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Feyen L, Kniep H, Blockhaus C, Weinzierl M, Katoh M, Haage P, Rohde S, Münnich N. Thrombectomy in ischemic stroke patients with alberta stroke program early computed tomography score 4-5 and 0-3: Factors associated with favorable outcome. J Stroke Cerebrovasc Dis 2023; 32:107104. [PMID: 37156088 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107104] [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: 11/27/2022] [Revised: 03/04/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy. MATERIAL AND METHODS All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanalization was defined as Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Multivariable logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome. RESULTS 621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neurological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanalization (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome. CONCLUSION Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable outcome in patients with low ASPECTS.
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Germany, Heusnerstraße 40, 42283, Wuppertal.
| | - Helge Kniep
- Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Christian Blockhaus
- Heart Centre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, Witten 58448, Germany
| | - Martin Weinzierl
- Department of Neurosurgery, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Patrick Haage
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Stefan Rohde
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany; German Society of Interventional Radiology and Minimal Invasive Therapy, German Society of Interventional Radiology and Minimal Invasive Therapy (DeGIR) and German Society of Neuroradiology (DGNR), Ernst Reuter Platz 10, Berlin 10587, Germany
| | - Nico Münnich
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany
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Shen Y, Zhou Y, Xiong J, Xiao K, Zhang P, Liu J, Ren L. Association Between Cerebral Autoregulation and Long-Term Outcome in Patients With Acute Ischemic Stroke. Neurologist 2022; 27:319-323. [PMID: 35680391 DOI: 10.1097/nrl.0000000000000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dynamic cerebral autoregulation (CA) is known to be impaired in patients with acute ischemic stroke (AIS), but whether or not dynamic CA can predict long-term outcomes is unclear. MATERIALS AND METHODS This prospective study included 103 patients with AIS between September 2017 and April 2019. We measured the middle cerebral artery blood flow velocity and blood pressure within 7 days of AIS onset using a transcranial Doppler and Finometer, respectively. We conducted transfer function analysis to calculate dynamic CA indices (phase and gain), with lower phase and higher gain parameters reflecting less efficient CA. We followed up all patients after 3 and 12 months. Patients with 12-month modified Rankin Scale scores of <2 and ≥2 were defined as having favorable and unfavorable outcomes, respectively. We then analyzed the predictors of unfavorable outcomes after 3 and 12 months using logistic regression. RESULTS The ipsilesional phase parameter was significantly lower in patients with unfavorable outcomes than in those with favorable outcomes. Multiple logistic regression analysis revealed that the ipsilesional phase parameter and the National Institutes of Health Stroke Scale score were nonmodifiable predictors of short-term and long-term outcomes. Moreover, in receiver operating characteristic analysis, the area under the curve of the ipsilesional phase parameter was 0.646 (95% confidence interval: 0.513-0.779, P =0.044). Notably, the optimal cut-off value was 20.33 degrees (sensitivity: 63%, specificity: 70%). CONCLUSION Dynamic CA is an independent predictor of outcomes at 3 and 12 months in patients with AIS.
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Affiliation(s)
- Yanxia Shen
- Department of Neurology, South China Hospital of Shenzhen University
| | - Yanxia Zhou
- Department of Neurology, the First Affiliated Hospital of Shenzhen University Shenzhen Second People's Hospital
| | - Juan Xiong
- School of Public Health, Health Science Center, Shenzhen University
| | - Kun Xiao
- Department of Neurology, the First Affiliated Hospital of Shenzhen University Shenzhen Second People's Hospital
| | - Pandeng Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, the First Affiliated Hospital of Shenzhen University Shenzhen Second People's Hospital
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Padmos RM, Arrarte Terreros N, Józsa TI, Závodszky G, Marquering HA, Majoie CBLM, Payne SJ, Hoekstra AG. Modelling collateral flow and thrombus permeability during acute ischaemic stroke. J R Soc Interface 2022; 19:20220649. [PMID: 36195117 PMCID: PMC9532024 DOI: 10.1098/rsif.2022.0649] [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: 11/05/2022] Open
Abstract
The presence of collaterals and high thrombus permeability are associated with good functional outcomes after an acute ischaemic stroke. We aim to understand the combined effect of the collaterals and thrombus permeability on cerebral blood flow during an acute ischaemic stroke. A cerebral blood flow model including the leptomeningeal collateral circulation is used to simulate cerebral blood flow during an acute ischaemic stroke. The collateral circulation is varied to capture the collateral scores: absent, poor, moderate and good. Measurements of the transit time, void fraction and thrombus length in acute ischaemic stroke patients are used to estimate thrombus permeability. Estimated thrombus permeability ranges between 10-7 and 10-4 mm2. Measured flow rates through the thrombus are small and the effect of a permeable thrombus on brain perfusion during stroke is small compared with the effect of collaterals. Our simulations suggest that the collaterals are a dominant factor in the resulting infarct volume after a stroke.
