Functional Outcome In Stroke Patients Research Articles

Impact of Cognitive Impairment on Functional Outcomes of Stroke Patients at a Tertiary Care Rehabilitation Institute

Impact of Cognitive Impairment on Functional Outcomes of Stroke Patients at a Tertiary Care Rehabilitation Institute

Deep learning on pre-procedural computed tomography and clinical data predicts outcome following stroke thrombectomy

BackgroundDeep learning using clinical and imaging data may improve pre-treatment prognostication in ischemic stroke patients undergoing endovascular thrombectomy (EVT).MethodsDeep learning models were trained and tested on baseline clinical and imaging...

A normative modeling approach to quantify white matter changes and predict functional outcomes in stroke patients.

The diverse nature of stroke necessitates individualized assessment, presenting challenges to case-control neuroimaging studies. The normative model, measuring deviations from a normal distribution, provides a solution. We aim to evaluate stroke-induced white matter microstructural abnormalities at group and individual levels and identify potential prognostic biomarkers. Forty-six basal ganglia stroke patients and 46 healthy controls were recruited. Diffusion-weighted imaging and clinical assessment were performed within 7 days after stroke. We used automated fiber quantification to characterize intergroup alterations of segmental diffusion properties along 20 fiber tracts. Then each patient was compared to normative reference (46 healthy participants) by Mahalanobis distance tractometry for 7 significant fiber tracts. Mahalanobis distance-based deviation loads (MaDDLs) and fused MaDDLmulti were extracted to quantify individual deviations. We also conducted correlation and logistic regression analyses to explore relationships between MaDDL metrics and functional outcomes. Disrupted microstructural integrity was observed across the left corticospinal tract, bilateral inferior fronto-occipital fasciculus, left inferior longitudinal fasciculus, bilateral thalamic radiation, and right uncinate fasciculus. The correlation coefficients between MaDDL metrics and initial functional impairment ranged from 0.364 to 0.618 (p < 0.05), with the highest being MaDDLmulti. Furthermore, MaDDLmulti demonstrated a significant enhancement in predictive efficacy compared to MaDDL (integrated discrimination improvement [IDI] = 9.62%, p = 0.005) and FA (IDI = 34.04%, p < 0.001) of the left corticospinal tract. MaDDLmulti allows for assessing behavioral disorders and predicting prognosis, offering significant implications for personalized clinical decision-making and stroke recovery. Importantly, our method demonstrates prospects for widespread application in heterogeneous neurological diseases.

Optimization of sensitivity and specificity of a biomarker-based blood test (LVOCheck-Opti): A protocol for a multicenter prospective observational study of patients suspected of having a stroke.

Acute ischemic stroke (AIS) is a time-critical medical emergency. For patients with large-vessel occlusions (LVO), mechanical thrombectomy (MT) is the gold-standard treatment. Mobile Stroke Units (MSUs) provide on-site diagnostic capabilities via computed tomography (CT) and have been shown to improve functional outcomes in stroke patients, but are cost-efficient only in urban areas. Blood biomarkers have recently emerged as possible alternative to cerebral imaging for LVO diagnosis. Prehospital LVO diagnosis offers the potential to transport patients directly to centers that have MT treatment available. In this study, we assess the accuracy of combining two biomarkers, HFABP and NT-proBNP, with clinical indicators to detect LVO using ultra-early prehospital blood samples. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00030399). We plan a multicenter prospective observational study with 800 patients with suspected stroke enrolled within 24 h of symptom onset. Study participants will be recruited at three sites (MSUs) in Berlin, Germany. Blood-samples will be taken pre-hospitally at the scene and tested for HFABP and NT-proBNP levels. Additional clinical data and information on final diagnosis will be collected and documented in an electronic case report form (eCRF). Sensitivity and specificity of the combination will be calculated through iterative permutation-response calculations. This study aims to evaluate the diagnostic capabilities of a combination of the biomarkers HFABP and NT-proBNP in LVO prediction. In contrast to most other biomarker studies to date, by employing MSUs as study centers, ultra-early levels of biomarkers can be analyzed. Point-of-care LVO detection in suspected stroke could lead to faster treatment in both urban and rural settings and thus improve functional outcomes on a broader scale. Deutsches Register klinischer Studien https://drks.de/search/de/trial/DRKS00030399, DRKS00030399.

