scholarly journals Intravenous Thrombolysis for Acute Mild Ischemic Stroke Patients: Higher ABCD2 Score Associated with Better Outcome

2019 ◽  
Author(s):  
Runnan Li ◽  
Chunyan Han ◽  
Xiuying Cai ◽  
Yan Kong ◽  
Lulu Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Final Diagnosis ◽  
Risk Scores ◽  
Stroke Patients ◽  
Duration Of Symptoms ◽  
Excellent Outcome ◽  
Abcd2 Score ◽  
Ischemic Attack

Abstract Background: Up to 30% of patients with mild ischemic stroke suffer neurologic deterioration. However, optimal medical approaches of such patients remain controversial given the efficacy and safety of intravenous thrombolysis (IVT). The purpose of this study was to evaluate whether patients with acute mild stroke stratified with ABCD2 score (the risk of stroke on basis of age, blood pressure, clinical features, duration of symptoms, and presence of diabetes mellitus) could benefit from IVT. Methods: Among 3321 patients with a final diagnosis of acute ischemic stroke or transient ischemic attack, we retrospectively included 227 patients identified with acute mild neurologic deficits (National Institution of Health Stroke Scale, NIHSS ≤5) treated with or without IVT. Odds ratios (OR) with their confidence intervals (CI) for outcomes between groups were assessed by using multivariable binary logistic regression analyses. And the heterogeneity of treatment effect magnitude for excellent outcome at 90 days (modified Rankin Scale [mRS] 0-1) was estimated in different subgroups. Results: A total of 227 cases were enrolled, 108 receiving IVT and 119 treated with secondary stroke prevention strategies alone. Patients receiving IVT had more history of atrial fibrillation. At 7 days, 32 (29.6%) patients with IVT treatment versus 17 (14.3%) patients not receiving IVT achieved significant improvement (≥4-point NIHSS score decrease; OR, 2.57; 95%CI, 1.29-5.12; P=0.007). At 90 days, excellent outcome was achieved in 85 (78.7%) patients treated with IVT versus 78 (65.5%) patients without IVT treatment (OR: 2.95; 95% CI, 1.44-6.03; P=0.003), especially in those with ABCD2 score≥4 (78.4% versus 64.6%; OR, 2.81; 95%CI, 1.31-6.03; P=0.008). Besides, 7(6.5%) IVT-treated patients versus 2 (1.7%) non-IVT-treated patients developed intracranial hemorrhage (ICH; OR, 4.05; 95%CI, 0.82-19.96; P=0.085), among these only 1 (0.9%) was symptomatic ICH with IVT treatment. Conclusions: For acute mild ischemic stroke patients, we reassured the safety and especially the efficacy of IVT at 7- and 90-days. Patients with 4 or more of ABCD2 score might benefit more from IVT. Keywords: Prognosis, risk scores, stroke, intravenous thrombolysis.

scholarly journals Intravenous Thrombolysis for Acute Mild Ischemic Stroke Patients: Higher ABCD2 Score Associated with Better Outcome

2019 ◽  
Author(s):  
Runnan Li ◽  
Chunyan Han ◽  
Xiuying Cai ◽  
Yan Kong ◽  
Lulu Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Final Diagnosis ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Duration Of Symptoms ◽  
Excellent Outcome ◽  
Abcd2 Score

