scholarly journals Neutrophil Count, Intracranial Atherosclerotic Stenosis, and Prognosis of Ischemic Stroke After Endovascular Treatment: A Mediation Analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Tingting Li ◽  
Zhonglun Chen ◽  
Xuyin Zhu ◽  
Xianbiao Tang ◽  
Song Pan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Scale Score ◽  
Neutrophil Count ◽  
Mediation Analysis ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Poor Outcomes

Background and Purpose: Data on the relationship among neutrophil count, intracranial atherosclerotic stenosis (ICAS), and functional outcomes after endovascular thrombectomy (EVT) for ischemic stroke patients remains unclear. We aimed to evaluate the association between neutrophil count and prognosis of EVT patients and to determine whether the association was mediated by ICAS.Methods: We retrospectively analyzed consecutive patients who underwent EVT at two comprehensive stroke centers between June 2016 and December 2019. A remaining stenosis >70%, or a lesser degree of stenosis with a tendency toward re-occlusion or flow impairment during the procedure, was classified as ICAS. A poor outcome was defined as a 90-day modified Rankin Scale score of 3–6.Results: Of the 221 patients (mean age, 65.9 years; males, 61.1%) included in this study, 81 (36.3%) had ICAS, and 120 (54.3%) experienced a poor outcome at 90 days, respectively. In the multivariate adjustment for potential confounders, neutrophil count (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.04–1.36; P = 0.012) and presence of ICAS (OR, 2.65; 95CI%, 1.28–5.45; P = 0.008) were risk factors of poor outcomes. Furthermore, mediation analysis indicated that total ICAS mediated the association between increased neutrophil count and worse functional outcome after EVT (the regression coefficient was changed by 11.7% for poor outcome, and 17.1% for modified Rankin Scale score, respectively).Conclusions: Our study demonstrated that a higher neutrophil count might increase the risk of a poor outcome among ischemic stroke patients who underwent EVT, which was partially mediated by ICAS.

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Emily H Marino ◽  
Bridget M Ho ◽  
Sandra K Hanson
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Mortality Rates ◽  
Weekend Effect ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Code Process

Background: It has been suggested that there is a “weekend effect” resulting in higher mortality rates for stroke patients admitted on weekends. We examine this phenomenon for acute ischemic stroke (AIS) patients presenting to telestroke (TS) sites to determine its effect on stroke code process times and outcomes. Methods: From October 2015-June 2017, we reviewed consecutive AIS patients receiving IV alteplase within our TS network who then were transferred to our CSC. We compared patients presenting to TS sites on weekdays (Monday 0700 to Friday 1859) to patients presenting on weekends (Friday 1900 to Monday 0659). We analyzed door to code activation, code activation to TS evaluation, door to imaging, and door to needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. Results: We identified 89 (54 weekday, 35 weekend) patients (mean age 71.8±13.3 years, 47.2% women) during the study period. Median door to code activation (15 [5, 27] vs 8 [1, 17] mins, p=0.01) and door to needle (61 [49, 73] vs 47 [35, 59] mins, p=0.003) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door to imaging (weekend 17 [7, 30] vs weekday 11 [6, 21], p=0.1) and code activation to TS evaluation (weekend 7 [6, 10] vs weekday 5 [4, 9], p=0.14) times. The rates of favorable outcome (weekend 50% vs weekday 66.7%, p=0.18) and death (weekend 8.3% vs weekday 4.8%, p=0.56) at 90 days were not significantly different. Conclusion: While there were no significant differences in outcomes, the “weekend effect” results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered.

Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

2016 ◽  
Vol 9 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Yahia Lodi ◽  
Varun Reddy ◽  
Gorge Petro ◽  
Ashok Devasenapathy ◽  
Anas Hourani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Large Artery ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Nihss Score ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Background and purposeIn recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39–68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO.MethodsBased on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS).Results18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10–23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0–12), 1 (0–12), and 0 (0–4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%.ConclusionsOur study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

scholarly journals National Institutes of Health Stroke Scale Zero Strokes

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3057-3059
Author(s):  
Elissavet Eskioglou ◽  
Mitra Huchmandzadeh Millotte ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Significant Proportion ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Recurrence Rates ◽  
Long Term Outcome