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Affiliation(s)
- Raymond M. Padmos
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands,Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628, The Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Tamás I. Józsa
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Gábor Závodszky
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
| | - Henk A. Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands,Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Stephen J. Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK,Institute of Applied Mechanics, National Taiwan University, Taiwan
| | - Alfons G. Hoekstra
- Computational Science Laboratory, Informatics Institute, Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam 1098, The Netherlands
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Jiang X, Morgenstern LB, Cigolle CT, Wang L, Claflin ES, Lisabeth LD. Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke. Stroke 2022; 53:120-127. [PMID: 34517767 PMCID: PMC8712371 DOI: 10.1161/strokeaha.120.032595] [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: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people. METHODS In a prospective cohort of ischemic stroke patients (2008-2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0-35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1-4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined. RESULTS Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score >3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant. CONCLUSIONS MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.
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Affiliation(s)
- Xiaqing Jiang
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Lewis B. Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Stroke Program, University of Michigan Medical School
| | - Christine T. Cigolle
- Department of Family Medicine and Internal Medicine, University of Michigan Medical School, Geriatric Research, Education and Clinical Center, VA Ann Arbor Healthcare System
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Edward S. Claflin
- Stroke Program, University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Stroke Program, University of Michigan Medical School
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Althaus K, Dreyhaupt J, Hyrenbach S, Pinkhardt EH, Kassubek J, Ludolph AC. MRI as a first-line imaging modality in acute ischemic stroke: a sustainable concept. Ther Adv Neurol Disord 2021; 14:17562864211030363. [PMID: 34471423 PMCID: PMC8404629 DOI: 10.1177/17562864211030363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Computed tomography (CT) scans are the first-line imaging technique in acute stroke patients based on the argument of rapid feasibility. Using magnetic resonance imaging (MRI) as the first-line imaging technique is the exception to the rule, although it provides much more diagnostic information and avoids exposure to radiation. We evaluated whether an MRI-based acute stroke concept is fast, suitable, and useful to improve recanalization rates and patient outcomes. Methods: We performed a retrospective observational cohort study comparing patients treated at a comprehensive stroke center (Ulm/Germany) applying an MRI-based acute stroke concept with patients recorded in a large comprehensive stroke registry in Baden-Württemberg (Germany). We analyzed the quality indicators of acute stroke treatment, patient’s outcome, and the rate of transient ischemic attack (TIA) at discharge. Results: A total of 2182 patients from Ulm and 82,760 patients from the Baden-Württemberg (BW) stroke registry (including 29,575 patients of comprehensive stroke centers (BWc)) were included. Intravenous thrombolysis rate was higher in Ulm than in BW or the BWc stroke centers (Ulm 27.4% versus BW 20.9% versus BWc 26.1; p < 0.01), while a door-to-needle time <30 min could be achieved more frequently (Ulm 73.6% versus BW 44.1% versus BWc 47.1%; p < 0.01). Thrombectomy rate in patients with a proximal vascular occlusion was higher (Ulm 69.2% versus BW 50.7% versus BWc 59.3; p < 0.01). The number of TIA diagnoses was lower (Ulm 16.2% versus BW 24.6% versus BWc 19.9%; p < 0.01). More patients showed a shift to a favorable outcome (Ulm 21.1% versus BW 16.9% versus BWc 15.3; p < 0.01). Complication rates were similar. Conclusions: The MRI-based acute stroke concept is suitable, fast and seems to be beneficial. The time-dependent quality indicators were better both in comparison to all stroke units and to the comprehensive stroke units in the area. Based on the MRI concept, high rates of recanalization procedures and fewer TIA diagnoses could be observed. In addition, there was a clear trend towards an improved clinical outcome. A clinical trial comparing the effects of CT and MRI as the primary imaging technique in otherwise identical stroke unit settings is warranted.
