Association Between Early Cognitive Impairment and Midterm Functional Outcomes Among Chinese Acute Ischemic Stroke Patients: A Longitudinal Study

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome

Stroke ◽

10.1161/str.43.suppl_1.a3275 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Leonard L Yeo ◽

Liang Shen ◽

Ben Wakerley ◽

Aftab Ahmad ◽

Kay W Ng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Symptom Onset ◽

Functional Outcomes ◽

Treatment Time ◽

Favorable Outcome ◽

Stroke Patients ◽

Neurological Improvement ◽

Iv Tpa

Background: Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months. Methods: Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months. Conclusion: Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.

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Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm9051471 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1471

Author(s):

Joonsang Yoo ◽

Jeong-Ho Hong ◽

Seong-Joon Lee ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Functional Outcomes ◽

Kidney Injury ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Factors Associated

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors.

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Effect of a novel designed intensive patient care program on cognitive impairment, anxiety, depression as well as relapse free survival in acute ischemic stroke patients: a randomized controlled study

Neurological Research ◽

10.1080/01616412.2019.1628410 ◽

2019 ◽

Vol 41 (9) ◽

pp. 857-866

Author(s):

Hong-Li Yu ◽

Dong-Xue Cao ◽

Jing Liu

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Acute Ischemic Stroke ◽

Care Program ◽

Controlled Study ◽

Stroke Patients ◽

Relapse Free Survival ◽

Free Survival ◽

Randomized Controlled ◽

Anxiety Depression

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Tissue Plasminogen Activator Overdose in Acute Ischemic Stroke Patients Linked to Poorer Functional Outcomes

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.01.004 ◽

2014 ◽

Vol 23 (1) ◽

pp. 155-159 ◽

Cited By ~ 11

Author(s):

Demetrios J. Sahlas ◽

Linda Gould ◽

Richard H. Swartz ◽

Naufal Mohammed ◽

Rhonda McNicoll-Whiteman ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Functional Outcomes ◽

Stroke Patients ◽

Tissue Plasminogen

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Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2018.04.003 ◽

2018 ◽

Vol 42 (5) ◽

pp. 274-282

Author(s):

L. Viña Soria ◽

L. Martín Iglesias ◽

L. López Amor ◽

I. Astola Hidalgo ◽

R. Rodríguez García ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Stroke Patients

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Characteristics of Cognitive Status in Sub-Population of Sub-Acute Stage of Ischemic Stroke Patients in West Nusa Tenggara, Indonesia

Kesmas National Public Health Journal ◽

10.21109/kesmas.v16i3.4297 ◽

2021 ◽

Vol 16 (3) ◽

Author(s):

Herpan Syafii Harahap ◽

Muhammad Akbar ◽

Jumraini Tammasse ◽

Andi Kurnia Bintang ◽

Andi Alfian Zainuddin

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Cognitive Decline ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Cognitive Status ◽

Acute Stage ◽

P Value ◽

Stroke Patients ◽

Cross Sectional

Cognitive decline is a significant complication that affects most stroke survivors. Early detection of cognitive decline in ischemic stroke patients and identification of risk factors improves their clinical outcomes. This study aimed to determine the characteristics of cognitive status in the sub-acute phase of ischemic stroke. A cross-sectional study was conducted on 89 sub-acute ischemic stroke patients in three hospitals in West Nusa Tenggara recruited consecutively from August 2019 to April 2020. The data collected were demographic and clinical characteristics, cognitive status, and functional outcome. The association between clinical and demographic characteristics and cognitive decline was analyzed using logistic regression. In addition, the relationship between cognitive status and functional outcomes of these patients was examined using the chi-square test. This study revealed that the prevalence of cognitive decline in these subjects was 71.9%. Multiple logistic regression showed that age was the only characteristic associated with cognitive decline in the subjects (OR = 5.12,95% CI = 1.08-24.28). Furthermore, the frequency of cognitive decline in these subjects was significantly associated with functional outcomes (p-value =0.014). Thus, there was a high prevalence of cognitive decline in sub-acute ischemic stroke patients associated with increasing age and poor functional outcomes.

