IMPACT OF TRANSFER STATUS ON THE CLINICAL OUTCOMES OF ACUTE STROKE PATIENTS TREATED WITH ENDOVASCULAR THERAPY

Background: The degree of variability in the rate of early DWI expansion has not been well characterized. We hypothesized that Target Mismatch patients with slowly expanding DWI lesions have more penumbral salvage and better clinical outcomes following endovascular reperfusion than Target Mismatch patients with rapidly expanding DWI lesions. Methods: This substudy of DEFUSE 2 included all patients with a clearly established time of symptom onset. The initial DWI growth rate was determined from the baseline scan by assuming a volume 0 ml just prior to symptom onset. Target Mismatch patients who achieved reperfusion (>50% reduction in PWI after endovascular therapy), were categorized into tertiles according to their initial DWI growth rates. For each tertile, penumbral salvage (comparison of final volume to the volume of PWI (Tmax > 6 sec)/ DWI mismatch prior to endovascular therapy), favorable clinical response, and good functional outcome (see figure for definitions) were calculated. We also compared the growth rate in patients with the Target mismatch vs. Malignant Profile. Results: 64 patients were eligible for this study. Target mismatch patients (n=44) had initial growth rates (range 0 to 43 ml/hr, median of 3 ml/hr) that were significantly less than the growth rates in Malignant profile (n=7) patients (12 to 92 ml/hr, median 39 ml/hr; p < 0.001). In Target mismatch patients who achieved reperfusion (n=30), slower early DWI growth rates were associated with better clinical outcomes (p<0.05) and a trend toward more penumbral salvage (n=27, p=0.137). Conclusions: The growth rate of early DWI lesions in acute stroke patients is highly variable; Malignant profile patients have higher growth rates than other MRI profiles. Among Target Mismatch patients, a slower rate of DWI growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.

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Different Levels of Ventilation Are a Plausible Explanation for Different Outcomes of Acute Stroke Patients Undergoing Endovascular Therapy

Anesthesiology ◽

10.1097/aln.0b013e318262567a ◽

2012 ◽

Vol 117 (3) ◽

pp. 683-683

Author(s):

E. Lynne Williams

Keyword(s):

Acute Stroke ◽

Endovascular Therapy ◽

Stroke Patients ◽

Different Levels

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Abstract W P11: A Clinical Scale to Predict Futile Arterial Recanalization in Acute Stroke Patients with Anterior Circulation Arterial Occlusion Treated with Endovascular Therapies.

Stroke ◽

10.1161/str.45.suppl_1.wp11 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Natalia Perez de la Ossa ◽

Maria Hernández-Pérez ◽

Monica Millán ◽

Meritxell Gomis ◽

Elena López-Cancio ◽

...

Keyword(s):

Acute Stroke ◽

Scale Score ◽

Endovascular Therapy ◽

Univariate Analysis ◽

Arterial Occlusion ◽

Stroke Patients ◽

Anterior Circulation ◽

History Of ◽

Stent Retrievers ◽

Arterial Recanalization

Introduction: Futile arterial recanalization (FAR), considered as a lack of functional recovery despite complete recanalization, is observed in up to 30-50% of acute stroke patients treated with endovascular therapy. We aimed to develop a prognostic scale based on baseline clinical and radiological factors to predict FAR. Methods: Prospective analysis of consecutive stroke patients with anterior circulation occlusion treated with endovascular therapy (97% mechanical thrombectomy with stent-retrievers). Complete recanalization was considered as a TICI 2b-3. FAR was defined as a modified Rankin scale >2 at 90 days in patients with complete recanalization. Baseline factors associated with FAR were detected on univariate analysis and were used to compose the predictive scale. Results: From a total of 229 patients with anterior arterial occlusion, 166 (72.5%) achieved complete recanalization. FAR was observed in 80/166 (48.2%). Factors significantly associated with FAR were included to compose the predictive scale as follow: Age (scoring 0 if ≤70 and 1 if >70 years old), history of diabetes mellitus (0 if absent, 1 if present), history of hypertension (0 if absent, 1 if present), NIHSS (1 if NIHSS ≤10, 2 if NIHSS 10-19, 3 if NIHSS>19), ASPECTS (1 if ASPECTS 9-10, 2 if ASPECTS 7-8, 3 if ASPECTS<7) and i.v tPA use (0 if yes, 1 if not). The higher the scale score, the higher the risk of FAR (Figure). The scale showed a good predictive value of FAR (c-statistics 0.71). A scale score <5 was associated with a low rate of FAR (25%) whereas a score >7 increased FAR up to 86%. Conclusion: We developed a simple scale that can easily predict futile arterial recanalization (FAR) in stroke patients with large arterial occlusion treated with endovascular therapies. A larger validation study is necessary to confirm the utility of this predictive scale.

