Outcome In Acute Stroke Patients Research Articles

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia.

Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.

Role of arterial spin labeling magnetic resonance perfusion in acute ischemic stroke

BackgroundArterial spin labeling (ASL) is a recently used magnetic resonance imaging (MRI) perfusion technique in acute cerebrovascular stroke conditions; it can detect the hypo perfused areas on basis of qualitative and quantitative measurements and also identify the area at risk known as penumbra by detecting the diffusion/perfusion mismatch. The purpose of this study was to assess the role of ASL perfusion technique in management of acute ischemic stroke and its ability to predict the clinical outcome of acute stroke patients. The study was prospectively carried out on 33 patients clinically presented with acute stroke from the first of August 2020 till the first of August 2021. All cases were clinically assessed by stroke consultant followed by brain imaging including conventional MRI and ASL perfusion technique, based upon which management was established. These imaging data were correlated with the clinical outcome after 3 months using Modified Rankin Scale.ResultsSixteen cases (48.48%) showed ischemic penumbra with diffusion perfusion mismatch with three cases presenting within the first 4 h managed by intravenous thrombolytic therapy and 13 cases presenting later than 4 h, 10 of whom were managed by endovascular intervention. The group with ischemic penumbra showed significant positive correlation with favorable clinical outcome while the group without ischemic penumbra showed significant positive correlation with poor clinical outcome. Quantitative ASL values were statistically significantly higher (p ≤ 0.05) in patients with favorable clinical outcome than those with poor clinical outcome. The estimated cut off values of ASL absolute cerebral blood flow and relative cerebral blood flow to predict favorable or poor outcome using ROC curve analysis were 19 ml/100gm/min and 74% compared to the contralateral side respectively.ConclusionThe use of MRI as a primary diagnostic tool in arterial ischemic stroke with the application of non-contrast ASL perfusion sequence allows precise detection of perfusion deficit and diffusion perfusion mismatch (penumbra) and provides a reliable insight into outcome prediction.

Abstract WMP11: Health-related Quality Of Life After Thrombolysis In Acute Stroke: Results From The Act Trial

Background and aims: Recent evidence from thrombolysis trials indicate the non-inferiority of the Tenecteplase (TNK) to the Alteplase (TPA) with respect to functional outcomes in acute stroke patients. This study examines the predictors of patient-reported health-related quality of life (HRQOL) in acute stroke patients who received thrombolysis therapy. Methods: Data were used from all acute stroke patients included in AcT, a pragmatic, registry-linked randomized trial comparing TNK with TPA. HRQOL at 90-day post-randomization was assessed using the EuroQol-5D-5L (EQ-5D) visual analogue scale (VAS). Based on the Canadian norms, health state utilities were estimated from the EQ-5D items using the EQ-5D time trade-off approach. Tobit regression model and linear mixed-effects regression were used to evaluate the adjusted effect of type of treatment on health utility scores and VAS score, respectively. Results: Of the 1262 patients included in this analysis, 647(51.3%) were administered the TNK, 584(46.3%) were female, and 380(30.1%) were greater than or equal to 80 years old. There was no significant adjusted effect of the type of thrombolysis on health utility scores (adjusted beta coefficient [95%CI] = 0.029 [-0.001, 0.062]), but patients who received TNK reported higher adjusted VAS scores than those that received TPA [adjusted beta coefficient [95%CI] = 2.1 [-0.29, 4.49]). Older age (p &lt; 0.01), female sex (p = 0.01), higher NIHSS score (p &lt; 0.01) were associated with lower health utilities and VAS scores. Conclusion: There is no differential effect of the type of thrombolysis on patient-reported global HRQOL and health state utilities of acute stroke patients. Disparities in HRQOL were mainly explained by sex, age, and disease severity.

Prognosis of ischemic stroke predicted by machine learning based on multi-modal MRI radiomics.

