Predictors of good outcome after intravenous tPA for acute ischemic stroke

Neurology ◽  
2001 ◽  
Vol 57 (3) ◽  
pp. 474-480 ◽  
Author(s):  
A. M. Demchuk ◽  
D. Tanne ◽  
M. D. Hill ◽  
S. E. Kasner ◽  
S. Hanson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Glucose Level ◽  
The United States ◽  
Baseline Serum ◽  
Good Outcome ◽  
History Of

Background: Thrombolytic therapy for acute ischemic stroke with IV alteplase is increasingly well established in North America but not elsewhere. Baseline factors that altered the response to alteplase were not identified by the National Institute of Neurological Disorders and Stroke tPA Stroke Study Group.Methods: The authors gathered information from centers in the United States, Canada, and Germany on 1,205 patients with acute ischemic stroke treated with IV alteplase. The purpose was to identify independent factors that were predictive of good outcome using multivariable logistic regression modelling. The modified Rankin Scale score was dichotomized into good outcome (mRS 0 to 1) and poor outcome (mRS >1) as the primary outcome measure.Results: In relative order of decreasing magnitude, milder baseline stroke severity, no history of diabetes mellitus, normal CT scan, normal pretreatment blood glucose level, and normal pretreatment blood pressure were independent predictors of good outcome among patients treated with IV alteplase for acute ischemic stroke. Confounding was observed among history of diabetes mellitus, CT scan appearance, baseline serum glucose level, and blood pressure, suggesting important relationships among these variables.Conclusions: Several factors were independently predictive of good outcome among patients with acute ischemic stroke treated with alteplase. These results require further confirmation before clinical implementation.

scholarly journals High blood pressure in acute ischemic stroke and clinical outcome

2009 ◽  
Vol 1 (1) ◽  
pp. 1 ◽  
Author(s):  
Yasuhiro Manabe ◽  
Syoichiro Kono ◽  
Tomotaka Tanaka ◽  
Hisashi Narai ◽  
Nobuhiko Omori
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
High Blood Pressure ◽  
Pressure Measurements ◽  
Pressure Group ◽  
History Of

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke.

scholarly journals KORELASI KADAR LAJU ENDAP DARAH DENGAN NILAI ASPECTS PADA PASIEN STROKE ISKEMIK

2015 ◽  
Vol 38 (1) ◽  
pp. 26
Author(s):  
Ratih Ismiranti Murni ◽  
Dwi Pudjonarko ◽  
Bambang Satoto ◽  
Sukma Imawati
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Clinical Manifestations ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Emergency Imaging ◽  
Brain Ct Scan ◽  
Relationship Of

AbstrakStroke adalah penyebab utama ke-3 kematian di Amerika Serikat. Stroke iskemik adalah kondisi kompleks dengan etiologi dan manifestasi klinis bervariasi. CT Scan kepala adalah pencitraan darurat stroke membedakan dengan perdarahan intrakranial. Beberapa peneliti mengemukakan adanya korelasi independent dan hubungan pemeriksaan rutin biomarkers pada pasien stroke iskemik akut termasuk di dalamnya parameter inflamasi yang berperan pada patofisiologi iskemia otak. Tujuan penelitian ini mengetahui korelasi kadar LED dengan penilaian ASPECTS pada pasien stroke iskemik. Penelitian ini merupakan penelitian observasional analitik belah lintang dari catatan rekam medik. Selama periode Desember 2012 - Oktober 2014. Didapatkan 16 sampel yang memenuhi kriteria inklusi dan ekslusi. Dengan beberapa karakteristik subyek penelitian meliputi usia, jenis kelamin, hipertensi, diabetes mellitus, dislipidemia, kadar LED 1 dan 2, awitan stroke iskemik akut. Uji statistik Rank Spearman’s,dan uji bivariat maupun multivariat. Didapatkan hasil tidak ada korelasi antara nilai ASPECTS dengan kadar LED dan faktor yang mempengaruhi nilai ASPECTS.AbstractStroke is the third major cause of death in United States. Ischemic stroke results from complex conditions with various etiologies and clinical manifestations. Brain CT Scan is a stroke emergency imaging to differentiate intracranial hemorrhage. Several studies claimed there were independent correlation and relationship of biomarker in routine examination of acute ischemic stroke patients including inflammation parameters that contribute to the pathophysiology of brain ischemic. The purpose in this study was to identify correlation between ESR level and ASPECTS in ischemic stroke patients. The method of study was analytical observational cross sectional taken from medical record. It was performed in 16 patients that fulfill the inclusion and exclusion criteria during December 2012- October 2014. Several characteristics of subject that affecting ASPECTS included age, gender, hypertention, diabetes mellitus, dyslipidemia, ESR level 1 and 2, and onset of acute ischemic stroke were assessed. Analytical test was performed by Rank spearman’s test and multivariate test. There was no correlation between ASPECTS with ESR level and factors that affect ASPECTS.

