A Retrospective Study on Statins and Post-stroke Patients: What About Functional Outcome and Follow-Up in a Stroke Rehabilitation Cohort?

Objective: Statins exert pleiotropic effects by influencing several mechanisms, including synaptogenesis, neurogenesis, cerebral flow regulation, and angiogenesis. Results from in vitro and animal models suggest that statins could have beneficial effect on functional recovery and outcome after stroke events. However, results in human studies are still controversial. The aim of our study was to evaluate the role of statin in influencing functional outcome and subsequent clinical follow-up in a large cohort of post-stroke rehabilitation patients.Methods: This retrospective study consecutively enrolled 413 adult patients with stroke event, admitted to the division of Neurorehabilitation of the IRCCS ICS Maugeri, Veruno (Italy), for an individual rehabilitation program between 2015 and 2017. Follow-up lasted 3–5 years after discharge. Demographic data, etiology, classification, and anatomical site of stroke lesion, functional assessment, use and duration of statin therapy, and death during hospitalization were collected at baseline and on discharge. Clinical data on subsequent follow-up were also evaluated, considering these as variables: stroke recurrence, bone fractures, cardiovascular complications, and death.Results: In our cohort, 177 patients (42.9%) were prescribed statin therapy, of whom 50 (28.2%) before the stroke event and 127 (71.8%) at the beginning of the rehabilitation process. The use and type of statin therapy as well as the duration of treatment were not associated with recovery and functional outcome, regardless of confounders including sex, age, etiology, and site of stroke lesion, and initial functional level. For what concern post-discharge clinical follow-up, the use of statin therapy was significantly associated with a lower risk of bone fractures (OR = 0.095, CI 95%: 0.012–0.743, p = 0.01) independently from age, sex, initial and final functional level, and comorbidities.Conclusions: The use of statins does not seem to influence the functional outcome in post-stroke patients. However, they could exert a protective role against bone fractures during post-discharge follow-up, suggesting further evaluation on this topic.

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Abstract W P29: Tissue Plasminogen Activator Mediated Reperfusion, and Subsequent Improvement in Resting State Connectivity Correlates with Functional Outcome in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.wp29 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Souvik Sen ◽

Johann Fridriksson ◽

Taylor Hanayik ◽

Christopher Rorden ◽

Isabel Hubbard ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Connectivity ◽

Functional Outcome ◽

Resting State ◽

Network Connectivity ◽

Stroke Patients ◽

Post Stroke ◽

Resting State Network ◽

Tissue Plasminogen

Background: Intravenous Tissue Plasminogen Activator (TPA) is the only FDA approved medical therapy for acute ischemic stroke (AIS). Prior study suggests that early recanalization is associated with better stroke outcome. Our aim was to correlate task-negative and task-positive (TN/TP) resting state network activity with tissue perfusion and functional outcome, in stroke patients who received TPA. Method: AIS patients were consented and underwent NIH stroke scale (NIHSS) assessment and magnetic resonance imaging (MRI) scans during TPA infusion (baseline) and six hours post stroke. The MRI sequences include contrast-enhanced perfusion weighted image (PWI) and resting state Blood Oxygen Level-Dependent or BOLD (RSB) images acquired using a Siemens Treo 3T MRI scanner. Additionally, the RSB scan and the NIHSS were obtained at a 30-day follow up visit. Results: Fourteen patients (mean age ± SD=63 ±14, 50% male, 50% white, 43% black and 7% others) who qualified for TPA completed the study at baseline and 6 hours post stroke. Of these, 6 patients had valid follow up data at 30 days. Three patients without cerebral ischemia were excluded. A paired samples t-test comparing baseline and 6h post stroke showed a significantly improved TP network t(10)= -4.24 p< 0.05. The resting network connectivity improved from 6 hours post stroke to 30-days follow up, t(5)= -5.35 p< 0.01. Similarly, NIHSS, at 6h post stroke t(10)= 3.62 p< 0.01 and at 30-days follow up t(5)= -3.4 p< 0.01 were significantly better than the NIHSS at baseline. The 6-hours post-stroke perfusion correlated with the resting network connectivity in both the damaged (r=-0.56 p= 0.07) and intact hemispheres (r= -0.57 p= 0.06). Differences in functional connectivity and NIHSS scores from baseline to 6 h were positively correlated (r= 0.56 p=0.07). Conclusion: In this pilot study we found that TPA led to changes in MRI based resting state networks and associated functional outcome. Correlations were found between perfusion, functional connectivity and NIHSS. This suggests that the improvement of resting state network means improved efficiency of brain activity indicated by functional outcome and may be a potential predictive MRI biomarker for TPA response. A larger study is needed to verify this finding.