Abstract Background: Up to 30% of patients with mild ischemic stroke suffer neurologic deterioration. However, optimal medical approaches of such patients remain controversial given the efficacy and safety of intravenous thrombolysis (IVT). The purpose of this study was to evaluate whether patients with acute mild stroke stratified with ABCD2 score (the risk of stroke on basis of age, blood pressure, clinical features, duration of symptoms, and presence of diabetes mellitus) could benefit from IVT. Methods: Among 3321 patients with a final diagnosis of acute ischemic stroke, we retrospectively included 224 patients identified with acute mild neurologic deficits (National Institution of Health Stroke Scale, NIHSS ≤5) treated with or without IVT. Odds ratios (OR) with their confidence intervals (CI) for outcomes between groups were assessed by using multivariable binary logistic regression analyses. And the heterogeneity of treatment effect magnitude for excellent outcome at 90d (modified Rankin Scale [mRS] 0-1) was estimated in different subgroups. Results: A total of 224 cases were enrolled, 106 receiving IVT and 118 treated with secondary stroke prevention strategies alone. At 7d, 30 (28.3%) patients with IVT treatment versus 16 (13.6%) patients not receiving IVT achieved significant improvement (≥4-point NIHSS score decrease or complete resolution; OR, 2.448; 95%CI, 1.204-4.977; P=0.013). At 90d, excellent outcome was achieved in 83 (78.3%) patients treated with IVT versus 77 (65.35%) patients without IVT treatment (OR, 3.156; 95%CI, 1.526-6.528; P=0.002), especially in those with ABCD2 score ≥5 (OR, 2.768; 95%CI, 1.196-6.406; P=0.017) and with stroke subtype of large artery atherosclerosis (OR, 5.616; 95%CI, 1.080-29.210; P=0.040). Besides, 7(6.6%) IVT-treated patients versus 2 (1.7%) non-IVT-treated patients developed intracranial hemorrhage (ICH; P=0.359), among these only 1 (0.9%) was symptomatic ICH in IVT group. Conclusions: For acute mild ischemic stroke patients, we reassured the safety and especially the efficacy of IVT at 7- and 90-days. Patients with 5 or more of ABCD2 score and stroke subtype of large artery atherosclerosis might benefit more from IVT.

scholarly journals Outcome of intravenous thrombolysis for acute ischemic stroke in patients with and without atrial fibrillation

2017 ◽  
Vol 70 (7-8) ◽  
pp. 203-208
Author(s):  
Zeljko Zivanovic ◽  
Dragan Adamovic ◽  
Aleksandra Lucic-Prokin ◽  
Timea Kokai-Zekic ◽  
Jelena Sekaric ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Binary Logistic Regression ◽  
Neurological Status ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Increased Risk ◽  
Favorable Clinical Outcome

Introduction. Atrial fibrillation is associated with an increased risk of ischemic stroke. The benefit of intravenous thrombolysis in patients with acute ischemic stroke and atrial fibrillation is still unclear. The aim of the study was to assess and compare the effects of intravenous thrombolysis in stroke patients with and without atrial fibrillation. Material and Methods. We analyzed stroke patients who were treated with intravenous thrombolysis. Patients were divided into two groups according to the presence of atrial fibrillation. Demographic, clinical and radiological characteristics of patients were compared between the two groups. The treatment efficacy was evaluated in relation to the improvement of neurological status after 24 hours, and functional recovery after three months. Binary logistic regression was used to evaluate predictors of outcome. Results. From a total of 188 patients, 39.4% presented with atrial fibrillation. Patients with atrial fibrillation were older (69.4 vs. 62.6 years; p <0.0001), with female predominance (43.2% vs. 28.9%, p = 0.04) and had clinically more severe stroke (National Institutes of Health Stroke Scale, score on admission 15.4 vs. 12.1; p = 0.0001). Significantly more patients without atrial fibrillation (61.4% vs. 43.2%, p = 0.01) had a favorable clinical outcome at three months after stroke. Nevertheless, atrial fibrillation was not an independent predictor of poor outcome at three months after stroke (p=0.66). Conclusion. Acute ischemic stroke patients, with atrial fibrillation, treated with intravenous thrombolysis, had worse outcomes than patients without atrial fibrillation did. However, it is mainly due to older age and a more severe stroke in patients with atrial fibrillation.

scholarly journals External Validation of Risk Scores for Major Bleeding in a Population-Based Cohort of Transient Ischemic Attack and Ischemic Stroke Patients

Stroke ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 601-606 ◽  
Author(s):  
Nina A. Hilkens ◽  
Linxin Li ◽  
Peter M. Rothwell ◽  
Ale Algra ◽  
Jacoba P. Greving
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
External Validation ◽  
Population Based ◽  
Risk Scores ◽  
Stroke Patients ◽  
Ischemic Attack

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

scholarly journals Incorporation of α2-Plasmin Inhibitor into Fibrin Clots and Its Association with the Clinical Outcome of Acute Ischemic Stroke Patients