Brush Sign on pre-treatment imaging is associated with good functional outcome in stroke patients treated with mechanical thrombectomy: A prospective monocentric study

BackgroundThe Brush Sign (BrS) is a radiological biomarker (MRI) showing signal decrease of subependymal and deep medullary veins on paramagnetic-sensitive magnetic resonance sequences. Previous studies have shown controversial results regarding the prognostic value of BrS. We aimed to assess whether BrS on T2*-weighted sequences could predict functional prognosis in patients treated with mechanical thrombectomy (MT). MethodsWe included all consecutive patients with large artery occlusion related stroke in anterior circulation treated with MT between February 2020 and August 2022 at Reims University Hospital. Multivariable logistic regression models were used to investigate factors associated with BrS and its impact on outcomes. ResultsOf the 327 included patients, 124 (37,9%) had a BrS on baseline MRI. Mean age was 72 ± 16 years and 184 (56,2 %) were female. In univariate analysis, BrS was associated with a younger age (67 vs 74; p<0.001), a higher NIHSS score (16(10–20) vs 13(8–19); p = 0.047) history of diabetes (15.3% vs 26.1 %; p = 0.022) and a shorter onset to MRI time (145.5 (111.3–188.5) vs 162 (126–220) p = 0.008). In multivariate analyses, patients with a BrS were younger (OR:0.970 (0.951 – 0.989)), tend to have a higher NIHSS score at baseline (OR:1.046 (1.000 – 1.094) and were less likely to have diabetes (OR: 0.433; 0.214–0.879). The presence of BrS was independently associated with functional independence (OR: 2.234(1.158–4,505) at 3 months but not with mortality nor with symptomatic intracerebral hemorrhage. ConclusionBrS on pre-treatment imaging could be considered as a biomarker of physiological adaptation to cerebral ischemia, allowing prolonged viability of brain tissue and might participate in the therapeutic decision.

Abstract TMP86: Effects of Tenecteplase versus Alteplase in Stroke Patients With Large Vessel Occlusions Who Achieve Full Recanalization

Introduction: Tenecteplase improves reperfusion and functional outcomes in stroke patients with large vessel occlusion. TNK is more specific for fibrin than TPA, however, it is unclear if this effect could increase efficacy of mechanical thrombectomy (MT). We aimed to determine if TNK is associated with higher recanalization rates and better clinical outcomes than TPA in patients who undergo MT. Methods: Electronic medical record review of acute stroke patients with LVO, age over 18 years, who received both thrombolysis with either TNK or TPA, and underwent MT at a tertiary medical center from January 2017 to April 2023 was performed. Use of TPA was converted to TNK on 1/11/2022 per hospital policy. Number of passes and time to full recanalization (defined as TICI 3) were recorded. Primary outcome was mRS at 90 days. Secondary outcomes were NIHSS at 24 hours and at discharge. Primary safety outcome was parenchymal hematoma type 2 (PH2) intracerebral hemorrhage. A t-test was used to examine association between outcomes and thrombolysis type. Fischer’s exact test was used to determine differences in recanalization and hemorrhage rates. Results: Of the 284 patients included, 213 received TPA and 71 received TNK. Mean age was 68, and 50.0% were females. Forty-three patients (60.6%) who received TNK, and 96 patients (45.1%) who received TPA achieved TICI 3 score (P=0.028). There was no difference in time to recanalization (38.5 min versus 32 min, p=0.872), median number of passes (1 versus 1, p=0.934), median 90-day mRS (2 versus 1.5, p=0.434), or the rate of PH2 hemorrhage (0% versus 2.3%, p=0.336) for TNK vs TPA in patients with TICI 3 recanalization. Median NIHSS at presentation (18.0 versus 16.0, p=0.398), at 24 hours (8.0 versus 7.0, p=0.406), and at discharge (3.0 versus 4.0, p=0.383) were similar for all patients receiving TNK and TPA, respectively. Conclusions: In our retrospective analysis, TNK showed a higher rate of TICI 3 recanalization for patients with LVO, who both received thrombolysis and underwent MT. There was no difference between TNK and TPA for number of passes, time to recanalization, parenchymal hematoma rate, and clinical outcomes in patients who achieved TICI 3. Overall clinical outcomes were also similar, irrespective of recanalization grade.

Adipokines and stroke: A systematic review and meta-analysis of disease risk and patient outcomes.

