scholarly journals Tick tock

2015 ◽  
Vol 84 (1) ◽  
pp. 7-9
Author(s):  
Alexander Levit ◽  
Brandon Chau
Keyword(s):  
Ischemic Stroke ◽  
Supportive Therapy ◽  
Late Presentation ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Treatment Access ◽  
Stroke Treatment ◽  
Inappropriate Treatment ◽  
Cerebrovascular Occlusion ◽  
Meta Analyses

Ischemic stroke causes morbidity and death in 55 000 Canadians each year. While acute supportive therapy is essential for stabilizing ischemic stroke patients, resolution of cerebrovascular occlusion can only be accomplished by injection of thrombolytic agents. However, older guidelines restrict thrombolysis to within the first 3 hours of symptom onset. This short window of opportunity for thrombolytic treatment is complicated by its inherent adverse reactions, making it necessary to readily identify potential stroke cases, but also to diagnose accurately to avoid inappropriate treatment. In light of statistics that identify late presentation as the most common reason for stroke patients not to receive thrombolytic treatment, and meta-analyses that now show benefits of thrombolytic treatment up to 6 hours after stroke onset, guidelines are undergoing revision to allow larger treatment windows. This, along with continuing improvements in stroke treatment access and infrastructure, will hopefully lead to better outlooks for Canadians who suffer ischemic stroke.

Outcomes of intra-arterial thrombolytic treatment in acute ischemic stroke patients with a matched defect on diffusion and perfusion MR images

2011 ◽  
Vol 4 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Gurpreet S Sandhu ◽  
Pankit T Parikh ◽  
Daniel P Hsu ◽  
Kristine A Blackham ◽  
Robert W Tarr ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Treatment ◽  
Mr Images ◽  
Stroke Patients ◽  
Perfusion Mr

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

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.

Abstract TP230: Prehospital Timeline of Mobile Stroke Treatment Unit and Traditional Ambulance

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason Mathew ◽  
Andrew Blake Buletko ◽  
Ather Taqui ◽  
Andrew Reimer ◽  
Stacey Winners ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Treatment Unit ◽  
Hospital System ◽  
Hospital Arrival ◽  
Stroke Treatment ◽  
Early Evaluation ◽  
Acute Stroke Treatment ◽  
The Times

Introduction: Prehospital evaluation and response is vital to effective and early delivery of acute stroke treatment. We aimed to compare the times across various prehospital times among stroke patients arriving by municipal EMS and MSTU. Methods: We performed a retrospective study of 107 patients with a final diagnosis of ischemic stroke within our hospital system from June 2014 to July 2015. We compared on scene arrival, hospital arrival, and time of physician assessment of patients evaluated on MSTU to traditional municipal EMS. Times are reported as medians and groups were compared by Rank-Sum Test. Results: Of 107 patients, 49 patients were evaluated by traditional EMS and 58 evaluated by MSTU. Time from dispatch to scene arrival was median 9 min (IQR 5.5 - 12min) in EMS group and median 12 min (IQR 8-16 min) n MSTU (p&lt0.01). Time on scene was 17 min (IQR 14 - 24min) in EMS group and median 42 min (IQR 36-48 min) in MSTU. There was no difference within the MSTU group in time on-scene among those treated with IV tpA (43 min) and those without (41 min, p=.08 ). After dispatch, patients arrived in hospital by EMS earlier (median 40 min, IQR 33-49min) than by MSTU (median 72 min, IQR 58-81min, p&lt.01), but patients on MSTU were evaluated by a physician at median 28 (IQR 21.5-34.5) min after dispatch. Conclusion: Early evaluation of ischemic stroke patients with MSTU, doubles the time on scene compared to municipal EMS.

Abstract TP52: Endovascular Therapy in Patients Over 80 Years of Age With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Janhavi M Modak ◽  
Syed Daniyal Asad ◽  
Jussie Lima ◽  
Amre Nouh ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Window ◽  
Extended Time ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Stroke Treatment ◽  
Group A ◽  
Group B

Introduction: Acute ischemic stroke treatment has undergone a paradigm shift, with patients being treated in the extended time window (6-24 hours post symptom onset). The purpose of this study is to assess outcomes in stroke patients above 80 years of age undergoing endovascular treatment (EVT) in the extended time window. Methods: Acute ischemic stroke patients presenting to Hartford Hospital between January 2017 to June 2019 were considered for the study. Stroke outcomes in patients above 80 years of age with anterior circulation ischemic strokes presenting in the extended time window (Group A, n=30) were compared to a younger cohort of patients below 80 years (Group B, n=31). Patients over 80 years treated in the traditional time window (within 6 hours of symptom onset) served as a second set of controls (Group C, n=40). Statistical analysis was performed with a significance level of 0.05 Results: For angiographic results, there were no statistically significant differences in terms of good outcomes (TICI 2b-3) among patients of Group A, when compared to Groups B or C (p>0.05). For the endovascular procedures, no significant differences were noted in the total fluoroscopy time (Median Group A 44.05, Group B 38.1, Group C 35.25 min), total intra-procedure time (Median Group A 144, Group B 143, Group C 126 min) or total radiation exposure (Median Group A 8308, Group B 8960, Group C 8318 uGy-m 2 ). For stroke outcomes, a good clinical outcome was defined as modified Rankin score of 0-2 at discharge. Significantly better outcomes were noted in the younger patients in Group B - 35.4%, when compared to 13.3% in Group A (p=0.03). Comparative outcomes differed in the elderly patients above 80 years, Group A -13.3% vs Group C - 25%, although not statistically significant (p=0.23). There was a significant difference in mortality in patients of Group A - 40% as compared to 12% in the younger cohort, Group B (p= 0.01). Conclusions: In the extended time window, patients above 80 years of age were noted to have a higher mortality, morbidity compared to the younger cohort of patients. No significant differences were noted in the stroke outcomes in patients above 80 years of age when comparing the traditional and the extended time window for stroke treatment.

