Quantifying candidate volume for endovascular therapy for acute ischemic stroke: a retrospective chart review

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

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Abstract P176: Improving Door to Needle Times With CT Telestroke

Stroke ◽

10.1161/str.52.suppl_1.p176 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sarah Jamieson ◽

Alexandra C Lesko ◽

Elizabeth Baraban ◽

Lisa R Yanase

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Chart Review ◽

Group Analysis ◽

Retrospective Chart Review ◽

Inclusion Criteria ◽

Night Time ◽

Intention To Treat ◽

The Difference ◽

Treat Analysis

Introduction: Thrombolytic treatment of acute ischemic stroke (AIS) during night-time hours and weekends is associated with prolonged door to needle (DTN) times. A CT suite telestroke unit (CTTU) was installed at two urban stroke centers to expedite treatment for AIS patients. The purpose of this study was to determine whether CTTU evaluation would decrease DTN times on nights and weekends. Methods: A retrospective chart review included patients 18 years and older presenting with AIS to the emergency department and treated with IV alteplase on a week-night (4pm-8am) or weekend (Friday 4pm - Monday 8am) between January 2019- February 2020. The distribution of median DTN times were compared for the following groups: (1) Pre-CTTU installation (January 1, 2019-July 28, 2019) versus post-CTTU installation (July 29, 2019 - February 29, 2020), regardless of telestroke usage (“intention to treat”), (2) Pre-CTTU (using traditional telestroke and excluding bedside evaluations) versus post-CTTU (using CTTU and excluding bedside evaluations) (“per-protocol”) and (3) Post-CTTU period use of traditional telestroke versus CTTU (“post-CTTU group”). Analyses were performed using the Mann-Whitney U test. Results: A total of 111 patients met inclusion criteria with 44 (39.6%) treated in the pre-CTTU period and 67 (60.4%) treated in the post-CTTU period. After installation, CTTU was utilized in 38.8% (n=26) of cases, traditional telestroke in 44.8% (n=30), and the remaining 16.4% (n=11) were evaluated at bedside. The intention-to-treat analysis showed no difference between the pre-CTTU and post-CTTU groups (44.0 minutes vs 44.0 minutes, p=0.909). The per-protocol analysis showed faster DTN times in the Post-CTTU group compared to the Pre-CTTU group (38.5 minutes vs 44.0 minutes, p=0.128), but the difference was not significant. The post-CTTU group analysis showed median DTN times significantly improved using CTTU compared to traditional telestroke (38.5 minutes vs 48.0 minutes, p=0.011). Conclusion: The use of CT telestroke in the evaluation of acute ischemic stroke patients decreased DTN time when a stroke neurologist is not on-site.

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Detection of Early Ischemic Changes in Noncontrast CT Head Improved with “Stroke Windows”

ISRN Neuroscience ◽

10.1155/2014/654980 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Shraddha Mainali ◽

Mervat Wahba ◽

Lucas Elijovich

Keyword(s):

Ischemic Stroke ◽

Basal Ganglia ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Chart Review ◽

Retrospective Chart Review ◽

Image Evaluation ◽

Head Ct ◽

Noncontrast Ct ◽

Ct Head

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P<0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P<0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P<0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

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Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2018.08.435 ◽

2019 ◽

Vol 73 (2) ◽

pp. 118-129

Author(s):

Hadi Hassankhani ◽

Amin Soheili ◽

Samad S. Vahdati ◽

Farough A. Mozaffari ◽

Justin F. Fraser ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Chart Review ◽

Retrospective Chart Review ◽

Treatment Delays

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Collateral Flow Predicts Response to Endovascular Therapy for Acute Ischemic Stroke

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.04.015 ◽

2011 ◽

Vol 2011 ◽

pp. 26-28

Author(s):

A.A. Rabinstein

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Collateral Flow

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Faculty Opinions recommendation of Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717953732.793459347 ◽

2012 ◽

Author(s):

Mark Wainwright

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Internal Carotid ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Carotid Artery Occlusion

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Current status of endovascular therapy for acute ischemic stroke

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.53.1166 ◽

2013 ◽

Vol 53 (11) ◽

pp. 1166-1168

Author(s):

Hiroshi Yamagami ◽

Nobuyuki Sakai

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Current Status

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Endovascular Therapy for Acute Ischemic Stroke

JAMA Neurology ◽

10.1001/jamaneurol.2015.1743 ◽

2015 ◽

Vol 72 (10) ◽

pp. 1101 ◽

Cited By ~ 7

Author(s):

Mark J. Alberts ◽

Ty Shang ◽

Alejandro Magadan

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy

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Abstract 2825: History of Cancer Predicts Mortality After Acute Endovascular Treatment for Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2825 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Karl Meisel ◽

