Mean NIHSS Research Articles

Association of post-stroke delirium with short-term trajectories of cognition.

Delirium could increase the risk of cognitive decline. We aimed to determine if changes in cognitive functions shortly after stroke differ between patients with and patients without delirium. We included patients who participated in the Prospective Observational Polish Study on post-stroke delirium and underwent the Montreal Cognitive Assessment (MoCA) at day 1, day 8 and 3months after stroke. Delirium was diagnosed using DSM-5 criteria. We used mixed linear regression models to characterize changes in mean adjusted MoCA scores over time. We included 402 patients (mean age: 68.9 ± 13.3years; mean NIHSS on admission: 6.2 ± 5.5; 48.8% female). Delirium occurred in 18.9% of them. Mean adjusted MoCA scores increased from day 1 to day 8 (20.48 vs 23.34, P<0.001) and then declined from day 8 to month 3 (23.34 vs 22.21, P<0.001). The rate of change in total MoCA scores from day 1 to day 8 (net effect: 0.65, 95%CI: -1.19; 2.49, P=0.489) and from day 8 to month 3 (net effect: -2.43, 95%CI: -4.84; -0.02, P=0.147) did not differ between patients with and patients without delirium. Compared with patients without delirium, those with delirium showed a greater improvement in naming, orientation and attention, accompanied by a worsening in memory from day 1 to day 8. They also experienced a greater decline in attention and orientation, along with a greater improvement in memory from day 8 to 3months. Post-stroke delirium is associated with short-term trajectories of specific cognitive domains, but not with changes in global cognition.

Stroke Thrombolysis in the Elderly: A Moroccan Retrospective Study

Background: Age increases the risk of mortality and poor prognosis following a stroke. The benefits of intravenous thrombolysis (IVT) in elderly patients have been well established. However, the outcomes in daily clinical practice may differ from those reported in other studies. The objectives of our study are to evaluate the effectiveness and safety of thrombolysis in elderly stroke patients and provide local data that can inform clinical practices in similar settings and raise awareness about specific challenges in treating elderly patients with ischemic stroke. Methods: We conducted a retrospective, cross-sectional, descriptive, and analytical study in the neurology department of Hassan II University Hospital in Fez, Morocco, from May 2015 to March 2021. All elderly patients aged ≥ 80 years within 6 h of onset who received intravenous thrombolysis were recruited. The primary outcomes were the rate of hemorrhagic transformation, NIHSS score at 24 h after IV thrombolysis and the rate of death within the first 7 days. Secondary outcomes were functional status at 3 months, assessed using the modified Rankin Scale (mRS). Our results were interpreted in light of the main studies in the literature. Results: 41 patients (58.5 % female, aged 84 ± 3.5 y.o) all received IV thrombolysis (tenecteplase 85.4% vs alteplase 14.6%) were included. The mean NIHSS score before IV thrombolysis was 13 (range, 3-20) and that 24 h after IV thrombolysis was 10 (rang, 1-19). Hemorrhagic transformations occurred in 31.7% of the patients within 7 days after onset (9.8% HI1, 9.8% HI2, 2.4% PH1, 9.8% PH2), and all of these cases were asymptomatic. The rate of death within the first 7 days was 22%. Among living patients, the median three months mRS was 3. The mortality rate at three months was 26.8% (n=11). However, there was no significant association between these outcomes and the occurrence of ICH after IVT. Conclusion: Despite the higher mortality rate in our sample, IV thrombolysis ...

Outcome of intravenous thrombolysis in acute ischemic stroke patients with small vessel disease

IntroductionLacunar stroke (LS) subtype accounts for a quarter of ischemic strokes. Intravenous thrombolysis (IVT) is known to improve overall stroke outcomes. Very few studies have focused on the outcome of IVT in lacunar strokes. Aim: To detect the outcome of IVT in LS patients compared to non-thrombolysed LS patients. MethodsFifty patients presenting with LS received the standard protocol of IVT (Group I). They were compared to fifty matched LS patients who presented beyond the time window and were selected as the control group (Group II). Clinical outcome was measured using NIHSS within 24 h, NIHSS at discharge, and MRS after 3 months. Risk factors that could have affected clinical outcomes were compared in the thrombolysis group. ResultsThe short-term clinical outcome of Group I showed statistically significant improvement of NIHSS after 24 hrs compared to Group II (mean NIHSS = 5.52±3.89 and 7.44±1.82 respectively), as well as on discharge (mean NIHSS = 3.88±3.50 and 5.78±2.97) respectively. For long-term outcomes, 94 % of GroupⅠ reached MRS 0, 1, and 2 (n = 47/50) versus 74 % (n = 36/50) in Group II. Longer door-to-needle time, severe WMCs (Fazekas score), and pneumonia were shown to be significant predictor factors for the worst outcome. ConclusionIVT has improved short- and long-term outcomes in LS patients. Longer door-to-needle time, severe WMCs, and pneumonia were shown to be significant predictor factors for the worst outcome.

