scholarly journals Investigation of Brain Vascular Territories in Stroke Patients Detected Non-Valve Atrial Fibrillation as an Etiological Factor

2018 ◽  
Author(s):  
Mustafa Karaoglan ◽  
Serkan Demir
Keyword(s):  
Etiological Factor ◽  
Vascular Involvement ◽  
Etiologic Factor ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Prospective Data ◽  
Exact Test ◽  
Significant Difference ◽  
The Mean ◽  
Posterior Circulation Infarct

Objective: It was aimed to investigate the cerebral vascular territories in stroke patients with NVAF as an etiologic factor. Material and Methods: A total of 104 patients who were referred to our hospital between January 2015 and September 2016, who were over 55 years of age, identified or documented as having a standard ECG or Holter ECG record on their medical history, and diagnosed with stroke were included. Our study was designed as a retrospective analysis of prospective data. Detailed history, physical examination and electrocardiography (ECG) evaluations of the patients were performed. Descriptive statistics were used in the detection of findings, and t-test, Pearson-square test and Fisher's exact test were used for differences analysis. Results: 53.8% (N = 56) of the patients were male and 46.2% (N = 48) were female. The mean age was 73.5. MCA was the most common site of vascular involvement in NVAF-dependent strokes. In MCA vascular territory, ischemic infarcts were detected most frequently in the upper and lower divisions. SCA and PCA followed MCA. Approximately 64% of the NVAF-related strokes were anterior circulation infarction (ASE) and 22% were posterior circulation infarct (PSE). There was a significant difference in age and past stroke history factors in favor of ASE (p<0.05). There was no significant difference between ASE and PSE in HT, cardiac history and DM factors (p>0.05). Conclusion: It was emphasized that the area of the vessel that underwent ischemia in the acutely displayed infarcts and the etiological factor for this vessel area could be predicted

scholarly journals Switch Strategy from Direct Aspiration First Pass Technique to Solumbra Improves Technical Outcome in Endovascularly Treated Stroke

2021 ◽  
Vol 18 (5) ◽  
pp. 2670
Author(s):  
Enrico Pampana ◽  
Sebastiano Fabiano ◽  
Gianluca De Rubeis ◽  
Luca Bertaccini ◽  
Alessandro Stasolla ◽  
...  
Keyword(s):  
Added Value ◽  
Stroke Patients ◽  
First Line ◽  
Anterior Circulation ◽  
First Pass ◽  
Procedural Time ◽  
The Mean ◽  
The Difference ◽  
Number Of Passes ◽  
Switch Strategy

Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.

Comparing the Effect of Hand and Foot Reflexology Massages on the Severity of Nausea, Vomiting and Ileus in patients after Abdominal Surgery

2021 ◽  
Vol 15 (6) ◽  
pp. 1589-1593
Author(s):  
Elham Shahraki Moghadam ◽  
Zahrasadat Manzari ◽  
Hossein Rashki Ghalenow ◽  
Hajar Noori Sanchooli
Keyword(s):  
Abdominal Surgery ◽  
Repeated Measures ◽  
Abdominal Distension ◽  
Repeated Measure ◽  
Chi Square ◽  
Exact Test ◽  
Positive Effects ◽  
Significant Difference ◽  
The Mean ◽  
Hands And Feet