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Affiliation(s)
- Katharina Althaus
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, Baden-Wuerttemberg 89075, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Sonja Hyrenbach
- Qualitätssicherung im Gesundheitswesen Baden-Württemberg, Stuttgart, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany
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Jiang X, Wang L, Morgenstern LB, Cigolle CT, Claflin ES, Lisabeth LD. New Index for Multiple Chronic Conditions Predicts Functional Outcome in Ischemic Stroke. Neurology 2021; 96:e42-e53. [PMID: 33024024 PMCID: PMC7884978 DOI: 10.1212/wnl.0000000000010992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/20/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke. METHODS A prospective cohort of patients with ischemic stroke (2008-2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1-4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments. RESULTS Prestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS. CONCLUSIONS A new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.
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Affiliation(s)
- Xiaqing Jiang
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI
| | - Lu Wang
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI
| | - Lewis B Morgenstern
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI
| | - Christine T Cigolle
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI
| | - Edward S Claflin
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI
| | - Lynda D Lisabeth
- From the Departments of Epidemiology (X.J., L.B.M., L.D.L.) and Biostatistics (L.W.), School of Public Health, University of Michigan; Stroke Program (L.B.M., E.S.C., L.D.L.), Department of Family Medicine (C.T.C.), Department of Internal Medicine (C.T.C.), and Ann Arbor Healthcare System, Department of Physical Medicine and Rehabilitation (E.S.C.), University of Michigan Medical School; and VA Geriatric Research Education and Clinical Center (C.T.C.), Ann Arbor, MI.
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Deb-Chatterji M, Pinnschmidt H, Flottmann F, Leischner H, Broocks G, Alegiani A, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G. Predictors of independent outcome of thrombectomy in stroke patients with large baseline infarcts in clinical practice: a multicenter analysis. J Neurointerv Surg 2020; 12:1064-1068. [DOI: 10.1136/neurintsurg-2019-015641] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
ObjectiveTo analyze outcome and its predictors after endovascular treatment (ET) in stroke patients suffering from large vessel occlusion with large pre-treatment infarct cores defined by an Alberta Stroke Program Early CT Score (ASPECTS) <6.MethodsWe analyzed data from an industry-independent, multicenter, prospective registry (German Stroke Registry – Endovascular Treatment) which enrolled consecutive patients treated by ET (June 2015–April 2018) with different devices. Multivariate logistic regression analyses identified predictors of independent outcome (IO) defined as a modified Rankin Scale (mRS) 0–2, and mortality at 90 days in patients with ASPECTS <6.ResultsOf 1700 patients included in the analysis, 152 (8.9%) had a baseline ASPECTS <6. Of these, 33 patients (21.6%) achieved IO, and 68 (44.7%) were dead at 90 days. A lower age, lower baseline National Institutes of Health Stroke Scale (NIHSS) score, and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) were predictors of IO. Successful recanalization had the strongest association with IO (OR 7.0, 95% CI 1.8 to 26.8). Pre-treatment parameters predicting IO were age <70 years (sensitivity 0.79, specificity 0.69) and NIHSS <12 (0.57 and 0.94). A higher age, a pre-stroke mRS score >1, and failed recanalization were predictors of death.ConclusionsA substantial proportion of stroke patients with an ASPECTS <6 can achieve independence after thrombectomy, in particular, if they are younger, have only moderate baseline stroke symptoms, and no relevant pre-stroke disability. These results may encourage considering thrombectomy in low ASPECTS patients in clinical practice until randomized trials are available.
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
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Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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9
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Çetiner M, Aydin HE, Güler M, Canbaz Kabay S, Zorlu Y. Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke. Clin Appl Thromb Hemost 2018; 24:171S-177S. [PMID: 30213193 PMCID: PMC6714831 DOI: 10.1177/1076029618796317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The objective of our study is to detect the patient group that will most benefit
from intravenous (IV) thrombolytic therapy by showing predictive factors of good
functional outcomes. The present study covers 88 patients who were admitted to
our clinic within the first 4.5 hours from the onset of stroke symptoms,
diagnosed with acute ischemic stroke and who received IV thrombolytic therapy
between May 2014 and June 2017 as a result of a retrospective analysis of a
database prospectively collected. The patients with a score of ≤2 on modified
Rankin scale within 3 months were accepted as good functional outcome and those
with a score of >2 were accepted as poor functional outcome. As a result,
within the period of 3 months posttreatment, good functional outcomes were
obtained in 45 (51.1%) patients and poor functional outcomes were obtained in 43
(48.9%) patients. In comparisons, cardioembolic stroke group was statistically
significantly higher in the good functional outcome group (P =
.03). Pretreatment National Institute of Health Stroke Scale (NIHSS) scores
(P < .001), presence of proximal hyperintense middle
cerebral artery sign in noncontrast computed brain tomography
(P = .03), and being aged ≥80 and older (P
= .04) were markedly higher in the group with poor functional outcomes. In
conclusion, our study demonstrated that cardioembolic strokes may have an impact
on good functional outcomes and being aged 80 and older, presence of proximal
HMCAS in computed brain tomography, and pretreatment NIHSS scores may have an
impact on poor functional outcomes.
