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Taboada M, Estany-Gestal A, Fernández J, Barreiro L, Williams K, Rodríguez-Yáñez M, Otero P, Naveira A, Caruezo V, Veiras S, San Luis E, Dos Santos L, Diaz-Vieito M, Arias-Rivas S, Santamaría-Cadavid M, Rodríguez-Castro E, Vázquez F, Blanco M, Mosquera A, Castiñeiras JA, Muniategui I, Ferreiroa E, Cariñena A, Tubio A, Campaña O, Selas S, Aneiros F, Martínez A, Eiras M, Costa J, Prieto JM, Álvarez J. Effect of early vs. delayed extubation on functional outcome among patients with acute ischemic stroke treated with endovascular thrombectomy under general anesthesia: the prospective, randomized controlled EDESTROKE trial study protocol. Trials 2024; 25:357. [PMID: 38835061 DOI: 10.1186/s13063-024-08181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Recent meta-analyses and randomized studies have shown that among patients with acute ischemic stroke undergoing endovascular thrombectomy, general anesthesia with mechanical ventilation is associated with better functional status compared to local anesthesia and sedation, and they recommend its use. But once the procedure is completed, when is the optimal moment for extubation? Currently, there are no guidelines recommending the optimal moment for extubation. Prolonged mechanical ventilation time could potentially be linked to increased complications such as pneumonia or disturbances in cerebral blood flow due to the vasodilatation produced by most anesthetic drugs. However, premature extubation in a patient who has suffered a stroke could led to complications such as agitation, disorientation, abolished reflexes, sudden fluctuations in blood pressure, alterations in cerebral blood flow, respiratory distress, bronchial aspiration, and the need for reintubation. We therefore designed a randomized study hypothesizing that early compared with delayed extubation is associated with a better functional outcome 3 months after endovascular thrombectomy treatment under general anesthesia for acute ischemic stroke. METHODS This investigator-initiated, single-center, prospective, parallel, evaluated blinded, superiority, randomized controlled trial will include 178 patients with a proximal occlusion of the anterior circulation treated with successful endovascular thrombectomy (TICI 2b-3) under general anesthesia. Patients will be randomly allocated to receive early (< 6 h) or delayed (6-12 h) extubation after the procedure. The primary outcome measure is functional independence (mRS of 0-2) at 90 days, measured with the modified Rankin Score (mRS), ranging from 0 (no symptoms) to 6 (death). DISCUSSION This will be the first trial to compare the effect of mechanical ventilation duration (early vs delayed extubation) after satisfactory endovascular thrombectomy for acute ischemic stroke under general anesthesia. TRIAL REGISTRATION The study protocol was approved April 11, 2023, by the by the Santiago-Lugo Research Ethics Committee (CEI-SL), number 2023/127, and was registered into the clinicaltrials.gov clinical trials registry with No. NCT05847309. Informed consent is required. Participant recruitment begins on April 18, 2023. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.
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Affiliation(s)
- Manuel Taboada
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain.
| | - Ana Estany-Gestal
- Research Methodology Unit, Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | - Jorge Fernández
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Laura Barreiro
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Kora Williams
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | | | - Pablo Otero
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Alberto Naveira
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Valentín Caruezo
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Sonia Veiras
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Eva San Luis
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Laura Dos Santos
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - María Diaz-Vieito
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Susana Arias-Rivas
- Department of Neurology, University Clinical Hospital of Santiago, Santiago, Spain
| | | | | | - Fernando Vázquez
- Department of Neuroradiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Miguel Blanco
- Department of Neuroradiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Antonio Mosquera
- Department of Neuroradiology, University Clinical Hospital of Santiago, Santiago, Spain
| | | | - Ignacio Muniategui
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Esteban Ferreiroa
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Agustín Cariñena
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Ana Tubio
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Olga Campaña
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Salomé Selas
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Francisco Aneiros
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Adrián Martínez
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - María Eiras
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Jose Costa