Obesity is reported to increase stroke risk, with adipocyte-derived cytokines or adipokines implicated as mediators. However, the relationship between adipokines and stroke is not well clarified. Thus, we aimed to evaluate the association of adipokines with stroke using fully adjusted risk estimates that incorporated body mass index in a meta-analysis. Data from 52 studies (62,428 patients) were pooled in a random-effects meta-analysis. Adiponectin was independently associated with a lower risk of pre-existing stroke (adjusted odds ratio: 0.64 [95% confidence interval: 0.46-0.88], p < 0.01), whereas leptin (1.08 [1.00-1.17], p = 0.04), resistin (1.06 [1.04-1.08], p < 0.01) and visfatin (1.04 [1.01-1.07], p = 0.01) are associated with a higher risk of stroke, but none with incident stroke. Adipokines independently associated with an ischaemic stroke subtype were adiponectin (0.48 [0.30-0.77], p < 0.01), leptin (1.10 [1.01-1.20], p = 0.04), and resistin (1.06 [1.04-1.08], p < 0.01). Fatty acid-binding protein-4 (FABP-4) independently predicted 6-month poor functional outcomes in stroke patients (adjusted hazard ratio: 1.09 [1.06-1.12], p < 0.01); whereas both FABP-4 (1.17 [1.03-1.34], p = 0.01) and visfatin (1.24 [1.00-1.55], p = 0.05) were predictive of 6-month mortality. Adipokines are associated with a greater risk of pre-existing stroke, but not with the relationship with incident stroke. Adipokines, such as FABP-4 and visfatin, may serve as biomarkers of stroke severity and worsening of stroke outcomes.

Deep Learning-Based Extraction of Biomarkers for the Prediction of the Functional Outcome of Ischemic Stroke Patients.

Accurately predicting functional outcomes in stroke patients remains challenging yet clinically relevant. While brain CTs provide prognostic information, their practical value for outcome prediction is unclear. We analyzed a multi-center cohort of 743 ischemic stroke patients (<72 h onset), including their admission brain NCCT and CTA scans as well as their clinical data. Our goal was to predict the patients' future functional outcome, measured by the 3-month post-stroke modified Rankin Scale (mRS), dichotomized into good (mRS ≤ 2) and poor (mRS > 2). To this end, we developed deep learning models to predict the outcome from CT data only, and models that incorporate other patient variables. Three deep learning architectures were tested in the image-only prediction, achieving 0.779 ± 0.005 AUC. In addition, we created a model fusing imaging and tabular data by feeding the output of a deep learning model trained to detect occlusions on CT angiograms into our prediction framework, which achieved an AUC of 0.806 ± 0.082. These findings highlight how further refinement of prognostic models incorporating both image biomarkers and clinical data could enable more accurate outcome prediction for ischemic stroke patients.

Evaluation of effectiveness and safety of the large-format pRESET 6-50 thrombectomy stent-retriever in the endovascular treatment of ischemic stroke: real-world experiences from two tertiary comprehensive stroke centers.

Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). First-pass (FP) reperfusion of the occluded vessel and fewer passes with stent retrievers show improvement in functional outcomes in stroke patients, while higher numbers of passes are associated with higher complication rates and worse outcomes. Studies indicate that a larger size of the stent-retriever is associated with a higher rate of first-pass reperfusion and improved clinical outcomes. In this retrospective study, we investigated the clinical performance of a recently developed and one of the largest stent-retrievers available in the treatment of LVO (pRESET 6-50, phenox GmbH, Bochum). All consecutive patients with ischemic stroke due to proximal large vessel occlusion treated with MT using the pRESET 6-50 stent-retriever in two tertiary stroke centers between 09/2021 and 07/2022 were included in this study. The reperfusion rate after MT was quantified by the modified thrombolysis in cerebral infarction (mTICI) score, and functional neurological outcome was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score and the major early neurological recovery (mENR) rate after 24 h. Successful FP reperfusion was defined as mTICI ≥ 2b. Successful and complete reperfusion were defined as mTICI ≥ 2b and mTICI ≥ 2c, respectively. In total, 98 patients (52 men and 46 women) with a median age of 75 (range 25-95 years) were included. A total of 70 (72%) patients presented with an occlusion of the middle cerebral artery (MCA) in the M1 segment, 6 (6%) patients with an occlusion of the M2 segment, 17 (17%) patients with an occlusion of the internal carotid artery (ICA), and 5 (5%) patients with an occlusion of the obstructed basilar artery (BA). Successful FP reperfusion was achieved in 58 patients (62%). Successful and complete reperfusion were achieved in 95 (97%) and 82 (83%) patients, respectively. The median National Institutes of Health Stroke Scale (NIHSS) in all treated patients improved from 17 to 7.5. Major early neurological recovery (mENR) was observed in 34 patients (35.1%). MT with the pRESET 6-50 stent-retriever achieves high successful first-pass and final reperfusion rates in patients with AIS and LVO. The results of this study support the thesis to use large-format stent-retriever in proximal vessel occlusion MT whenever feasible in order to improve high FP and final reperfusion rate, which are known predictors of good clinical outcome.