Increased risk of stroke is highly associated with psychiatric disorders. We aimed to conduct the machine learning model based on multi-modal magnetic resonance imaging (MRI) radiomics predicting the prognosis of ischemic stroke. This study retrospectively analyzed 148 patients with acute ischemic stroke due to anterior circulation artery occlusion. Based on the modified Rankin Scale (mRS) score, patients were divided into good (mRS ≤ 2) and poor (mRS > 2) outcome groups. Segmentation of the infarct region was performed by manually outlining a mask of the lesion on diffusion-weighted images (DWI) using MRIcron software. The apparent diffusion coefficient (ADC), fluid decay inversion recoverage (FLAIR), susceptibility weighted imaging (SWI) and T1-weighted (T1w) images were aligned to the DWI images and the radiomic features within the lesion area were extracted for each image modality. The calculations were done using pyradiomics software and a total of 4,744 stroke-related imaging features were automatically calculated. Next, feature selection based on recursive feature elimination was used for each modality and three radiomic features were extracted from each modality plus one feature from the lesion mask, for a total of 16 radiomic features. At last, five machine learning (ML) models were trained and tested to predict stroke prognosis, calculate the received operating characteristic (ROC) curves and other parameters, evaluate the performance of the models and validate their predictive efficacy by five-fold cross-validation. Sixteen radiomic features were selected to construct the ML models for prognostic classification. By five-fold cross-validation, light gradient boosting machine (LightGBM) model-based muti-modal MRI radiomic features performed best in binary prognostic classification with accuracy of 0.831, sensitivity of 0.739, specificity of 0.902, F1-score of 0.788 and an area under the curve (AUC) of 0.902. The ML models based on muti-modal MRI radiomics are of high value for predicting clinical outcomes in acute stroke patients.

Cancer-Associated Stroke and Acute Endovascular Reperfusion Therapy.

Since stroke is often associated with cancer, acute stroke patients with cancer undergoing endovascular therapy (EVT) are not uncommon. Reportedly, the proportion of such cases is approximately 6%-7% of all stroke EVT cases. Ischemic stroke in patients with active cancer (cancer-associated stroke) includes not only strokes caused by cancer-related hypercoagulability but also coincident strokes due to common etiologies, strokes associated with tumor emboli, direct tumor invasion of blood vessels, and strokes associated with cancer therapy. Stroke caused by cancer-related hypercoagulability itself encompasses various entities, including paradoxical embolism, stroke due to nonbacterial thrombotic endocarditis, and in situ arterial occlusion due to disseminated intravascular coagulation or thrombotic microangiopathy. Thus, diverse mechanisms contribute to cancer-associated stroke, emphasizing the need to consider individualized treatment strategies for acute cases involving large vessel occlusion. Observational studies have shown that EVT for cancer-associated stroke results in poorer clinical outcomes, but with comparable rates of successful reperfusion and symptomatic intracranial hemorrhage when compared with stroke patients without cancer. This suggests that denying patients EVT solely on the basis of comorbid active cancer is inappropriate, and decision-making should be shared with the patients and their families, preferably through a multidisciplinary team approach. Thrombi retrieved from patients with stroke caused by cancer-related hypercoagulability have unique characteristics, being predominantly platelet rich and difficult to retrieve. Preprocedural imaging and serum biomarkers, including the hyperdense vessel sign on non-contrast CT, susceptibility vessel sign on T2* or susceptibility-weighted MRI, three-territory sign on MRI, and D-dimer levels, are valuable in evaluating the stroke subtype and thrombus features. Thrombectomy techniques, such as contact aspiration and stent retriever monotherapy, have shown varying degrees of effectiveness for stroke caused by cancer-related hypercoagulability, warranting further study. After reperfusion therapy, appropriate treatment for the prevention of stroke recurrence should be initiated, considering the specific stroke subtypes. In conclusion, cancer-associated stroke encompasses diverse subtypes, and thrombi associated with stroke caused by cancer-related hypercoagulability present various challenges for thrombectomy. Individualized treatment approaches based on underlying mechanisms are essential for improving outcomes in acute stroke patients with active cancer. Optimization of preprocedural diagnosis, EVT techniques, and secondary prevention of stroke caused by cancer-related hypercoagulability will lead to better management of these patients and enhance their quality of life.