- Department of Neuroradiology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Jose María Prieto
- Department of Neurology, University Clinical Hospital of Santiago, Santiago, Spain
| | - Julián Álvarez
- Department of Anesthesiology, University Clinical Hospital of Santiago, Santiago, Spain
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He P, Bao X, Jiang F, Liu X, Xu W, Yu D, Chen L, Chen F. Evaluating high-flow oxygen therapy after mechanical thrombectomy under general anesthesia in acute ischemic stroke: A retrospective single-center study. Clin Neurol Neurosurg 2024; 243:108359. [PMID: 38838421 DOI: 10.1016/j.clineuro.2024.108359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/29/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The use of mechanical thrombectomy for acute intracranial vascular occlusion under general anesthesia with endotracheal intubation is well-established as a safe and effective method. However, the process of extubation post-surgery presents challenges for certain patients. This retrospective study assesses the safety and efficacy of combining mechanical ventilation with high-flow oxygen inhalation as an interim strategy, while also examining its impact on long-term clinical outcomes. METHODS This research enrolled 119 patients with acute intracranial large vessel occlusion who underwent mechanical thrombectomy under general anesthesia with tracheal intubation between January 2020 and November 2023. Participants were categorized into two groups: Group 1 (n=55), which received high-flow oxygen (HFO) post-extubation, and Group 2 (n=64), which was treated with routine oxygen supplementation (RO). The study compared reintubation and tracheotomy rates between these groups to determine safety and effectiveness. Additionally, it analyzed long-term clinical outcomes by comparing NIHSS and mRS scores before treatment and at 90-day follow-up. RESULTS The reintubation rate post-extubation was significantly lower in the HFO group (12.7 %, n=7) compared to the RO group (31.2 %, n=20, p=0.016). The incidence of tracheotomy within 7 days was also reduced in the HFO group compared to the RO group (7.3 %, n=4 vs 20.3 %, n=13, p=0.043). Moreover, a greater proportion of patients in the HFO group achieved mRS scores of 0-2 at 90 days post-stroke than those in the RO group (60 %, n=33 vs 40.6 %, n=26, p=0.035). The median NIHSS score at 90 days was more favorable in the HFO group than in the RO group (6, IQR [1-18] vs 8, IQR [1-20], p=0.005). CONCLUSION The study suggests that high-flow oxygen therapy after mechanical thrombectomy under general anesthesia with tracheal intubation may lessen the need for reintubation and tracheotomy, potentially leading to improved long-term prognosis.
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Affiliation(s)
- Pingyou He
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiang Bao
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - FengFeng Jiang
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiaobo Liu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wei Xu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Danfeng Yu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lin Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
| | - Feng Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
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Zhu H, Liang W, Zhu J, He X, Zou P, Yang K, Li G, Liao B, Deng H, Liang Z, Zhao J, Zhao Z, Chen J, He Q, Ning W. Nomogram to predict ventilator-associated pneumonia in large vessel occlusion stroke after endovascular treatment: a retrospective study. Front Neurol 2024; 15:1351458. [PMID: 38803642 PMCID: PMC11129686 DOI: 10.3389/fneur.2024.1351458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Ventilator-Associated Pneumonia (VAP) severely impacts stroke patients' prognosis after endovascular treatment. Hence, this study created a nomogram to predict the occurrence of VAP after endovascular treatment. Methods The individuals with acute ischemic stroke and large vessel occlusion (AIS-LVO) who received mechanical ventilation and endovascular therapy between July 2020 and August 2023 were included in this retrospective study. The predictive model and nomogram were generated by performing feature selection optimization using the LASSO regression model and multifactor logistic regression analysis and assessed the evaluation, verification and clinical application. Results A total of 184 individuals (average age 61.85 ± 13.25 years, 73.37% male) were enrolled, and the rate of VAP occurrence was found to be 57.07%. Factors such as the Glasgow Coma Scale (GCS) score, duration of stay in the Intensive Care Unit (ICU), dysphagia, Fazekas scale 2 and admission diastolic blood pressure were found to be associated with the occurrence of VAP in the nomogram that demonstrating a strong discriminatory power with AUC of 0.862 (95% CI, 0.810-0.914), and a favorable clinical net benefit. Conclusion This nomogram, comprising GCS score, ICU duration, dysphagia, Fazekas scale 2 and admission diastolic blood pressure, can aid clinicians in predicting the identification of high-risk patients for VAP following endovascular treatment in large vessel occlusion stroke.