Effects of immediate thrombolytic treatment in imaging area on functional outcome in patients with acute ischemic stroke.

Door-to-needle time (DNT) is an established predictor of outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Several strategies have been proposed to streamline in-hospital pathways, among which treatment at CT/MR bed. To explore the impact of treatment at CT/MR bed, here defined as imaging area (IA), on functional outcome in stroke patients treated with IVT alone. All AIS patients treated with IVT alone at our center in 2020, 2021, and 2022 were included. Patients with any previous disability were excluded. The cohort was divided into two groups, depending on the treatment site. One group received IVT at IA, the other at emergency room or stroke unit (non-IA). Regression analysis assessed the association between treatment site and 3-month outcome. A total of 327 patients who received IVT alone were included in the analysis. One hundred thirty-three (40.7%) were in the IA group and 194 (59.3%) in the non-IA group. The groups showed similar baseline characteristics. In the IA group, DNT was 45 min shorter. Despite similar rates of functional independence (mRS 0-2), the IA group showed higher rates of excellent outcome (mRS 0-1) compared to the non-IA group (60.1% vs 42.8%, p<0.01). Immediate treatment at IA was independently associated to excellent outcome (OR 1.78 [1.03-3.08]). Thrombolytic treatment at IA lowers DNT and is an independent predictor of excellent outcome after AIS. Our study emphasizes the importance of immediate thrombolytic treatment at IA, soon after radiological eligibility is confirmed. Immediate treatment at IA should be a standard-of-care for AIS.

A linear model-based simulation tool for estimating number of trials needed for upper limb stroke recovery in a given rehabilitation session

Traditional methods for assessing upper-limb functional outcomes in stroke patients often fail to estimate the number of trials required to achieve performance stability of a chosen kinematic metric. Limited non-model-based studies have attempted to tackle this issue. To bridge this gap, this study utilized an iterative learning algorithm (ILA) in MATLAB, employing linear models to represent the muscle dynamics and forearm extension of impaired patients. The reference task space trajectory was set as a straight-line point-point trajectory within a range of 0 - 0.2828m. By using the root mean square error (RMSE) as a metric for evaluating kinematic accuracy, a maximum kinematic deviation error of 0.01m was imposed with respect to the trajectory by the (ILA). Results indicate that over 16 trials, performance stability was obtained with improvement in deviation error from 0.0168m in the first trial to 0.0060 at sixteen trials. The result obtained is in line with similar non-model studies and our findings inform the potential of ILAs with linear models for estimation of trial numbers required to attain performance stability of a selected kinematic metric (i.e., kinematic accuracy).

Effects of extracorporeal shock wave therapy on spasticity, walking and quality of life in poststroke lower limb spasticity: a systematic review and meta-analysis

Objective To determine the effects of extracorporeal shock wave therapy (ESWT) on lower limb function, walking, and quality of life in patients with lower limb poststroke spasticity. Data Sources A comprehensive and systematic electronic database search of PubMed, Web of Science, ProQuest thesis Dissertation checks, Google Scholar was conducted from January 2010 to March 2022. Review Method Initially, the bibliography was screened to identify randomized and nonrandomized controlled trials evaluating the effects of ESWT on lower limb spasticity and functional outcomes in stroke patients. Two reviewers independently screened the title and abstract, full-text articles, extracted data, and assessed the quality of the selected studies. The primary evaluation outcome was spasticity assessed by Modified Ashworth Scale (MAS), and the secondary outcomes were walking performance and quality of life measured on different scales. Data Synthesis Out of the total of 483 records, 15 studies (389 participants) were finally found eligible for inclusion. A meta-analysis was performed and beneficial effects of ESWT were observed in the experimental group compared with the control group on spasticity. MAS: Standard mean difference (SMD = 0.626), (95%CI = −0.133, 1.119), (p < 0.01), ROM: (SMD = 0.573), (95%CI = 0.074, 1.072), (p < 0.02). The result for before and after ESWT application on TUG: (SMD = 0.174), (95%CI=-0.151, 0.499), (p = 0.29). The results for walking performance were not significant and inconclusive which may be due to the heterogeneity of the studies included. Conclusion Evidence suggests that ESWT has promising effects in reducing spasticity and improving lower limb motor function. However, uncertainty exists regarding its effectiveness in walking performance.