Comparison of Drip‐and‐Ship Versus Mothership Delivery Models of Mechanical Thrombectomy Delivery

Background It remains uncertain whether the drip‐and‐ship (DS) strategy (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the organizational stroke model associated with the best functional outcome in acute stroke patients with large vessel occlusion. In this study, we compared the periprocedural complications and outcomes at 90 days of acute stroke patients with large vessel occlusion of the anterior circulation directly admitted to our comprehensive stroke center compared to those referred from primary stroke centers treated with mechanical thrombectomy. Methods This is a single‐center prospective observational study where patients with DS and MS were compared regarding the disability at 90 days, as assessed by applying the modified Rankin scale, the rate of successful reperfusion, and the rate of immediate complications postprocedure. Results Of 579 patients, 216 (37.30%) were MS, and 363 (62.7%) were DS. There was no difference regarding the modified Rankin scale at 3 months between the MS (36.4%) and DS (39.3%) groups of patients treated with mechanical thrombectomy ( P =0.362). There was no significant difference regarding the National Institutes of Health Stroke Scale at 24 hours, mortality at 90 days, and rate of successful recanalization postprocedure between the 2 groups. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage (odds ratio, 5.414 [95% CI, 1.572–18.644]; P =0.007). Conclusion Our single‐center study showed no difference in terms of functional independence between the DS and MS organizational paradigm. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage.

Poor collateral flow with severe hypoperfusion explains worse outcome in acute stroke patients with atrial fibrillation.

Atrial fibrillation (AF) is associated with poorer functional outcomes in acute stroke patients. It has been hypothesized that this is due to poor collateral recruitment. This study aimed to investigate the relationship between AF and collaterals with outcome in thrombectomy patients. This retrospective cohort study identified 1036 acute ischemic patients from the INternational Stroke Perfusion Imaging REgistry. The cohort was divided into two groups: 432 with AF and 604 without AF. Patients were stratified by collateral grades as good, moderate, and poor. Within each collateral grade, the prediction of AF versus No AF for good outcome (3-month modified Rankin Scale of 0-2) was determined. Then, within each collateral grade, perfusion was compared between those with and without AF. AF was negatively associated with good outcome in patients with poor collaterals (26.7% vs 51.2% for AF vs No AF, odds ratio = 0.32 (95% confidence interval = 0.22-0.50), p < 0.001), but not in patients with good (50.9% vs 58.1% for AF vs No AF, odds ratio = 0.75 (0.46-1.23), p = 0.249) or moderate collaterals (43.6% vs 50.9% for AF vs No AF, odds ratio = 0.75 (0.47-1.18), p = 0.214). AF was associated with severe hypoperfusion only in patients with poor collateral flow (54.0 vs 35.5 mL for AF vs No AF, p < 0.001). AF-related stroke is associated with more severe hypoperfusion and worse outcome in those with poor collaterals.

Role of Head Position in Stroke Outcome: An Observational Study from Tertiary Care Hospital in Pakistan

Background and Aim: Acute ischemic stroke patients mainly rely on cerebral blood flow (CBF) to sustain penumbral tissue perfusion in turn depend on arterial blood pressure in affected cerebral autoregulation. Head positioning either sitting-up or lying flat allows gravitational force to enhance leptomeningeal circulation and collateral blood flow. The present study aimed to determine the role of head position in acute ischemic stroke patients. Methodology: This prospective observational study was conducted on 500 stroke patients in the Department of Neurology and Medical department of Fauji Foundation Hospital, Rawalpindi from January 2020 to December 2021. Patients with acute ischemic stroke receive care in either a lying flat on bed or sitting-up position with elevated head position at 30 to 45 degrees. The designated position was established shortly after hospital admission and was held for 24 hours. Outcomes such as pneumonia, aspiration pneumonia, and increased hospital stay, disability, and mortality were associated with flat head position and elevated head position. Modified Rankine scale (0-6) was used for assessing the degree of disability as a primary outcome in three months. Rankine scale higher score indicates the greater disability and maximum score 6 indicate mortality. Results: The average time from initiation of assigned position and onset of ischemic stroke symptoms was 14 hours (IQR 5-35). Patients in the sitting position group (93%, p&lt;0.001) were more likely than the lying-flat group (82%, p&lt;0.001) in maintaining their position for 24 hours. Based on a modified Rankine scale, both lying flat and sitting-up position groups had no significant differences in a proportional-odds model in terms of 90-days disability outcomes distribution. The mortality rate in lying flat and sitting-up position was 6.8% and 6.9% (p=0.79). Also, both groups had no significant differences in terms of severe outcomes including pneumonia. Conclusion: The present study found that disability outcomes in acute stroke patients were similar irrespective of their position either flat or sitting position with head elevated at 30 to 45 degree for 24 hours. The prevalence of AIS was 95.6%. Keywords: Head position, Acute ischemic stroke, Outcomes