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Affiliation(s)
- Huishan Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Wenfei Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingling Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Xiaohua He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Pengjuan Zou
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Kangqiang Yang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Guoshun Li
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Bin Liao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Huiquan Deng
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zichong Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jiasheng Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zhan Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingyi Chen
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Qiuxing He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weimin Ning
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
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Jia Y, Feng Y, Ma Y, Feng G, Xu N, Li M, Liu M, Fan Z, Wang T. Type of anesthesia for endovascular therapy in acute ischemic stroke: A literature review and meta-analysis. Int J Stroke 2024:17474930241228956. [PMID: 38234158 DOI: 10.1177/17474930241228956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) has been proven as the standard treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). However, the ideal anesthetic strategy during EVT still remains unclear. Therefore, this systematic review and meta-analysis aimed to determine the optimal anesthetic modality for patients with AIS undergoing EVT based on current randomized controlled trials (RCTs). METHODS The databases Medline (via PubMed), EMBASE, Web of Science, and the Cochrane Library were searched for RCTs comparing general anesthesia (GA) and conscious sedation (CS) in AIS patients undergoing EVT. The primary outcome was a favorable functional outcome at 90 days postintervention. Data analysis was conducted using the Review Manager software (RevMan V.5.3). RESULTS Eight RCTs involving 1199 patients were included. There was no significant difference between GA and CS group in the rate of functional independence (risk ratio (RR) = 1.10, 95% confidence interval (CI) = 0.96 to 1.25; p = 0.17; I2 = 30%). Compared with the CS group, the GA group attained a higher successful recanalization rate (RR = 1.14, 95% CI = 1.08 to 1.20; p < 0.00001; I2 = 17%). In addition, patients in the GA were associated with a higher rate of hypotension (RR = 1.87, 95% CI = 1.44 to 2.41; p < 0.00001; I2 = 66%) and a higher incidence of pneumonia (RR = 1.38, 95% CI = 1.05 to 1.8; p = 0.02; I2 = 37%). CONCLUSION For AIS patients receiving EVT, the choice of anesthetic modality did not influence the 3-month neurological outcome while GA is superior to CS in terms of successful reperfusion rate. Moreover, the patients in the GA group were at a higher risk of developing hypotension and pneumonia. Further studies are required to provide more sufficient evidence.
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Affiliation(s)
- Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guang Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Na Xu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhen Fan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Jin G, Hu W, Zeng L, Diao M, Chen H, Chen J, Gu N, Qiu K, Lv H, Pan L, Xi S, Zhou M, Liang D, Ma B. Development and verification of a nomogram for predicting short-term mortality in elderly ischemic stroke populations. Sci Rep 2023; 13:12580. [PMID: 37537270 PMCID: PMC10400586 DOI: 10.1038/s41598-023-39781-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Stroke is a major healthcare problem worldwide, particularly in the elderly population. Despite limited research on the development of prediction models for mortality in elderly individuals with ischemic stroke, our study aimed to address this knowledge gap. By leveraging data from the Medical Information Mart for Intensive Care IV database, we collected comprehensive raw data pertaining to elderly patients diagnosed with ischemic stroke. Through meticulous screening of clinical variables associated with 28-day mortality, we successfully established a robust nomogram. To assess the performance and clinical utility of our nomogram, various statistical analyses were conducted, including the concordance index, integrated discrimination improvement (IDI), net reclassification index (NRI), calibration curves and decision curve analysis (DCA). Our study comprised a total of 1259 individuals, who were further divided into training (n = 894) and validation (n = 365) cohorts. By identifying several common clinical features, we developed a nomogram that exhibited a concordance index of 0.809 in the training dataset. Notably, our findings demonstrated positive improvements in predictive performance through the IDI and NRI analyses in both cohorts. Furthermore, calibration curves indicated favorable agreement between the predicted and actual incidence of mortality (P > 0.05). DCA curves highlighted the substantial net clinical benefit of our nomogram compared to existing scoring systems used in routine clinical practice. In conclusion, our study successfully constructed and validated a prognostic nomogram, which enables accurate short-term mortality prediction in elderly individuals with ischemic stroke.
