(s):  
Fabrizio Sallustio ◽  
Enrico Pampana ◽  
Alessandro Davoli ◽  
Stefano Merolla ◽  
Giacomo Koch ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Stroke Patients ◽  
Frequent Site ◽  
Symptomatic Intracranial Hemorrhage ◽  
Procedural Outcomes

Background and purposeTo report clinical and procedural outcomes of acute ischemic stroke patients after endovascular treatment with the new thromboaspiration catheter AXS Catalyst 6.MethodsPatients with anterior and posterior circulation stroke were selected. Successful reperfusion defined as a Thrombolysis in Cerebral Infarction (TICI) score ≥2 b and 3-month functional independence defined as a modified Rankin Scale (mRS) ≤2 were the main efficacy outcomes. Symptomatic intracranial hemorrhage and mortality were the main safety outcomes.Results107 patients were suitable for analysis. Mean age was 73.18±12.62 year and median baseline NIHSS was 17 (range: 3–32). The most frequent site of occlusion was the middle cerebral artery (MCA) (60.7%). 76.6% of patients were treated with AXS Catalyst 6 alone without the need for rescue devices or thromboaspiration catheters. Successful reperfusion was achieved in 84.1%, functional independence in 47.6%, symptomatic intracranial hemorrhage occurred in 3.7%, and mortality in 21.4%.ConclusionsEndovascular treatment with AXS Catalyst 6 proved to be safe, technically feasible, and effective. Comparison analyses with other devices for mechanical thrombectomy are needed.

scholarly journals Prior antiplatelet therapy in patients undergoing endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry

2020 ◽  
pp. 174749302094697
Author(s):  
Rob A van de Graaf ◽  
Sanne M Zinkstok ◽  
Vicky Chalos ◽  
Robert-Jan B Goldhoorn ◽  
Charles BLM Majoie ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Symptomatic Intracranial Hemorrhage ◽  
Mr Clean

Background Antiplatelet therapy may increase the risk of symptomatic intracranial hemorrhage after endovascular treatment for ischemic stroke but may also have a beneficial effect on functional outcome. The aim of this study is to compare safety and efficacy outcomes after endovascular treatment in patients with and without prior antiplatelet therapy. Methods We analyzed patients registered in the MR CLEAN Registry between March 2014 and November 2017, for whom data on antiplatelet therapy were available. We used propensity score nearest-neighbor matching with replacement to balance the probability of receiving prior antiplatelet therapy between the prior antiplatelet therapy and no prior antiplatelet therapy group and adjusted for baseline prognostic factors to compare these groups. Primary outcome was symptomatic intracranial hemorrhage. Secondary outcomes were 90-day functional outcome (modified Rankin Scale), successful reperfusion (extended thrombolysis in cerebral infarction score ≥2B) and 90-day mortality. Results Thirty percent ( n = 937) of the 3154 patients were on prior antiplatelet therapy, who were matched to 477 patients not on prior antiplatelet therapy. Symptomatic intracranial hemorrhage occurred in 74/937 (7.9%) patients on prior antiplatelet therapy and in 27/477 (5.6%) patients without prior antiplatelet therapy adjusted odds ratio 1.47, 95% confidence interval 0.86–2.49. No associations were found between prior antiplatelet therapy and functional outcome (adjusted common odds ratio 0.87, 95% confidence interval 0.65–1.16), successful reperfusion (adjusted odds ratio 1.23, 95% confidence interval 0.77–1.97), or 90-day mortality (adjusted odds ratio 1.15, 95% confidence interval 0.86–1.54). Conclusion We found no evidence of an association of prior antiplatelet therapy with the risk of symptomatic intracranial hemorrhage after endovascular treatment, nor on functional outcome, reperfusion, or mortality. A substantial beneficial or detrimental effect of antiplatelet therapy on clinical outcome cannot be excluded. A randomized clinical trial comparing antiplatelet therapy versus no antiplatelet therapy is needed.

