Higher NIHSS Research Articles

Abstract 88: Workflow Delays And Outcome Of Endovascular Thrombectomy In The Late Stroke Window:results From A Pooled Multicenter Analysis

Background: Efficient healthcare workflow leads to faster reperfusion and better functional outcomes of stroke in the early-time window. We investigated the impact of care delays on the outcomes of stroke patients treated with endovascular thrombectomy (EVT) in the late window. Methods: Pooled data from seven randomized clinical trials and registries that only included patients who underwent EVT in the late time window (onset/last known well (LKW) time to imaging time of 6 hours or more) were combined for this analysis. The time intervals from stroke onset to successful reperfusion were analyzed. Logistic regression was used to estimate the likelihood of a functionally independent outcome at 90 days (modified Rankin scale 0-2) for each time interval while adjusting for relevant patients’ characteristics. Negative binomial regression was used to evaluate the relationship between each time interval and the predictors. Results: 584 patients were included in this analysis. The median age was 70 years (IQR: 21), 293 [50.17%] were females, 298 (53.31%) had wake-up strokes, and the median ASPECTS was 8 (IQR: 2). All patients had CT, and CTA imaging, and 360 (61.64%) underwent perfusion imaging. Successful reperfusion was achieved in 469 (80.45%) patients, and 249 (44.54%) had independent outcomes at 90 days. For every 30 minutes delay, the estimated probability of functional independence decreased by 19% for the emergency department (ED) arrival to imaging time interval, by 25% from groin puncture to end of EVT, and by 12% from ED arrival to end of EVT. Older age and higher NIHSS were associated with longer time from imaging to groin puncture. However, only age was associated with a longer estimated times from stroke onset/LKW to arrival in ED and from stroke onset/LKW to the end of EVT. Conclusion: Faster in-hospital care is associated with improved functional independence among late-window patients. Page 1

Abstract 43: Comparative Effectiveness Of Routine Tenecteplase Thrombolysis In Acute Stroke Compared With Alteplase: An INternational Collaboration (CERTAIN Collaboration): Rates Of Symptomatic Intracranial Hemorrhage

Introduction: Despite pharmacological and practical advantages for tenecteplase (TNK) over alteplase (ALT), no differences were observed in percent of symptomatic intracranial hemorrhage (sICH) in randomized trials (fewer than 900 total patients for either treatment). We compared rates of sICH in patients treated with either drug, using a large, multicenter, international registry. Methods: The CERTAIN collaboration is an ongoing registry of deidentified patient-level data of thrombolytic treated ischemic stroke from various hospitals/programs in New Zealand, Australia, and the United States that have used ALT or TNK since July 1, 2018. Standardized data were abstracted and harmonized from local or regional clinical registries. We defined sICH as clinical worsening of at least 4 points on NIHSS, attributed to parenchymal hematoma, subarachnoid or intraventricular hemorrhage. We used logistic regression for binary variables, adjusting sICH differences for age, baseline NIHSS, thrombectomy, and source hospital network and Mann-Whitney test for continuous baseline variables. Results: A total of 7891 patients were included in the initial analysis. The TNK group was older, more likely to be male, had higher NIHSS, and more frequently underwent mechanical thrombectomy (Table. Sample Characteristics). The sICH rate was 3.71% for ALT and 2.13% for TNK: adjusted OR (95%CI) = 0.49 (0.31-0.76) p=0.002. For patients not undergoing thrombectomy after thrombolytic, the sICH rate was 3.00% for ALT and 1.74% for TNK, adjusted OR (95%CI) = 0.48 (0.27-0.87), p=0.016. For thrombectomy treated cases, sICH rate was 6.80% for ALT and 2.80% for TNK, adjusted OR (95%CI) 0.60 (0.31-1.16), p=0.129. Conclusion: In this preliminary analysis from a large, multicenter registry, ischemic stroke treated with tenecteplase was associated with a lower rate of sICH than with alteplase. An updated analysis with patient data from additional sites will be presented at the Conference.