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Affiliation(s)
- Guangyong Jin
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Hu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Longhuan Zeng
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengyuan Diao
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chen
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiayi Chen
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nanyuan Gu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Qiu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huayao Lv
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Pan
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaosong Xi
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Menglu Zhou
- Department of Intensive Care Unit, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Dongcheng Liang
- Department of Intensive Care Unit, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
| | - Buqing Ma
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Beuker C, Köppe J, Feld J, Meyer CL, Dröge P, Ruhnke T, Günster C, Wiendl H, Reinecke H, Minnerup J. Association of age with 1-year outcome in patients with acute ischaemic stroke treated with thrombectomy: real-world analysis in 18 506 patients. J Neurol Neurosurg Psychiatry 2023; 94:631-637. [PMID: 37001983 PMCID: PMC10359560 DOI: 10.1136/jnnp-2022-330506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND To evaluate the association of age with long-term outcome after thrombectomy. METHODS In a retrospective cohort study based on routine healthcare data from Germany between 2010 and 2018, we included 18 506 patients with acute ischaemic stroke treated with mechanical thrombectomy. Association between age and mortality, disability, and level of care at 1 year was assessed. RESULTS The median age was 76 years, 36.3% were aged ≥80 years and 55.8% were women. Patients aged ≥80 compared with those <80 years had a higher mortality (55.4% vs 28.5%; adjusted HR 1.13; 95% CI 1.05 to 1.31), more often had moderate/severe disability (35.5% vs 33.2%, adjusted HR 1.14; 95% CI 1.06 to 1.23) and less frequently had no/slight disability (17.4% vs 41.0%) at 1 year. Older age was associated with a higher likelihood of living in a nursing home (13.4% vs 9.2%, adjusted HR 1.09; 95% CI 0.97 to 1.22) and a lower likelihood of living at home (33.8% vs 62.8%) at 1 year. These associations were also robust when analysed in patients with no disability prior to stroke. Factors most strongly associated with worse 1-year outcomes in elderly patients were chronic limb-threatening ischaemia (67.9% vs 56.4%; HR 1.59, 95% CI 1.38 to 1.82), dementia at baseline (65.2% vs 47.3%; HR 1.29, 95% CI 1.17 to 1.44) and ventilation >48 hours (79.3% vs 52.2%; HR 2.91, 95% CI 2.66 to 3.18). CONCLUSIONS In this large 'real-world' cohort, outcomes after mechanical thrombectomy were strongly associated with age. Of patients aged ≥80 years more than half were dead and less than one-fifth were functionally independent at 1 year. Certain comorbidities and ventilation >48 hours were associated with even worse outcomes.
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Affiliation(s)
- Carolin Beuker
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Christian Lennart Meyer
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | | | | | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
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Cárdenas SA, Vásquez A, Ortiz AF, Correa PA, Vera DD, Ramírez DA, Florez MA, Ochoa ME, Galvis M, Vargas O, Ferreira CA, Mantilla D. Clinical perspective in relation to age in patients treated with thrombectomy for anterior circulation stroke in a stroke center in Colombia. Interv Neuroradiol 2023:15910199231153195. [PMID: 36751025 DOI: 10.1177/15910199231153195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND AIMS Endovascular treatment for cerebrovascular disease is accepted as a first-line option with level I evidence in patients with an early and late time of window of onset symptoms, and an additional option in patients who do not respond or with contraindications to systemic thrombolysis; nevertheless the efficacy and outcomes of some groups were not clear, one of them are patients aged 80 years and older, because they were excluded of the trials, so the evidence is controversial with significant heterogeneity, for that reason in our study, we decided to analyze the age in the patients treated in our stroke center, as a predictor of prognosis, and to provide a baseline for the establishment of personalized treatment plans. METHODS Observational, retrospective study of patients that received endovascular treatment for cerebrovascular disease in a Colombian stroke center between 2016 and 2020, continuous and categorical variables were compared using the Student's t test and Chi-Square. To determine cut-off points in the variable against death and Rankin score variable on 90th day. RESULTS In total, 108 patients were recruited, 35 of them were of 80 or more years, and the mean age was 72.7 years, we found age as a significant variable to predict the risk in the population over 80 years of age [RR 3.37 CI (95% 1.14-103) p = 0.029]. CONCLUSIONS Age younger than 80 is a significant predictor for results and long-term outcomes in patients suffering from stroke, and in patients older than 80 years old a Thrombolysis in Cerebral Infarction score 2b-3 is a predictor of good outcomes. Further studies are needed to evaluate the relationship between intrahospital complications and long-term outcomes.
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Affiliation(s)
- Sauder A Cárdenas
- Fellowship of Interventional Radiology, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | | | - Andrés F Ortiz
- Fellowship of Interventional Radiology, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Paula A Correa
- 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Daniela D Vera
- 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | | | - Maria A Florez
- Fundación Oftamologica de Santander, Santander, Colombia
| | - Miguel E Ochoa
- 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Melquizidel Galvis
- Interventional Neuroradiology Department, 536071Fundación Oftamologica de Santander, Santander, Colombia
- Interventional Radiology Department, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Oliverio Vargas
- Interventional Neuroradiology Department, 536071Fundación Oftamologica de Santander, Santander, Colombia
- Interventional Radiology Department, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Carlos A Ferreira
- Interventional Neuroradiology Department, 536071Fundación Oftamologica de Santander, Santander, Colombia
- Interventional Radiology Department, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
| | - Daniel Mantilla
- Interventional Neuroradiology Department, 536071Fundación Oftamologica de Santander, Santander, Colombia
- Interventional Radiology Department, 27968Universidad Autonoma de Bucaramanga, Santander, Colombia
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Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients. Anaesth Crit Care Pain Med 2023; 42:101188. [PMID: 36599377 DOI: 10.1016/j.accpm.2022.101188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke.