scholarly journals Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus

Stroke ◽  
2019 ◽  
Vol 50 (6) ◽  
pp. 1497-1503 ◽  
Author(s):  
Matthew E. Ehrlich ◽  
Li Liang ◽  
Haolin Xu ◽  
Andrzej S. Kosinski ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Type ◽  
Stroke Patients ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
History Of

Abstract WMP16: Eloquence-Weighted Imaging Improves Clinical Outcomes Prediction in Endovascular Stroke Therapy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
David S Liebeskind ◽  
Conrad W Liang ◽  
Albert J Yoo ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Left Hemisphere ◽  
Right Hemisphere ◽  
Infarct Volume ◽  
Good Outcome ◽  
Relative Contribution ◽  
C Statistic ◽  
The Right

Background: Larger infarct size at presentation as determined by ASPECTS is associated with reduced likelihood of good outcome in acute ischemic stroke. However, infarct volume alone explains only a modest fraction (∼30%) of the variation in stroke outcome. Incorporating the relative eloquence of each ASPECTS region may improve the predictive power. Methods: In the combined database of the SWIFT and STAR trials, we identified patients treated with the Solitaire stent retriever. Using the 24hr CT scan, a multivariate linear regression was used to determine the relative contribution of each ASPECTS region, separately in each hemisphere, to freedom from disability (mRS 0-2) at 90 days. The coefficients from the regression were used to create an Eloquence-weighted ASPECTS score (EL-ASPECTS), which was compared against the original in predicting outcome based on the presentation CT scan. Results: Among 254 patients treated with ET, average age was 68, 64% were female, and NIHSS was mean 16 (SD +/- 5). Mean ASPECTS at presentation was 8.2 and 6.4 at 24 hrs. The most commonly involved ASPECTS regions were the lentiform nuclei (70%), insula (55%), and caudate (52%). In multivariate analysis, for the right hemisphere on 24hr CT, preservation of M1 (OR 1.6) and M4 (OR 1.2) regions were most strongly predictive of good outcome. For the left hemisphere on 24 hr CT, preservation of M3 (OR 2.6), and M5 (OR 2.5) and involvement of M2 (OR -1.9) were most predictive. Eloquence weights were assigned to all 20 R/L ASPECTS regions to create EL-ASPECTS. EL-ASPECTS, compared with original ASPECTS, demonstrated improved discrimination for independent functional outcome for right hemisphere (C-statistic 0.78 vs. 0.69), left hemisphere (0.78 vs. 0.72), and all stroke patients (0.76 vs. 0.70). On presentation CTs, multivariate analyses including age and presentation NIHSS demonstrated EL-ASPECTS but not original ASPECTS was predictive of good clinical outcome (OR 1.65, p<.01). Higher C-statistic values were seen with EL-ASPECTS in analysis of presentation CT scans. Conclusions: Incorporation of regional weighting into ASPECTS improves the ability to predict who will achieve independent functional outcomes with endovascular therapy in acute ischemic stroke.

scholarly journals Lower Intraprocedural Systolic Blood Pressure Predicts Good Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

2015 ◽  
Vol 4 (3-4) ◽  
pp. 151-157 ◽  
Author(s):  
Seby John ◽  
Walaa Hazaa ◽  
Ken Uchino ◽  
Gabor Toth ◽  
Mark Bain ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Hemodynamic Variable ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Nihss Score ◽  
Good Outcome