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Abstract W P48: Flair Vessel Hyper-intensities Could Predict Target Mismatch Signs in Acute Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.wp48 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Manabu Inoue ◽

Michael Mlynash ◽

Carlo W Cerada ◽

Nishant K Mishra ◽

Soren Christensen ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Clinical Outcomes ◽

Pooled Analysis ◽

Stroke Patients ◽

Good Clinical Outcome ◽

Kappa Score ◽

Early Reperfusion ◽

Diffusion Weighted Images ◽

Fluid Attenuated Inversion Recovery

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.

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Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽

10.1161/str.46.suppl_1.tp158 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Takayuki Matsuki ◽

Masatoshi Koga ◽

Shoji Arihiro ◽

Kenichi Todo ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Clinical Outcomes ◽

Reperfusion Therapy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Multicenter Observational Study ◽

Spot Urine ◽

Poor Outcome ◽

The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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Abstract TP38: Re-Occlusion During Endovascular Therapy for Acute Stroke Patients With Large Vessel Occlusion

Stroke ◽

10.1161/str.50.suppl_1.tp38 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Qing Hao ◽

Jacob Morey ◽

Xiangnan Zhang ◽

Emily Chapman ◽

Reade DeLeacy ◽

...

Keyword(s):

Acute Stroke ◽

Endovascular Therapy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion

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Clinical outcomes of acute stroke patients with atrial fibrillation

Expert Review of Cardiovascular Therapy ◽

10.1586/erc.09.11 ◽

2009 ◽

Vol 7 (4) ◽

pp. 371-374 ◽

Cited By ~ 20

Author(s):

Chee W Khoo ◽

Gregory YH Lip

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Clinical Outcomes ◽

Stroke Patients

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Logistical and financial obstacles for endovascular therapy of acute stroke implementation

International Journal of Stroke ◽

10.1177/1747493016641959 ◽

2016 ◽

Vol 11 (5) ◽

pp. 502-508 ◽

Cited By ~ 2

Author(s):

Peter D Schellinger ◽

Martin Köhrmann ◽

Raul G Nogueira

Keyword(s):

Acute Stroke ◽

Endovascular Therapy ◽

Treatment Efficacy ◽

Wide Spread ◽

Stroke Patients ◽

High Degree

After publication of the recent positive randomized clinical endovascular trials, several questions and obstacles for wide spread implementation remain. We address specific issues namely efficacy, safety, logistics, timing, sedation, numbers, imaging, manpower, centers, geographics, and economical aspects of endovascular therapy. As we move forward, a high degree of collaboration will be crucial to implement a therapy with established overwhelming treatment efficacy for severe acute stroke patients.

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Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211045876 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110458

Author(s):

Lina Palaiodimou ◽

Vasileios-Arsenios Lioutas ◽

Vaia Lambadiari ◽

Aikaterini Theodorou ◽

Marios Themistocleous ◽

...

Keyword(s):

Acute Stroke ◽

Clinical Outcomes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Standard Of Care ◽

Stroke Patients ◽

Neurological Improvement ◽

Finger Prick ◽

Before And After

Introduction: Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients. Methods: Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented. Results: A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated. Conclusions: Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

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