Notch3 Mutation Detection in Stroke Patients and Selective Nanoliposome in Stroke Alleviation in a Mouse Model

2021 ◽  
Vol 17 (9) ◽  
pp. 1735-1744
Author(s):  
Yanxia Wang ◽  
Xinmeng Li ◽  
Ying Liu ◽  
Wenjing Guo ◽  
Jiangpo Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mouse Model ◽  
Control Group ◽  
Stroke Therapy ◽  
Stroke Patients ◽  
Brain Vessels ◽  
Stroke Treatment ◽  
Pathological Alteration ◽  
Notch3 Mutation ◽  
Long Term Prognosis

This study analyzed the correlation between the Notch3 mutation and stroke by testing an effective nanoparticle-loaded aspirin in stroke therapy. Fifty patients with ischemic stroke were followed for two years, and fifty healthy persons served as the control group. By RT-PCR, this study revealed that the Notch3 mutation existed in ischemic stroke patients who were more likely to have a family history, small vessel lesions, relatively frequent cerebral hemorrhage, and poor long-term prognosis. Liposome-aspirin-chitosan nanoparticle (LACN) was constructed as a nano-composite for stroke treatment. Notch3 Arg170Cys knock-in mice were prepared as a mutant Notch3 mouse model to test the LACN infiltration efficiency and observe the anti-stroke capacity. We found that LACN could better transport aspirin into brain vessels than the Polyethyleneimine (PEI) delivery system. However, in the Notch3 mutation mouse model, cerebral infarction and hemorrhage often occurred after being treated with aspirin. Still, LACN better prolongs the half-life of aspirin, rescues the pathological alteration of stroke in the brain, and reduces inflammatory reaction and oxidative stress response. In conclusion, the Notch3 mutation is closely related to stroke occurrence, and LACN may be a better choice for stroke therapy in the future.

scholarly journals Comparison of conventional and modern methods in determining ischemic stroke etiology by general and stroke neurologists

2019 ◽  
Author(s):  
REFİK KUNT ◽  
MUSTAFA KÜRŞAD KUTLUK ◽  
BEDİLE İREM TİFTİKÇİOĞLU ◽  
NAZİRE EFSER YEŞİM AFŞAR FAK ◽  
ALİ KEMAL ERDEMOĞLU ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Evidence Based ◽  
Q Value ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Subtype Assignment ◽  
Stroke Etiology ◽  
Medical Centers ◽  
Modern Methods

Background/aim: To investigate the consistency between stroke and general neurologists in subtype assignment using Trial of ORG-10172 using Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Materials and methods: Fifty consecutive, acute ischemic stroke patients admitted to Stroke Unit were recruited. Patients were classified two stroke and two general neurologists, each from different medical centers, according to TOAST followed by CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using Kappa(ĸ)-value. Results: Kappa(ĸ)-value of diagnostic compliance between stroke neurologists was 0.61 (95%CI 0.45-0.77) for TOAST and 0.78 (95%CI 0.62-0.94) for CSS-5. Kappa(ĸ)-value was 0.64 (95%CI 0.48–0.80) for TOAST and 0.75 (95%CI 0.60–0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ:0.59 (95%CI 0.52–0.65)] in TOAST and was strong [ĸ:0.75 (95%CI 0.68–0.81)] in CCS-5 for all 4 neurologists. ‘Cardioembolism’(91.04%) has reached the highest compliance in both systems. The frequency of group with ‘undetermined etiologies’ was less in CCS (26%) compared to TOAST. Conclusions: The CCS system improved the compliance in both stroke and general neurologists compared with TOAST. These suggest that automatic, evidence-based, easily reproducible CCS system was superior to TOAST system. Keywords: TOAST, CCS, Ischemic stroke, Etiology

scholarly journals Role of the Neurosurgeon in Acute Ischemic Stroke Treatment From Triage to Intensive Care Unit

Neurosurgery ◽  
2019 ◽  
Vol 85 (suppl_1) ◽  
pp. S47-S51
Author(s):  
Kimberly P Kicielinski ◽  
Christopher S Ogilvy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Setting ◽  
Stroke Treatment

Abstract As ischemic stroke care advances with more patients eligible for mechanical thrombectomy, so too does the role of the neurosurgeon in these patients. Neurosurgeons are an important member of the team from triage through the intensive care unit. This paper explores current research and insights on the contributions of neurosurgeons in care of acute ischemic stroke patients in the acute setting.

Advanced neuroimaging in acute ischemic stroke: extending the time window for treatment

2011 ◽  
Vol 30 (6) ◽  
pp. E5 ◽  
Author(s):  
E. Jesus Duffis ◽  
Zaid Al-Qudah ◽  
Charles J. Prestigiacomo ◽  
Chirag Gandhi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Time Window ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Improved Outcomes ◽  
Potential Applications ◽  
Selection Of Patients ◽  
Selection Of

Early treatment of ischemic stroke with thrombolytics is associated with improved outcomes, but few stroke patients receive thrombolytic treatment in part due to the 3-hour time window. Advances in neuroimaging may help to aid in the selection of patients who may still benefit from thrombolytic treatment beyond conventional time-based guidelines. In this article the authors review the available literature in support of using advanced neuroimaging to select patients for treatment beyond the 3-hour time window cutoff and explore potential applications and limitations of perfusion imaging in the treatment of acute ischemic stroke.

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