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Affiliation(s)
- Mustafa Çetiner
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Hasan Emre Aydin
- Department of Neurosurgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Merve Güler
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Sibel Canbaz Kabay
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Yaşar Zorlu
- Department of Neurology, Ministry of Health Tepecik Teaching and Research Hospital, İzmir, Turkey
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10
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Long-term outcomes of acute ischemic stroke patients treated with endovascular thrombectomy: A real-world experience. J Neurol Sci 2018; 390:77-83. [DOI: 10.1016/j.jns.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/21/2022]
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11
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Zwahlen M, Salanti G. Causal inference from experiment and observation. EVIDENCE-BASED MENTAL HEALTH 2018; 21:34-38. [PMID: 29289944 PMCID: PMC10283410 DOI: 10.1136/eb-2017-102859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
Results from well-conducted randomised controlled studies should ideally inform on the comparative merits of treatment choices for a health condition. In the absence of this, one attempts to use evidence from the impact of treatment when administered according to decisions of the physicians and the patients (observational evidence). Naïve comparisons between treatment options using observational evidence will lead to biased results. Under certain conditions, however, it is possible to obtain valid estimates of the comparative merits of different treatments from observational data. Causal inference can be conceptualised as a framework aiming to provide valid information about causal effects of treatments using observational evidence. It can be viewed as a missing data problem in which each patient has two outcomes: the observed outcome under the treatment actually received and a counterfactual (unobserved) outcome had the patient received a different treatment. Methodological developments over the last decades clarified the appropriate conditions and methods to obtain valid comparisons. This article provides an introduction to some of these methods.
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Affiliation(s)
- Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Geogia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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12
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The impact of IV alteplase on long-term patient survival: The Georgia Coverdell acute stroke registry's experience. Am J Emerg Med 2018; 36:262-265. [DOI: 10.1016/j.ajem.2017.07.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/28/2017] [Accepted: 07/30/2017] [Indexed: 11/23/2022] Open
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13
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Hemmrich M, Peterson E, Thomitzek K, Weitz J. Spotlight on unmet needs in stroke prevention: The PIONEER AF-PCI, NAVIGATE ESUS and GALILEO trials. Thromb Haemost 2017; 116:S33-S40. [DOI: 10.1160/th16-06-0487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/10/2016] [Indexed: 11/05/2022]
Abstract
SummaryAtrial fibrillation (AF) is a major healthcare concern, being associated with an estimated five-fold risk of ischaemic stroke. In patients with AF, anticoagulants reduce stroke risk to a greater extent than acetylsalicylic acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel. Non-vitamin K antagonist oral anticoagulants (NOACs) are now a widely-accepted therapeutic option for stroke prevention in non-valvular AF (NVAF). There are particular patient types with NVAF for whom treatment challenges remain, owing to sparse clinical data, their high-risk nature or a need to harmonise anticoagulant and antiplatelet regimens if co-administered. This article focuses on three randomised controlled trials (RCTs) that are investigating the utility of rivaroxaban, a direct, oral, factor Xa inhibitor, in additional areas of stroke prevention where data for anticoagulants are lacking: oPenlabel, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment (PIONEER AF-PCI); New Approach riVaroxoban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS); and Global study comparing a rivAroxaban-based antithrombotic strategy to an antipLatelet-based strategy after transcatheter aortIc vaLve rEplacement to Optimize clinical outcomes (GALILEO). Data from these studies present collaborative efforts to build upon existing registrational Phase III data for rivaroxaban, driving the need for effective and safe treatment of a wider range of patients for stroke prevention.