Lipoprotein(a) and functional outcome of acute ischemic stroke when discordant with low-density lipoprotein cholesterol.

Several studies have indicated that residual cardiovascular risk might be associated with elevated lipoprotein(a) [Lp(a)] even in the setting of controlled low-density lipoprotein cholesterol (LDL-C). We aimed to prospectively examine the association between Lp(a) and unfavorable functional outcome among patients with acute ischemic stroke when Lp(a) and LDL-C were discordant. Based on samples from the Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke study, 973 patients with baseline plasma Lp(a) levels were included. The primary outcome was the composite outcome of death or major disability (modified Rankin Scale score of 3-6) at 6months. Logistic regression models were used to estimate the risk for the primary outcome. Discordance analyses were performed, using difference in percentile units (>10units), to detect the relative risk when Lp(a) and LDL-C were discordant. In total, 201 (20.7%) participants experienced major disability or death at 6months. The multivariable-adjusted odds ratio (OR) for the highest quartile was 1.88 [95% confidence interval (CI): 1.16-3.04] compared with the lowest quartile. Each 1-SD higher log-Lp(a) was associated with a 23% increased risk (95% CI: 2%-47%) for the primary outcome. Compared with the concordant group, the high Lp(a)/low LDL-C discordant group was associated with increased risk for the primary outcome (adjusted OR: 1.59, 95% CI: 1.01-2.52). Elevated plasma Lp(a) levels were associated with increased risk of major disability and death at 6months. Discordantly high Lp(a)/low LDL-C was associated with an unfavorable functional outcome, supporting the predictive potential of plasma Lp(a) after ischemic stroke, especially when discordant with LDL-C. Key messages What is already known on this topic Previous studies have indicated that a positive association between increased lipoprotein(a) [Lp(a)] and cardiovascular disease risk remained even in patients who achieved controlled low-density lipoprotein cholesterol (LDL-C) levels. The findings of studies exploring the association between Lp(a) and unfavorable clinical outcomes of stroke were inconsistent, and whether Lp(a) can predict the risk of unfavorable functional outcome in stroke patients when Lp(a) and LDL-C levels are discordant remains unknown. What this study adds Elevated plasma Lp(a) levels were associated with increased risk of major disability and death at 6months beyond LDL-C levels in acute ischemic stroke patients. How this study might affect research, practice, or policy The combination of LDL-C-lowering therapies and Lp(a)-lowering therapies may have better clinical efficacy for patients with ischemic stroke, and it is of great clinical interest to further explore this possibility in dedicated randomized trials.

A STUDY ON THE EFFECT OF ADDITIONAL BACKWARD WALKING TRAINING ON BALANCE AND FUNCTIONAL OUTCOMES IN PATIENTS WITH STROKE

Objective: Stroke is a significant cause of mortality and disability globally, with a higher prevalence in urban areas of India compared to rural regions. Men in India face a greater risk of stroke, attributed to factors such as smoking and drinking, which are more prevalent among Indian men. This study aimed to evaluate the influence of backward walking training on balance and functional outcomes in stroke patients.&#x0D; Methods: Experimental Group received 30 min of backward walking training three times per week for three weeks. Balance was assessed using the Berg Balance Scale (BBS), and functional outcomes were measured using the Barthel Index (BI) before and after the intervention. Data analysis was performed using Student's paired t-test and unpaired t-test.&#x0D; Results: Before the intervention, there were no significant differences between the Control Group and Experimental Group in terms of BBS and BI scores. However, after the intervention, the Experimental Group showed a significant improvement in both balance (BBS) and functional outcomes (BI) compared to the Control Group. The Experimental Group demonstrated a greater improvement in BI scores (9.94%) compared to the Control Group (4.95%), and a similar pattern was observed for BBS scores, with the Experimental Group showing a greater improvement (7.87%) compared to the Control Group (3.49%). These differences were statistically significant (p&lt;0.01), indicating that the intervention in the Experimental Group was more effective than the Control Group.&#x0D; Conclusion: These findings suggest that incorporating backward walking training into stroke rehabilitation programs can be beneficial for patients in terms of enhancing their balance and functional abilities.