Background: It is unknown if intraprocedural blood pressure (BP) influences clinical outcomes and what BP parameter best predicts outcomes in acute ischemic stroke (AIS) patients who undergo intra-arterial therapy (IAT) for emergent large vessel occlusion. Methods: We retrospectively reviewed 147 patients who underwent IAT for anterior circulation AIS from January 2008 to December 2012 at our institution. Baseline demographics, stroke treatment variables, and detailed intraprocedural hemodynamic variables were collected. Results: The entire cohort consisted of 81 (55%) females with a mean age of 66.9 ± 15.6 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 16 (IQR 11-21). Thirty-six (24.5%) patients died during hospitalization, 25 (17%) achieved a 30-day modified Rankin Scale score of 0-2, and 24 (16.3%) suffered symptomatic parenchymal hematoma type 1/2 hemorrhage. Patients who achieved a good outcome had a significantly lower admission NIHSS score, a higher baseline CT ASPECTS score, and a lower rate of ICA terminus occlusions. Successful recanalization was more frequent in the good-outcome group, while symptomatic hemorrhages occurred only in poor-outcome patients. The first systolic BP (SBP; 146.5 ± 0.2 vs. 157.7 ± 25.6 mm Hg, p = 0.042), first mean arterial pressure (MAP; 98.1 ± 20.8 vs. 109.7 ± 20.3 mm Hg, p = 0.024), maximum SBP (164.6 ± 27.6 vs. 180.9 ± 18.3 mm Hg, p = 0.0003), and maximum MAP (125.5 ± 18.6 vs. 138.5 ± 24.6 mm Hg, p = 0.0309) were all significantly lower in patients who achieved good outcomes. A lower maximum intraprocedural SBP was an independent predictor of good outcome (adjusted OR 0.929, 95% CI 0.886-0.963, p = 0.0005). Initial NIHSS score was the only other independent predictor of a good outcome. Conclusion: Lower intraprocedural SBP was associated with good outcome in patients undergoing IAT for AIS, and maximum SBP was an independent predictor of good outcome. SBP may be the optimal hemodynamic variable to monitor intraprocedurally during IAT and may predict outcome.

Timeline of blood pressure changes after intra-arterial therapy for acute ischemic stroke based on recanalization status

2016 ◽  
Vol 9 (5) ◽  
pp. 455-458 ◽  
Author(s):  
Seby John ◽  
Walaa Hazaa ◽  
Ken Uchino ◽  
Muhammad S Hussain
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Artery Occlusion ◽  
Vessel Occlusion ◽  
Short Period ◽  
Successful Group ◽  
History Of ◽  
Pressure Changes ◽  
Cerebral Artery Occlusion

BackgroundThere is sparse literature on the natural history of blood pressure (BP) after intra-arterial therapy (IAT) for acute ischemic stroke (AIS).MethodsA retrospective analysis was performed of patients with AIS who underwent IAT without endotracheal intubation for internal carotid artery terminus (ICA-T) or M1 middle cerebral artery occlusion from January 2008 to February 2012. Systolic BP (SBP) values at the beginning (First) and end (End) of IAT and for 36 h after the procedure were collected. Successful recanalization was defined as Thrombolysis In Cerebral Infarction (TICI) 2b–3.ResultsSixty-two patients (14 (22.5%) ICA-T, 46 (74.2%) M1, 2 (3.2%) ICA-T+M1) met the study criteria and 37 (59.7%) achieved successful recanalization. The First and End SBP values were similar in the successful (Group R) and unsuccessful (Group NR) recanalization groups. Taking the whole cohort, End SBP was significantly lower than First SBP, but this decline was significant only in Group R. Subsequently, absolute SBP values in Group R were not significantly different from Group NR. However, when comparing the hourly decline of SBP with First SBP, Group R demonstrated a greater fall than Group NR and the decline was significantly different from hours 8 to 12 post-procedure. The SBP in Group NR then decreased further, and its difference from baseline was similar to Group R from hour 14 onwards. Mean SBP and SBP variability over 36 h were similar between the two groups.ConclusionsSBP falls significantly in patients with AIS with large vessel occlusion who recanalize with IAT. While SBP in non-recanalized patients also drops from baseline, it occurs to a lesser degree and stays higher only for a short period of time before falling to similar levels as in recanalized patients.

Abstract 2840: Aspect Score: DWI or CT Scan, Which One Is Better Marker For Stroke Morbidity And Outcome?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Manoj Mittal ◽  
Raymond Seet ◽  
Zhang Yi ◽  
Alejandro Rabinstein
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Good Outcome ◽  
The Difference

Background and Objective The Alberta Stroke Program Early CT Score (ASPECTS) is a validated grading system to assess ischemic changes on CT in acute ischemic stroke. Magnetic resonance imaging with diffusion weighted imaging (DWI) sequence is commonly used to identify the final ischemic changes. We examined the difference between the relationship of NIHSS at admission and ASPECT score calculated using CT scan versus MRI DWI sequence. Methods We conducted a retrospective analysis of prospectively collected data from 99 cases of acute ischemic stroke treated with IV rt-PA by time criteria, admitted to Mayo Clinic from March, 2002 through June, 2011. CT head at 24 hours and MRI DWI sequence were used to assign ASPECT score. We dichotomized ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcome at 3 month (modified Rankin score less than equal to 2 and more than 2). Univariate analysis including t-test, Chi-square, and Fisher Exact test was used when appropriate. Results Mean age was 70±14 years. Mean admission NIHSS score was 8±4. DWI ASPECTS (p<0.001) and CT ASPECTS (p=0.127) were inversely associated with admission NIHSS. Higher (8-10) CT ASPECTS (p=0.001) or DWI ASPECTS (p=0.002) were associated with good outcome (mRS ≤2) at 3 months. Sensitivity, specificity, positive predictive value and negative predictive value for good outcome identified by CT ASPECTS versus DWI ASPECTS were 81% vs 52%, 54% vs 54%, 83% vs 59% and 50% vs 47% respectively. Conclusion CT and MRI DWI are comparably useful to calculate the ASPECTS for estimation of functional outcome, but CT scan at 24 hours may be more sensitive for the prediction of good recovery.

