scholarly journals Predictors and Prognosis of Symptomatic Intracranial Hemorrhage in Acute Ischemic Stroke Patients Without Thrombolysis: Analysis of Data From the Chinese Acute Ischemic Stroke Treatment Outcome Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhiyuan Shen ◽  
Haiqiang Jin ◽  
Yuxuan Lu ◽  
Wei Sun ◽  
Ran Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Nihss Score ◽  
All Cause Mortality ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage ◽  
Outcome Registry

Background and Purpose: There is limited information on symptomatic intracranial hemorrhage (sICH) in stroke patients without thrombolysis. This study aimed to evaluate the risk factors of sICH and the association between sICH and the prognosis at 3 and 12 months in acute ischemic stroke patients without thrombolysis.Methods: Data originated from the Chinese Acute Ischemic Stroke Treatment Outcome Registry. Univariate analysis and multivariate logistic regression were used to screen the risk factors of sICH. Multivariable logistic regression models were used to assess the association of sICH with poor outcome and all-cause mortality.Results: Totally, 9,484 patients were included, of which 69 (0.73%) had sICH. Atrial fibrillation (odds ratio [OR], 3.682; 95% confidence interval [CI], 1.945–6.971; p < 0.001), history of tumors (OR, 2.956; 95% CI, 1.115–7.593; p = 0.024), and the National Institutes of Health Stroke Scale (NIHSS) score on admission ([6–15: OR, 2.344; 95% CI, 1.365–4.024; p = 0.002] [>15: OR, 4.731; 95% CI, 1.648–13.583; p = 0.004]) were independently associated with sICH. After adjustment of the confounders, patients with sICH had a higher risk of poor outcome (OR, 1.983; 95% CI, 1.117–3.521; p = 0.018) at 3 months and that of all-cause mortality at 3 (OR, 6.135; 95% CI, 2.328–16.169; p < 0.001) and 12 months (OR, 3.720; 95% CI, 1.513–9.148; p = 0.004).Conclusion: sICH occurred in 0.73% of acute ischemic stroke patients without thrombolysis and was associated with a worse prognosis at 3 and 12 months. Atrial fibrillation, history of tumors, and NIHSS score at admission were independent risk factors of sICH.

scholarly journals MRI-based thrombolytic therapy in patients with acute ischemic stroke presenting with a low NIHSS

Neurology ◽  
2019 ◽  
Vol 93 (16) ◽  
pp. e1507-e1513 ◽  
Author(s):  
Shahram Majidi ◽  
Marie Luby ◽  
John K. Lynch ◽  
Amie W. Hsia ◽  
Richard T. Benson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Outcome Data ◽  
Favorable Outcome ◽  
Nihss Score ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage

ObjectiveTreatment of patients with stroke presenting with minor deficits remains controversial, and the recent Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS) trial, which randomized patients to thrombolysis vs aspirin, did not show benefit. We studied the safety and efficacy of thrombolysis in a population of patients with acute stroke presenting with low NIH Stroke Scale (NIHSS) scores screened using MRI.MethodsThe NIH Natural History of Stroke database was reviewed from January 2006 to December 2016 to identify all patients with an initial NIHSS score ≤5 who received thrombolysis within 4.5 hours of symptom onset after being screened with MRI. The 24-hour postthrombolysis MRIs were reviewed for hemorrhagic transformation. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and favorable 90-day outcome modified Rankin Scale score 0–1. Subgroup analysis was performed on patients who would have been eligible for the PRISMS trial, which enrolled patients with a nondisabling neurologic deficit.ResultsA total of 121 patients were included in the study with a median age of 65 and an NIHSS score of 3; 63% were women. The rate of any hemorrhagic transformation was 13%, with 11% of them being limited to petechial hemorrhage. The rate of sICH was <1%. Sixty-six patients had 90-day outcome data; of those, 74% had a favorable outcome. For the subgroup of 81 PRISMS-eligible patients, none experienced sICH. Fifty of these patients had 90-day outcome data; of these, 84% had a favorable outcome.ConclusionsThrombolytic therapy was safe in our patients with stroke with minor deficits who were initially evaluated by MRI. Future studies of this population may benefit from MRI selection.Classification of evidenceThis study provides Class IV evidence that for patients with acute ischemic stroke and NIHSS ≤5 screened with MRI, IV tissue plasminogen activator is safe.

