scholarly journals The impact of selected cardiovascular factors on the safety and efficacy of intravenous thrombolysis for acute ischemic stroke in routine practice in a rural hospital

2018 ◽  
Vol 34 (3) ◽  
pp. 232-240 ◽  
Author(s):  
Aleksandra Wach-Klink ◽  
Karol Paciura ◽  
Alicja Zwadowska ◽  
Małgorzata Adamczak ◽  
Wioletta Strojewska ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Rural Hospital ◽  
Routine Practice ◽  
Safety And Efficacy ◽  
The Impact

Abstract TP21: Is Presence of Diabetes Mellitus a Key Prognostic Factor among Patients Receiving Endovascular Treatment for Acute Ischemic Stroke?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong-Joon Lee ◽  
Yang-Ha Hwang ◽  
Ji Man Hong ◽  
Jin Wook Choi ◽  
Dong-Hun Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
The Impact

Introduction: Given the recent positive endovascular therapy trials for acute ischemic stroke (AIS), this therapeutic strategy is now being increasingly incorporated into routine clinical practice. Identifying prognostic factors among AIS patients receiving endovascular revascularization treatments (ERT) in the real world could be important for clinicians and patients. While the impact of diabetes mellitus (DM) on IV thrombolytic outcomes after AIS has been extensively investigated, there is a paucity of data assessing effects of DM on ERT outcomes after AIS. We evaluated the impact of comorbid DM on ERT for AIS. Methods: From Jan 2011 to Feb 2016, patients with AIS who underwent ERT for cervicocephalic occlusions were consecutively enrolled into the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective (ASIAN KR) registry from 3 hospitals. Patients were excluded if onset to puncture time over 8 hours, in-hospital stroke, or unavailable 3-month mRS. DM was diagnosed if a patient had the history, or hemoglobin A1c on admission was over 6.5. Univariate analysis was performed to compare the characteristics between DM and non-DM population. Multiple logistic regression analysis was used to validate the effect of comorbid DM on 3 month outcomes. Results: Of 721 patients, 667 (93%) were finally included, with 233 DM patients and 434 non-DM patients. In the univariate analysis, comorbidity with hypertension (71.2% vs. 58.3%, p=0.001) and dyslipidemia (36.7% vs. 26.7%, p=0.012) were more frequent in the DM population. Periprocedural factors such as target vessels, intravenous thrombolysis, and final reperfusion grades did not differ. Good outcomes with mRS 0-2 were less frequent in the DM population (43.3% vs. 53.7%, p=0.011). In the logistic regression analysis adjusting age, male sex, initial NIHSS, premorbid mRS, hypertension history, atrial fibrillation, intravenous thrombolysis, onset to puncture time and successful reperfusion, DM was an independent predictor of poor outcomes (mRS 3-6; 1.933, 1.274-2.933, p=0.002). Conclusion: In patients receiving ERT for AIS due to cervicocephalic artery occlusions, the presence of DM as a comorbidity confers greater odds of a poor functional outcome.

Management of acute ischemic stroke

BMJ ◽  
2020 ◽  
pp. l6983 ◽  
Author(s):  
Michael S Phipps ◽  
Carolyn A Cronin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Time ◽  
Recurrent Stroke ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Developed Countries ◽  
Future Research ◽  
The Impact

ABSTRACT Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.

Red Cell Distribution Width Before Intravenous Thrombolysis in Prediction of 1-year Outcome and Mortality in Patients with Acute Ischemic Stroke

2019 ◽  
Author(s):  
Weiyi Ye ◽  
Jia Li ◽  
Xiang LI ◽  
Xuezhi Yang ◽  
Yiyun Weng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Cell ◽  
Acute Ischemic Stroke ◽  
Red Blood Cell ◽  
Survival Function ◽  
Intravenous Thrombolysis ◽  
Cox Proportional Hazards ◽  
Cell Distribution ◽  
Distribution Width ◽  
The Impact

Abstract Background: It is well known that red blood cell distribution width(RDW)is a parameter reflecting the heterogeneity of red blood cell volume，which recently may be associated with the development of cardiovascular events or mortality in patients after myocardial infarction .However, little is known about the association between RDW and stroke, especially regarding indisputable endpoints such as death. The purpose of the study was to explore the prognostic value of RDW and its effect on mortality among patients with acute ischemic stroke (AIS) undergoing Intravenous thrombolysis (IVT). Methods: We carried out retrospective analysis of acute anterior ischemic strokes cases treated with IVT between January 2016 and March 2018.The effect of RDW on poor outcome (modified Rankin score 3-6) and mortality in 1 year were assessed. Use multivariate logistic regression to explore the predictors. Receiver operating characteristic (ROC) curve was used to evaluate the predictive capability of variables, furthermore, we applied Cox proportional-hazards models to analyze the impact of factors on survival. Results: RDW (Multivariate OR 1.179;95%CI 0.900-1.545,p=0.232) was not associated with clinical outcome. Surviving patients have lower baseline RDW compared with patients who later died. Adding RDW to NIHSS could improve the prediction of the mortality of stroke clinical outcomes. Conclusions: The finding of our study implied that higher RDW was a potential predictive factor of mortality in 1 year in patients with AIS undergoing IVT，but RDW might not be associated with worse survival function among stroke survivors.

scholarly journals The impact of intravenous thrombolysis on outcome of patients with acute ischemic stroke after 90 years old