Endovascular Treatment in Patients With Acute Ischemic Stroke and Comorbid Cancer: Analysis of the Italian Registry of Endovascular Treatment in Acute Stroke

Background Acute stroke patients with comorbid cancer (CC) are more preferably addressed with endovascular treatment (EVT) than thrombolytic therapy, due to the presumed potential risk of hemorrhagic transformation and systemic bleeding. This study aims to evaluate clinical and procedural outcomes of acute stroke patients with CC receiving EVT. Methods Using the Italian Registry of Endovascular Treatment in Acute Stroke, we reviewed prospectively collected data of CC patients treated with EVT from 2011 to 2017. Outcome measures were modified Thrombolysis in Cerebral Infarction score, symptomatic intracranial hemorrhage rate, and 3‐month modified Rankin scale. We also compared CC patients with a control group without cancer (non‐comorbid cancer) receiving EVT and matched the 2 populations with a 1:1 propensity score. Results Out of 4598 stroke patients treated with EVT, 165 (3.6%) had a CC. Modified Thrombolysis in Cerebral Infarction 2b‐3 was obtained in 73.8% of CC and 74.5% of non‐comorbid cancer patients ( P =0.84), whereas the rate of symptomatic intracranial hemorrhage rate was 8.2% and 6.9%, respectively. Three‐month all‐cause mortality was 33.3% in CC patients and 18.6% non‐comorbid cancer patients ( P &lt;0.001), and after propensity score was 35.4% and 22.1%, respectively ( P =0.012). In CC patients, the presence of metastasis and a more recent diagnosis of cancer were significantly associated with a higher 3‐month mortality ( P =0.018 and 0.021, respectively). Breast cancer showed a significant correlation with mild or no disability (odds ratio, 3.32; CI, 1.28–8.67; P =0.014) and less death cases at 3‐months (odds ratio, 0.44; CI, 0.16–1.21; P =0.114) compared to the other most represented malignancies. Conclusion Although 3‐month all‐cause mortality was significantly higher in CC patients, successful recanalization and hemorrhagic transformation rate were comparable in both groups. In cancer patients, a metastatic and active disease seem to be associated with a poorer functional outcome, whereas a diagnosis of breast cancer appears to be more frequent in patients with a mild or no disability at long term.

Prognostic nomogram for the outcomes in acute stroke patients with intravenous thrombolysis.

The prediction of neurological outcomes in ischemic stroke patients is very useful in treatment choices, as well as in post-stroke management. This study is to develop a convenient nomogram for the bedside evaluation of stroke patients with intravenous thrombolysis. We reviewed all enrolled stroke patients with intravenous thrombolysis retrospectively. Favorable outcome was defined as modified Rankin Score (mRs) less than 2 at 90 days post thrombolysis. We compared the clinical characteristics between patients with favorable outcome and poor outcome. Then, we applied logistic regression models and compared their predictability. A total of 918 patients were enrolled in this study, 448 patients from one hospital were included to develop a nomogram, whereas 470 patients from the other hospital were used for the external validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with baseline NIHSS, blood sugar, blood cholesterol level, part-and full anterior circulation infarction (OCSP type). The AUC was 0.767 (95% CI 0.653-0.772) and 0.836 (95% CI 0.697-0.847) in the derivation and external validation cohorts, respectively. The calibration plot for the probability of severe neurological outcome showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. A convenient outcome evaluation nomogram for patients with intravenous thrombolysis was developed, which could be used by physicians in making clinical decisions and predicting patients' prognosis.