scholarly journals Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

2020 ◽  
Vol 49 (4) ◽  
pp. 442-450
Author(s):  
Zhiyong Fu ◽  
Chuanli Xu ◽  
Xin Liu ◽  
Zhengze Wang ◽  
Lianbo Gao
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Safety And Efficacy ◽  
Symptomatic Intracranial Hemorrhage ◽  
Favorable Functional Outcome ◽  
Review Manager

Objectives: Tirofiban is widely used in clinical practice for acute ischemic stroke (AIS). However, whether tirofiban increases the bleeding risk or improves the outcome of AIS patients with endovascular treatment (ET) is unknown. The aim of this meta-analysis is to evaluate the safety and efficacy of tirofiban compared with those without tirofiban in AIS patients receiving ET. Methods: Systematic literature search was done in PubMed and EMBASE databases without language or time limitation. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes were recanalization rate and favorable functional outcome. Review Manager 5.3 and Stata Software Package 15.0 were used to perform the meta-analysis. Results: Eleven studies with a total of 2,028 patients were included. A total of 704 (34.7%) patients were administrated tirofiban combined with ET. Meta-analysis suggested that tirofiban did not increase the risk of sICH (odds ratio (OR) 1.08; 95% confidence interval (CI) 0.81–1.46; p = 0.59) but significantly decreased mortality (OR 0.68; 95% CI 0.52–0.89; p = 0.005). There was no association between tirofiban and recanalization rate (OR 1.26; 95% CI 0.86–1.82; p = 0.23) or favorable functional outcome (OR 1.21; 95% CI 0.88–1.68; p = 0.24). Subgroup analyses indicated that preoperative tirofiban significantly increase recanalization rate (OR 3.89; 95% CI 1.70–8.93; p = 0.001) and improve favorable functional outcome (OR 2.30; 95% CI 1.15–4.60; p = 0.02). Conclusions: Tirofiban is safe in AIS patients with ET and can significantly reduce mortality; preoperative tirofiban may be effective, but further studies are needed to confirm the efficacy.

Abstract NS2: RACE to Treat Stroke: The Results

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrea M Korsnack
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Arterial Occlusion ◽  
First Responders ◽  
Stroke Patients ◽  
Intravenous Tissue Plasminogen Activator ◽  
Number Of Patients ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

Background: In June of 2015 we revised the County-Level Emergency Medical Services (EMS) protocol and algorithm to include the Rapid Arterial oCclusion Evaluation (RACE) scale in addition to the Cincinnati Prehospital Stroke Scale (CPPS) to determine if first responders could differentiate between which stroke patients could benefit from endovascular treatment using this simple algorithm. Preliminary data showed that first responders can accurately differentiate between which stroke patients could benefit from endovascular treatment but does it increase treatment rates and decrease treatment times? Purpose: To determine if first responders transporting stroke patients to the closest Interventional Stroke Center for treatment increased the number of stroke patients receiving interventional treatment and/or intravenous tissue plasminogen activator (IV tPA) and does door to needle and door to computerized axial tomography scan (CT) times decrease? Method: We analyzed the number of thrombectomies done and the number of patients receiving IV tPA from July 2014 to June 2015 (before implantation of the RACE protocol) compared to July 2015 to June 2016 (after implantation of the RACE protocol) and examined our door to needle and door to CT scan times over the same period. Results: EMS brought 56 ischemic stroke patients to our primary stroke center from July 2014 to June 2015. 10 patients received IVtPA (17.8%) and 5 underwent thrombectomies (8.9%). EMS brought 83 ischemic stroke patients to our primary stroke center from July 2015 to June 2016 using the RACE protocol. 29 patients received IVtPA (34.9%) and 18 underwent thrombectomies (21.7%). Our door to needle times for IVtPA decreased from a median of 64 minutes to 37 minutes, and door to CT times decreased from a median of 24 minutes to 13 minutes over the same time period. Conclusion: Our data suggests that if first responders transport patients using the RACE protocol, a greater percentage of stroke patients will be eligible for endovascular treatment and use of IV tPA and treatment times can also be improved. Future evaluation could measure the outcomes of these patients using the Modified Rankin Score (mRS).

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