Association of intraprocedural near admission-level blood pressure with functional outcome in stroke patients treated with mechanical thrombectomy

BackgroundOptimal blood pressure management during endovascular stroke treatment is not certain. We hypothesized that time or proportion of intraprocedural systolic blood pressure spent in a range around admission blood pressure might be associated with better clinical outcome.MethodsWe conducted a retrospective observational study at a single center at a university hospital, which included patients from August 2018 to September 2020 suffering from acute ischemic stroke with anterior circulation vessel occlusion and treated with endovascular therapy. Time and proportion of procedure time where systolic blood pressure (SBP) was near the baseline SBP on admission (bSBP) were used as exposure variables. The primary outcome was the occurrence of mRS score 0–2 three months after stroke. The primary analysis was performed by fitting a logistic regression model adjusted for baseline NIHSS, pre-stroke mRS, mTICI score, intubation, age and sex.ResultsWe included 589 patients in the analysis. Mean (SD) age was 76 (12) years, 315 were women (53%) and mean (SD) NIHSS score at admission was 15 (7.5). Mean (SD) bSBP was 167 (28) mmHg and mean (SD) intraprocedural SBP was 147 (21) mmHg. The proportion of time where intraprocedural SBP was in range of bSBP ± 20% was associated with a slightly higher odds of achieving favorable outcome (adjusted OR, 1.007; 95% CI, 1.0003–1.013).ConclusionA higher proportion of intraprocedural time with systolic blood pressure in range of ± 20% of the admission level is associated with higher odds of favorable functional outcome.Trial RegistrationNot applicable.

Evaluation of Neutrophil to Lymphocyte Ratio with Neurological Severity and Short-Term Outcome in Acute Ischemic Stroke

Introduction: Stroke represents a significant global health care challenge, ranking as the second most common cause of mortality and disability worldwide. Inflammatory process plays an important role in pathophysiology of acute ischemic stroke. These inflammatory responses increase the brain damage and cause neurological deterioration. Neutrophils and lymphocytes serve as pivotal mediators of inflammatory response. Aims and Objectives: This study aims to evaluate the association between the Neutrophils to lymphocyte ratio (NLR) with the initial severity of stroke and the short-term functional outcome using the NIHSS and BARTHEL index respectively. Materials and Methods: We conducted an observational cross-sectional study on 80 patients admitted at Father Muller Medical College Hospital, which is a tertiary care centre in Mangalore between May 2023 to April 2024. Diagnosis of stroke was based on clinical evaluation and Radiological imaging. Peripheral blood samples were collected for complete blood count within 24 hours of stroke onset. The NLR was determined by dividing the absolute neutrophil count (ANC) to the absolute lymphocyte count (ALC). This was then correlated with the NIHSS and the BARTHEL index. Results: This study included 80 patients, with the mean age of 65.1 years. Majority of the patients were in the age group 51-70years (55%). The mean NLR was found to be 13.39. The mean NIHSS and BARTHEL index was 11.08 and 63.69 respectively. The NLR showed significant correlation with the initial stroke severity and the short-term functional outcomes. For the purpose of correlation NLR was divided into three groups i.e. &gt;3, 3-5 and &gt;5. Patients with higher NLR (&gt;5) were more likely to have a severe stroke and greater dependency. Conversely, those with lower NLR (&lt;3) had a minor stroke and slight dependency. 80% of the patients with severe stroke had a NLR above 5, while 82% of the patients with minor stroke had a NLR below 3 (p value &lt;0.001). This study also found a strong correlation between NIHSS and the BARTHEL index - patients with lower NIHSS and NLR were found to have a better short term function outcome. Conclusion: NLR was found to be significantly associated with the initial severity of stroke and the shortterm functional outcome. Because of its high specificity, low cost, routine use NLR can be used for the prediction of severity of stroke and patients can be prioritised for specialised treatment thus reducing the mortality rates.