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Tran T, Bliuc D, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse RG, Kaiser SM, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR. Population-Wide Impact of Non-Hip Non-Vertebral Fractures on Mortality. J Bone Miner Res 2017; 32:1802-1810. [PMID: 28256011 DOI: 10.1002/jbmr.3118] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2016] [Accepted: 02/27/2016] [Indexed: 11/11/2022]
Abstract
Data on long-term consequences of non-hip non-vertebral (NHNV) fractures, accounting for approximately two-thirds of all fragility fractures, are scanty. Our study aimed to quantify the population-wide impact of NHNV fractures on mortality. The national population-based prospective cohort study (Canadian Multicentre Osteoporosis Study) included 5526 community dwelling women and 2163 men aged 50 years or older followed from July 1995 to September 2013. Population impact number was used to quantify the average number of people for whom one death would be attributable to fracture and case impact number to quantify the number of deaths out of which one would be attributable to a fracture. There were 1370 fragility fractures followed by 296 deaths in women (mortality rate: 3.49; 95% CI, 3.11 to 3.91), and 302 fractures with 92 deaths in men (5.05; 95% CI, 4.12 to 6.20). NHNV fractures accounted for three-quarters of fractures. In women, the population-wide impact of NHNV fractures on mortality was greater than that of hip and vertebral fractures because of the greater number of NHNV fractures. Out of 800 women, one death was estimated to be attributable to a NHNV fracture, compared with one death in 2000 women attributable to hip or vertebral fracture. Similarly, out of 15 deaths in women, one was estimated to be attributable to a NHNV fracture, compared with one in over 40 deaths for hip or vertebral fracture. The impact of forearm fractures (ie, one death in 2400 women and one out of 42 deaths in women attributable to forearm fracture) was similar to that of hip, vertebral, or rib fractures. Similar, albeit not significant, results were noted for men. The study highlights the important contribution of NHNV fractures on mortality because many NHNV fracture types, except for the most distal fractures, have serious adverse consequences that affect a significant proportion of the population. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Thach Tran
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - Dana Bliuc
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - Tineke van Geel
- Department of Family Medicine, Research School Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Claudie Berger
- Canadian Multicentre Osteoporosis Study (CaMos) National Coordinating Centre, McGill University, Montreal, Quebec, Canada
| | - Joop van den Bergh
- Department of Internal Medicine, Subdivision of Rheumatology, Research School Nutrim, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands
| | - John A Eisman
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Research School Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands.,Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - David Goltzman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - David A Hanley
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G Josse
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie M Kaiser
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Lisa Langsetmo
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jerilynn C Prior
- Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tuan V Nguyen
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline R Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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15
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Brown MD, Burton JH, Nazarian DJ, Promes SB. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med 2016; 66:322-333.e31. [PMID: 26304253 DOI: 10.1016/j.annemergmed.2015.06.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Willeit J, Geley T, Schöch J, Rinner H, Tür A, Kreuzer H, Thiemann N, Knoflach M, Toell T, Pechlaner R, Willeit K, Klingler N, Praxmarer S, Baubin M, Beck G, Berek K, Dengg C, Engelhardt K, Erlacher T, Fluckinger T, Grander W, Grossmann J, Kathrein H, Kaiser N, Matosevic B, Matzak H, Mayr M, Perfler R, Poewe W, Rauter A, Schoenherr G, Schoenherr HR, Schinnerl A, Spiss H, Thurner T, Vergeiner G, Werner P, Wöll E, Willeit P, Kiechl S. Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study. Lancet Neurol 2015; 14:48-56. [DOI: 10.1016/s1474-4422(14)70286-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Determinants of early outcomes in patients with acute ischemic stroke and proximal artery occlusion. J Stroke Cerebrovasc Dis 2014; 23:2527-2532. [PMID: 25238927 DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/23/2014] [Accepted: 03/29/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Proximal artery occlusions (PAO) recanalize in only a small percentage of acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV tPA) alone, yet the benefits of adjunctive or substitutive intra-arterial therapy (IAT) in this patient subgroup are not well established. We evaluated early poststroke outcomes in a cohort of AIS patients with PAO categorized as "likely to benefit" (LTB) from IAT using prespecified criteria. METHODS Using a prespecified protocol, 193 patients from our institutional stroke database admitted between January 1, 2007, and December 31, 2011, were prospectively deemed LTB from IAT. Logistic regression was used to determine independent predictors of favorable (discharge to home or acute rehabilitation) versus unfavorable (discharge to skilled nursing facility, hospice, or in-hospital mortality) outcome. RESULTS Of the patients included, 29.5% received IV tPA only, 11.4% underwent IAT only, and 37.8% had both. Overall in-hospital mortality was 19.2%. In a univariate analysis, age (odds ratio [OR], .95; 95% confidence interval [CI], .93-.98), IV tPA (OR, 2.3; 95% CI, 1.2-4.3), and history of atrial fibrillation (OR, .5; 95% CI, .28-.97) were associated with outcome. Effect of IAT was not statistically significant (OR, 1.3; 95% CI, .7-2.3; P = .4). In multivariate analysis, the only independent predictor of favorable outcome was IV tPA administration (OR, 2.4; 95% CI, 1.2-5.0). The odds of favorable poststroke outcome were significantly lowered (OR, .3; 95% CI, .1-.6; P = .0006) in those receiving neither IV tPA nor IAT. CONCLUSIONS In AIS patients with PAO thought most likely to benefit from IAT, IV tPA independently predicted favorable outcomes. These data reinforce the recommendation to provide early IV tPA to all eligible patients.