Abstract WP19: Diaschisis Of The Blood-brain Barrier

Background: Focal ischemia is thought to have global effects on the brain. Chronic cerebrovascular disease is associated with blood-brain barrier (BBB) disruption. We aimed to determine if ischemic stroke has a remote effect on the BBB. Methods: Patients with acute ischemic stroke who were imaged with MR perfusion weighted imaging (PWI) on presentation and again 24 hours later were included in the study. PWI source images were used to measure BBB disruption as a percentage of the signal that is due to gadolinium leakage. BBB was averaged within a region of interest (ROI) consisting of supratentorial white matter (WM) contralateral to the ischemic stroke. The ROI was defined using a group-averaged diffusion tensor imaging (DTI) fractional anisotropy map. For infratentorial strokes the ROI consisted of bilateral supratentorial WM. For bilateral strokes, the ROI consisted of WM in the less affected hemisphere after removal of the infarct. Segmentation algorithms were used to define infarct volume in mL on DTI at 24 hours and WM hyperintensity volume (WMHvol) on the initial FLAIR image. Average percent BBB disruption was compared with age, baseline modified Rankin scale (mRS), NIHSS, stroke volume, and WMHvol using linear regression. Results: 44 patients were included with a median age of 74, 39% female. Median NIHSS was 4; mean stroke volume was 10 mL. The baseline mRS ranged from 0-3 with a median of 0. The median BBB was 0.86% (IQR:0.72%-1.09%). Higher average BBB disruption measured in the WM remote from the acute stroke was associated with larger stroke volumes (p=0.006, r 2 =0.17, beta 0.410, CI:0.003-0.018), larger WMHvol (p<0.001, r 2 =0.26, beta 0.51, CI: 0.10-0.32), and higher NIHSS (p=0.039, r 2 =0.01, beta 0.312, CI:0.002-0.064) but not with age (p=0.447), sex (p=0.729), or baseline mRS (p=0.093). In multiple linear regression stroke volume (p=0.008) and WMHvol (p<0.001) were independently associated with remote disruption of the BBB but not NIHSS (p=0.684). Conclusions: Focal ischemia resulted in a proportional disruption of the BBB in the WM remote from the acute lesion. This effect was independent of the severity of WMHvol, a measure of cerebral small vessel disease. These findings support the concept of ischemic stroke having global effects on the brain.

Abstract TP5: Early Intubation Of Hyperacute Stroke Patients In The Emergency

Background: Stroke patients at times will present to the emergency department in unstable condition necessitating early intubation. Given the time-sensitive nature of thrombolysis for ischemic stroke, we sought to characterize the rates and predictors of intubation on ED arrival for hyperacute stroke patients transported by paramedics. Methods: Subjects were participating in the NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial. Subjects were enrolled in the field ambulance within 2 hours of last known well and taken to their usual care emergency department. Early intubation was noted by study nurses on their initial NIHSS after ED arrival. Results: A total of 1700 cases were included, aged 69±13 years, 42.6% were women, median NIHSS on ED arrival was 9 [IQR 3-17], final diagnosis was cerebral ischemia in 73.3%, intracranial hemorrhage (ICH) in 22.8%, and a stroke-mimicking condition in 3.9%. The median time form last known to ED arrival was 59 minutes. Early ED intubation was more common in ICH compared to CI or mimic (18% vs. 1% vs. 3%, p<0.001). Early intubation was associated with higher NIHSS [32 v 9]. The final diagnosis for both stroke mimic cases with early intubation was seizure. Among the 88 cases intubated early in the ED, there were 71 (81%) ICH, 15 (17%) ischemia and 2 (3%) mimics. Rates of TPA utilization in cerebral ischemia cases were 53% in the intubated group and 36% in the non-intubated group. Conclusion: Early intubation in the ED was more common in the ICH cases and occurred in only 1% of cerebral ischemia cases.

Abstract WP202: Comorbidities, But Not Mechanism, Are Associated With Long-term Mortality After Stroke

Introduction: Stroke is one of the leading causes of death worldwide. Our study aimed to investigate clinical variables that influence long-term mortality. Methods: A retrospective study was done in patients admitted with stroke to Columbia University Irving Medical Center - New York Presbyterian Hospital between 1990 and 2020 from whom data adjudication and long-term outcome were available at the time of analyses. Stroke was classified as cardioembolic, large vessel, small vessel and cryptogenic. We established 5 models which were progressively adjusted for cardiovascular risk factors and treatment modalities. Data was analyzed using cox proportional regression analysis to obtain hazard ratios (HR) with 95% confidence intervals (CI). Results: The study included 775 patients with a mean age of 67±16 years; 47% were men, 32% had diabetes, 39% had dyslipidemia and 22% had a history of atrial fibrillation (AF). On discharge, 84% received statin therapy. After 8.9±5.9 years (0-17 years) of follow-up, 257 (33.2%) of the initial cohort died. In univariate analysis, stroke due to AF was the only predictor of long-term mortality compared to other mechanisms (HR 1.9, 95% CI 1.5-2.3), but the effect size and statistical significance were progressively attenuated after adjusting for confounders (HR 1.2, 95% CI 0.9-1.6). In the fully adjusted model, statin therapy on discharge (HR 0.6, 95% CI 0.5-0.9) was associated with decreased long-term mortality whereas higher NIHSS score on admission, older age and a history of diabetes were associated with higher long-term mortality (Table 1). Conclusion: Comorbidities, and not stroke mechanism per se, are determinants of long-term mortality after stroke. Advanced age, diabetes mellitus, high NIHSS score are associated with higher long-term mortality whereas statin prescription upon discharge is associated with lower mortality. Post-stroke care strategies need to be targeted to reduce the risk of mortality in high-risk patients.