Abstract WP34: Prevalence and Predictors of Endovascular Treatment-related Nephropathy in Acute Ischemic Stroke Patients: an Analysis of the Acute Stroke Due to Intracranial Atherosclerotic Occlusion and Neurointervention Korean Retrospective (ASIAN KR) Registry

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Il Sohn ◽  
Jeong-Ho Hong ◽  
Hyuk-Won Chang ◽  
Chang-Hyun Kim ◽  
Ji M Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Multivariable Analysis ◽  
Relative Increase ◽  
Poor Clinical Outcome ◽  
Absolute Increase ◽  
Nihss Score ◽  
History Of

Background and Purpose: As endovascular therapy (EVT) occupies a growing role in the management of acute ischemic stroke (AIS), contrast-induced nephropathy (CIN) associated with consecutive contrast media administration for vascular imaging and distal subtraction angiography is an emerging concern. We investigated the incidence, risk factors and clinical outcome of CIN in AIS patients who underwent EVT. Methods: Multicenter data from the ASIAN KR registry collected between January 2011 and Mar 2016, on consecutive patients who received EVT for AIS, were analyzed. Diagnostic criteria for CIN were: an absolute increase in serum creatinine (SCr) by ≥0.3 mg/dL from baseline within 48 hours after EVT; or a relative increase in SCr levels by ≥50% from baseline. Results: Of 721 patients, 616 patients (85%) were eligible for this study. CIN was diagnosed in 47 (7.6%), and was more associated with history of hypertension (p=0.011), history of diabetes mellitus (DM) (p=0.002), and higher initial NIHSS score (16.6 vs. 18.7 p=0.006). In multivariable analysis, independent risk factors of CIN were hypertension history (OR 2.465, 95% CI 1.027-5.919, p=0.043), DM history (1.978, 1.023-3.822, p=0.042), initial NIHSS score (1.071, 1.014-1.132, p=0.014), initial SCr level (1.603, 1.159-2.217, p=0.004) and duration from puncture to final angiography (1.006 per minute, 1.000-1.012, p=0.045). In multiple logistic regression, CIN was an independent risk factor of poor clinical outcome (modified Rankin Scale at 3 months 4-6; 3.782, 1.770-8.083, p=0.001) after adjusting age, sex, initial NIHSS, hypertension history, DM history, onset to puncture time and successful reperfusion. Conclusions: CIN is not uncommon and associated with poor clinical outcome after EVT in AIS. Clinicians should be aware that key factors associated with an increased likelihood of CIN are hypertension history, DM history, abnormal SCr level, higher NIHSS score and longer procedure duration.

scholarly journals Serum Ferritin Levels in Acute Ischemic Stroke Patients - A Cross Sectional Study from Thiruvananthapuram, Kerala

2021 ◽  
Vol 8 (20) ◽  
pp. 1516-1520
Author(s):  
Rupa Gopinathan ◽  
Deepa Gopalakrishna ◽  
Saboora Beegum ◽  
Thomas Iype
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Serum Ferritin ◽  
Stroke Patients ◽  
Iron Storage ◽  
Iron Stores ◽  
History Of

BACKGROUND Disturbance of brain iron homeostasis have been linked to acute neuronal injury following cerebral ischemia. Increased body iron stores measured as serum ferritin is an acute-phase reactant involved in cellular defence against oxidative stress and it constitutes the main intracellular iron storage protein. In a healthy population, iron excess may not be a major concern; however, in persons with high oxidative stress and dyslipidaemia, iron excess may place them at greater risk. Hence this study is undertaken to find out the role of iron in acute ischemic stroke and to estimate the iron stores, measured as serum ferritin in acute ischemic stroke patients. METHODS A minimum of 180 consecutive patients above 40 years in the acute phase of ischemic stroke within 72 hours of first episode admitted to the neurology department was selected for the study. Data collection was based on Interview method by detailed questionnaire and laboratory investigations. Quantitative determination of serum ferritin was done by immunoenzymatic colorimetric method using ELISA technique. Association of risk factors like age, gender, place of residence, history of hypertension, dyslipidaemia and diabetes between cases with elevated ferritin and normal values were analysed. RESULTS In the present study incidence of stroke was more common among patients with the age group of more than 50 years and among the 180 cases, 75 % showed elevated serum ferritin levels. Association of risk factors between cases with elevated ferritin and cases with normal ferritin were studied and it shown that history of hypertension, dyslipidaemia and diabetes were statistically significant. Multiple logistic regression showed history of hypertension and dyslipidaemia that were independent predictors of elevated ferritin levels among stroke patients. CONCLUSIONS Serum Ferritin was increased in acute ischemic stroke patients. There was significant association of factors like history of hypertension, dyslipidaemia and diabetes with elevated ferritin levels. KEYWORDS Stroke, Ferritin, Oxidative Stress, Free Radicals

Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Chase A Rathfoot ◽  
Camron Edressi ◽  
Carolyn B Sanders ◽  
Krista Knisely ◽  
Nicolas Poupore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Clinical Decision Making ◽  
Past Medical History ◽  
Clinical Factors ◽  
Stroke Patients ◽  
Factors Associated ◽  
History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Abstract P686: Ischemic Stroke in Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aayushi Garg ◽  
Amjad Elmashala ◽  
Santiago Ortega
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Survey Design ◽  
Inpatient Rehabilitation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Hospital Charges ◽  
Multivariable Logistic Regression Analysis ◽  
Cerebral Vasoconstriction ◽  
History Of

Introduction: Ischemic stroke is the cause for major morbidity and mortality in reversible cerebral vasoconstriction syndrome (RCVS). While there is evidence to suggest that ischemic stroke in RCVS is associated with proximal vasoconstriction, it is still unclear why some patients develop ischemic lesions. The aim of this study was to evaluate the risk factors and outcomes of ischemic stroke in RCVS. Methods: We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with the discharge diagnosis of RCVS. Occurrence of acute ischemic stroke was identified. Hospitalizations with the diagnosis of hemorrhagic stroke were excluded. Survey design methods were used to generate national estimates. Independent predictors of ischemic stroke were analyzed using multivariable logistic regression analysis with results expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: Among the total 1,065 hospitalizations for RCVS during the study period (mean±SD age: 49.0±16.7 years, female 69.7%), 267 (25.1%) had occurrence of acute ischemic stroke. Patients with ischemic stroke were more likely to have history of hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Patients with stroke were more likely to develop cerebral edema. They also had longer hospital stay, higher hospital charges, and lower likelihood of being discharged to home or inpatient rehabilitation facility. They had higher in-hospital mortality rate, the difference was however not statistically significant. Conclusion: In conclusion, ischemic stroke affects nearly 25% of patients with RCVS and is associated with an increased rate of other neurologic complications and worse functional outcomes. Patients with traditional cerebrovascular risk factors might have a higher predisposition for developing the ischemic lesions.

scholarly journals HUBUNGAN PERDARAHAN GASTROINTESTINAL DENGAN LUARAN PASIEN STROKE ISKEMIK AKUT

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Rico Defryantho ◽  
Lisda Amalia ◽  
Ahmad Rizal ◽  
Suryani Gunadharma ◽  
Siti Aminah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Risk Of Death ◽  
History Of ◽  
Gcs Score