Background: Common clinical problems after surgery include nausea, vomiting and ileus that many patients complain of after their surgery. These complications can delay the patient's discharge from hospital. Nowadays, to reduce drug side effects, the use of complementary medicine, including reflexology, has received a great deal of attention. Aim: To compare the effect of hand and foot reflexology massages on the severity of nausea, vomiting and ileus in patients after abdominal surgery. Methods: This is a clinical trial study that was conducted between 2013 and 2015 in the emergency surgical departments of Imam Reza (AS) and Ghaem (AS) hospitals in Mashhad. The samples of this study included 90 women with cholecystitis and appendicitis who met the inclusion criteria. In this study, patients were randomly divided into 3 groups of hand reflexology massage, foot reflexology massage and control. To check the digestive status, gastrointestinal sounds were checked every hour using a clinical stethoscope. Also, information on gas and feces elimination was collected and recorded every hour. The intervention was performed 1 and 12 hours after the surgery. In both groups of hands and foot reflexology massages, after general massage of the hands and feet, the areas related to the abdominal distension and removal of the ileus were pressed. It should be noted that, the duration of massage for each person was 10 minutes (20 minutes in total). Data were analyzed by SPSS software version 16 using Chi-square, Fisher’s exact test, two-way ANOVA, Kruskal-Wallis test and repeated measures ANOVA. Results: There was no statistically significant difference in the mean score of severity of nausea before the intervention between the three groups (p = 0.90), but after the intervention a significant difference was observed in the mean score of severity of nausea between the three groups (p=0.002). Also, the result of ANOVA test with repeated measure showed a statistically significant difference in the mean score of nausea by group and stage (p<0.001). There was also no statistically significant difference in the frequency of vomiting severity between the three groups after the intervention. However, at 4 and 24 hours after the intervention, a statistically significant difference was observed between the three groups in that regard. Conclusion: The results showed that both types of hand and foot reflexology massage has positive effects on nausea and return of gastrointestinal movements, so nurses can use reflexology as a non-pharmacological and complementary method to reduce the severity of nausea and return gastrointestinal movements in postoperative patients. Since the reflexology had little or no effect on the severity of vomiting and the acceleration of gastrointestinal movements in patients, further studies in this area are recommended. Keywords: Reflexology, Pain, Nausea and vomiting, Ileus, Surgery

Abstract TP148: The Hydration Influence on the Risk of Ischemic Stroke Outcomes (THIRST-EXPANSION STUDY)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammad Moussavi ◽  
Gustavo Rodriguez ◽  
Joseph Alario ◽  
Ravjot Sodhi ◽  
Aaron Nizam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Negative Impact ◽  
Serum Osmolality ◽  
Hydration Status ◽  
Stroke Severity ◽  
Past Study ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Significant Difference ◽  
The Mean

Introduction: Extensive studies have not been done in patients presenting with ischemic stroke regarding hydration status. It is unclear whether all of the elements of hydration status affect disability on discharge. Our past study suggests that high serum osmolality has a negative impact on ischemic stroke severity. This continuation of our prior study aims to test the effect of all laboratory elements of dehydration on severity and outcome of ischemic stroke patients. Methods: We conducted a retrospective analysis of ischemic stroke patients admitted between 2004 and 2009 at a community teaching hospital. Serum BUN/Creatinine and serum osmolality (sOsm) was calculated at initial presentation. sOSm, BUN/Cr, hematocrit and bicarbonate levels were analyzed for association with NIHSS and mRS. Patients were divided into two groups by sOsm as follows: (1) sOsm < 295, (2) sOsm ≥ 295; and two groups by BUN/Cr as follows: (3) BUN/Cr < 20, (4) BUN/Cr ≥ 20. Discharge mRS score was compared between (1) and (2); and (3) and (4) to determine the effect of sOsm and BUN/Cr on stroke outcomes. All data was analyzed using SPSS software version 20. Results: Of 1350 patients, 543 (mean age = 72.5 +/-14.2, 56% female) were included. There was a significant difference between the mean admission NIHSS in (1) 8.57, n = 222 and (2) 7.09, n = 319, p < .05 and between (3) 8.90, n = 219 and (4) 6.87, n = 322, p < .05. There was a significant difference in the mean mRS score between (1) 2.92, n = 222 and (2) 2.54, n = 317, p < .05, and (3) 2.92, n = 218 and (4) 2.56, n = 321, p < .05. The same results were found when comparing discharge sOsm values to predict patient outcome. Discharge sOsm correlated with mRS (r = .147, p < .05). Initial BUN/Cr correlated with NIHSS (r = .128, p < .05) and mRS (r = .107, p < .05) and final BUN/Cr with mRS (r = .161, p < .001). Bicarbonate levels at admission correlated with NIHSS at admission (r = -0.134), p < 0.05. Hematocrit levels at discharge correlated with mRS (r= -0.183), p <0.001. Conclusion: Our study suggests that patients with BUN/Cr and sOsm above normal levels at admission and dishcarge have worse outcome at discharge. We also found a correlation between other laboratory variables of dehydration status, namely hematocrit levels and outcome. A future prospective randomized study is warranted.