Abstract TP37: Teach-back Method And Hospital Readmission

Introduction: The transitions of care can be stressful and challenging to the AIS survivors and their families as each adjusts to unfamiliar roles. During care transitions, patients are faced with self-care challenges that can often lead to unplanned readmission. Patient education is an essential component of supporting the patient and family in preventing secondary stroke and promoting self-management. However, 40-80% of the medical information during education sessions is forgotten immediately, and can be misunderstood. Hypothesis: The researcher hypothesized that age of ≥ 75 years old; LOS ≥ 5 days; the presence of multiple modifiable risk factors; a NIHSS score ≥ 5; discharge destination to a SNF; and/or a high LACE score are the characteristics that will be seen most often among AIS patients with a 30-day readmission. The researcher also hypothesized that patient education using the teach-back method will decrease all-cause 30-day hospital readmission rates of patients with AIS. Method: A chart review of 955 medical records over 2 years was collected using a researcher-designed spreadsheet. Data were analyzed through descriptive and inferential statistics using measures of central tendency, Mann-Whitney, and Chi-Square Comparison. Results: The research study showed a high readmission rate on patients with a LOS ≥ six days (p=.006), discharge destination to SNF (p=.008), NIHSS score of ≥ 6 points (p=.03), and high LACE score (p=.008). However, there is a weak correlation between each variable and readmission. There was no significant difference in readmission rate between the pre-intervention group (3.3%) and the post-intervention group (4.35%) (p = .40). Conclusion: The researcher concluded that patient characteristics such as a higher length of stay, discharge to a SNF, high NIHSS score, and high LACE score can influence the risk of readmission. Since the contributing factors to 30-day hospital readmission are complex and multifactorial, identification of high-risk patients may allow opportunities for specific interventions such as patient education using the teach-back method. However, interventions must be patient, and family-centered, and targeted at the transitions of care.

Abstract WP143: Stroke Severity Mediates The Association Between Neighborhood Socioeconomic Deprivation And Poor Outcomes Among Patients With Intracerebral Hemorrhage

Background: Relationships between neighborhood socioeconomic deprivation (NSD) and Intracerebral hemorrhage (ICH) outcomes are not well characterized. We sought to evaluate the impact of NSD on ICH outcomes and assessed mediating pathways for association between NSD and poor outcomes. Methods: Clinical data were extracted from the electronic medical records and 90-day modified Rankin Scale (mRS) scores were obtained from a prospectively collected stroke registry at a large healthcare system. Presentation NIHSS score was used to assess ICH severity. Exact patient addresses were geocoded, and state-level Area Deprivation Index (ADI) was calculated, with high NSD (H-NSD) categorized as top 15% of ADI scores. The outcome was severe disability or death (SDD) (mRS ≥ 4). Age-adjusted logistic regression models were fitted, and mediation analyses were performed utilizing structured equation modeling. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Final analyses included 486 patients with complete data (mean age: 65.6 years, 45.9 % female, 28.8% non-Hispanic Black, 20.2% Hispanic, median presentation NIHSS: 10, and median 90-day mRS 4). In separate age-adjusted models, both high NIHSS scores (OR, CI: 1.24, 1.20 - 1.29) and H-NSD (OR, CI: 1.59, 1.02 - 2.46) were associated with SDD. In a mediation analysis, H-NSD significantly contributed to higher NIHSS scores (OR, CI: 14.30, 1.44 - 141.61) and in turn higher NIHSS scores were significantly associated with SDD (OR, CI: 1.03, 1.03 - 1.04). In this analysis, H-NSD did not retain a significant direct effect on SDD (OR, CI: 1.38, 0.96 - 1.12) and was instead fully mediated by high NIHSS scores (Figure 1). Discussion: Our analyses uniquely identify higher stroke severity as a potential causal pathway between NSD and poor ICH outcomes. These findings warrant comprehensive understanding of factors that may predispose the disadvantaged to experience higher ICH severity and greater neurological deficit.