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EP58 Procedural and functional outcomes for aspiration thrombectomy in acute ischemic stroke patients with differing clot dwell times: A subset analysis from the COMPLETE registry

10.1136/neurintsurg-2021-esmint.57 ◽

2021 ◽

Author(s):

O Zaidat ◽

AE Hassan ◽

S Abdul Kareem ◽

JT Fifi

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Stroke Patients ◽

Aspiration Thrombectomy ◽

Subset Analysis

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Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz094 ◽

2019 ◽

Vol 21 (9) ◽

pp. 1181-1188 ◽

Cited By ~ 1

Author(s):

Peng Zhang ◽

Zhen-Ni Guo ◽

Xin Sun ◽

Yingkai Zhao ◽

Yi Yang

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Cochrane Library ◽

Stroke Patients ◽

Good Functional Outcome

Abstract Introduction The existence of the smoker’s paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT). Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies exploring the association between smoking and good functional outcome (modified Rankin Scale score ≤ 2) following IVT or EVT were searched via the databases of PubMed, Embase, and the Cochrane Library from inception to August 8, 2018. Information on the characteristics of included studies was independently extracted by two investigators. Data were pooled using a random-effects or fixed-effects meta-analysis according to the heterogeneity of included studies. Results Among 20 identified studies, 15 reported functional outcomes following IVT, and five reported functional outcomes following EVT. Unadjusted analyses showed that smoking increased the odds of good functional outcomes with a pooled odds ratio (OR) of 1.48 (95% confidence interval [CI]: 1.36–1.60) after IVT and 2.10 (95% CI: 1.47–3.20) after EVT. Of IVT studies, only eight reported outcomes adjusted for covariates and none of the EVT studies reported adjusted outcomes. After adjustment, the relation between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81–1.59]). Conclusion Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis. Implications The existence of the smoker’s paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional outcome at 3 months in acute ischemic stroke patients who received intravenous thrombolysis (IVT). However, a major limitation of their meta-analysis was that the process of data synthesis was based on unadjusted data. Therefore, we conducted this meta-analysis to investigate the association based on adjusted data and a larger sample size. Our meta-analysis suggested that smoking was not associated with good functional outcome after adjusting for covariates.

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Abstract 1122‐000104: 24‐Hours NIHSS as a Predictor of 90‐day Outcome in the STRATIS Registry

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000104 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Alicia C Castonguay ◽

Zeinab Zoghi ◽

Syed Zaidi ◽

Nils Mueller‐Kronast ◽

Osama O Zaidat ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Predictive Power ◽

Surrogate Marker ◽

Continuous Variable ◽

Systematic Evaluation ◽

Stroke Patients ◽

The Third ◽

First Choice

Introduction : Previous studies have suggested that 24‐hour NIHSS may serve as a surrogate marker for functional outcomes in acute ischemic stroke patients. Here, we examine if 24‐hour NIHSS is a predictor of 90‐day mRS in the prospective Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) Registry. Methods : Data from the STRATIS Registry, a multicenter, non‐randomized, observational study of AIS LVO patients treated with the Solitaire stent‐retriever as the first‐choice therapy within 8 hours from symptoms onset, were analyzed. Patients with premorbid mRS>2, posterior circulation stroke, missing 24 NIHSS or 90‐day mRS were excluded from the analysis. The ability of 24‐hour NIHSS (continuous and thresholds ≤6 and ≤8) to predict 90‐day mRS using logistic regression was examined. The models were adjusted for age, baseline NIHSS, hypertension, diabetes, atrial fibrillation, IV‐tPA use, time to recanalization, and revascularization status. Results : Of the 938 STRATIS patients, 662 with 24‐hour NIHSS and 90‐day mRS were included. A model trained with the continuous 24‐hours NIHSS had higher predictive power (sensitivity 0.89, specificity 0.76, AUC 0.89±0.013, P<0.001) than the models trained with thresholds ≤6 and ≤8. Conclusions : When adjusted for covariates, 24‐hour NIHSS as a continuous variable was the strongest predictor of dichotomous mRS outcomes in STRATIS patients. Twenty‐four hour NIHSS ≤6 and ≤8 present the second and the third best results, respectively.

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