Abstract WP25: Concomitant IV tPA Does Not Increase Harm to Patients Who Receive Simultaneous Mechanical Thrombectomy and Emergent Carotid Artery Stent Treatment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hormozd Bozorgchami ◽  
Jeremy Fields ◽  
Gary Walker ◽  
Cindy Jahans ◽  
Helmi Lutsep ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Treated Group ◽  
Stroke Patients ◽  
Time To Treatment ◽  
Exact Test ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Iv Tpa

Background: Stenting of the cervical internal carotid artery (ICA) may be performed acutely in patients undergoing endovascular intervention for stroke due to occlusion of the intracranial ICA or MCA. It is unclear if pre-intervention IV tPA increases complications of carotid artery stenting (CAS) in this group. Hypothesis: We assessed the hypothesis that pre-intervention IV tPA does not increase the risk of complications in acute ischemic stroke patients (AIS) who require concurrent mechanical thrombectomy and emergent CAS. Methods: Patients undergoing both mechanical thrombectomy and CAS within 24 hours of stroke onset were identified from the Merci Registry, a prospective database of AIS patients treated with the Merci Retriever. Those receiving IV tPA were compared with those that did not for associations with functional independence (mRS 0-2) and risk of symptomatic intracerebral hemorrhage (sICH). The primary endpoint for this study was the percentage of patients with mRS 0-2 at 90 days. Secondary endpoints included 90-day mortality and sICH. Outcomes were compared with Fisher’s exact test. Results: 103 patients were included. Thirty received IV tPA (mean age 59.1, time to treatment 6.3 hrs, median NIHSS 18) and 74 did not (mean age 66.1, time to treatment 9.8 hrs, median NIHSS 16). Although numerically higher, there was no significant difference in sICH at 24 hours, occurring in 18.2% (4/22) of IV tPA patients and 7.3% (4/55) of patients without IV tPA (p=0.22) [sICH data was not available on 28 patients]. At 90 days, 40% of the IV tPA group (12/30) was functionally independent while 30.6% (22/73) was functionally independent in the non-IV tPA group (p=0.36). There was no difference in 90-day mortality between the two groups (26.7% vs. 34.7%, p=0.67). Conclusions: This study demonstrates that concomitant IV tPA use in acute stroke patients who had simultaneous mechanical thrombectomy and CAS did not significantly affect patient outcomes or increase complications. Although neither result was statistically significant, there was a trend toward improved functional outcomes at 90 days in the IV tPA treated group despite a trend toward increased rates of sICH.

scholarly journals A profile and treatment outcome of seasonal hyper-acute panuveitis

1970 ◽  
Vol 2 (1) ◽  
pp. 35-38 ◽  
Author(s):  
E Shrestha
Keyword(s):  
Visual Acuity ◽  
Medical Treatment ◽  
Visual Outcome ◽  
P Value ◽  
Fisher Exact Test ◽  
Mean Values ◽  
Exact Test ◽  
Pediatric Age Group ◽  
Significant Difference ◽  
The Mean

Introduction: Seasonal hyper-acute panuveitis (SHAPU) is a sight-threatening disease and its management is challenging. Objective: To study the profile and evaluate the visual outcome of the patients of clinicallydiagnosed cases of SHAPU after treatment. Subjects and methods: A retrospective interventional hospital-based study was carried out involving 21 subjects with clinically-diagnosed SHAPU. The data were retrieved from the record section of the hospital and analyzed. The variables studied were demographic pattern, clinical condition, duration of presentation and visual acuity before and after the treatment. Statistics: The data were analyzed using Epi Info version 2000. Percentage prevalence, mean values with standard deviation, relative risk, 95% CI and p value were calculated. P value of < 0.05 was considered to be significant. Results: Among the 21 cases, the numbers of male and female were 11 (52.4 %) and 10 (46.7 %) respectively. A comparative analysis of gender in children and adults did not show any significant difference (RR=0.47, 95% CI = 0.22 - 1.01, Fisher exact test: p = 0.14). The mean for all ages was 7 ± 12.68 years, while the mean age in pediatric cases was 4.5 ± 3.91 years. Thirteen (61.9%) cases occurred in children below fifteen years. Fifteen (71.4 %) cases reported during September and October. Presenting visual acuity of all cases was less than 3/60. All of them received medical treatment. By the end of the 4th week, seven (33.3 %) patients regained vision to 6/18. Conclusion: SHAPU is more prevalent in pediatric age group. It is equally prevalent among males and females. The visual acuity can improve with early medical treatment. Keywords: SHAPU; panuveitis; steroid; phthisis bulbi DOI: 10.3126/nepjoph.v2i1.3702 Nep J Oph 2010;2(1) 35-38

