scholarly journals Relationship between the national institutes health stroke scale score and bispectral index in patients with acute ischemic stroke

2021 ◽  
Vol 38 (4) ◽  
pp. 440-444
Author(s):  
Serdar ÖZDEMİR ◽  
Tuba CİMİLLİ ÖZTÜRK ◽  
Özge ECMEL ONUR
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bispectral Index ◽  
Sedative Drug ◽  
Nihss Score ◽  
Scale Scores ◽  
History Of ◽  
Clinically Significant ◽  
Gcs Score ◽  
The Relationship

This study aimed to investigate the relationship between the bispectral index and the National Institutes of Health Stroke Scale (NIHSS) score in patients admitted to the emergency department with a first-time acute ischemic stroke. Methods: This prospective, observational study was conducted with patients admitted to our clinic with acute ischemic stroke symptoms. Patients with known cranial pathologies, such as space- occupying lesions, those with a history of clinically significant cerebrovascular events or sedative drug administration, and those with altered consciousness due to metabolic causes were excluded from the study. The National Institutes Health Stroke Scale scores were recorded by the clinician. Cerebral arterial territories were assessed on DWI and CT. The relationship between the NIHSS score and bispectral index was evaluated. Results: Forty-three patients were included in the study. The mean bispectral index of the cases was 84.23 ± 9.50. There was no significant correlation between the bispectral index values and the NIHSS score (p<0.05). Conclusion: In our study, the bispectral index values were decreased due to ischemic stroke. The results should be reevaluated studies conducted with larger series to reveal the relationship between infarcted territories, NIHSS score, bispectral index, and the GCS score.

Abstract TP201: The Relationship Between Chronic Kidney Diseases and the Presence of Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kana Ueki ◽  
Asako Nakamura ◽  
Masahiro Yasaka ◽  
Takahiro Kuwashiro ◽  
Seiji Gotoh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
White Matter Lesion ◽  
Kidney Diseases ◽  
Univariate Analysis ◽  
Small Vessel ◽  
Chronic Kidney Diseases ◽  
History Of ◽  
The Relationship

Introduction: Cerebral small vessel diseases (SVDs) i.e. white matter lesion and cerebral microbleeds (CMBs) are related to the patients with stroke more deeply than those without. In general population, in addition to age, hypertension, diabetes chronic kidney diseases (CKD) is well known to be related to SVDs, but it remains unclear in patients with stroke. We investigated the relationship between CKD and the presence of SVDs in patients with acute ischemic stroke. Methods: We enrolled 493 patients with acute ischemic stroke patients or transient ischemic attack patients (mean age 71; 60% male) who had undergone 1.5T MR imaging within a week of the index events from April 2013 to march 2015. We evaluated kidney function by estimated glomerular filtration rate (eGFR) with the modification of diet in Renal Disease. CKD was defined as an eGFR less than 60mil/min/1.73m 2 . CMBs were defined as focal areas of very low signal intensity smaller than 10mm. White matter lesion as Periventricular hyper intensity (PVH)>grade 2 and Deep and Subcortical White Matter Hyper intensity (DSWMH)> grade 2 were defied as advanced PVH and advanced DSWMH, respectively. We investigated relationship between CKD and CMBs, advanced PVH and advanced DSWMH using a logistic regression analysis. Results: We noted CMBs in 173 patients (35%), PVH in 81 (16%), and DSWMH in 151 (31%). An univariate analysis revealed that the age, CKD, history of stroke, and antiplatelet agents were associated with presence of CMBs, advanced PVH and severe DSWMH . The multivariate analysis revealed that CMBs, advanced PVH and advanced DSWMH were associated with age (CMBs: odds ratio(OR) ; 1.32 ; 95% confidence interval(CI), 1.10-1.60, p=0.004, advanced PVH : OR ; 3.00 ; 95% CI, 2.17-4.26, p<0.01, advanced DSWMH: OR ; 1.94; 95% CI, 1.56-2.45, p<0.01 ), history of stroke(CMBs : OR ; 2.01 ; 95% CI, 1.21-3.34, p=0.007, advanced PVH : OR ; 2.25 ; 95% CI, 1.18-4.27, p=0.01, advanced DSWMH: OR ; 1.78 ; 95% CI, 1.03-3.06, p=0.038). CKD was associated with CMBs (OR ; 1.62 ; 95% CI, 1.04-2.52, p=0.03), but PVH and DSWMH were not. Conclusions: It seems that age and history of stroke are related to CMBs, advanced PVH and advanced DSWMH, and that CKD is associates with CMBs but not with either advanced PVH or advanced DSWMH.