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
S. Sagnier ◽  
P. Galli ◽  
M. Poli ◽  
S. Debruxelles ◽  
P. Renou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
The Impact

Abstract P30: Safety and Efficacy of Intravenous Tirofiban in Acute Ischemic Stroke With Extended Window Period

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
VIJAYA PAMIDIMUKKALA ◽  
RANJITH K ◽  
SRINIVASA RAO N ◽  
LAKSHMI PRASANNA K ◽  
SOMA SUNDARAM A ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Total Mortality ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Safety And Efficacy ◽  
Window Period ◽  
Good Outcome ◽  
Symptomatic Intracerebral Hemorrhage

Introduction: Intravenous Thrombolysis is approved upto 4½ hrs and Endovascular Therapy upto 24 hrs in eligible Acute Ischemic Stroke (AIS) patients with Large Vessel Occlusion. There are still substantial number of AIS patients where there is no effective treatment available. In this Study we aim to test the safety and Efficacy of the reversible gp IIb/IIIa receptor inhibitor antagonist Tirofiban in AIS beyond 4 ½ hrs and within 24 hrs. Methodology: Among a total of 750 AIS patients admitted in our Stroke Unit, from July 2019 to March 2020, 100 Consecutive patients were included in this study and received Intravenous tirofiban as an initial bolus followed by infusion. Inclusion criteria were Age 18-80yrs, Window Period 4 ½ to 24 hrs. National Institute of health Stroke Scale score (NIHSS) between 5-20, No contraindication for lytic drugs. CT Brain excluding Hemorrhage or > 1/3 rd infarct. Cardioembolic strokes were excluded. Efficacy Assessments: NIHSS and modified Rankin scale (mRS) performed at baseline, within 48hrs, Day-7 and Day-90. The good outcome was defined as mRS 0-1 at 3 months. The safety outcomes were assessed by the incidence of Symptomatic Intracerebral hemorrhage (SICH), Systemic Bleeding and any mortality. Results: There were 74 males, 26 females with median Age of 56 yrs (range from 18 to 80yrs). The Median NIHSS is 10 (range from 5-20), Majority (87%) had anterior circulation strokes and 13% were in Posterior circulation. One patient (1%) developed symptomatic parenchymal Hemorrhage, 4 patients (4%) had mild haemorrhagic transformation within infarct, 8 patients (8%) had nonfatal systemic bleed in the form of Hematuria. Total Mortality - 2 patients (2%), one patient died in the hospital due to cardiac arrest and another patient died at home after discharge. At 3 months, 62 patients (62%) had good outcome (mRS 0-1) and 33 patients (33%) had favourable outcome (mRS 2-3). Conclusion: In this Observational Study we found that Intravenous Tirofiban is not only safe, but effective in AIS patients with extended window period. However, Randomized Clinical Trials are needed to further clarify our observation.

scholarly journals The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

PLoS ONE ◽  
2017 ◽  
Vol 12 (10) ◽  
pp. e0185589 ◽  
Author(s):  
Florica Gadalean ◽  
Mihaela Simu ◽  
Florina Parv ◽  
Ruxandra Vorovenci ◽  
Raluca Tudor ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
The Impact

scholarly journals Sex and Hemisphere - A Neglected, Nature-Determined Relationship in Acute Ischemic Stroke

2015 ◽  
Vol 40 (1-2) ◽  
pp. 59-66 ◽  
Author(s):  
Christian Hametner ◽  
Peter Ringleb ◽  
Lars Kellert
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Specific Treatment ◽  
Intravenous Thrombolysis ◽  
Ordinal Regression ◽  
Matched Cohort ◽  
Exact Matching ◽  
Stroke Patients ◽  
Good Outcome ◽  
The Impact

Background: Sex differences in the structural connectome of the brain are clinically highly relevant, but they have mostly been neglected in stroke trials. We investigated the impact of the interaction sex-by-hemisphere on outcome in stroke patients after intravenous thrombolysis (IVT). Methods: This is an observational study based on consecutively collected supratentorial stroke patients treated with IVT (n = 1,231). The 3-month modified Rankin scale (mRS) was estimated by adjusted binary (mRS 0-2 for good outcome) and ordinal regression analysis. As baseline characteristics differ substantially between the sexes, we aimed for better covariate balance by employing coarsened exact matching. Results: Sex-by-hemisphere predicted good outcome in the entire cohort (726 left, 505 right hemispheric strokes, p valueinteraction 0.032) and in the matched cohort (338 left, 273 right, p valueinteraction 0.003). Ordinal regression suggested a comparable estimate in the matched cohort (p valueinteraction 0.006). Further investigation revealed relevant between-sex and within-sex risk: right hemispheric strokes in men were 1.54 times (95% confidence intervals (CIs) 1.15-2.01) more likely than in women to achieve mRS 0-2. Women with right hemispheric strokes were 0.72 times (95% CI 0.54-0.92) less likely to reach mRS 0-2 than women with left hemispheric strokes. Conversely, men with right hemispheric strokes were 1.35 times (95% CI 1.06-1.70) more likely to achieve mRS 0-2 than men with left hemispheric strokes. Conclusion: This study suggests that outcomes are different in both sexes after IVT when different hemispheres are affected. Further consideration of this hypothesis in clinical trials might help in guiding individualized, injury-specific treatment approaches for acute ischemic stroke.

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