Inpatient assessment of the neurological outcome of acute stroke patients based on the National Institute of Health Stroke Scale (NIHSS)

ObjectiveIdentify the association between stroke severity and the neurological outcome of an acute stroke using the National Institutes of Health stroke scale (NIHSS).Study designA descriptive cross-sectional study.Place and duration of study: Northwest hospital Hayatabad Peshawar.MethodologyA cross-sectional descriptive study was done in the general plus stroke unit of the northwest hospital in Peshawar, KPK during Jan 2022 to July 2022.400 admitted patients diagnosed with acute stroke in the past three months were included for NIHSS assessment and were classified as mild, moderate, or severe stroke. After entering all of the data from the collection into SPSS version 16, the information was transferred to an Excel spreadsheet. To further assess the results, the researcher and statistician evaluated all of the cases, radiological findings, and laboratory test data.ResultsIn this cross-sectional descriptive study, 400 individuals ranging from 30 to 90 years of age were divided into two groups: males and females. The survey was conducted by 49% of men and 51% of women. The stroke severity was assessed to be mild in 22% of cases, moderate in 49%, and severe in 29% of patients. As evaluated by the NIHSS, Patients with acute ischemic stroke were divided into four groups depending on their neurological outcomes: those who improved were 160 (40%), those who remained stable were 124 (31%), and those who deteriorated were 52 (13%), and those who died were 64 (16%). Patients with greater triglyceride levels were 88, while those with lower levels were 312. Acute stroke was also detected in 34% of patients with a covid history, 28% of patients who were covid positive, and 38% of patients who were covid free in this investigation.ConclusionAccording to our findings, the NIHSS is a reliable scale for evaluating patients' neurological outcomes and determining the association between acute stroke severity and cognitive functioning (NIHSS).

COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience.

The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases. A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality. Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months. Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.

Nicardipine versus Labetalol for Hypertension during Acute Stroke: A Systematic Review and Meta-Analysis.

Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke. MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods. Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112-0.438, P = 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077-2.113, I2 = 0.00%, P = 0.757). The quality of included studies was found to be low. More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions.

Outcome after Thrombectomy of Acute M1 and Carotid-T Occlusions with Involvement of the Corticospinal Tract in Postinterventional Imaging.

Objectives: Until now, thrombectomy studies have provided little reliable information about the correlation between the infarct topography and clinical outcome of acute stroke patients with embolic large-vessel occlusions. Therefore, we aimed to analyze whether infarcts of the corticospinal tracts in the central white matter (CWM) or the internal capsule on postinterventional imaging controls are associated with poor clinical outcome after thrombectomy. Materials and Methods: We retrospectively analyzed imaging data from 70 patients who underwent endovascular thrombectomy for emergent middle cerebral artery or carotid-T occlusions. Inclusion criteria were postinterventional infarct demarcation in the regions of the internal capsule, caudate, lentiform nucleus, and CWM. Primary outcome was the mRS after 90 days and secondary endpoints were subgroup analyses regarding additional cortical infarction. Conclusions: In this exploratory study, we found no indication that infarcts in the course of the corticospinal tracts predict poor clinical outcome after successful thrombectomy in patients with embolic carotid-T or M1 occlusions. In our analysis, a significant number of patients showed a favorable 90 day outcome. Additional cortical infarcts may have a greater impact on the risk of an unfavorable outcome. Results: Good clinical outcome after 90 days (mRS 0–2) was shown in 36 out of 70 patients (51.4%), with excellent clinical outcome (mRS 0–1) in 23 patients (32.9%). Here, 58.6% patients lived at home without nursing service after 90 days. Patients with minimal additional cortical infarction in postinterventional imaging had a 75.6% better chance of excellent outcome.

Ankle-Brachial Index Predicts Long-Term Renal Outcomes in Acute Stroke Patients.