     ASSOCIATION BETWEEN GASTROINTESTINAL BLEEDING WITH CLINICAL OUTCOME ACUTE ISCHEMIC STROKE PATIENTABSTRACTIntroduction: Gastrointestinal bleeding associated by the delay in the administration of antiplatelet and anticoagulant, thus affected the clinical outcome and patient treatment.Aims: To find the association between gastrointestinal bleeding and clinical outcome in acute ischemic stroke patient.Methods: This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung in November 2017 to February 2018. Acute ischemic stroke patients that fulfill the inclusion and exclusion criteria were observed while being treated in the ward and the survival rate and length of stay were studied. This study used univariate, bivariate, multivariate, and stratification analysis.Results: In the study period, 100 acute ischemic stroke patients were found and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found in patient with gastrointestinal bleeding (20.8%). Median NIHSS score was higher (16 vs 7) and GCS score was lower (12 vs 15) in patients with bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival and length of stay. The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7  vs  22.5 times and 1.5 vs 2 times).Discussion: Ischemic stroke with gastrointestinal bleeding had higher mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.Keyword: Acute ischemic stroke, gastrointestinal bleeding, length of stay, mortalityABSTRAKPendahuluan: Perdarahan gastrointestinal berhubungan dengan penundaan terapi antiplatelet atau antikoagulan, sehingga berpengaruh terhadap luaran dan tata laksana pasien.Tujuan: Mengetahui hubungan perdarahan gastrointestinal dengan luaran pasien stroke iskemik akut.Metode: Penelitian prospektif observasional terhadap pasien stroke iskemik akut di RSUP Dr. Hasan Sadikin, Bandung pada bulan November 2017 hingga Februari 2018. Pasien stroke iskemik akut yang memenuhi kriteria inklusi dan eksklusi diobservasi selama perawatan untuk mengetahui survival dan lama perawatan di rumah sakit. Analisis statistik yang digunakan adalah univariat, bivariat, multivariat, dan stratifikasi.Hasil: Selama periode penelitian didapatkan 100 subjek stroke iskemik akut dengan 24 subjek mengalami perdarahan gastrointestinal. Riwayat ulkus peptikum/perdarahan gastrointestinal sebelumnya sebanyak 20,8% pada perdarahan gastrointestinal. Median skor NIHSS lebih tinggi (16 vs 7) dan skor GCS lebih rendah (12 vs 15) pada perdarahan. Analisis multivariat didapatkan perdarahan gastrointestinal memiliki hubungan signifikan dengan survival dan lama perawatan. Berdasarkan analisis stratifikasi subjek dengan infeksi yang kemudian mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih rendah dibandingkan subjek tanpa infeksi kemudian mengalami perdarahan gastrointestinal (1,7 vs 22,5 kali dan 1,5 vs 2 kali).Diskusi: Stroke iskemik akut yang mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih tinggi dibandingkan tanpa perdarahan gastrointestinal.Kata kunci: Lama perawatan, mortalitas, perdarahan gastrointestinal, stroke iskemik akut

scholarly journals Hypoxia Inducible Factor 1-α in Acute Ischemic Stroke: Good Predictor for Clinical Outcome

2019 ◽  
Author(s):  
Lisda Amalia ◽  
Yeremia Tatang ◽  
Henny Anggraini Sadeli ◽  
Ida Parwati ◽  
Ahmad Rizal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Hypoxia Inducible Factor ◽  
Rank Test ◽  
Large Artery ◽  
Stroke Treatment ◽  
Nihss Score ◽  
Hypoxia Inducible Factor 1 ◽  
Angiogenesis Process

Abstract Background. Stroke is the third leading causes of death and can cause severe disability. Ischemic stroke has a higher prevalence compared to hemorrhage stroke. Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor which maintains cellular homeostasis in response to hypoxia. It can trigger apoptosis while stimulating angiogenesis process and decrease neurological deficit after an ischemic stroke. However, this protein complex has not been widely investigated. Objective. Here, we examined the potential of HIF-1α as a marker for neuroplasticity process after ischemic stroke. Methods. Serum HIF-1α were measured in acute ischemic stroke patients. National Institute of Health Stroke Scale (NIHSS) were assessed on the admission and discharge day (between days 7 and 14). To classify the ischemic stroke, we used (Trial of Org 10172 in Acute Stroke Treatment) TOAST criteria. Statistical significances were calculated with Spearman rank test. Results. A total of 58 patients, 31 with large artery atherosclerosis LVD and 27 with small vessel disease (SVD) were included in this study. HIF-1α level in LVD group was (mean ± SD) 0.5225 ± 0.2459 mg/L and in SVD group was 0.3815 ± 0.121 mg/L. HIF-1α was higher (p = 0.004) in LVD group than in SVD group. The initial NIHSS score in LVD group was (mean ± SD) 15.46 ± 2.61 and discharge NIHSS score was 13.31 ± 3.449. Initial NIHSS score in SVD group was 6.07 ± 1.82 and the discharge NIHSS was 5.703 ± 1.7055. In LVD group, HIF-1α was correlated significantly with initial NIHSS (p = 0.0000) and discharge NIHSS (p = 0.0000, r = 0.93). This was also the case for SVD. We found a significant correlation between the level of HIF-1α with initial NIHSS (p = 0.0000) and discharge NIHSS (p = 0.0383) in SVD group (r = 0.94). Conclusion. HIF-1α has a strong correlation with NIHSS and it may be used as the predictor of acute ischemic stroke outcome.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

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