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18
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Schmitz ML, Simonsen CZ, Hundborg H, Christensen H, Ellemann K, Geisler K, Iversen H, Madsen C, Rasmussen MJ, Vestergaard K, Andersen G, Johnsen SP. Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study. Stroke 2014; 45:3070-2. [PMID: 25190440 DOI: 10.1161/strokeaha.114.006570] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes. RESULTS Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients. CONCLUSIONS Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.
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Affiliation(s)
- Marie Louise Schmitz
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
| | - Claus Z Simonsen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Heidi Hundborg
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Hanne Christensen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Karsten Ellemann
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Karin Geisler
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Helle Iversen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Charlotte Madsen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Mary-Jette Rasmussen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Karsten Vestergaard
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Grethe Andersen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
| | - Soeren P Johnsen
- From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.)
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Eugène F, Gauvrit JY, Ferré JC, Gentric JC, Besseghir A, Ronzière T, Raoult H. One-year MR angiographic and clinical follow-up after intracranial mechanical thrombectomy using a stent retriever device. AJNR Am J Neuroradiol 2014; 36:126-32. [PMID: 25125665 DOI: 10.3174/ajnr.a4071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the consequences of arterial wall damage that may be due to mechanical endovascular thrombectomy. Our aim was to perform 1-year MR angiographic and clinical follow-up of patients treated with mechanical endovascular thrombectomy using the Solitaire device. MATERIALS AND METHODS Patients with stroke treated between August 2010 and July 2012 were prospectively evaluated with a minimum follow-up of 1 year after mechanical endovascular thrombectomy. Angiographic follow-up was performed on a 3T MR imaging scanner and included intracranial artery TOF MRA and supra-aortic artery gadolinium-enhanced MRA. Images were assessed to detect arterial abnormalities (stenosis, occlusion, dilation) and were compared with the final post-mechanical endovascular thrombectomy run to differentiate delayed and pre-existing abnormalities. Clinical evaluation was performed with the mRS and the 36-Item Short-Form Health Survey questionnaire quality-of-life scale. RESULTS Thirty-nine patients were angiographically assessed at the mean term of 19 ± 4 months. MRA showed intracranial artery abnormalities in 10 patients, including 5 delayed intracranial artery abnormalities in 4 patients (4 stenoses and 1 dilation), 4 cases of pre-existing intracranial artery stenosis, and 2 occlusions. Pre-existing etiologic cervical artery stenosis or occlusion was observed in 2 patients. All these patients remained asymptomatic during the follow-up period. A significant clinical improvement was observed at 1-year follow-up in comparison with 3-month follow-up (P < .0001), with a good outcome achieved in 62.5% of patients and an acceptable quality of life restored. CONCLUSIONS One-year follow-up identifies delayed asymptomatic arterial abnormalities in patients treated with the Solitaire device.
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Affiliation(s)
- F Eugène
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-Y Gauvrit
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-C Ferré
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
| | - J-C Gentric
- Department of Neuroradiology (J.-C.G.), Centre Hospitalier Universitaire, Brest, France
| | | | - T Ronzière
- Neurology (T.R.), Centre Hospitalier Universitaire, Rennes, France
| | - H Raoult
- From the Departments of Neuroradiology (F.E., J.-Y.G., J.-C.F., H.R.)