Renal dysfunction is common after stroke. We aimed to investigate the clinical predictability of the ankle–brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) on poststroke renal deterioration. A total of 956 consecutive participants with acute ischemic stroke between 1 July 2016, and 31 December 2017 were enrolled and a final of 637 patients were recruited for final analysis. By using the group-based trajectory model (GBTM), the patients’ renal function trajectories were grouped into the low, intermediate, and high categories (LC, IC, and HC). Significant deterioration in the slope was noted in the IC (p < 0.001) and LC (p = 0.002) groups but was nonsignificant in the HC (p = 0.998) group. Abnormal ABI (ABI ≤ 0.9) was independently related to LC (adjusted odds ratio: 2.40; 95% CI, 1.16–4.95; p = 0.019) and was also independently associated with increased risks of a ≥30% decline in eGFR (adjusted hazard ratio [aHR], 2.28; 95% CI, 1.29–4.05; p = 0.005), a doubling of serum creatinine (aHR, 3.60; 95% CI, 1.93–8.34; p < 0.001) and ESRD (HR, 3.28; 95% CI, 1.23–8.74; p = 0.018). However, baPWV did not have a significant relationship with any of the renal outcomes. Patients with a lower ABI during acute stroke should receive regular renal function tests and should be closely monitored to improve poststroke renal care.

Hospital Outcome of Acute Stroke Patients Associated with Various Risk Factors and Co-morbidities

Background: Stroke is a global health problem, leading cause of death all over the world. It accounts for chronic illness and disability in a large segment of population. It imposes a great loss on economy of the nation due to loss of service of the workforce during illness and extended hospitalization they require during recovery. Stroke continues to have a great impact on public health. It is associated with multiple risk factors and co-morbid conditions. Objective: To find out the hospital outcome of acute stroke patients associated with various risk factors and co-morbidities. Materials and methods: This is a cross sectional observational study, carried out in the department of Medicine and Neurology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh for a period of 6 months. One hundred patients presented with acute stroke diagnosed on clinical &amp; investigational background fulfilling the inclusion and exclusion criteria were enrolled in the study. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) score. Patients’ symptoms, degree of disability or dependence in the daily activities and clinical outcome were evaluated and measured by the modified Rankin Scale (mRS). Result: This study showed that a majority of patients (49%) were in the 51-60 years age group, mean age was 56.81 years. Male and female ratio was 1.38:1. Among all all-risk factors, hypertension is the most common, present in 72% cases; the next most common risk factors were DM (59%), smoking (47%), heart disease (35%), and migraine (14%). About 72% of patients had a mild stroke, 17% of patients had a moderate stroke and 11% of patients had a severe stroke according to NIHSS score at admission. Seventy-four (74%) of them had infarction and the rest had hemorrhage. The study showed that 62% of the patients recovered (mRS score 0 to 2) and among them the maximum were ischemic stroke. 29% had poor outcomes, disabled and they were discharged on request or risk bond (mRS score 3 to 5). 9% expired during hospital stay (mRS score 6). Logistic analysis revealed that age &gt;50 years, hypertension, diabetes mellitus, heart disease, hyperlipidemia, family history of CVD, CAD, past history of stroke / TIA, migraine and peripheral vascular disease were associated with poor stroke outcome. Conclusion: This study shows that the main risk factors &amp; the comorbid conditions for a stroke were hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and smoking. People suffering from a stroke with these risk factors have poorer outcomes than those with no risk factors &amp; comorbidities. Identifying characteristics of people at high risk of recurrence has important implications for planning secondary prevention strategies to reduce the disease burden. Early detection and prevention of the risk factors can reduce health care burden and disability. Bangladesh Crit Care J March 2022; 10 (1): 15-18

Clinical and radiological factors predicting stroke outcome after successful mechanical intervention in anterior circulation.

The recanalization effect of large-vessel occlusion (LVO) in anterior circulation is well documented but only some patients benefit from endovascular treatment. We analysed clinical and radiological factors determining clinical outcome after successful mechanical intervention. We included 146 patients from the Prague 16 study enrolled from September 2012 to December 2020, who had initial CT/CTA examination and achieved good recanalization status after mechanical intervention (TICI 2b-3). One hundred and six (73%) patients achieved a good clinical outcome (modified Rankin Scale 0–2 in 3 months). It was associated with age, leptomeningeal collaterals (LC), onset to intervention time, ASPECTS, initial NIHSS, and leukoaraiosis (LA) in univariate analysis. The regression model identified good collateral status [odds ratio (OR) 5.00, 95% confidence interval (CI) 1.91–13.08], late thrombectomy (OR 0.24, 95% CI 0.09–0.65), LA (OR 0.44, 95% CI 0.19–1.00), ASPECTS (OR 1.45, 95% CI 1.08–1.95), and NIHSS score (OR 0.86, 95% CI 0.78–0.95) as independent outcome determinants. In the late thrombectomy subgroup, 14 out of 33 patients (42%) achieved a favourable clinical outcome, none of whom with poor collateral status. The presence of LC and absence of LA predicts a good outcome in acute stroke patients after successful recanalization of LVO in anterior circulation. Late thrombectomy was associated with higher rate of unfavourable clinical outcome. Nevertheless, collateral status in this subgroup was validated as a reliable selection criterion.