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 Effect of Edaravone on Neurological Symptoms in Real-World Patients With Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1805-1811 ◽  
Author(s):  
Susumu Kobayashi ◽  
Shingo Fukuma ◽  
Tatsuyoshi Ikenoue ◽  
Shunichi Fukuhara ◽  
Shotai Kobayashi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Symptoms ◽  
Small Vessel ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Ischemic Stroke Subtype ◽  
History Of

Background and Purpose— In Japan, nearly half of ischemic stroke patients receive edaravone for acute treatment. The purpose of this study was to assess the effect of edaravone on neurological symptoms in patients with ischemic stroke stratified by stroke subtype. Methods— Study subjects were 61 048 patients aged 18 years or older who were hospitalized ≤14 days after onset of an acute ischemic stroke and were registered in the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between June 2001 and July 2013. Patients were stratified according to ischemic stroke subtype (large-artery atherosclerosis, cardioembolism, small-vessel occlusion, and cryptogenic/undetermined) and then divided into 2 groups (edaravone-treated and no edaravone). Neurological symptoms were evaluated using the National Institutes of Health Stroke Scale (NIHSS). The primary outcome was changed in neurological symptoms during the hospital stay (ΔNIHSS=NIHSS score at discharge−NIHSS score at admission). Data were analyzed using multivariate linear regression with inverse probability of treatment weighting after adjusting for the following confounding factors: age, gender, and systolic and diastolic blood pressure at the start of treatment, NIHSS score at admission, time from stroke onset to hospital admission, infarct size, comorbidities, concomitant medication, clinical department, history of smoking, alcohol consumption, and history of stroke. Results— After adjusting for potential confounders, the improvement in NIHSS score from admission to discharge was greater in the edaravone-treated group than in the no edaravone group for all ischemic stroke subtypes (mean [95% CI] difference in ΔNIHSS: −0.46 [−0.75 to −0.16] for large-artery atherosclerosis, −0.64 [−1.09 to −0.2] for cardioembolism, and −0.25 [−0.4 to −0.09] for small-vessel occlusion). Conclusions— For any ischemic stroke subtype, edaravone use (compared with no use) was associated with a greater improvement in neurological symptoms, although the difference was small (<1 point NIHSS) and of limited clinical significance.

Prevention of Venous Thromboembolism after Acute Ischemic Stroke with Enoxaparin Versus Unfractionated Heparin and the Impact of Stroke Severity.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 713-713 ◽  
Author(s):  
David G. Sherman ◽  
Gregory W. Albers ◽  
Christopher Bladin ◽  
Min Chen ◽  
Cesare Fieschi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thromboembolism ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Primary Efficacy ◽  
Primary Efficacy Endpoint ◽  
Stroke Patients ◽  
Nihss Score ◽  
Vte Prophylaxis ◽  
Clinically Significant