Clinical features and predictors of early neurological deterioration in patients with Trousseau syndrome-related cerebral infarction

Objective: This study aimed to explore the clinical features of Trousseau syndrome (TS)-related cerebral infarction and determine predictors of early neurological deterioration (END). Methods: A retrospective study was conducted on patients with TS-related cerebral infarction admitted to the Zhongshan Hospital Affiliated with Xiamen University, from December 2015 to December 2023. Patients were categorized into groups with and without END. The laboratory findings and imaging data were compared, and receiver operating characteristic (ROC) curves were constructed to determine the best predictors of END. Results: The study included 30 patients with TS-related cerebral infarction, comprising 17 males and 13 females with an average age of 70.93 ± 8.7 years. Five patients experienced END. Lung cancer was the most common primary malignancy (n=13, 43.33%), with most patients (n=22, 73.33%) having stage IV disease with extensive metastasis. The primary neurological symptom was hemiplegia (n=17, 56.67%). The mean NIHSS score at admission was 9.33 ± 5.83. Imaging revealed varying stages of cerebral infarction in 10 patients (38.46%). Within three months, 25 patients (83.33%) died, 8 of whom (32%) succumbed to tumor-related complications. The incidence of END in TS-related cerebral infarction patients was 16.67% (5/30). Patients in the END group had significantly greater D-dimer levels and lower fibrinogen (Fib) levels upon admission (P &lt; 0.001, P = 0.042). Comparisons of ROC curves revealed that D-dimer (AUC 0.916, optimal cutoff 17.86, sensitivity 1.000, specificity 0.840) and Fib (AUC 0.788, optimal cutoff 2.54, sensitivity 1.000, specificity 0.740) significantly predicted END (P = 0.004, P = 0.045). The combined use of these markers improved the AUC to 0.952, with a sensitivity of 1.00 and specificity of 0.920, surpassing those of the individual markers (P = 0.002). Conclusion: TS-related cerebral infarction most commonly occurs in patients with advanced-stage lung cancer with widespread metastasis and is associated with poor long-term prognosis. Elevated D-dimer and decreased fibrinogen levels are significant predictors of END in patients with TS-related cerebral infarction.

ROTEM and von Willebrand Factor in COVID patients presenting with acute ischemic stroke: A case series: ROTEM and von Willebrand Factor in COVID-19 Related Stroke

ObjectivesSARS-CoV-2 (COVID) induces systemic thrombotic complications including acute ischemic stroke. In this case series, we report markers of inflammation, coagulation factors including von Willebrand factor antigen, and rotational thromboelastometry (ROTEM) data. Materials and methodsRetrospective case series of COVID patients seen at a single comprehensive stroke center between 2020–2022. For patients undergoing mechanical thrombectomy (MT), ROTEM data was collected during the procedure and analyzed on ROTEM delta system. ResultsFifteen patients (33.3% female) median age 65-years-old presented with COVID and acute ischemic stroke. Thirteen had LVO. The mean NIHSS was 15 (range 0–35) on admission and 18 (0–42) at discharge. Most were cryptogenic (N=7, 46.7%), followed by cardioembolic (N=6, 40%) and large artery-to-artery embolization (N=2, 13.3%). mRS was < 3 in 8 (53%) patients at discharge. None of the patients were on anticoagulation, and five were on antiplatelet therapy pre-hospitalization. Seven received thrombolytics with alteplase (tPA), and 10 had MT.Baseline platelet count was 102 K/uL (range 102–291 K/uL). vWF was measured in 12 patients, all elevated, with seven having levels >400 (180%). ROTEM data was collected in six patients. Three who received tPA had abnormal EXTEM and FIBTEM data (CT extem > 85secs, A10 EXTEM < 45mm, and A10 FIBTEM < 10mm). Notably, INTEM (CT INTEM >208secs) was abnormal in five of the six patients, two of whom did not receive tPA. ConclusionsElevated vWF antigen levels with abnormal ROTEM data suggests that COVID induces changes in the clotting cascade. More robust research is needed to investigate these findings. Thrombolytics, MT, and antiplatelet agents should be utilized to treat COVID-related ischemic stroke based on current clinical guidelines.