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

BackgroundThis study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of D-dimer levels for endovascular thrombectomy decisions.MethodsWe analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 h with following criteria: age ≥18 years, NIHSS ≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial D-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates.ResultsAmong 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low D-dimer group showed a higher rate of successful recanalization and favorable outcome than the high D-dimer group. The mortality rate was higher in the high D-dimer group. No EVT and high D-dimer level were independent predictors of mortality, whereas lesion volume and low D-dimer level were independently associated with favorable outcomes.ConclusionsD-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

Relationship between Neuron-specific Enolase Serum Levels with Lesion Volume and Clinical Outcome in Acute Stroke Patients

BACKGROUND: Neuron-specific enolase (NSE) is released in the cerebrospinal fluid and bloodstream in response to brain damage. Serum NSE levels can be used as a marker of brain nerve cells either in ischemic or hemorrhagic stroke, associated with lesion volume and functional outcome. AIM: The aim of the study was to evaluate the correlation between NSE serum level with lesion volume and functional outcome in acute stroke patients. METHODS: A cross-sectional study was conducted on 29 patients with ischemic stroke and 29 hemorrhagic strokes admitted to Haji Adam General Hospital. All the subjects were assessed with the National Institute of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS), and assessment of lesion volume. RESULTS: Subjects consist of 27 male (46.4%) and 31 female (53.4%), with mean age of 61.67 ± 12.26 years. The mean serum NSE levels in stroke patients were 19.79 ± 8.88 ng/ml and lesion volume was 25.09 ± 24.52 ml. There was a significant positive correlation of increase in serum NSE levels with infarct volume (r = 0.863 and p &lt; 0.001) and hemorrhagic volume (r = 0.644 and p &lt; 0.001) and clinical outcome assessed by NIHSS score (r = 0.761 and p &lt; 0.001) and mRS score (r = 0.762 and p &lt; 0.001) in ischemic stroke and NIHSS score (r = 0.525 and p = 0.003), and mRS score (r = 0.468 and p = 0.010) in hemorrhagic stroke. CONCLUSION: High NSE serum levels in the acute phase were associated with lesion volume and poor outcomes in stroke patients.

Body temperature in assessment of 7th day outcome in acute stroke patients - A hospital-based study

Background: Worldwide stroke is accounted as the second leading cause of death and third cause of disability. Changes in physiological variables such as temperature, blood pressure, blood glucose levels, and their deleterious effect in terms of mortality and morbidity are of major concerns for the treating physicians. Aim and Objectives: The aim of the study was to study changes in temperature and its relation to 7th day outcome in acute stroke patient. Materials and Methods: A prospective hospital-based study was conducted, after approval of Institutional Ethical committee, recruiting 150 acute stroke patients presenting within 6 h of developing symptoms. Temperature was recorded every 8 h for 48 h and stroke severity was assessed using modified Rankin scale on admission and on the 7th day after admission. Results: Categorical variables were analyzed using Chi-square analysis and means of continuous variables were compared using analysis of variance. For any significant difference in mean temperature at two consecutive readings, paired sample t-test was used. Multinomial logistic regression analysis was done to predict outcome in acute stroke patients. The difference in the mean temperature at 8 h, 16 h and 40 h after admission was significant between male and female patients. Temperature at 16th h of admission was found to be significant for improved, status quo, and worsened comparison. Temperature at 24th h of admission was also found to have significant value but only for status quo and worsened outcome. Conclusion: The authors conclude that the mean temperature of the patients remained within the normal range in the first 48 h. The temperature at various intervals may not consistently predict the 7th day outcome in acute stroke patients.