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Guo M, Shi Y, Gao J, Yu M, Liu C. Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study. BMC Anesthesiol 2022; 22:296. [PMID: 36114451 PMCID: PMC9479244 DOI: 10.1186/s12871-022-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection. Methods We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias. Results Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching. Conclusions Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01836-w.
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10
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Stösser S, Isakeit J, Bode FJ, Bode C, Petzold GC. Sepsis in Patients With Large Vessel Occlusion Stroke–Clinical Characteristics and Outcome. Front Neurol 2022; 13:902809. [PMID: 35903123 PMCID: PMC9315268 DOI: 10.3389/fneur.2022.902809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infections are an important complication after stroke and negatively affect clinical outcome. While pneumonia and urinary tract infections are well recognized after stroke, the incidence and consequences of sepsis remain unclear. The aim of this study was to evaluate the frequency and characteristics of sepsis in patients undergoing endovascular therapy for large vessel occlusion stroke, and its association with clinical outcome. Methods We analyzed a cohort of patients who underwent endovascular therapy at a single center between 2016 and 2020. The diagnosis and timing of infections and Sequential Organ Failure Assessment scores were evaluated retrospectively to identify patients with sepsis. Patients with sepsis were compared to controls regarding clinical characteristics and outcome. Results Fifty-four of 406 patients (13.3%) were found to have sepsis. The median onset of sepsis was 2 days after admission. The majority of cases (85.2%) was caused by pneumonia. At 3 months, 72.5% of patients with sepsis were bedridden or dead compared to 25.7 and 42.7% of controls and patients with an infection without sepsis, respectively. The adjusted odds ratio (95% confidence interval) for a poor outcome was 5.4 (1.6–17.6) for patients with sepsis vs. controls, and 2.0 (0.8–5.2) for patients with sepsis vs. patients with an infection without sepsis. Conclusions Sepsis is a frequent complication after large vessel occlusion stroke, and may be associated with a poor clinical outcome. More studies are needed to determine specific risk factors and measures to early recognize and reduce the possibly negative impact of sepsis on outcome after stroke.
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Affiliation(s)
- Sebastian Stösser
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
- *Correspondence: Sebastian Stösser /0000-0002-1182-705X
| | - Julia Isakeit
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Felix J. Bode
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Gabor C. Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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Equiza J, de la Riva P, Angel Larrea J, Marta-Enguita J, Albájar I, Lüttich A, Garmendia E, Alonso M, de Arce A, Díez N, Gonzalez F, Iruzubieta P, Sulibarria N, Puig J, Martínez-Zabaleta M. Impact on functional outcome of an adaptive Stroke Unit based system of care for patients undergoing endovascular treatment during pandemic times. Eur Stroke J 2022; 7:248-256. [DOI: 10.1177/23969873221098269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The COVID19 pandemic collapsed intensive care units (ICUs) all around the world, conditioning systems of care (SOC) for other critical conditions such as severe ischemic stroke requiring endovascular treatment (EVT). Our aim was to evaluate the impact of an adaptive Stroke Unit (SU) based SOC on functional outcomes, with the goal of avoiding both general anesthesia (GA) and ICU admission in stroke patients treated with EVT. Material and methods: We performed an observational study comparing data from our traditional ICU-GA based SOC and the adaptive SU-Conscious Sedation (CS) based SOC (consecutive patients undergoing EVT 1 year prior and after onset of the pandemic). Primary outcome was 90-days modified Rankin Scale (mRS), and secondary outcomes included, among others, in-hospital complications, and hospital length of stay (LOS). Results: A total of 210 EVT were performed during the study period (107 under the traditional-SOC and 103 under the adaptive-SOC). A significantly greater proportion of patient was treated under CS (15.9% vs 57.3%; p < 0.001) and admitted for post-procedural care at SU (15% vs 66%; p < 0.001) in the adaptive SOC. Rates of in-hospital complications were similar in both periods, with reduced hospital LOS in the adaptive SOC (10 (7–15) vs 8 (6–12); p = 0.005). The adaptive SOC was associated with higher odds for 90 days favorable outcome (mRS 0–2) (aOR 3.15 (1.34–7.39); p = 0.008). Conclusion: In our case, an adaptive SOC that combined both preference for CS and postprocedural care in SU was associated with better functional outcomes and reduced healthcare resource use for patients undergoing EVT.