Abstract WP57: Association Between Stroke Presentation During Off-hours And Mechanical Thrombectomy

Background: Access to mechanical thrombectomy in the US remains limited, in part due to a relative lack of trained interventionalists. Given potential staffing challenges, we hypothesized that access to thrombectomy would be worse on nights and weekends. Methods: We used 2016-2018 all-payer claims data from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Using recorded arrival times, hospital presentation was classified as on-hours if it fell between 8:00 a.m. and 6:00 p.m. on weekdays and as off-hours otherwise. For patients who underwent interhospital transfer, we used the arrival time at the initial hospital. We examined the association between off-hours arrival and mechanical thrombectomy using multiple logistic regression adjusted for age, sex, race/ethnicity, insurance type, socioeconomic status, urban-rural location of residence, the Charlson comorbidity index, initial presentation to a thrombectomy hub, and treatment with intravenous thrombolysis. We performed a sensitivity analysis limited to patients who presented with a probable large-vessel occlusion, defined as a documented NIHSS score ≥12, to a thrombectomy hub and underwent intravenous thrombolysis. Results: Among 169,199 patients with ischemic strokes, the 82,784 (48.9%) who presented during off-hours had higher NIHSS scores (4 [IQR, 2-10] vs 2 [IQR, 1-9], P <0.001) and underwent thrombolysis more often (9.3% vs 8.5%, P <0.001). There were no differences between groups in rates of mechanical thrombectomy (3.4% on-hours vs 3.5% off-hours, P = 0.25). In adjusted models, off-hours presentation was not significantly associated with lower odds of mechanical thrombectomy (OR, 0.94; 95% CI, 0.85-1.03). Our findings were similar in a sensitivity analysis limited to patients with a probable large-vessel occlusion who initially presented to a thrombectomy hub and underwent intravenous thrombolysis (OR, 0.87; 0.69-1.09). Conclusions: In a large population-based sample of ischemic stroke patients across the US, the odds of mechanical thrombectomy did not vary by time of presentation.

Abstract 113: Duration Between Stroke Onset And Presentation Over Time: A Population-based Study

Background: In acute stroke, reducing delays between symptom onset and treatment can improve outcomes. While in-hospital delays have been successfully reduced, pre-hospital delays have persisted. Public health campaigns have attempted to reduce these delays by increasing stroke symptom awareness, but it is unknown whether these efforts have improved the percentage of patients presenting early after symptom onset. Methods: We performed an analysis of the Greater Cincinnati/Northern Kentucky Stroke Study, a population-based study of all stroke patients in a large geographic area. We looked at the 2010 and 2015 study years. All stroke cases (ischemic and hemorrhagic) presenting to the 16 regional EDs were included. We examined the time between symptom onset and ED arrival times, dichotomized into ≤3.5 hours and >3.5 hours. In cases without a clear onset, estimates were derived using wake-up or last known well times. Comparisons were made using multivariable logistic regression. Results: Among 4633 total stroke patients, 1359 patients presented early (29%). Results of the multivariable analysis are shown in the Table . There was no improvement the rate of early presentation in 2015 (aOR 1.01, 95% CI 0.89-1.16). EMS utilization, night arrival, higher NIHSS scores, and better premorbid function were associated with early arrival. Patients who lived alone were less likely to arrive early. Conclusion: We found no evidence for improvement in the rate of early presentation over the years studied. Work is needed to address other barriers to early hospital arrival, including underutilization of EMS.

Abstract WP161: Patients With Lower Stroke Scales Take Longer To Treat With Endovascular Thrombectomy Because Of A Longer Time To Identify Their Lvo Not Because Of Longer Procedural Time: Time To Identify And Triage An Lvo Is More Important Determinant Of Treatment Speed Than Procedural Time