Background and Purpose— We aimed to characterize acute ischemic stroke patients who have an immeasurable deficit on the admission National Institutes of Health Stroke Scale (NIHSS), and to evaluate their long-term outcome. Methods— We retrospectively compared all acute ischemic stroke patients with an admission NIHSS of 0 in the Acute Stroke Registry and Analysis of Lausanne from 2003 to 2013 with all other acute ischemic stroke patients. We compared demographics, clinical, radiological, and laboratory findings. Outcome was considered favorable at 3 months if the modified Rankin Scale score corrected for prestroke disability was ≤1. Stroke recurrences >12 months were also assessed. Results— Comparing 108 NIHSS zero (NIHSS=0) patients with the 2889 other strokes by multivariate analysis, NIHSS=0 had lower prestroke disability, longer onset-to-hospital delays and more lacunar and infratentorial strokes. NIHSS=0 patients were less likely to have early ischemic changes on acute computed tomography, had less arterial pathology and lower creatinine levels. They were more likely to have favorable modified Rankin Scale score after correction for prestroke modified Rankin Scale score (zero versus others: 83.2% versus 44.6%) and less likely to die (3.9% versus 13.3%) at 12 months. Stroke and transient ischemic attack recurrence rates were similar (11% versus 11.4%), however. Conclusions— Patients with NIHSS=0 strokes are characterized by lacunar and infrantentorial strokes, normal acute computed tomography, and less arterial pathology. However, a significant proportion face recurrent ischemic events and persistent handicap at 12 months. Therefore, NIHSS=0 stroke patients require aggressive secondary prevention and adequate follow-up.

scholarly journals Association of local anesthesia versus conscious sedation with functional outcome of acute ischemic stroke patients undergoing embolectomy

2020 ◽  
Vol 26 (4) ◽  
pp. 396-404
Author(s):  
Joseph T Marion ◽  
Seyed Mohammad Seyedsaadat ◽  
Jeffery J Pasternak ◽  
Alejandro A Rabinstein ◽  
David F Kallmes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Local Anesthesia ◽  
Conscious Sedation ◽  
Modified Rankin Scale ◽  
Hemodynamic Parameters ◽  
Stroke Patients

Purpose Compare functional outcomes of acute ischemic stroke patients undergoing embolectomy with either local anesthesia or conscious sedation. Secondarily, identify differences in hemodynamic parameters and complication rates between groups. Materials and methods Single institution, retrospective review of all acute ischemic stroke patients undergoing embolectomy between January 2014 and July 2018 ( n = 185). Patients receiving general anesthesia ( n = 27) were excluded. One-hundred and eleven of 158 (70.3%) composed the local anesthesia group, and 47 (29.7%) composed the conscious sedation group. Median age was 71 years (interquartile range 59–79). Seventy-eight (49.4%) were male. The median National Institute of Health stroke scale score was 17.5 (interquartile range 11–21). Hemodynamic, medication, complication, and functional outcome data were collected from the anesthesia protocol and medical records. Good functional outcome was defined as a three-month modified Rankin Scale < 2. A multivariate analysis was performed to estimate the association of anesthesia type on three-month modified Rankin Scale score. Results Three-month modified Rankin Scale score <2 was similar between groups ( p = 0.5). Patients receiving conscious sedation were on average younger than patients receiving local anesthesia ( p = 0.01). Conscious sedation patients were more likely to receive intravenous thrombolytic prior to embolectomy ( p = 0.025). The complication rate and hemodynamic parameters were similar between groups. Conclusion Functional outcome of acute ischemic stroke patients undergoing embolectomy appears to be similar for patients receiving local anesthesia and conscious sedation. This similarity may be beneficial to a future study comparing general anesthesia to local anesthesia and conscious sedation. The use of local anesthesia or conscious sedation does not significantly impact hemodynamic status.

Abstract P627: Sleep Apnea Risk is Independently Associated With Functional Outcome After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alice S Oliveira ◽  
Moises C Dantas ◽  
Pedro Antonio A Jesus ◽  
Daniel S Farias ◽  
Bruno M Almeida ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Functional Outcome ◽  
Risk Score ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Obstructive Sleep ◽  
Risk Patients ◽  
Cerebrovascular Risk ◽  
Poor Outcomes

Introduction: Obstructive sleep apnea (OSA) is highly prevalent after stroke and associated with stroke recurrence. Several clinical scales have been used to predict OSA, but their relevance for functional outcomes are unknown. Objective: We aimed to determine if a sleep apnea risk score is associated with functional outcome in stroke patients. Methods: Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale (NIHSS) to quantify stroke severity and STOP-BANG questionnaire to quantify risk of OSA on admission (0 to 8, higher scores indicating higher risk). Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Results: We recruited 382 patients with ischemic stroke between October, 2018 and November, 2019, mean age 64 +/- 13 years, 189 (49.5%) female, median NIHSS 8 (interquartile range - IQR - 6 to 14) and median STOP-BANG score 5 (IQR 4 to 5). After 90 days, 216 (56.5%) had poor outcomes. Median STOP-BANG score was higher in patients with poor, when compared to good outcomes (4 vs 3, respectively, p=0.001). In multivariable logistic regression, STOP-BANG score was independently associated with poor outcome (odds ratio 1.56, 95% confidence interval 1.02 to 2.63, p=0.003), after adjustment for age, sex, NIHSS, cerebrovascular risk factors and stroke etiology. When STOP-BANG score was stratified by OSA risk, patients with mild, moderate and high OSA risk reached poor outcomes in 38.2%, 58.7% and 62.1%, respectively (p=0.004). Conclusions: A simple sleep apnea risk score (STOP-BANG) is independently associated with poor functional outcome in ischemic stroke patients.

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