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Affiliation(s)
- Jon Equiza
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Patricia de la Riva
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - José Angel Larrea
- Interventional Neuroradiology Section, Department of Radiology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Juan Marta-Enguita
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Inés Albájar
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Alex Lüttich
- Interventional Neuroradiology Section, Department of Radiology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Eñaut Garmendia
- Interventional Neuroradiology Section, Department of Radiology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Maitane Alonso
- Interventional Neuroradiology Section, Department of Radiology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Ana de Arce
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Noemí Díez
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Félix Gonzalez
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Pablo Iruzubieta
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Naroa Sulibarria
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
| | - Josep Puig
- Department of Radiology, Dr. Josep Trueta University Hospital and Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Maite Martínez-Zabaleta
- Stroke Unit, Department of Neurology, Donostia University Hospital, Donostia-San Sebastian, Spain
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12
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Schaller-Paule MA, Foerch C, Bohmann FO, Lapa S, Misselwitz B, Kohlhase K, Rosenow F, Strzelczyk A, Willems LM. Predicting Poststroke Pneumonia in Patients With Anterior Large Vessel Occlusion: A Prospective, Population-Based Stroke Registry Analysis. Front Neurol 2022; 13:824450. [PMID: 35250827 PMCID: PMC8893016 DOI: 10.3389/fneur.2022.824450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To assess predictive factors for poststroke pneumonia (PSP) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of the anterior circulation, with special regard to the impact of intravenous thrombolysis (IVT) and endovascular treatment (EVT) on the risk of PSP. As a secondary goal, the validity of the A2DS2, PNEUMONIA, and ISAN scores in LVO will be determined. Methods Analysis was based on consecutive data for the years 2017 to 2019 from the prospective inpatient stroke registry covering the entire federal state of Hesse, Germany, using the Kruskal-Wallis test and binary logistic regression. Results Data from 4,281 patients with LVO were included in the analysis (54.8% female, median age = 78 years, range = 18–102), of whom 66.4% (n = 2,843) received recanalization therapy (RCT). In total, 19.4% (n = 832) of all LVO patients developed PSP. Development of PSP was associated with an increase in overall in-hospital mortality of 32.1% compared with LVO patients without PSP (16.4%; p < 0.001). Incidence of PSP was increased in 2132 patients with either EVT (n = 928; 25.9% PSP incidence) or combined EVT plus IVT (n = 1,204; 24.1%), compared with 2,149 patients with IVT alone (n = 711; 15.2%) or conservative treatment only (n = 1,438; 13.5%; p < 0.001). Multivariate analysis identified EVT (OR 1.5) and combined EVT plus IVT (OR 1.5) as significant independent risk factors for PSP. Furthermore, male sex (OR 1.9), age ≥ 65 years (OR 1.7), dysphagia (OR 3.2) as well as impaired consciousness at arrival (OR 1.7) and the comorbidities diabetes (OR 1.4) and atrial fibrillation (OR 1.3) were significantly associated risk factors (each p < 0.001). Minor stroke (NIHSS ≤ 4) was associated with a significant lower risk of PSP (OR 0.5). Performance of risk stratification scores varied between A2DS2 (96.1% sensitivity, 20.7% specificity), PNEUMONIA (78.2% sensitivity and 45.1% specificity) and ISAN score (98.0% sensitivity, 20.0% specificity). Conclusion Nearly one in five stroke patients with LVO develops PSP during acute care. This risk of PSP is further increased if an EVT is performed. Other predictive factors are consistent with those previously described for all AIS patients. Available risk stratification scores proved to be sensitive tools in LVO patients but lack specificity.