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Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

Cerebrovascular Diseases Extra ◽

10.1159/000521442 ◽

2021 ◽

Author(s):

Deidre Anne de Silva ◽

Kaavya Narasimhalu ◽

Ian Wang Huang ◽

Fung Peng Woon ◽

John C. Allen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Age Group ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Post Stroke ◽

The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

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Method of virtual reality for early comprehensive rehabilitation of patients with acute stroke

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2001-04 ◽

2020 ◽

pp. 39-45

Author(s):

N. Nozdryukhina ◽

E. Kabayeva ◽

E. Kirilyuk ◽

K. Tushova ◽

A. Karimov

Keyword(s):

Virtual Reality ◽

Literature Review ◽

Acute Stroke ◽

Functional Outcome ◽

Recovery Process ◽

Stroke Patients ◽

Post Stroke ◽

Stroke Disability ◽

Comprehensive Rehabilitation ◽

High Level

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

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Abstract TP63: Lacunarization After Endovascular Treatment: a Surrogate Marker of Good Functional Outcome

Stroke ◽

10.1161/str.47.suppl_1.tp63 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Pedro Cardona ◽

Helena Quesada ◽

Blanca Lara ◽

Nuria Cayuela ◽

Xavier Ustrell ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Functional Outcome ◽

Surrogate Marker ◽

Source Image ◽

Stroke Patients ◽

Good Functional Outcome ◽

Lacunar Syndrome ◽

Contrast Ct

Introduction: Multiple randomized trials have demonstrated that endovascular treatment (EVT) in selected stroke patients is associated with good clinical outcome (90 days mRankin 0-2: 44-60%). However the percentage of good functional outcome could be improved if we consider patients without cortical clinical impairment with presentation of classical lacunar syndrome despite non-lacunar radiological infarct. Methods: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed between May 2010 and April 2015. On admission NCCT (non-contrast CT) and CTASI (CT Angiography Source Image) were performed in stroke patients according to our hospital guidelines. We independently applied the ASPECT score in all baselines NCCT, CTASI and follow-up NCCT 24H, and magnetic resonance (MR) during hospitalization. Five pure clinical lacunar syndromes (CLS) were recorded within 24h exam after EVT in our stroke unit and 90 days follow-up Results: We review 428 thrombectomies of patients with acute ischemic stroke. Ninety-five percent of occlusions were located in middle cerebral artery or terminal internal carotid, (49% women, mean age 65+/-13 years; NIHSS at admission: 17; baseline mRS 0-1:96%). Successful recanalization (TICI 2b-3) was achieved in 81%. At 3 months good functional outcome (mRS 0-2) was seen in 51% and death occurred in 13%. CLS were indentified in 42% patients within 24h after EVT. This clinical syndromes were associated to ASPECT score in 24 NCCT and CTASI in patients with recanalization 2b-3 (p:0.003), but only 4% had a defined radiological lacunar stroke on MR. CLS turned out to be one of independence predictors of good outcomes (Rankin 0-2 at 90d) after adjustment for ages, sex and baseline NIHSS scores (OR 1.85; CI:1.4-3.1; p:0.001). Also CLS were still present in 34% of patients with Rankin>2 at 90d (Rankin 3:26%; Rankin 4:7%) Conclusions: These results suggest that a neurological exam 24h after EVT with identification of pure lacunar syndrome can predict favorable functional outcome at 90days. This group of patients presents radiological findings with an unusual location and size with regard to CLS. We suggest to consider patients with CLS as good outcome after EVT regardless 90d mRankin>2.