scholarly journals Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection

2018 ◽  
Vol 44 (4) ◽  
pp. E8 ◽  
Author(s):  
James K. Liu ◽  
Nicole A. Silva ◽  
Ilesha A. Sevak ◽  
Jean Anderson Eloy
Keyword(s):  
Surgical Outcomes ◽  
Tumor Volume ◽  
Vascular Involvement ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Significant Difference ◽  
Csf Leakage ◽  
The Mean

OBJECTIVEThere has been much debate regarding the optimal surgical approach for resecting olfactory groove meningiomas (OGMs). In this paper, the authors analyzed the factors involved in approach selection and reviewed the surgical outcomes in a series of OGMs.METHODSA retrospective review of 28 consecutive OGMs from a prospective database was conducted. Each tumor was treated via one of 3 approaches: transbasal approach (n = 15), pure endoscopic endonasal approach (EEA; n = 5), and combined (endoscope-assisted) transbasal-EEA (n = 8).RESULTSThe mean tumor volume was greatest in the transbasal (92.02 cm3) and combined (101.15 cm3) groups. Both groups had significant lateral dural extension over the orbits (transbasal 73.3%, p < 0.001; combined 100%), while the transbasal group had the most cerebral edema (73.3%, p < 0.001) and vascular involvement (66.7%, p < 0.001), and the least presence of a cortical cuff (33.3%, p = 0.019). All tumors in the combined group were recurrent tumors that invaded into the sinonasal cavity. The purely EEA group had the smallest mean tumor volume (33.33 cm3), all with a cortical cuff and no lateral dural extension. Gross-total resection was achieved in 80% of transbasal, 100% of EEA, and 62.5% of combined cases. Near-total resection (> 95%) was achieved in 20% of transbasal and 37.5% of combined cases, all due to tumor adherence to the critical neurovascular structures. The rate of CSF leakage was 0% in the transbasal and combined groups, and there was 1 leak in the EEA group (20%), resulting in an overall CSF leakage rate of 3.6%. Olfaction was preserved in 66.7% in the transbasal group. There was no significant difference in length of stay or 30-day readmission rate between the 3 groups. The mean modified Rankin Scale score was 0.79 after the transbasal approach, 2.0 after EEA, and 2.4 after the combined approach (p = 0.0604). The mean follow-up was 14.5 months (range 1–76 months).CONCLUSIONSThe transbasal approach provided the best clinical outcomes with the lowest rate of complications for large tumors (> 40 mm) and for smaller tumors (< 40 mm) with intact olfaction. The role of EEA appears to be limited to smaller, appropriately selected tumors in which olfaction is already absent. EEA also plays an important adjunctive role when combined with the transbasal approach for recurrent OGMs invading the sinonasal cavity. Careful patient selection using an individualized, tailored strategy is important to optimize surgical outcomes.

scholarly journals Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

2020 ◽  
Author(s):  
Soraiya Manji ◽  
Jasmit Shah ◽  
Ahmed Twahir ◽  
Ahmed Sokwala
Keyword(s):  
Weight Gain ◽  
Univariate Analysis ◽  
Sodium Concentration ◽  
University Hospital ◽  
Exact Test ◽  
Interdialytic Weight Gain ◽  
Significant Difference ◽  
Blood Pressures ◽  
The Mean ◽  
Dialysate Sodium

Abstract BackgroundChronic kidney disease is highly prevalent across the globe with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137meq/l and 140meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results41 patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137meq/l group and 2.35 for the 140meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain although further studies with a larger sample size are warranted.