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Affiliation(s)
- Martin A. Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- *Correspondence: Martin A. Schaller-Paule
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | | | - Konstantin Kohlhase
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Laurent M. Willems
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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Wu M, Zha M, Zhang X, Yuan K, Huang K, Xie Y, Dai Q, Liu X. Predictors of mortality for acute vertebrobasilar artery occlusion receiving endovascular treatment. Acta Neurol Scand 2021; 144:433-439. [PMID: 34105145 DOI: 10.1111/ane.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute vertebrobasilar artery occlusion (VBAO) is a devastating type of stroke with a high mortality rate. This study aimed to investigate the predictors of 3-month and 1-year mortality in VBAO patients receiving endovascular treatment (EVT). MATERIALS & METHODS Consecutive acute VBAO patients undergoing EVT between January 2014 and December 2019 were retrospectively analyzed in a prospectively maintained database. Multivariate logistical regression models were used to explore the potential predictors of mortality at 3 months and 1 year, respectively. The discrimination of the final model was assessed with the area under the receiver operating characteristic curve. RESULTS A total of 100 patients were enrolled in this study (mean age 62 years; 77.0% male). After excluding patients lost to follow-up, the overall mortality rate was 34.3% (34/99) at 3 months and 45.4% (44/97) at 1 year. The Glasgow Coma Scale (GCS) score at 24 h (Odds ratio [OR], 0.676; 95% confidence interval [CI], 0.540-0.846; p = .001) and mechanical ventilation (MV) (OR, 7.356; 95% CI, 2.200-24.593; p = .001) were predictors of 3-month mortality after adjusting for potential confounders in multivariable analysis. Furthermore, the GCS score at 24 h (OR, 0.714; 95% CI, 0.590-0.864; p = .001), intracranial hemorrhage (OR, 7.330; 95% CI, 1.772-30.318; p = .006), and MV (OR, 5.804; 95% CI, 1.841-18.294; p = .003) were independently associated with mortality at 1 year. Sensitivity analyses showed similar results. CONCLUSION The 24-h GCS score and MV were common predictors of 3-month and 1-year mortality, and ICH was an additional predictor of 1-year mortality.
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Affiliation(s)
- Min Wu
- Department of Neurology Jinling HospitalThe First School of Clinical MedicineSouthern Medical University Nanjing China
| | - Mingming Zha
- Department of Neurology Jinling HospitalMedical School of Southeast University Nanjing China
| | - Xiaohao Zhang
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Kang Yuan
- Department of Neurology Jinling HospitalNanjing Medical University Nanjing China
| | - Kangmo Huang
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Yi Xie
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Qiliang Dai
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
| | - Xinfeng Liu
- Department of Neurology Jinling HospitalThe First School of Clinical MedicineSouthern Medical University Nanjing China
- Department of Neurology Jinling HospitalAffiliated Medical School of Nanjing University Nanjing China
- Stroke Center & Department of Neurology Division of Life Sciences and Medicine the First Affiliated Hospital of USTCUniversity of Science and Technology of China Hefei China
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Fandler-Höfler S, Stauber RE, Kneihsl M, Wünsch G, Haidegger M, Poltrum B, Pichler A, Deutschmann H, Enzinger C, Fickert P, Gattringer T. Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke. Ther Adv Neurol Disord 2021; 14:17562864211037239. [PMID: 34484426 PMCID: PMC8411648 DOI: 10.1177/17562864211037239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Liver fibrosis has been identified as an outcome predictor in cardiovascular
disease and has been associated with hematoma expansion and mortality in
patients with primary intracerebral hemorrhage. We aimed to explore whether
clinically inapparent liver fibrosis is related to neurological outcome,
mortality, and intracranial hemorrhage risk in ischemic stroke patients
after mechanical thrombectomy. Methods: We included consecutive patients with anterior circulation large vessel
occlusion stroke treated at our center with mechanical thrombectomy between
January 2011 and April 2019. Clinical data had been collected prospectively;
laboratory data were extracted from our electronic hospital information
system. We calculated the Fibrosis-4 index (FIB-4), an established
non-invasive liver fibrosis test. The main outcomes were postinterventional
intracranial hemorrhage, unfavorable functional status (modified Rankin
scale scores of 3–6), and mortality three months post-stroke. Results: In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4
indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated
with unfavorable neurological outcomes and mortality three months
post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for
unfavorable outcome in patients with positive FIB-4, 95% confidence interval
(CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI
1.16–4.03, p = 0.01]. However, FIB-4 was neither related to
hemorrhagic transformation nor symptomatic intracranial hemorrhage.