Abstract Background: Venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) is recommended in acute ischemic stroke patients, but most studies comparing LMWH and UFH are limited in methodology or sample size. The PREVAIL study was designed to assess the superiority of enoxaparin over UFH for VTE prophylaxis in acute ischemic stroke patients and to evaluate efficacy and safety according to stroke severity. Methods: Patients with acute ischemic stroke, confirmed by CT scan, and unable to walk unassisted due to motor impairment of the leg were enrolled in this prospective, open-label, parallel group, multicenter study. Patients from 15 countries were randomized within 48 h of stroke symptoms to receive enoxaparin 40 mg SC qd or UFH 5000 IU SC q12h for 10±4 days. Patients were stratified by NIH Stroke Scale score (NIHSS; severe ≥14, less severe &lt;14). The primary efficacy endpoint was the composite of symptomatic or asymptomatic deep-vein thrombosis (DVT), symptomatic pulmonary embolism (PE), or fatal PE during treatment. DVT was confirmed primarily by venography, or ultrasonography when venography was not practical. PE was confirmed by VQ or CT scan, or angiography. Primary safety endpoints included clinically significant intracranial and major extracranial bleeding. Results: 1762 acute ischemic stroke patients were randomized. Characteristics were similar between groups; mean age was 66.0±12.9 yrs, mean NIHSS score was 11.3. In the efficacy population, enoxaparin (n=666) and UFH (n=669) were given for a mean of 10.5±3.2 days. Enoxaparin resulted in a 43% relative reduction in the risk of the primary efficacy endpoint compared with UFH (10.2% vs 18.1%; RR 0.57; 95% CI 0.44–0.76; p=0.0001, adjusted for NIHSS score). Incidences of VTE events are shown in Table 1. Reductions in the primary endpoint remained significant in patients with a NIHSS score ≥14 (16.3% vs 29.7%, p=0.0036) and &lt;14 (8.3% vs 14.0%, p=0.0043). The composite of clinically significant intracranial and major extracranial bleeding was low and not significantly different between groups (Table 1). Conclusion: Enoxaparin 40 mg qd is superior to UFH q12h for reducing the risk of VTE in acute ischemic stroke patients, with no significant difference in clinically relevant bleeding. The reduction in VTE risk was consistent in patients with a NIHSS score ≥14 or &lt;14. Table 1: Incidence of VTE and bleeding Endpoint Enoxaparin n/N (%, 95% CI) UFH n/N (%, 95% CI) *P&lt;0.001 Symptomatic VTE 2/666 (0.3, 0.0–0.7) 6/669 (0.9, 0.2–1.6) Proximal DVT 30/666 (4.5, 2.9–6.1) 64/669 (9.6, 7.3–11.8)* Distal DVT 44/666 (6.6, 4.7–8.5) 85/669 (12.7, 10.2–15.2)* PE 1/666 (0.2, 0.0–0.4) 6/669 (0.9, 0.2–1.6) Composite of major extracranial and clinically significant intracranial bleeding 11/877 (1.3, 0.5–1.9) 6/872 (0.7, 0.1–1.2)

Abstract W P14: Significant Correlation between Neurological and Functional Recoveries in the Natural History of Acute Ischemic Stroke from Large Vessel Occlusion

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vallabh Janardhan ◽  
Albert J Yoo ◽  
Donald F Frei ◽  
Lynne Ammar ◽  
Sophia S Kuo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Strong Correlation ◽  
Infarct Volume ◽  
Large Vessel ◽  
Infarct Core ◽  
Nihss Score ◽  
History Of

Purpose: There have been conflicting reports on the correlation between neurological and functional recoveries in acute ischemic stroke. NIHSS and mRS scores not always correlated in patients after treatment. Since the inconsistencies could be related to the variable effectiveness of treatments, the aim of this study was to test their correlation in patients with large vessel proximal occlusion who are eligible but not treated with endovascular therapy. In addition, we analyzed the data based on trichotomized ASPECTS scores to minimize the confounding influence of the infarct core. Methods: The FIRST Trial is a prospective natural history study of a stroke cohort eligible for but untreated by endovascular therapy and ineligible or refractory to IV rtPA. NIHSS and mRS scores were measured in 93 patients at admission, 24 hour and 7 days after hospital presentation and were analyzed by logistic regression against different core infarct volume as indexed by ASPECTS scores of 8-10, 5-7, and 0-4. Results: Median admission NIHSS score was 18 (IQR 14-23, N=93). The mean and mean increase at 24 h NIHSS both showed correlations with trichotomized ASPECTS, p=0.0064 and 0.0202, respectively. NIHSS at 24 h and 7 days displayed a strong relationship with 90 day mRS 0-2 (p=0.0002, N=67; p=0.0003, N=66). NIHSS had a strong correlation to 90 day mRS scores (continuous), with high 7 day scores correlated with high mRS scores and 7 day NIHSS change negatively correlated to 90 day mRS scores (Spearman correlations, all p<0.0001). Significant correlations were seen between 24 h and 7 day NIHSS and 90 day mRS by trichotomized ASPECTS (both p=0.04275). In addition, controlling for trichotomous ASPECTS groups, 7 Day NIHSS score was the best predictor of mRS 90d 0-2 (OR= 0.717, p= 0.0018). Conclusion: These data indicate that there is a strong correlation between neurological and functional recoveries in the natural history of acute ischemic when the confounding influences of treatment and the infarct core are taken into account.