Mahesh Jayaraman ◽

Jonathan Grossberg ◽

Anthony Kim

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Hospice Care ◽

Exploratory Analysis ◽

Endovascular Intervention ◽

Consecutive Series ◽

History Of ◽

History Of Cancer

Introduction: Endovascular treatment is an emerging therapy for acute ischemic stroke. There is no clear consensus about how best to select patients that may benefit from intervention. We conducted an exploratory analysis of clinical risk factors to predict mortality after endovascular intervention in order to better understand how to improve outcomes for patients with acute ischemic stroke. Methods: We identified consecutive series of patients treated with endovascular therapy for acute ischemic stroke at two academic hospitals between 2005 to 2010. Key clinical data elements and clinical outcomes at the time of discharge were abstracted from medical records. We evaluated univariate and multivariable associations using logistic regression and compared mean NIH Stroke Scale between those with and without a history of cancer using the t-test. Results: We identified 88 patients who received endovascular intervention with intra-arterial tissue plasminogen activator (t-PA) and/or mechanical thrombectomy. The mean age of the cohort was 68.2 (SD 16.6) and 44 (55%) were female. A total of 23 (26.1%) patients died during the index hospitalization or were discharged to hospice care. A history of cancer was documented in 20 (22.7%) patients. A history of cancer was associated with a 3.2-fold (95% CI 1.1-9.1) higher odds of mortality. This association persisted after adjusting for age greater than 80 years and hypertension (OR of 4.0, 95% CI 1.3-12). The average NIH Stroke Scale was 15.6 in those with cancer compared to 14.6 without (p=0.53). A history of cancer was not associated with parenchymal hemorrhagic transformation (OR 1.2, 95% CI 0.3-4.9), IV tPA (OR 0.5, 95% CI 0.1-2.3), a TIMI score of 2b or 3 (OR 0.5, 95% CI 0.2-1.3), or an internal carotid artery occlusion (OR 1.7, 95% CI 0.5-5.1). Conclusions: In an exploratory analysis of consecutive patients with acute ischemic stroke treated with endovascular therapy, a history of cancer was strongly associated with significantly increased odds of mortality. One possible explanation could be that patients with cancer may have earlier withdrawal of care but the reasons for this observed association are unclear. Further investigation is necessary to verify and explain the reasons for this observation in order to improve outcomes for acute ischemic stroke patients.

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Abstract T P10: Therapeutic Time Window for Endovascular Therapy of Acute Ischemic Stroke Depends on THRIVE Score: A Retrospective Single-center Study

Stroke ◽

10.1161/str.46.suppl_1.tp10 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Kenichi Todo ◽

Nobuyuki Sakai ◽

Tomoyuki Kono ◽

Taku Hoshi ◽

Hirotoshi Imamura ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Time Window ◽

Medical Center ◽

Multivariate Logistic Regression Analysis ◽

Symptom Duration ◽

Vascular Events ◽

Good Outcome ◽

Therapeutic Time Window

Background and purpose: The outcome after endovascular therapy in acute ischemic stroke is associated with onset-to-reperfusion time (ORT). The Totaled Health Risks in Vascular Events (THRIVE) score is also an important pre-thrapeutic predictor of outcome. We hypothesized that the therapeutic time window is narrower in patients with the higher THRIVE score. Methods: We retrospectively studied consecutive 109 ischemic stroke patients with successful reperfusion after endovascular therapy between October 2005 and March 2014 at a single institute (Kobe City Medical Center General Hospital). Inclusion criteria was as follows: National Institutes of Health Stroke Scale (NIHSS) score ≥8, stroke symptom duration ≤8 h, premorbid modified Rankin Scale (mRS) score ≤2, and thrombolysis myocardial infarction score 2-3. We analyzed the relationships of ORT, THRIVE score, and THRIVE+ORT score with good outcome (mRS ≤2 at 3 months). The THRIVE+ORT score was defined as the sum of the THRIVE score and ORT (h). Results: Median ORT was 5.5 h (IQR; 4.4-7.1 h), median THRIVE score was 5 (IQR; 4-6), and median THRIVE+ORT score was 10.8 (IQR; 9.2-12.5). Good outcome rates for patients with ORT ≤4 h, >4 and ≤6 h, >6 and ≤8 h, and >8h were 50.0%, 45.8%, 37.0%, and 21.4%, respectively (p=0.3), those with THRIVE score ≤3, >3 and ≤5, >5 and ≤7, and >7 were 57.1%, 51.4%, 28.3%, and 20.0%, respectively (p9 and ≤11, >11 and ≤13, and >13 were 64.0%, 44.1%, 34.4%, and 16.7%, respectively (p<0.05). Multivariate logistic regression analysis revealed that THRIVE+ORT score was an independent predictor of good outcome after adjusted for THRIVE score (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.082-1.728) or after adjusted for ORT (OR, 1.517: 95% CI, 1.160-1.983). Conclusion: Our study showed that THRIVE+ORT score was associated with outcome that was independent from THRIVE score or ORT. This is the first report to suggest that patients with the higher THRIVE score require the shorter ORT for good outcome.

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