Introduction: The seminal trials of thrombectomy in 2015/16 enrolled a relatively homogenous population of patients with ICA terminus or M1 occlusion and a consistent mean NIHSS of 17. However, with advancing techniques and technology, our ability to use EVT for rapid, effective and safe treatment is broadening EVT eligibility to include patients with more distal occlusions, lower NIH Stroke Scales and larger core infarcts. Given the importance of speed in achieving the most favorable outcomes, here we evaluate treatment speed in patients with low NIHSS scores compared to those who have higher NIHSS scores. We also evaluated whether identification of EVT candidacy (door to puncture) or procedural time (puncture to first pass) was a stronger determinant of treatment speed. Methods: Retrospective data from 17 hospitals within the Providence St Joseph Health System were analyzed and included 2,365 acute ischemic stroke patients who received EVT between January 2015 and May 2021. Generalized linear models were used to assess if admission NIHSS impacted the following treatment benchmark times: door to groin puncture (GP) in < 60 minutes, GP to first pass (FP) in <30 minutes or door to FP in < 90 minutes. Patients with an NIHSS of ≥11 were compared to those with an NIHSS of ≤10. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported. Results: There were a total of 2,365 EVT patients included, 1,649 (70.0%) with NIHSS ≥ 11 and 707 (30.0%) with NIHSS ≤10. Patients with NIHSS ≥ 11 were more likely to have door to GP < 60 minutes (AOR=1.87, 95% CI: 1.42, 2.47) and door to FP <90 minutes (AOR=1.56, 95% CI: 1.22, 2.00) but not GP to FP <30 min (AOR=.997, 95% CI: .772, 1.29) compared to patients with an NIHSS </=10. Conclusions: Patient’s with lower stroke scales take longer to treat with endovascular thrombectomy. This delay in time to treatment is driven by increased time in identification and triage rather than procedural time.

Abstract WP207: Switching Antiplatelets In Breakthrough Ischemic Stroke: Long Term Outcomes And Safety

Introduction: Previous studies have shown that switching antiplatelets after having an ischemic stroke on aspirin may have better outcomes. However, these studies included patients who were switched to dual antiplatelets, which have an established benefit in the immediate post-stroke period. The purpose of this study is to assess outcomes in patients who continue aspirin versus switch to clopidogrel after having a cerebrovascular event on aspirin. Methods: We retrospectively identified patients within 14 Southern California hospitals using ICD-9 and ICD-10 codes who had a diagnosis of ischemic stroke on aspirin from January 2017-December 2019. Outcomes included recurrent hospital admission or emergency room visit for ischemic stroke, TIA, or intracranial hemorrhage up to two years post index event. Patients were grouped by which antiplatelet was prescribed at discharge. Those prescribed dual antiplatelets or an anticoagulant were excluded. Cox regression analysis was used to estimate risk of readmission. Results: Of the 580 patients who met the inclusion criteria, 372 (64%) continued aspirin and 208 (36%) switched to clopidogrel. Those with coronary artery disease (55.0% versus 45.0%, p = 0.015), dyslipidemia (61.4% versus 38.6%, p = 0.001), diabetes (59.5% versus 40.5%, p = 0.007), and a higher NIHSS score (mean 6.06 +/- 6.96 SD versus 4.08 +/- 4.32 SD, p = 0.001) were more likely to be discharged on aspirin. There were no differences in recurrent ischemic stroke {18.8% versus 15.4%, HR 1.12 (95% CI, 0.74-1.72), p = 0.587}, ischemic stroke plus TIA {19.9% versus 18.3%, HR (95% CI, 0.84-1.86), p = 0.253}, systemic embolism {25.5% versus 21.6%, HR 1.16 (95% CI, 0.82-1.66), p = 0.413} or intracranial hemorrhage {3.2% versus 2.4%, HR 0.94 (95% CI, 0.34-2.70), p = 0.919} between those discharged on aspirin versus clopidogrel, respectively. Conclusion: This study suggests that switching antiplatelets after having an ischemic stroke on aspirin may not be warranted.

Abstract TMP69: Poor Clinical Outcome Of Patients With Early Neurological Deterioration In Large Vessel Occlusion And Low NIHSS