SERUM ALBUMIN LEVELS AND ITS CORRELATION WITH SHORT TERM OUTCOME IN ACUTE ISCHEMIC STROKE PATIENTS

2021 ◽  
pp. 12-13
Author(s):  
Avtar Singh Dhanju ◽  
Thiyagu K ◽  
Ajay Chhabra ◽  
Pashaura Singh
Keyword(s):  
Ischemic Stroke ◽  
Serum Albumin ◽  
Acute Ischemic Stroke ◽  
Albumin Level ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Short Term ◽  
Term Outcome ◽  
Nihss Score ◽  
The Relationship

Aim:The study was undertaken with the aim to establish the denite correlation between serum albumin levels and outcome of ischemic stroke. Methodology: The present observational study was conducted on 100 acute ischemic stroke patients meeting inclusion and exclusion criteria. All patients were investigated for hypoalbuminemia and their stroke severity was assessed by NIHSS score on day 1 and day 7. The relationship between admission albumin levels, NIHSS values and outcome of those patients was ascertained. Results: There was increased prevalence of hypoalbuminemia in AIS patients and there was signicant correlation between NIHSS score on day 1&7, mortality and hypoalbuminemia in AIS patients and there was signicant association between high NIHSS score and mortality in AIS patients. Conclusion: serum albumin is an independent predictor of functional outcome following an acute ischemic stroke and serum albumin level is inversely correlated with severity of stroke at presentation.

scholarly journals Relationship Between NIHSS score (National Institues Of Healt Stroke Scale Scores), Vessel Occlusion And Affected Hemisphere In Acute Ischemic Stroke

2016 ◽  
Vol 5 (1) ◽  
pp. 8-15
Author(s):  
Muhammed Nur Ögün ◽  
Bahar Aksay Koyuncu ◽  
Özlem Güngör Tuncer ◽  
Gökhan Evcili ◽  
Reha Tolun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Scale Scores

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.

Hypercoagulation on Thromboelastography Predicts Early Neurological Deterioration in Patients with Acute Ischemic Stroke

2018 ◽  
Vol 46 (3-4) ◽  
pp. 123-129 ◽  
Author(s):  
Zhu Shi ◽  
Wei C. Zheng ◽  
Xiao L. Fu ◽  
Xue W. Fang ◽  
Pei S. Xia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
High Sensitivity ◽  
Roc Curves ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Lower Tertile ◽  
Reactive Protein ◽  
Early Neurological Deterioration ◽  
History Of

Background: Thromboelastography (TEG) provides an integrated measurement of blood coagulation function and has been reported to be a useful tool for predicting clinical outcomes in patients with cardiovascular diseases. We aimed to investigate the application of TEG on admission for predicting early neurological deterioration (END) in patients with acute ischemic stroke and its potential correlation with the evolution of ischemic lesions. Methods: Among patients consecutively admitted between January 1, 2016, and September 31, 2017, those presenting with mild and moderate acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤14) within 24 h of stroke onset were identified and included in this study. TEG was performed on the first day of admission. END was defined as an increase of ≥1 on subitems of the NIHSS or the emergence of new symptoms within 72 h of admission. Demographics, lab test results, and TEG values were compared according to whether END occurred. A multiple logistic regression model was then developed to investigate the predictive power of TEG for END. Receiver operating characteristic (ROC) curves were then plotted to evaluate the optimal cutoff values. Results: Of the 246 eligible patients (mean age 65.3 ± 12.9 years, 73.6% male), END was identified in 72 (29.3%) patients. Patients with END corresponded to a higher proportion of females, a more prevalent history of diabetes mellitus (DM), higher baseline NIHSS scores, higher serum high-sensitivity C-reactive protein (hsCRP) levels, and significantly shorter R on TEG (4.0 ± 1.0 vs. 4.7 ± 1.2 min, p < 0.001). In further comparisons stratified by R tertiles, significant trends were found between shorter R and being female and older and being more likely to exhibit diffusion weighted imaging progression on follow-up MRI. After adjusting for female sex, baseline NIHSS score, DM, and hsCRP, the lower tertile of R (R ≤3.8 min) was strongly associated with END (OR 3.556, 95% CI 1.165–10.856, p < 0.001). ROC analysis demonstrated that R ≤3.45 min had the best predictive value for END with 87.9% sensitivity and 40.3% specificity. Conclusion: Decreased R time on admission TEG is associated with END within 3 days in patients with acute ischemic stroke.

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