Abstract WP74: Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Taking Warfarin with Subtherapeutic INR

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Aurangzeb Memon ◽  
Navdeep Lail ◽  
Haris Kamal ◽  
Annemarie Crumlish ◽  
Marilou Ching ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Retrospective Chart Review ◽  
Case Control ◽  
Warfarin Group ◽  
Good Outcome ◽  
Significant Difference ◽  
History Of ◽  
Group 2

Introduction: AHA/ASA guidelines allow use of IV rtPA in warfarin-treated acute ischemic stroke (AIS) patients with INR ≤1.7. Concerns remain regarding safety of IV rtPA, as value of 1.7 was not determined through randomized trials, and available data is controversial. Objectives: To evaluate symptomatic intracranial hemorrhage (sICH) rate and outcome of IV rtPA treated AIS patients taking warfarin with INR ≤ 1.7, and compare with non-warfarin patients. Also, to evaluate rate of sICH and outcome in different INR ranges in warfarin-treated AIS patients who received IV rtPA. Methods: Retrospective chart review was performed on patients who received IV rtPA for AIS from the beginning of January 200 till the end of August 2015 (n=834), with 55 patients (6.5%) identified to be on Warfarin prior to AIS. One of these patients was excluded because of INR being greater than 1.7. Due to differences in sample size (54 vs 779), Warfarin group was matched in case-control manner with 54 non-warfarin patients with similar sICH risk factors (age, admission NIHSS, history of diabetes, history of atrial fibrillation), eliminating need to adjust for covariates. Good outcome was defined as mRS of 0-2 on discharge, and sICH was defined as an increase in NIHSS ≥4. Frequencies of good outcome and sICH were calculated for each group and compared. Warfarin group was also dichotomized based on INR (1-1.3 vs 1.31-1.7), and safety and outcome measures of the two groups were compared. Results: In the Warfarin group, 2 patients (3.7 %) developed sICH post IV rtPA . Fifteen patients in this group (27.8%) had good outcome on discharge. After case-control matching, no significant difference was found in the frequency of patients with good outcome on discharge or occurrence of sICH between warfarin and non-warfarin groups (P=0.270 and P=0.874 respectively). Also, there were no between group differences in frequency of patients with good outcome and rate of sICH between subjects on Warfarin with an INR 1.31-1.7 ( 0 % with sICH; 26.7% with good outcome) and those with INR < 1.3 (5.1% with sICH ; 28.2 % with good outcome) (p=0.910 and p=0. 371 respectively) Conclusion: Our results suggest that IV rtPA does not increase the risk of sICH in Warfarin treated patients with INR≤1.7.

scholarly journals Glycemic Status and In-hospital Complications in Acute Ischemic Stroke

2018 ◽  
Vol 8 (2) ◽  
pp. 44-48
Author(s):  
Md Amir Hossain ◽  
MA Hannan ◽  
Ripon Barua ◽  
Mohammed Shahadat Hossain ◽  
Sharif Uddin Ahmed ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Urinary Tract Infection ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Electrolyte Imbalance ◽  
Glycemic Status ◽  
History Of ◽  
Group A ◽  
Group B ◽  
The Impact

Although on-admission high glycemic status in acute ischemic stroke (AIS) patients is associated with poor in-hospital outcome, the impact of on-admission different glycemic status in AIS is less clear. This prognostic cohort study was aimed to evaluate the association of on-admission high glycemic status with in-hospital complications of AIS patients. This study was conducted by measurement of random blood glucose (RBG) in 90 AIS patients within 24 hours of hospitalization. The patients were divided into three groups based on their RBG in mg/dl: Group A <120, Group B 120-180 and Group C >180. The average age was 59 years and 35.6% patients were diabetic. In AIS patients, higher RBG was associated with increased in-hospital complications regardless of a history of diabetes mellitus (p=0.047, 0.040, 0.003 and 0.015 for urinary tract infection, bed sore, electrolyte imbalance and mixed complications respectively). Optimal glucose targets in hospitalized patients with AIS are currently undetermined. Glycemic and nonglycemic interventions should be studied for their impact on in-hospital complications and cost.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 44-48

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