Alcohol use in adolescence: 5 years admissions at a pediatric emergency department

2018 ◽  
Vol 32 (4) ◽  
Author(s):  
Marlene Rodrigues ◽  
Teresa Pontes ◽  
Juliana Almeida ◽  
Alexandra Estrada ◽  
Susana Carvalho
Keyword(s):  
Emergency Department ◽  
Alcohol Use ◽  
Pediatric Emergency ◽  
Heavy Episodic Drinking ◽  
High Rate ◽  
Easy Access ◽  
Pediatric Emergency Department ◽  
Exact Test ◽  
Significant Difference ◽  
The Mean

AbstractObjectiveTo characterize the profile and pattern of alcohol consumption in adolescents, admitted with acute alcoholic intoxication (AAI) at a pediatric emergency department of North Portugal.MethodsRetrospective descriptive study of adolescents aged between 10 and 17 years, admitted with AAI between 2012 and 2016. The following variables were evaluated: age, gender, drinking context, quantity and type of alcohol, Glasgow Coma Scale (GCS), previous episodes, associated injuries, transport to the emergency department, other drug consumption, blood alcohol level (BAL), blood glucose level, treatment and orientation. The χ2/Fisher’s exact test and t-Student test were performed (p < 0.05).ResultsA total of 180 adolescents with AAI presented. The majority of adolescents were older than 15 years old (71%) and 3% were younger than 14 years old. The mean age was 15.9 years [standard deviation (SD) 1.1 years] and 65% were males. The most common type of alcohol consumed was distilled drinks (60%). Recurrent alcohol use was identified in 7% and binge drinking was reported in 37% of patients. The mean BAL was 1.58 g/L (SD 0.6 g/L) and there were other drug consumptions (mainly cannabinoids) observed in 11% of patients. After emergency department discharge, 17% were followed at hospital consultation. There was no significant difference between boys and girls or between BAL and injuries or other drugs consumption.ConclusionThis study confirms a high rate of alcohol use among adolescents, in particular “heavy episodic drinking”, revealing an easy access to alcohol at this age. The integration of alcohol use prevention programs in community and education systems should be encouraged and implemented in every adolescent consultation.

scholarly journals Effects of Treadmill Training and Stationary Cycling Training to Improve Ambulatory Function and Cardiovascular Fitness

2021 ◽  
Vol 15 (9) ◽  
pp. 2171-2174
Author(s):  
Mian Ali Raza ◽  
Misbah Waris ◽  
Farrukh Murtaza ◽  
Sadaf Waris ◽  
Rabiya Noor ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Cardiovascular Fitness ◽  
Treadmill Training ◽  
Walk Test ◽  
Stroke Patients ◽  
Significant Difference ◽  
The Mean ◽  
Cycle Group ◽  
Cycling Training ◽  
10 Meter Walk Test

Background: Stroke is a universal health care disease, the important cause of long time disability in world. Stroke leads to an inactive living, physical restrictions, and not good physical levels, which are related with common post-stroke participation limits. Aerobic capability and walking ability are decreased in old chronic patients of stroke. Aim: To determine the effects of treadmill training and stationary cycling training to improve ambulatory function and cardiovascular fitness in hemiparetic stroke patients Methods: 54 chronic stroke patients were allocated to treadmill training group(n=27) or stationary cycle exercise group (n=27). All participants received conventional physical therapy along with treadmill or stationary cycle training. The 10MWT was conducted to measure gait function and 6 min walk test was used to measure cardiovascular health. Results: The mean of treadmill group for 10 meter walk test is 10.01 + 15.48. The mean of stationary cycle group for 10 meter walk test is 9.80 + 6.77. The mean of treadmill group for 6 min walk test is 22.04+ 17.45. The mean of stationary cycle group for 6 min walk test is 23.20+ 22.92. The p value of 0.000 shows significant difference. This significant difference reflects that both interventions show equal improvement in participants. There is significant difference between pre and post treatment values of both interventions. Both intervention groups displayed significant effect in ambulatory functions and cardiovascular fitness. The results between groups were non significant, it means both interventions showed equal effect but results with in groups were significant. Conclusion: The study showed that treadmill training and stationary cycling training equally enhanced the gait ability and cardiovascular health of chronic stroke patients. Therefore, these exercises could be used to enhance walking and cardiovascular health in management of stroke. Keywords: treadmill training, stationary cycle training, ambulatory function, cardiovascular fitness, stroke

scholarly journals Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics

2018 ◽  
Vol 24 (4) ◽  
pp. 392-397
Author(s):  
T Mehta ◽  
N Desai ◽  
K Mehta ◽  
R Parikh ◽  
S Male ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Mechanical Thrombectomy ◽  
Carotid Stenting ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Tube Placement ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Increased Risk ◽  
Significant Difference

Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.

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