Prevalence and Risk Factors of Cerebral Microbleeds among Egyptian Patients with Acute Ischemic Stroke.

Cerebral microbleeds (CMBs) are markers of underlying hemorrhage-prone cerebral small vessel disease detected on MRI. They are associated with a heightened risk of stroke and cognitive decline. The prevalence of CMBs among Egyptian patients with ischemic stroke is not well studied. Our aim was to detect the prevalence of CMBs and associated risk factors among Egyptian patients with ischemic stroke. A prospective, cross-sectional, single-center study of consecutive patients with ischemic stroke. Patients were recruited between January 2021 and January 2022 at the Assiut University Hospital in the south of Egypt. Patients with known bleeding diathesis were excluded. All participants underwent full neurological assessment, urgent laboratory investigations, and MRI with T2* sequence. The study included 404 patients, 191 (47.3%) of them were females. The mean age of the study population was 61 ± 1 years, and the mean NIHSS on admission was 12 ± 5. The prevalence of CMB was 26.5%, of whom 6.5% were young adults (age ≤45 years). CMBs were detected in 34.6% of patients with stroke caused by large artery atherosclerosis, 28.0% with small vessel disease stroke subtype, 25.2% with stroke of undetermined cause, and in 12.1% with cardioembolic stroke. History of AF, hypertension, dyslipidemia, Fazekas score &gt;2, dual antiplatelet use, combined antiplatelet with anticoagulant treatment, and thrombolytic therapy remained independently associated with CMBs following multivariable regression analyses. The high number of identified CMBs needs to inform subsequent therapeutic management of these patients. We are unable to determine whether the association between CMBs and antithrombotic use is a causal relationship or rather confounded by indication for these treatments in our observational study. To understand more about the underlying cause of this finding, more studies are needed.

Correlation between Mean Platelet Volume, Fibrinogen and D-dimer with NIHSS Score

Introduction: Stroke is a clinical syndrome that develops rapidly due to focal or global brain disorders with symptoms last for &gt;24 hours and potentially cause death. Due to the consideration that this Mean Platelet Volume (MPV) marker is not invasive, easy to do and is in line with the pathogenesis of stroke, researchers are interested in carrying out this research. And hopefully this research can provide information for the world of education and health about changes in MPV, fibrinogen and D-dimer in ischemic stroke patients. So it can be taken as consideration in the early management of ischemic stroke patients. Subject and Methods: This research was an observational study with a cross-sectional design at Haji Adam Malik General Hospital from October to November 2023. The research subjects were stroke patients who were treated in emergency room and met inclusion criteria. This research was to study about correlation of MPV, fibrinogen, and D-dimer with NIHSS scores of ischemic stroke patients. The method used in this research is the Pearson correlation test where data was normally distributed. All statistical tests with a p value &lt; 0.05 were considered significant. Results: The mean MPV was 10.4 ± 1.6, while the mean NIHSS value was 19.9 ± 8.7, and there was a statistically significant correlation between the MPV value and the NIHSS score (p&lt;0.05). The mean fibrinogen was 421.9 ± 109.3, while mean NIHSS value was 19.9 ± 8.7, and there was a statistically significant correlation between fibrinogen values and NIHSS scores (p&lt;0.001). The mean D-Dimer was 8.0 ± 11.3, while the mean NIHSS value was 19.9 ± 8.7, and showed a statistically significant correlation between D-Dimer value and NIHSS score (p&lt;0.05). The r value of MPV, fibrinogen, and D-dimer on NIHSS score was 0.494; 0.495; and 0.504. The regression coefficient for MPV variable is 0.093, therefore MPV variable influence on NIHSS variable is positive. Conclusion: There is a strong correlation between D-dimer and the NIHSS score, and a moderate correlation between MPV and fibrinogen with NIHSS score.

Clinical Characteristics, Functional Outcome, and Socioeconomic Impact of Ischemic Stroke among Young Egyptian Adults.