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20
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Rocha J, Pinho J, Varanda S, Amorim J, Rocha J, Fontes JR, Maré R, Ferreira C. Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: predictive factors and prognosis. Clin Neurol Neurosurg 2014; 125:19-23. [PMID: 25080045 DOI: 10.1016/j.clineuro.2014.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 06/30/2014] [Accepted: 07/07/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis. METHODS We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS≥10 were included. Improvement of ≥10 or a score ≤3 24h after thrombolysis was defined as DR. RESULTS In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p=0.024), less total anterior circulation infarcts (p=0.009), more partial anterior circulation infarcts (p=0.003) and lower blood glucose on admission (118 vs 128mg/dL, p=0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p=0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p<0.001). Intracranial hemorrhage on 24h-control CT scan was less frequent in the DR group (p<0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR=2.35, 95%CI=1.32-4.16, p=0.003) and CT evidence of recanalization was independently associated with DR (OR=11.60, 95%CI, 3.02-44.53, p<0.001). CONCLUSION DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization.
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Affiliation(s)
- João Rocha
- Neurology Department of Hospital de Braga, Braga, Portugal.
| | - João Pinho
- Neurology Department of Hospital de Braga, Braga, Portugal
| | - Sara Varanda
- Neurology Department of Hospital de Braga, Braga, Portugal
| | - José Amorim
- Neuroradiology Department of Hospital de Braga, Braga, Portugal
| | - Jaime Rocha
- Neuroradiology Department of Hospital de Braga, Braga, Portugal
| | | | - Ricardo Maré
- Neurology Department of Hospital de Braga, Braga, Portugal
| | - Carla Ferreira
- Neurology Department of Hospital de Braga, Braga, Portugal
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21
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Heldner MR, Mattle HP, Jung S, Fischer U, Gralla J, Zubler C, El-Koussy M, Schroth G, Arnold M, Mono ML. Thrombolysis in patients with prior stroke within the last 3 months. Eur J Neurol 2014; 21:1493-9. [DOI: 10.1111/ene.12519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. R. Heldner
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - H. P. Mattle
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - S. Jung
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - U. Fischer
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - J. Gralla
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - C. Zubler
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - M. El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - G. Schroth
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - M. Arnold
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - M.-L. Mono
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
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22
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Moro CHC, Gonçalves ARR, Longo AL, Fonseca PG, Harger R, Gomes DB, Ramos MC, Estevam ALG, Fissmer CS, Garcia AC, Nagel V, Cabral NL. Trends of the Incidence of Ischemic Stroke Thrombolysis over Seven Years and One-Year Outcome: A Population-Based Study in Joinville, Brazil. Cerebrovasc Dis Extra 2013; 3:156-66. [PMID: 24570681 PMCID: PMC3924708 DOI: 10.1159/000356984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background In a population-based setting, we aimed to measure the incidence trends of ischemic stroke (IS) thrombolysis, thrombolysis times, proportion of symptomatic intracerebral hemorrhage (sICH), 30-day case fatality and functional outcomes. We also compared the 12-month functional status between thrombolyzed and nonthrombolyzed patients. Methods Using data from the Joinville Population-Based Stroke Registry, we prospectively ascertained a cohort of all thrombolyses done in Joinville citizens, Southern Brazil, from 2005 to 2011. For the definition of sICH we used European Cooperative Acute Stroke Study (ECASS) II criteria. Results Over 7 years, 6% (220/3,552) of all IS were thrombolyzed. The thrombolysis incidence increased from 1.4 [95% confidence interval (CI), 0.6-2.9] in 2005 to 9.8 (7.3-12.9) per 100,000 population in 2011 (p < 0.0001). The thrombolysis incidence age-adjusted to the world population in 2011 was 11 (8.2-14.3) per 100,000. Only 30% (50/165) were thrombolyzed within 1 h of arrival at hospital. In 7 days, 6.4% (14/220) had sICH and 57% (8/14) of those died. In the 2009-2011 period, a favorable functional outcome [modified Rankin scale (mRS) 0-1] at 12 months among patients who received thrombolysis was more frequent [mRS 0-1; 36% (38/107)] than among patients who did not receive thrombolysis [mRS 0-1; 24% (131/544); p = 0.016]. The logistic regression showed that thrombolyzed IS patients had a more favorable outcome (mRS 0-1; HR 2.13; 95% CI, 1.2-3.7; p < 0.016) than nonthrombolyzed patients. Conclusion In a population setting of a middle income country, the thrombolysis incidence and outcomes were similar to those of other well-structured services. After 1 year, patients thrombolyzed in the 4.5-hour time window had a better outcome. More than proportions, rates provide additional information and could be used to benchmark services against others.