Biomolecules ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 347
Author(s):  
Zsuzsa Bagoly ◽  
Barbara Baráth ◽  
Rita Orbán-Kálmándi ◽  
István Szegedi ◽  
Réka Bogáti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Fibrin Clot ◽  
Clot Lysis ◽  
Stroke Patients ◽  
Plasmin Inhibitor ◽  
Fibrin Clots

Cross-linking of α2-plasmin inhibitor (α2-PI) to fibrin by activated factor XIII (FXIIIa) is essential for the inhibition of fibrinolysis. Little is known about the factors modifying α2-PI incorporation into the fibrin clot and whether the extent of incorporation has clinical consequences. Herein we calculated the extent of α2-PI incorporation by measuring α2-PI antigen levels from plasma and serum obtained after clotting the plasma by thrombin and Ca2+. The modifying effect of FXIII was studied by spiking of FXIII-A-deficient plasma with purified plasma FXIII. Fibrinogen, FXIII, α2-PI incorporation, in vitro clot-lysis, soluble fibroblast activation protein and α2-PI p.Arg6Trp polymorphism were measured from samples of 57 acute ischemic stroke patients obtained before thrombolysis and of 26 healthy controls. Increasing FXIII levels even at levels above the upper limit of normal increased α2-PI incorporation into the fibrin clot. α2-PI incorporation of controls and patients with good outcomes did not differ significantly (49.4 ± 4.6% vs. 47.4 ± 6.7%, p = 1.000), however it was significantly lower in patients suffering post-lysis intracranial hemorrhage (37.3 ± 14.0%, p = 0.004). In conclusion, increased FXIII levels resulted in elevated incorporation of α2-PI into fibrin clots. In stroke patients undergoing intravenous thrombolysis treatment, α2-PI incorporation shows an association with the outcome of therapy, particularly with thrombolysis-associated intracranial hemorrhage.

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

2021 ◽  
pp. 1-8
Author(s):  
Ki-Woong Nam ◽  
Chi Kyung Kim ◽  
Sungwook Yu ◽  
Jong-Won Chung ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Risk Scores ◽  
Stroke Patients ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Close Relationship ◽  
The Relationship

<b><i>Background:</i></b> Stroke risk scores (CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. <b><i>Objective:</i></b> The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. <b><i>Methods:</i></b> We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. <b><i>Results:</i></b> A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA<sub>2</sub>DS<sub>2</sub>-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS<sub>2</sub> scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. <b><i>Conclusions:</i></b> High CHA<sub>2</sub>DS<sub>2</sub>-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

Abstract WP78: Intracranial Calcification is Predictive for Hemorrhage Transformation and Prognosis After Intravenous Thrombolysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yao Yu ◽  
Fu-Liang Zhang ◽  
Yin-Meng Qu ◽  
Hong-Wei Zhou ◽  
Zhenni Guo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Poor Prognosis ◽  
Intravenous Thrombolysis ◽  
Major Complication ◽  
Third Party ◽  
Intracranial Calcification ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Cerebrovascular Function ◽  
Lesion Side

Introduction: Hemorrhage transformation is the major complication of intravenous thrombolysis, which can deteriorate the prognosis of ischemic stroke patients. Calcification is widely used as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhage transformation has not been fully explained. Here, we aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhage transformation, and prognosis. Methods: Acute noncardiogenic ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University from July 2015 to June 2017 were retrospectively consecutively included. All the patients included underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used for segmentation and measurement of the calcification volume. A vascular non-bone component with a CT value >130 HU was judged to be calcified. The criterion for poor prognosis was an mRS score > 2 at 3 months. Results: A total of 146 patients were included, among which 128 patients were identified to have calcification. Twenty-one patients developed hemorrhage transformation. The risk of hemorrhage transformation in the extreme group of calcification volume on the lesion side was 10.018 times that of the none to mild groups (OR=10.018, 95% CI: 1.030-97.396). Sixty-one patients had poor prognosis. The risk of poor prognosis increased by 54.7% for each additional calcified vessel (OR=1.547, 95% CI: 1.038-2.305). Conclusions: High calcification volume burden on the lesion side is associated with hemorrhage transformation after intravenous thrombolysis. The higher the number of calcified vessels, the greater is the risk of poor prognosis.

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