Stroke in young patients results in disproportionately high societal cost given the productive life-years lost. Little is known about stroke in young Egyptian patients. We aimed to analyze clinicodemographic characteristics, functional outcome, and socioeconomic impact of ischemic stroke among young Egyptian adults. This is a prospective, observational cohort study of consecutively recruited patients with acute ischemic stroke (AIS), 18-50 years, between September 2022 and September 2023 at a tertiary stroke center in the south of Egypt. We recorded baseline demographic and cardiovascular risk factors, stroke severity, stroke subtype according to the TOAST classification, intravenous thrombolysis, employment, and ambulation status pre- and post-stroke, post-stroke complications, and 90-day functional outcome measured by the modified Rankin Scale (mRS). Our cohort comprised 210 patients, 38.0 (±7.8) years, 89 (42%) females. Mean NIHSS score was 11.2 (±4.8); in-hospital case fatality was 9% (19 patients). Dyslipidemia (n = 105, 50%), smoking (n = 105, 50%), and hypertension (n = 67, 32%) were the most prevalent cardiovascular risk factors. At 90 days, 58 (29%) patients had a 90-day mRS 0-1 and 53 (26%) met criteria for depression diagnosis. Sixty-nine of the 116 employed individuals (59%) remained out of work after 90 days of stroke, 61 of whom were single earners in their household. 36/60 (60%) thrombolysis-eligible patients received it; an additional 98 otherwise thrombolysis-eligible patients presented &gt;4.5 h from symptom onset. Patients receiving IV thrombolysis were significantly more likely to have resumed full-time work at 90 days (32% vs. 11%, p = 0.006) but with no significant difference in 90-day mRS. Young adult AIS patients in Egypt experience high rates of post-stroke depression and face challenges in their ability to work and provide for their families. Since most patients have treatable cardiovascular risk factors and only about two-thirds of eligible patients receive thrombolysis, reinforcing primary prevention, education about early stroke signs, and benefits of acute can improve outcomes and have significant potential societal benefit.

Distal mechanical thrombectomy using beveled tip aspiration zoom catheters: A preliminary study.

Distal medium vessel occlusion (DVO) thrombectomy has been shown to be efficacious with safety profiles comparable to large vessel occlusion (LVO) thrombectomy. A novel, highly-trackable, bevel-tipped Zoom 35 catheter can be used as an aspiration catheter for DVO thrombectomy. This is a retrospective, single-arm, multi-institutional observational study evaluating the efficacy and safety of aspiration thrombectomy for DVO using the Zoom 35 catheter. Patient demographics, presenting and discharge NIHSS, primary and rescue thrombectomy, site of occlusion, TICI score, and intracranial hemorrhage were chart abstracted. Descriptive statistics were used to evaluate the efficacy and safety of thrombectomy. Fourteen patients (mean age 66.64 ± 13.75 years) were included. The mean NIHSS at presentation was 10.79 ± 5.48, and the mean ASPECTS was 9.00 ± 0.89. Nine patients (64.3%) received tPA. Primary occlusion location was M3 in nine cases (64.3%), M2/M3 junction in two cases (14.3%), A2 in one case (7.1%), A3 in one case (7.1%), and P1 in one case (7.1%). TICI scores were 3 in seven cases (50.0%), 2C in three cases (21.4%), and 2B in four cases (28.6%). There was one postoperative SAH (7.1%) and one asymptomatic ICH (7.1%). Mean discharge NIHSS was 3.38 ± 4.44, with a mean decrease of 7.31 from presentation (p < 0.0001, t-test). Zoom 35 beveled-tip aspiration microcatheters are highly trackable and associated with improved radiographic and clinical outcomes for the treatment of DVO with a good safety profile.

Prehospital neurologic assessment using mobile phones: Comparison between neurologists and emergency physicians