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Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽

10.1161/str.48.suppl_1.tp308 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Janet Prvu Bettger ◽

Sara Jones ◽

Anna Kucharska-Newton ◽

Janet Freburger ◽

Walter Ambrosius ◽

...

Keyword(s):

Transitional Care ◽

Discharge Planning ◽

Care Transitions ◽

Cluster Randomized Trial ◽

Stroke Patients ◽

Care Needs ◽

Post Discharge ◽

Exact Test ◽

Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

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Abstract 105: Early But Not Too Early, High Intensity Physical Exercise Rehabilitation May be Beneficial: A Pilot Clinical Study

Stroke ◽

10.1161/str.48.suppl_1.105 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yanna Tong ◽

Jamie Y Ding ◽

Mordechai G Sadowsky ◽

Huishan Du ◽

Xiaokun Geng ◽

...

Keyword(s):

Stroke Unit ◽

Controlled Trial ◽

Early Mobilization ◽

Favorable Outcome ◽

Initiation Time ◽

Post Discharge ◽

Post Stroke ◽

Standard Medical Therapy ◽

The Difference

Introduction: Very early mobilization (VEM) is thought to be beneficial for stroke-unit care, but many key factors, such as initiation time and intensity, have not been optimized. We attempted to determine an optimal mobilization plan with well-defined initiation time and intensity in clinical practice. Methods: We conducted a randomized controlled trial with blinded assessment at follow-up. Patients with ischemic stroke, first or recurrent, admitted to the stroke unit within 24 h of stroke onset who met physiological criteria were randomly assigned (1:1:1) to 3 groups: Routine Mobilization (RM) received a lower dose of out-of-bed mobilization (<1.5h/d) 24-48 h post-stroke, Very Early and Intensive Mobilization (VEIM) received a higher dose of out-of-bed mobilization (≥3h/d) within 24 h, and Early and Intensive Mobilization (EIM) received a higher dose of out-of-bed mobilization (≥3h/d) 24-48 h post-stroke. Out-of-bed mobilization involves sitting, standing, and walking with or without assistance. The intervention period lasted 10-14 days. All the patients received standard medical therapy according to their different conditions. Patient function was evaluated with the modified Rankin Scale (mRS) score at discharge, 3 months after, and 6 months after. The primary target was a favorable outcome at follow-up, defined as an mRS score of 0-2. We used the Friedman test and the chi-squared test on a fourfold table for significance. Results: A total of 150 patients were recruited, and 120 (80%) finished the training and follow-up assessment with 30 patients dropping out (10 in RM, 12 in VEIM and 8 in EIM). Patients receiving VEIM had lower odds of a favorable outcome at both 3 and 6 months, although the difference did not reach the p = 0.05 level of significance. In the VEIM group, only 42.1% of patients had a favorable outcome 6 months after discharge, as opposed to 55.0% of RM patients and 61.9% of EIM patients. Conclusions: The higher dose mobilization protocol started within 24 h post-stroke was not associated with an increase of favorable outcomes at both 3 and 6 months post-discharge, but rather with a trend toward poorer outcomes. However, the higher dose mobilization protocol started within 48 h post-stroke may lead to a better outcome.

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Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp288 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jonathan Muller ◽

Barbara Gatton ◽

Linda Fox ◽

Joseph A Bove ◽

Johanna Donovan Turner ◽

...