EFFECTIVENESS OF SUPPLEMENTED BACKWARD WALKING TRAINING ALONG WITH CONVENTIONAL THERAPY ON BALANCE AND FUNCTIONAL OUTCOME IN PATIENTS WITH STROKE

Objective: A stroke is a significant cause of mortality and disability worldwide, including in India, where it ranks as the second leading cause of death and the third most common cause of disability. Impairments in motor functions, such as balance and walking, are common consequences of stroke and have a substantial impact on functional abilities. Various rehabilitation strategies have been employed, but the effectiveness of these approaches varies.&#x0D; Methods: The study included 40 individuals with a history of stroke who met specific inclusion and exclusion criteria. The subjects were randomly assigned to either the control group or the experimental group. The control group received conventional therapy, while the experimental group received supplemented backward walking training along with conventional therapy. Functional outcomes were assessed using the Barthel Index (BI), and balance was evaluated using the Berg Balance Scale (BBS). Pre-and post-test scores were collected for both groups.&#x0D; Results: The results showed that the experimental group demonstrated a significantly higher improvement in BI scores (9.94%) compared to the control group (4.95%), indicating that the supplemented backward walking training had a greater impact on enhancing activities of daily living. In terms of balance, both groups showed improvements in BBS scores, with the control group exhibiting a 3.49% change and the experimental group showing a larger improvement of 7.87%. These improvements were statistically highly significant.&#x0D; Conclusion: Supplemented backward walking training, when combined with conventional therapy, has a positive impact on balance and functional outcomes in stroke patients. The results emphasize the potential of incorporating backward walking training into stroke rehabilitation programs to enhance recovery and improve the quality of life for stroke survivors. However, the study has limitations, including a relatively small sample size and short intervention duration, necessitating further research with larger sample sizes and longer intervention periods to validate the effectiveness of supplemented backward walking training in stroke rehabilitation.

Pre-stroke physical activity is related to good functional outcomes in stroke patients after endovascular thrombectomy.

Abstract. Studies have shown that regular physical activity (PA) may re-duce the risk of stroke. Nevertheless, the protective effect of pre-stroke PA on the post-stroke functional status in patients treated with endovascular throm-bectomy (EVT) is still uncertain. For this study, hospitalized patients with acute ischemic stroke were selected, all of whom underwent EVT after occlusion of the large vessels in the anterior circulation. The PA levels before the stroke were assessed by the International Physical Activity Questionnaire, and the outcome indicators (the modified Rankin scale score and the Barthel index) were evalu-ated. A total of 144 patients were included in this study. Among the patients with high PA levels before the stroke, men were more active than women, and the proportion of patients with smoking and alcohol abuse was high before admission. Also, the patients with a high PA level were more likely to have no history of hypertension and atrial fibrillation, and had lower triglyceride levels at admission. We determined that a high pre-stroke PA level is independently related to a favorable functional outcome at three months. In addition, there was no correlation between a high pre-stroke PA and a good functional outcome at two weeks. A high pre-stroke PA level is independently associated with sat-isfactory activities of daily living at three months. Regular PA before a stroke is an independent predictor of a favorable functional outcome in patients with anterior circulation strokes who receive EVT, and it has a protective effect on the functional prognosis.

Predictors for clinical and functional outcomes in stroke patients with first-pass complete recanalization after thrombectomy.