BackgroundAmbulance-based telestroke may be a promising solution to improving stroke care. We assessed the technical feasibility and reliability of prehospital evaluations using commercial mobile phones with fifth-generation wireless communication technology. MethodsSix standardized patients portrayed scripted stroke scenarios during ambulance transport in an urban city and were remotely evaluated by independent raters using tablets (three neurologists and three emergency physicians) in a hospital, assisted by paramedics (trained in National Institute of Health Stroke Scale [NIHSS] assessment) in the ambulance; commercial cellular networks were utilized for videoconferencing transmission. The primary outcomes were mean difference (MD) and correlation of NIHSS scores between the face-to-face and remote assessments. We also examined the Bland-Altman plot for itemized NIHSS components, and Kaplan–Meier curves were used to compare the differences in the duration of the two evaluations between neurologists and emergency physicians. ResultsWe conducted 32 ambulance runs and successfully completed all NIHSS examinations. No significant difference was found between the face-to-face and remote evaluations (MD, 0.782; 95% confidence interval [CI], −0.520–0.395). The correlation of NIHSS scores between the two methods was 0.994 (95% CI, 0.945–1.026), and three items exhibited the highest frequency of runs, with score differences between the two methods. There were no significant differences between neurologists and emergency physicians in the mean evaluation duration and NIHSS scores for the two methods. ConclusionPrehospital evaluation using commercial mobile phones with fifth-generation wireless communication technology is feasible and reliable during ambulance transport in urban areas. Emergency physicians and neurologists performed similarly in stroke evaluations.

Clinical and Therapeutic Aspects of Ischemic Stroke in Atrial Fibrillation at the Neurology Department of CHU Conakry

Introduction: The main cause of ischemic stroke in our setting is atrial fibrillation. The aim of this study was to evaluate the clinical and therapeutic aspects of atrial fibrillation during ischemic stroke. Material and Methods: We conducted a retrospective descriptive study lasting one year from November 1, 2020 to November 31, 2021, involving all patients with ischemic stroke diagnosed by CT or MRI. We included patients with atrial fibrillation confirmed by a 12-lead électrocardiogrammes (ECG) or a 24-hour ECG holter. Thromboembolic risk was assessed by the CHA2DS2Vasc score and bleeding risk by the HAS-BLED score. Results: A total of 1,400 patients (19.64%) were enrolled. Mean age was 57.3 +/-16.64 years, predominantly female (54.5%), with hypertension as a risk factor (45.09%). The mean NIHSS score was 17.9 +/-3.2, associated with disorders of consciousness (44.36%) and hemiplegia (100%). atrial fibrillation was persistent in 54.90% of cases. A CHA2DS2-VASc score ≥ 2 was found in 94.9% of cases, and a low HAS-BLED score in 73% of cases, for whom Rivaroxaban was the first-line treatment in 76.72% of cases. Conclusion: This study has shown that atrial fibrillation is common in cardioembolic cerebral infarctions with age and hypertension as risk factors.

Door to needle time trends after transition to tenecteplase: A Multicenter Texas stroke registry

BackgroundTenecteplase (TNK) is considered a promising option for the treatment of acute ischemic stroke (AIS) with the potential to decrease door-to-needle times (DTN). This study investigates DTN metrics and trends after transition to tenecteplase. MethodsThe Lone Star Stroke (LSS) Research Consortium TNK registry incorporated data from three Texas hospitals that transitioned to TNK. Subject data mapped to Get-With-the-Guidelines stroke variables from October 1, 2019 to March 31, 2023 were limited to patients who received either alteplase (ALT) or TNK within the 90 min DTN times. The dataset was stratified into ALT and TNK cohorts with univariate tables for each measured variable and further analyzed using descriptive statistics. Logistic regression models were constructed for both ALT and TNK to investigate trends in DTN times. ResultsIn the overall cohort, the TNK cohort (n = 151) and ALT cohort (n = 161) exhibited comparable population demographics, differing only in a higher prevalence of White individuals in the TNK cohort. Both cohorts demonstrated similar clinical parameters, including mean NIHSS, blood glucose levels, and systolic blood pressure at admission. In the univariate analysis, no difference was observed in median DTN time within the 90 min time window compared to the ALT cohort [40 min (30–53) vs 45 min (35-55); P = .057]. In multivariable models, DTN times by thrombolytic did not significantly differ when adjusting for NIHSS, age (P = .133), or race and ethnicity (P = .092). Regression models for the overall cohort indicate no significant DTN temporal trends for TNK (P = .84) after transition; nonetheless, when stratified by hospital, a single subgroup demonstrated a significant DTN upward trend (P = 0.002). ConclusionIn the overall cohort, TNK and ALT exhibited comparable temporal trends and at least stable DTN times. This indicates that the shift to TNK did not have an adverse impact on the DTN stroke metrics. This seamless transition is likely attributed to the similarity of inclusion and exclusion criteria, as well as the administration processes for both medications. When stratified by hospital, the three subgroups demonstrated variable DTN time trends which highlight the potential for either fatigue or unpreparedness when switching to TNK. Because our study included a multi-ethnic cohort from multiple large Texas cities, the stable DTN times after transition to TNK is likely applicable to other healthcare systems.

Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation

BackgroundLong-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). However, data on the impact of AC on in-hospital stroke outcomes is lacking. MethodsThe National Inpatient Sample was used to identify adult inpatients with AF and a primary diagnosis of ischemic stroke between 2016 and 2020. Data was stratified between AC users and nonusers. A multivariate regression model was used to describe the in-hospital outcomes, adjusting for significant comorbidities. ResultsA total of 655,540 hospitalizations with AF and a primary hospitalization diagnosis of ischemic stroke were included, of which 194,560 (29.7 %) were on long-term AC. Patients on AC tended to be younger (mean age, 77 vs. 78), had a higher average CHA2DS2VASc score (4.48 vs. 4.20), higher rates of hypertension (91 % vs. 88 %), hyperlipidemia (64 % vs. 59 %), and heart failure (34 % vs. 30 %) compared to patients not on long-term AC. Use of AC was associated with decreased in-hospital mortality (aOR [95 % CI]: 0.62 [0.60–0.63]), decreased stroke severity (mean NIHSS, 8 vs. 10), decreased use of tPA (aOR 0.42 [0.41–0.43]), mechanical thrombectomy (aOR 0.85 [0.83–0.87]), intracranial hemorrhage (aOR 0.69 [0.67–0.70]), gastrointestinal bleeding (aOR 0.74 [0.70–0.77]), and discharge to skilled nursing facilities (aOR 0.90 [0.89–0.91]), compared to patients not on AC (P<0.001 for all comparisons). ConclusionAmong patients with AF admitted for acute ischemic stroke, AC use prior to stroke was associated with decreased in-hospital mortality, decreased stroke severity, decreased discharge to SNF, and fewer stroke-related and bleeding complications.

PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety.

Lipid-lowering therapies are mainstays in reducing recurrence after acute ischemic stroke (AIS). Evolocumab, a Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, is a promising lipid-lowering agent known to decrease LDL cholesterol and mitigate vascular events alongside statins. However, its effects on the early functional outcomes post-mechanical thrombectomy (MT) remain unclear. This study aimed to assess the short-term effects and incidence of bleeding events after the early, off-label use of PCSK9 inhibitors in AIS patients undergoing MT. We retrospectively analyzed patients who had MT at a Regional Stroke Center from December 2018 to April 2023. Our primary outcome was discharge functional outcomes. Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles. Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, p = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, p = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94-4.22] for mRS ≤ 3 and 0.47[0.27-0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time. Early use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.

The Relationship between CT Angiography Collateral Score and Biochemical Parameters during Acute Ischemic Stroke Caused by Middle Cerebral Artery Infarct.

Background/Objectives: Collateral development after AIS is important for prognosis and treatment. In this study, we aimed to investigate the relationship and correlation between biochemical parameters and CT angiography collateral score within the first 9 h and its effect on the neurological outcomes of patients with AIS due to MCA infarction. Methods: A total of 98 patients with MCA infarction were hospitalized for diagnosis and treatment after undergoing CT angiography within 9 h of suffering a stroke. Demographic data, admission biochemical parameters, hospitalization data, and discharge NIHSS scores were recorded. Souza's scoring system for collateral distribution was used to evaluate collaterals. Souza CS system and clinical disability comparison outcomes identified. Results: According to the Souza CS system, 13 patients were in the malignant profile category, and 85 patients were in the good profile category. The NIHSS value of patients with a malignant profile was 27, while the mean NIHSS value of patients with a good profile was 9. There was a statistically significant difference in uric acid, total cholesterol, triglyceride, HDL cholesterol, CRP, hsCRP, D-Dimer, troponin I, vitamin B12, fibrinogen, NSE, homocysteine, aPTT, and INR levels according to collateral distribution. Conclusions: This study demonstrates that biochemical parameters can influence the distribution of malignant and benign collaterals in AIS independent of age and gender.

Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion.