Keyword(s):

Support Groups ◽

Medical Information ◽

Patient Adherence ◽

Hospital Readmissions ◽

Phone Call ◽

Stroke Patients ◽

Post Discharge ◽

Phone Calls ◽

Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

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The views of public and clinician stakeholders on risk assessment tools for post-stroke dementia: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-025586 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025586 ◽

Cited By ~ 2

Author(s):

Eugene Tang ◽

Catherine Exley ◽

Christopher Price ◽

Blossom Stephan ◽

Louise Robinson

Keyword(s):

Risk Assessment ◽

Qualitative Study ◽

Secondary Care ◽

Assessment Tools ◽

Stroke Patients ◽

Post Stroke ◽

North East ◽

Increased Risk ◽

Diagnosis Of Dementia

ObjectiveStroke-survivors are at increased risk of future dementia. Assessment to identify those at high risk of developing a disease using predictive scores has been utilised in different areas of medicine. A number of risk assessment scores for dementia have been developed but none has been recommended for use clinically. The aim of this qualitative study was to assess the acceptability and feasibility of using a risk assessment tool to predict post-stroke dementia.DesignQualitative semi-structured interviews were conducted and analysed thematically. The patients and carers were offered interviews at around 6 (baseline) and 12 (follow-up) months post-stroke; clinicians were interviewed once.SettingThe study was conducted in the North-East of England with stroke patients, family carers and healthcare professionals in primary and secondary care.ParticipantsThirty-nine interviews were conducted (17 clinicians and 15 stroke patients and their carers at baseline. Twelve stroke patients and their carers were interviewed at follow-up, some interviews were conducted in pairs).ResultsBarriers and facilitators to risk assessment were discussed. For the patients and carers the focus for facilitators were based on the outcomes of risk assessment for example assistance with preparation, diagnosis and for reassurance. For clinicians, facilitators were focused on the process that is, familiarity in primary care, resource availability in secondary care and collaborative care. For barriers, both groups focused on the outcome including for example, the anxiety generated from a potential diagnosis of dementia. For the patients/carers a further barrier included concerns about how it may affect their recovery. For clinicians there were concerns about limited interventions and how it would be different from standard care.ConclusionsRisk assessment for dementia post-stroke presents challenges given the ramifications of a potential diagnosis of dementia. Attention needs to be given to how information is communicated and strategies developed to support the patients and carers if risk assessment is used.

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Novel Predictors of Future Vascular Events in Post-stroke Patients—A Pilot Study

Frontiers in Neurology ◽

10.3389/fneur.2021.666994 ◽

2021 ◽

Vol 12 ◽

Author(s):

Diana Schrick ◽

Erzsebet Ezer ◽

Margit Tokes-Fuzesi ◽

Laszlo Szapary ◽

Tihamer Molnar

Keyword(s):

Ex Vivo ◽

Platelet Reactivity ◽

Recurrent Stroke ◽

Stroke Patients ◽

Vascular Events ◽

Post Stroke ◽

Coronary Syndrome ◽

Impedance Aggregometry ◽

Selection Of

Introduction: A modified platelet function test (mPFT) was recently found to be superior compared to impedance aggregometry for selection of post-stroke patients with high on-treatment platelet reactivity (HTPR). We aimed to explore some peripheral blood cell characteristics as predictors of recurrent ischemic episodes. The predictive value of mPFT was also assessed in a cohort followed up to 36 months regarding recurrent ischemic vascular events.Methods: As a novelty, not only whole blood (WB), but after 1-h gravity sedimentation the separated upper (UB) and lower half blood (LB) samples were analyzed including neutrophil antisedimentation rate (NAR) in 52 post-stroke patients taking clopidogrel. Area under the curve (AUC, AUCupper and AUClower, respectively) was separately measured by Multiplate in the WB, UB and LB samples to characterize ex vivo platelet aggregation in the presence of ADP. Next, the occurrence of vascular events (stroke, acute coronary syndrome, ACS) were evaluated during 36-month follow-up.Results: A total of 11 vascular events (stroke n = 5, ACS n = 6) occurred during the follow-up period. The AUCupper was significantly higher in patients with recurrent stroke compared to those with uneventful follow-up (p = 0.03). The AUCupper with a cut-off value ≥70 based on the mPFT, was able to predict all stroke events (p = 0.01), while the total vascular events were independently predicted by NAR with a sensitivity of 82% and specificity of 88%.Conclusions: A combination of NAR reflecting the inflammatory state and AUCupper indicating HTPR may provide a better prediction of recurrent ischemic events suggesting a better selection of patients at risk, thus providing an individually tailored vascular therapy.

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