Introduction: Early neurological deterioration (END) in patients with large vessel occlusion (LVO) stroke with low NIHSS treated with medical management (MM) has been well described. However, the effect of END on 90-day disability outcomes relative to patients presenting with more severe stroke, remains undetermined. Methods: From our multi-center prospective registry across 4 comprehensive stroke centers, we identified patients with LVO (basilar, ICA, M1/2, or P1 identified on CTA or MRA) from January 2018 to June 2020. Low NIHSS was defined as 0-5, and END as a worsening of > 3 points. To determine the effect of END on outcomes, we used propensity score to match patients who presented with low NIHSS who suffered END by age and worsened NIHSS (i.e. subsequent, greater NIHSS) to patients who presented initially with LVO and comparable NIHSS. Results: Among 348 patients with LVO acute ischemic stroke, median age was 67 [IQR 59-76], 46.6% were female. 58 patients (17%) of the cohort had low NIHSS. Compared to the higher NIHSS group, low NIHSS group had less EVT performed (39.7% vs 78.3%, p=<0.001), greater ASPECTS (9 vs 8, p=0.001), fewer M1 occlusions (27.6% vs 51.7%, p<0.001), and lower prevalence of risk factors, such as hypertension, hyperlipidemia, and congestive heart failure (50.0% vs 71.4, p=0.001; 20.7% vs 36.9%, p=0.018; and 0.0% vs 9.3%, p=0.016, respectively). Overall 90-day disability outcomes (mRS 0-2) were better in the low NIHSS group (58.6% vs 44.8%, p=0.055) although it did not reach statistical significance. On the other hand, 41.4% of low NIHSS group did not achieve functional independence. Of 35 patients with initial MM in the low NIHSS group, 7 (20%) suffered END. The median increase in NIHSS was 7 (range 4-15), and only 1 patient achieved 90-day mRS 0-2. In a propensity matching analysis, LVO patients with initially low NIHSS patients followed by END had significantly worse outcomes than the patients who initially presented with comparable NIHSS (Coef=26, p=<0.001). Conclusions: In patients with low NIHSS and LVO, those treated initially with MM who suffer END have worse clinical outcomes when matched to patients with comparable NIHSS post-worsening. These finding suggest that the delaying EVT in this population may lead to worsened outcomes.

Синдром апноэ сна при остром инсульте у больных сахарным диабетом: особенности течения и терапии

В результате проведенного исследования установлено, что вероятность возникновения респираторных нарушений во время сна у больных сахарным диабетом в случае возникновения у них острого инсульта является высокой (63,3 %). Факторами риска являются мужской пол, ожирение, высокий балл по NIHSS (> 15). С целью диагностики расстройств дыхания во время сна у этих больных при поступлении нужно проводить скрининг-диагностику синдрома обструктивного апноэ сна для определения необходимости и тактики респираторной поддержки. Особенностями развития синдрома обструктивного апноэ сна у пациентов с острым инсультом и сопутствующим сахарным диабетом являются быстрое улучшение показателей в 1–3-й дни лечения (при условии респираторной поддержки) и потребность в длительной терапии на последующих этапах. У этих больных позиционная терапия и неинвазивная респираторная поддержка могут быть начаты рано при хорошей переносимости и относительно небольшом риске осложнений.

Distribution of risk factors of ischemic stroke in Chinese young adults and its correlation with prognosis

BackgroundThe risk factors for ischemic stroke in young people are complex, varied and closely related to prognosis. This study aims to analyze the risk factors for ischemic stroke in Chinese young people and to explore the main factors influencing the prognosis.MethodA total of 444 patients aged 16 to 45 years with ischemic stroke admitted to Suzhou tertiary hospital from 2011 to 2019 were retrospectively analyzed. Risk factors were identified according to the IPSS definition of pediatric stroke and the TOAST classification. All patients were followed up, and the modified Rankin score was used to evaluate the prognosis. Logistic regression analysis was used to explore the influencing factors of poor prognosis.ResultsAmong the patients, 12 risk factors were found according to the IPSS definition of pediatric stroke, and 5 types of stroke were found according to the TOAST classification. A total of 299 patients had a good prognosis. Anemia, venous sinus thrombosis, isolated large-vessel occlusion, and high baseline NIHSS score were significant risk factors.ConclusionThe IPSS definition enables patients to be classified on the basis of more risk factors than other classification methods. The prognosis of ischemic stroke in young people is generally good in the 5 years following the event. Anemia, venous sinus thrombosis, isolated large-vessel occlusion and high baseline NIHSS score were associated with poor prognosis.

The Short-Term and Medium-Term Prognosis of a Stroke and the Factors of Poor Prognosis in Liberville

Objectives: was to determine the factors influencing stroke prognosis in Libreville. Methods: This was a multicenter study prospective with a descriptive and analytical focus carried out from March 1st to July 31, 2014. Recruitment was systematic and exhaustive. The data collected was processed and analyzed using Epi-Info 3.3.5 software. Results: This study involved 66 patients including 27 male (40.9%) and 39 female (59.1%). Mean age was 55.1 +/? 15.3 years, mostly female. There were 57.5% ischemic stroke, 42.5% hemorrhagic stroke. The mean NIHSS was 7.8 +/? 6.6 at admission. Intra- hospital stroke mortality rates at 1 and 3 months were 7.6% and 9.1% respectively, ranging from 18.2% to 31.8%. The following factors were identified as associated with death at 1 month: age, high NIHSS at admission, high blood pressure, leukocytosis, hyperthermia and delay in admission. As for functional outcome, patients were relatively autonomous at discharge and factors associated with poor functional outcome (Rankin < 2) at 1 month were: age, high NIHSS, blood glucose and length of hospital stay. Factors associated with mortality and follow-up at 3 months could not be assessed due to 9 lost to follow-up (living or dead). Conclusion: This study highlights many factors influencing prognosis of stroke. The poor prognostic factors were age, high NIHSS at admission, high blood pressure, hyperthermia, blood glucose, leukocytosis, delay in admission and length of hospital stay. Addressing these factors in the acute phase management strategies may improve the prognosis of stroke patients in Gabon.