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Affiliation(s)
- Carla H C Moro
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | | | - Alexandre L Longo
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Patricia G Fonseca
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Rodrigo Harger
- University of Joinville Region-Univille, Joinville, Brazil
| | - Débora B Gomes
- University of Joinville Region-Univille, Joinville, Brazil
| | | | | | | | - Adriana C Garcia
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
| | - Vivian Nagel
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
| | - Norberto L Cabral
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
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Bing F, Jacquin G, Poppe A, Roy D, Raymond J, Weill A. The cost of materials for intra-arterial thrombectomy. Interv Neuroradiol 2013; 19:83-6. [PMID: 23472729 DOI: 10.1177/159101991301900113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/06/2012] [Indexed: 11/16/2022] Open
Abstract
This paper reports the cost of endovascular materials used for the treatment of large-vessel ischemic stroke in the anterior circulation according to the angiographic score and clinical results at three months. From November 2009 to July 2011, 57 ischemic patients (mean age, 64.6 ±13.8 years) with anterior large vessel occlusion were included. Mean National Institutes of Health Stroke Scale (NIHSS) on admission was 18.4 ± 4.9. Mean duration of symptoms until the arterial puncture was 207±67 minutes. Recanalization was assessed using the Thrombolysis In Myocardial Infarction (TIMI) score. Patient selection was performed on a non-enhanced CT scanner. According to the TIMI final angiographic score and the modified Rankin score (mRS) at three months, we determined the cost of the material used. Complete (n=12, TIMI grade 3) or partial perfusion (n=35, TIMI grade 2) was achieved in 47 (82.5%) lesions. At three months, 33.3% (n=19) had a mRS score ≤ 2. The mean cost of the material used in the operative room was 5018±2402 euro. Intra-arterial thrombolysis presents a substantial initial cost and the long-term economic impact has to be evaluated. Our health system has to take the price of these new technologies into account for future medical choices and urgently evaluate them in randomized controlled trials.
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Affiliation(s)
- F Bing
- Department of Interventional Radiology, University Hospital of Strasbourg, NHC, Strasbourg, France.
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24
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The efficacy and safety of intravenous thrombolysis with alteplase in the treatment of ischaemic stroke in a rural hospital. Neurol Neurochir Pol 2013; 47:310-8. [DOI: 10.5114/ninp.2013.36755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mazighi M, Meseguer E, Labreuche J, Serfaty JM, Laissy JP, Lavallée PC, Cabrejo L, Guidoux C, Lapergue B, Klein IF, Olivot JM, Rouchaud A, Desilles JP, Schouman-Claeys E, Amarenco P. Dramatic recovery in acute ischemic stroke is associated with arterial recanalization grade and speed. Stroke 2012; 43:2998-3002. [PMID: 22935403 DOI: 10.1161/strokeaha.112.658849] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Dramatic recovery (DR) is a predictor of stroke outcome among others. However, after successful recanalization, systematic favorable outcome is not the rule. We sought to analyze the impact of recanalization on DR in patients with acute ischemic stroke eligible for any revascularization strategies (either intravenous or endovascular). METHODS We analyzed data collected between April 2007 and May 2011 in our prospective clinical registry. All patients with acute ischemic stroke with National Institutes of Health Stroke Scale≥10 at admission and an identification of arterial status before treatment were included. DR was defined as National Institutes of Health Stroke Scale≤3 at 24 hours or a decrease of ≥10 points within 24 hours. RESULTS DR occurred in 75 of 255 patients with acute ischemic stroke (29.4%). Patients with persistent occlusion had a low DR rate (11.1%) than those with no documented occlusion (36.5%) and those with occlusion followed by recanalization (35.3%; both P<0.001). Among patients with recanalization monitored by angiography, DR was higher among patients with complete recanalization than among those with partial recanalization (46.8% versus 14.3%; P<0.001) and increased with tertiles of time to recanalization (Ptrend=0.002). In multivariable logistic regression analysis, grade and time to recanalization appeared independently associated with DR; the adjusted ORs were 4.17 (95% CI, 1.61-10.77) for complete recanalization and 1.24 (95% CI, 1.04-1.48) for each 30-minute time decrease. Patients with versus without DR more frequently had modified Rankin Scale≤1 (67.6% versus 9.0%; P<0.001) and less frequently had hemorrhage (17.3% versus 33.9%; P=0.024). CONCLUSIONS DR is strongly associated with favorable clinical outcome and is dependent on complete recanalization and time to recanalization.
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Affiliation(s)
- Mikael Mazighi
- Department of Neurology and Stroke Centre, Bichat University Hospital, INSERM U-698, Paris-Diderot University, 46, rue Henri Huchard, 75018 Paris, France.
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