The aim was to identify baseline clinical and radiological/procedural predictors and 24-h radiological predictors for clinical and functional outcomes in stroke patients obtaining complete recanalization in one pass of mechanical thrombectomy (MT) in an optimal baseline and procedural setting. A retrospective analysis was conducted of prospectively collected data from 924 stroke patients with anterior large vessel occlusion, Alberta Stroke Program Early Computed Tomography (ASPECT) score ≥6 and pre-stroke modified Rankin Scale score 0, who started MT ≤6 h from symptom onset and obtained first-pass complete recanalization. A first logistic regression model was performed to identify baseline clinical predictors and a second model to identify baseline radiological/procedural predictors. A third model including baseline clinical and radiological/procedural predictors was performed, and a fourth model including independent baseline predictors from the third model plus 24-h radiological variables (hemorrhagic transformation [HT] and cerebral edema [CED]). In the fourth model, higher National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.089) and higher ASPECT score (OR 1.292) were predictors of early neurological improvement (ENI) (NIHSS score ≤4 points from baseline or NIHSS score of 0 at 24 h), whereas older age (OR 0.973), longer procedure time (OR 0.990), HT (OR 0.272) and CED (OR 0.569) were inversely associated with ENI. Older age (OR 0.970), diabetes mellitus (OR 0.456), higher NIHSS score (OR 0.886), general anesthesia (OR 0.454), longer onset-to-groin time (OR 0.996), HT (OR 0.340) and CED (OR 0.361) were inversely associated with 3-month excellent functional outcome (mRS score 0-1), whereas higher ASPECT score (OR 1.294) was a predictor of excellent outcome. Higher NIHSS score was a predictor of ENI but inversely associated with 3-month excellent outcome. Older age, HT and CED were inversely associated with both good outcomes.

The role of the autonomic nervous system in cerebral blood flow regulation in stroke: A review.

Stroke is a pathophysiological condition which results in alterations in cerebral blood flow (CBF). The mechanism by which the brain maintains adequate CBF in presence of fluctuating cerebral perfusion pressure (CPP) is known as cerebral autoregulation (CA). Disturbances in CA may be influenced by a number of physiological pathways including the autonomic nervous system (ANS). The cerebrovascular system is innervated by adrenergic and cholinergic nerve fibers. The role of the ANS in regulating CBF is widely disputed owing to several factors including the complexity of the ANS and cerebrovascular interactions, limitations to measurements, variation in methods to assess the ANS in relation to CBF as well as experimental approaches that can or cannot provide insight into the sympathetic control of CBF. CA is known to be impaired in stroke however the number of studies investigating the mechanisms by which this occurs are limited. This literature review will focus on highlighting the assessment of the ANS and CBF via indices derived from the analyses of heart rate variability (HRV), and baroreflex sensitivity (BRS), and providing a summary of both clinical and animal model studies investigating the role of the ANS in influencing CA in stroke. Understanding the mechanisms by which the ANS influences CBF in stroke patients may provide the foundation for novel therapeutic approaches to improve functional outcomes in stroke patients.

Association of Co-morbidities with Functional Outcomes in Stroke Patients with Atrial Fibrillation on long-term Oral anticoagulation (P11-5.030)

Association of Co-morbidities with Functional Outcomes in Stroke Patients with Atrial Fibrillation on long-term Oral anticoagulation (P11-5.030)

111 Improved Functional Outcomes of Stroke Patients Undergoing Mechanical Thrombectomy After Arriving via Mobile Stroke Unit

INTRODUCTION: Mobile stroke units (MSUs) have been implemented worldwide for stroke care, but outcome data is lacking to show their efficacy specifically in patients undergoing mechanical thrombectomy (MT). METHODS: A retrospective review of a stroke database was performed to identify patients who underwent MT after arrival via MSU from August 2019 to December 2020. Demographic factors, past medical history, stroke characteristics, treatment variables, complications, and functional outcomes were recorded. These were compared to date-matched patients who underwent MT after arrival via conventional means. RESULTS: Seven patients were treated with MT after arriving by MSU. These were compared to 50 date- matched patients who underwent thrombectomy after arrival through conventional means. No statistically significant difference between cohorts was observed in terms of demographic variables, co-morbidities, stroke characteristics, or tPA administration. Patients from the MSU cohort had significantly shorter time from symptom onset to groin puncture time (191.33 mins ± 77.53 vs 483.51 mins ± 322.66, p = 0.034). Importantly, MSU-transferred patients had significantly better discharge functional status measured by modified Rankin Scale (mRS) (1.86 ± 1.35 vs 3.57 ± 1.88, p = 0.024). No significant difference in final TICI score, complications, length of stay, or mortality was observed. CONCLUSIONS: Our pilot study demonstrates the efficacy of the MSU in decreasing door-to-puncture time and a concordant improvement in discharge mRS. Further prospective studies are needed to assess cost-efficacy and optimal protocol for MSUs in stroke care.