Background: Basilar artery occlusion (BAO) is a serious disease with a poor prognosis if left untreated. Endovascular therapy (EVT) is the most effective treatment that is able to reduce mortality and disability. Treatment results are influenced by a wide range of factors that have not been clearly identified. In the present study, direct aspiration was chosen as a first-line treatment. The safety and effectiveness of direct aspiration in BAO were determined, and factors affecting patient outcomes were identified. Methodology: Data for patients with BAO treated between November 2013 and December 2021 were evaluated using a database. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 89 patients with BAO were identified. Full recanalization was achieved in 69.7% of cases and partial recanalization in 19.1%. Intracranial hemorrhage was detected in 11 (12.4%) patients, of which, eight (9.0%) patients experienced symptomatic intracranial hemorrhage. Patients with good outcomes presented with milder strokes (mean NIHSS score of 12.58 vs. 24.00, p < 0.001), had higher collateral scores (6.79 vs. 5.88, p = 0.016), more often achieved complete recanalization (87.9% vs. 58.9%, p = 0.009), and more often experienced early neurological improvement (66.7% vs. 26.8%, p < 0.001). On the contrary, patients with worse outcomes had higher serum glucose levels (p = 0.05), occlusion of the middle portion of the basilar artery (MAB) (30.3% vs. 53.6%, p = 0.033), longer thrombus lengths (10.51 vs. 16.48 mm, p = 0.046), and intracranial hemorrhage (p = 0.035). Conclusions: The present study results suggest that direct aspiration is a safe and effective treatment for patients with BAO. We identified several factors affecting the patients' outcome.

Association between acute stroke and COVID-19 infection among patients with acute stroke

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS COV 2) infection is associated with multiple neurological complications. Cerebrovascular accidents are considered as one of the common neurological complications associated with corona virus (COVID-19). It may represent the first presentation of the patients of COVID-19 or may occur anytime during the course of the disease.ResultsThis study included 381 patients after the diagnosis of cerebrovascular accident. The mean age of the participants was 57.1 ± 15 years. 53.5% of the participants were males and 46.5% were females. The participants had COVID-19 infection in past 3 months with mean duration was 35.5 ± 18 days. The mean NIHSS among the participants was 10.5 ± 6.2. Small artery stroke was higher among PCR negative patients and controls, while large artery stroke was higher among PCR positive patients. 26% of patients with stroke and confirmed COVID-19 infection developed stroke immediately after COVID-19 infection (within 1 week). Within 1 month from getting infection with COVID-19, 41.7% of patients developed stroke and 32.3% had developed stroke after 1 month of infection with COVID-19. Female gender, older age of the patients and presence of vascular risk factors were associated with increased severity of infection as evidenced by higher NIHSS and more ICU admission among COVID-19 positive patients.ConclusionsCOVID-19 infection has been associated with both venous and arterial stroke, especially in elderly patients. COVID-19 infection was associated with increased stroke severity as evidenced by higher NIHSS and more ICU admission. Small vessel disease was higher among COVID-19 negative patients, while large artery stroke was higher among positive COVID-19 patients.

A Study of Efficacy and Outcomes of Two Techniques of Mechanical Thrombectomy in Acute Ischemic Stroke

Abstract Background Endovascular mechanical thrombectomy (A Direct Aspiration First Pass Technique [ADAPT] and Solitaire stent retrieval techniques) as an emergency reperfusion therapy in acute ischemic stroke patients avoids secondary brain insult and thereby prevents permanent neurological deficits. As studies comparing the two thrombectomy procedures are scarce, we evaluated their efficacy. Methods In this prospective observational study done at Manipal Hospitals Bangalore, 75 patients were separated into two groups based on the final reperfusion technique employed: ADAPT group with 39 patients who underwent contact aspiration technique and Solitaire group with 36 patients who underwent stent retrieval thrombectomy. The rate of successful reperfusion (modified treatment in cerebral infarction scores [mTICI]); functional outcomes (modified Rankin scale [mRS] and National Institutes of Health Stroke Scale [NIHSS]) at 24 hours, 1 month and 3 months postintervention; and the adverse events were compared between the two groups. Results Successful reperfusion was significantly higher in the ADAPT group. Mean NIHSS and mRS scores reduced significantly postintervention for both groups, but was greater for the ADAPT group, while mortality and other adverse events were significantly greater in the solitaire group. Conclusion Mechanical thrombectomy is an effective reperfusion therapy for acute ischemic stroke patients. Comparing the two techniques revealed better outcomes for ADAPT, than stent retrieval technique.