Predictors of unfavorable outcomes of ischemic stroke associated with COVID-19

To study predictors of unfavorable outcomes in ischemic stroke associated with COVID-19. A retrospective analysis of 173 case histories of patients with ischemic stroke and COVID-19 was carried out. The average age was 68.64±11.39 (95% CI 66.93-70.35; median 92, mean 34) years. By gender, women predominated (64.16%). Fatal outcome was observed in 62 (35.84%) patients. Risk factors were studied using binary logistic regression. The risk of a fatal stroke in a univariate analysis was established in the presence of a general severe condition of the patient and a number of other factors, which included the severity of COVID-19, acute coronary syndrome, multiple organ failure, the need for a ventilator, a history of kidney disease, pneumonia, high NIHSS score, oxygen partial pressure level, respiratory rate, number of hospitalizations, complete blood count (erythrocytes, hemoglobin, hematocrit, leukocytes, neutrophils), coagulogram, glucose, liver and kidney markers (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, urea), levels of creatine phosphokinase, lactate dehydrogenase and C-reactive protein. A model based on multivariate analysis was used, which makes it possible to predict the probability of a fatal outcome. A regression function was obtained, which included the content of C-reactive protein, urea and NIHSS score. In patients with a value of 35% and above, there was an increased risk of death, in the case of a value below 35%, a favorable outcome was assumed. The model was statistically significant (p<0.001). The sensitivity and specificity of the model were 88.9% and 97.9%, respectively. The revealed predictors of the probability of a fatal stroke outcome can be guidelines for a Coctor in choosing a patient management strategy at different stages of patient care.

Quality of life after ischaemic stroke\u2014accent on patients with thrombolytic therapy

BackgroundIntravenous thrombolysis is a widely approved treatment method for acute ischemic stroke (AIS). Nevertheless, there is a growing interest in its impact on functional outcomes and Health-related Quality of life (HR-QoL). We aimed to evaluate and compare the HR-QoL in patients receiving intravenous thrombolysis (IVT) and in those without thrombolytic therapy during the first 3-month post-stroke in a defined Bulgarian population.ResultsPatients treated with IVT have simillar functional outcomes and HR-QoL on the third month as the group with conservative treatment, besides their higher NIHSS on admission. Patients with IVT had better self-assessed recovery after the AIS. The higher NIHSS and mRS scores and the lower HR-QoL on discharge are reliable predictors for a poor functional outcome on the third month. A door-to-needle of 60 min or less, and the absence of pathological neuroimaging findings 24-h post IVT predict more beneficial HR-QoL outcome.ConclusionThere were no significant differences in HR-QoL and functional outcomes between the groups. Nevertheless, IVT is a treatment option with great importance for improving the clinical outcomes after ischemic stroke, which should be performed in well selected patients.

Abstract 1122‐000208: Imaging Characteristics for Post Stroke Delirium

Introduction : Delirium after acute ischemic stroke (AIS) is a common clinical occurrence, present in 13–48% of patients. Post‐stroke delirium is associated with longer hospital admissions, worse functional outcomes, and increased mortality in the short term and has been associated with worse long‐term outcomes. Prior studies have shown right‐sided strokes are more associated with delirium, but very few other imaging characteristics of post‐stroke delirium have been described. We conducted a prospective study evaluating imaging characteristics for patients with delirium. Methods : Between Sept 2019 and June 2021, patients diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)‐ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Data regarding demographics, comorbidities, hospital stay, stroke metrics, lab work and medications were analyzed. Imaging characteristics were adjudicated by authors based on either the patient’s first MRI or the 24 hr CT after admission. Infarct size measured based on ABC/2 formula based on diffusion‐weighted imaging on MRI or stroke appearance on CT. Results : Over the course of 12 non‐consecutive months, we evaluated 213 patients, of which 177 could be assessed with the CAM‐ICU. Delirium was present in 88 (49.7%). There were no statistically significant differences in age, gender, race, co‐morbidities, or TOAST etiology among patients with and without delirium (Table 1). Patients with delirium had higher NIHSS and were more likely to receive tPA. Patients with delirium were more likely to have MCA territory strokes, strokes involving the insula, and to have infarct sizes ≥10 cc. On multivariate modeling, NIHSS (OR 1.07; 95% CI 1.01, 1.13), MCA territory stroke (OR 2.62; 95% CI 1.09, 6.30), and infarct size ≥10 cc (OR 3.23; 95% CI 1.46, 6.90) were associated with delirium. Conclusions : In a cohort of AIS patients without significant expected mortality on admission, the incidence of delirium is high. On evaluation, infarct size ≥10 cc and in the MCA territory were more associated with delirium than NIHSS. These imaging characteristics should be considered in any future predictive models for identifying patients at risk for delirium.

Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke

Background: Acute ischemic stroke continues to be one of the leading causes of disability and death and is a financial burden to an already taxed health care system. Early intra-arterial treatment with mechanical thrombectomy devices is safe and effective for reducing disability and is superior to standard treatment with intravenous thrombolysis alone for the treatment large artery occlusion stroke. Nevertheless prognostics factors need to be systematically analyzed in the context of these new therapeutic strategies. The aim of this study was to analyze prognostic factors related to clinical outcome following thrombectomy in ischemic stroke. Methods: This single - center prospective study included 84 patients with large vessel occlusion stroke, in the anterior and the posterior circulation. Sexes, age, time to recanalization were prospectively collected. Clinical outcome was assessed post treatment, day one and discharge by means of a NIHSS. Three months mRS evaluation was performed by an independent neurologist. The probability of good outcome at 3 months was assessed by forward stepwise logistic regression using baseline NIHSS score, Glasgow score (GCS) at entrance, hyperglycemia, dyslipidemia, NIHSS at discharge, ASPECT score, collateral scale, TICI scale and time to recanalization. All variables significantly associated with the outcome in the univariate analysis were entered in the model. The significance of adding or removing a variable from the logistic model was determined by the maximum likelihood ratio test. Odds - ratio (OR) and their 95% confidence intervals were calculated. Results: At 3 months 55.2% of patients had a mRS 0 - 2. Baseline NIHSS score (p = 0.001), hyperglycemia (p = 0.024), dyslipidemia (p = 0.016), ASPECT score at entrance (p = 0.005), Good collateral status (p = 0.046) were all factors significantly associated with 3 month clinical outcome. Collateral scale, TICI scale and time to final TICI were not correlated to 3 months outcome. Baseline NIHSS score (OR, 2.539; 95% CI, 1.278 - 5.049; p = 0.008), hyperglycemia (OR, 29.841; 95% CI, 1.050 - 848.183; p = 0.047), emerged as independent predictors of outcome at 3 months. Overall embolic complication rate was 5%, and symptomatic intracranial hemorrhage was 3.5%. Conclusions: There are multiple factors that determine the predictors of clinical outcome in patients who undenwent endovascular treatment. High NIHSS and hyperglycemia at admission were the two factor independently associated with a bad outcome at 90 days.

A Novel Nomogram for Predicting Prognosis after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke.

Mounting evidence has shown that mechanical thrombectomy (MT) improves clinical outcomes for large vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS) of the anterior circulation. The present study aimed to provide a comprehensive analysis of risk factors associated with clinical outcomes in AIS patients receiving MT. A total of 212 consecutive patients who underwent MT for AIS were enrolled in the present study. Clinical characteristics were recorded at admission. Two endpoints were defined according to the 3-month modified Rankin scale (mRS) score after AIS (good outcome, mRS 0-2; and death, mRS 6). Additionally, we compared the clinical outcomes and safety of MT alone and bridging therapy in AIS patients. Of the 212 patients treated with MT, 114 (53.77%) patients had a good outcome and 31 (14.62%) died. The incidence of a worse outcome after MT was significantly elevated in males and patients with high WBC counts, high admission blood glucose levels, high baseline NIHSS scores and a long interval time from groin puncture to reperfusion in AIS patients treated with MT after adjustment for covariates (P<0.05); these risk factors were further confirmed by our constructed nomograms. In addition, we observed no significant benefit of bridging therapy compared to MT alone in AIS patients. Our constructed nomogram based on male sex, admission WBC, admission blood glucose, NIHSS, and the interval time from groin puncture to reperfusion predicts prognosis after mechanical thrombectomy in patients with acute ischemic stroke.