Moreover, atrial fibrillation was more frequent in patients with liver
fibrosis (p < 0.001). Two further commonly-used liver
fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded
comparable results regarding outcome and atrial fibrillation. Conclusions: Clinically inapparent liver fibrosis (based on simple clinical and laboratory
parameters) represents an independent risk factor for unfavorable outcomes,
including mortality, at three months after stroke thrombectomy. Elevated
liver fibrosis indices warrant further hepatological work-up and thorough
screening for atrial fibrillation in stroke patients.
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Affiliation(s)
| | - Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Gerit Wünsch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Birgit Poltrum
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, 8036, Austria Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria
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Li Y, Luo NC, Zhang X, Hara T, Inadomi C, Li TS. Prolonged oxygen exposure causes the mobilization and functional damage of stem or progenitor cells and exacerbates cardiac ischemia or reperfusion injury in healthy mice. J Cell Physiol 2021; 236:6657-6665. [PMID: 33554327 DOI: 10.1002/jcp.30317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/31/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
Oxygen is often administered to patients and occasionally to healthy individuals as well; however, the cellular toxicity of oxygen, especially following prolonged exposure, is widely known. To evaluate the potential effect of oxygen exposure on circulating stem/progenitor cells and cardiac ischemia/reperfusion (I/R) injury, we exposed healthy adult mice to 100% oxygen for 20 or 60 min. We then examined the c-kit-positive stem/progenitor cells and colony-forming cells and measured the cytokine/chemokine levels in peripheral blood. We also induced cardiac I/R injury in mice at 3 h after 60 min of oxygen exposure and examined the recruitment of inflammatory cells and the fibrotic area in the heart. The proportion of c-kit-positive stem/progenitor cells significantly increased in peripheral blood at 3 and 24 h after oxygen exposure for either 20 or 60 min (p < .01 vs. control). However, the abundance of colony-forming cells in peripheral blood conversely decreased at 3 and 24 h after oxygen exposure for only 60 min (p < .05 vs. control). Oxygen exposure for either 20 or 60 min resulted in significantly decreased plasma vascular endothelial growth factor levels at 3 h, whereas oxygen exposure for only 60 min reduced plasma insulin-like growth factor 1 levels at 24 h (p < .05 vs. control). Protein array indicated the increase in the levels of some cytokines/chemokines, such as CXCL6 (GCP-2) at 24 h after 60 min of oxygen exposure. Moreover, oxygen exposure for 60 min enhanced the recruitment of Ly6g- and CD11c-positive inflammatory cells at 3 days (p < .05 vs. control) and increased the fibrotic area at 14 days in the heart after I/R injury (p < .05 vs. control). Prolonged oxygen exposure induced the mobilization and functional impairment of stem/progenitor cells and likely enhanced inflammatory responses to exacerbate cardiac I/R injury in healthy mice.
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Affiliation(s)
- Yu Li
- School of Medicine, Nanchang University, Nanchang, Jiangxi, China
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Na-Chuan Luo
- School of Medicine, Nanchang University, Nanchang, Jiangxi, China
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Xu Zhang
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chiaki Inadomi
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tao-Sheng Li
- Department of Stem Cell Biology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Michalski D, Jungk C, Brenner T, Dietrich M, Nusshag C, Reuß CJ, Fiedler MO, Bernhard M, Beynon C, Weigand MA. [Focus neurological intensive care medicine : Intensive medical care studies from 2019/2020]. Anaesthesist 2021; 70:164-170. [PMID: 33051691 PMCID: PMC7851099 DOI: 10.1007/s00101-020-00861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Michalski
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - C Jungk
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - M Dietrich
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Nusshag
- Klinik für Endokrinologie, Stoffwechsel und klinische Chemie/Sektion Nephrologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C J Reuß
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M O Fiedler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - C Beynon
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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17
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Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy. Transl Stroke Res 2021; 12:791-798. [PMID: 33398648 PMCID: PMC8421282 DOI: 10.1007/s12975-020-00881-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Data on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.
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Cappellari M, Toni D. Response by Cappellari and Toni to Letter Regarding Article, “General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke”. Stroke 2020; 51:e333-e334. [DOI: 10.1161/strokeaha.120.032094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Manuel Cappellari
- DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C.)
| | - Danilo Toni
- Emergency Department Stroke Unit, Sapienza University Hospital, Roma, Italy (D.T.)
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Zhu Y, Gao J, Lv Q, Yin Q, Yang D. Risk Factors and Outcomes of Stroke-Associated Pneumonia in Patients with Stroke and Acute Large Artery Occlusion Treated with Endovascular Thrombectomy. J Stroke Cerebrovasc Dis 2020; 29:105223. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
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