Outcome In Acute Stroke Patients Research Articles

Leukoaraiosis and earlier neurological outcome after mechanical thrombectomy in acute ischemic stroke

Background and purposeThe aim of the study was to evaluate whether leukoaraiosis (LA) severity is associated with earlier neurological outcome in acute stroke patients undergoing mechanical thrombectomy. Materials and methodsIn this retrospective multicenter study, we evaluated 273 acute stroke patients treated with mechanical thrombectomy. LA severity was graded as 0–2 (absent-to-moderate) versus 3–4 (severe) according to the van Swieten scale. The main clinical outcome was the proportion of early neurological improvement and early neurological deterioration. Early neurological improvement was defined as a decrease of≥4 points on the NIHSS, or an NIHSS score of zero 24hours after baseline assessment. Early neurological deterioration was defined as an increase of≥4 points on the NIHSS 24hours after baseline assessment. ResultsThere was a significantly lower early neurological improvement rate (17.1% versus 39.2%; P=0.006) and non-significantly higher early neurological deterioration rate (29.3% versus 17.7%; P=0.084) in patients with severe LA (sLA) compared with patients with absent-to-moderate LA. In multivariable analysis, sLA was inversely associated with early neurological improvement (OR, 0.31; 95% CI, 0.13–0.78; P=0.012). There was no significant association of sLA with early neurological deterioration. However, in patients without symptomatic intracranial hemorrhage, sLA was an independent predictor of early neurological deterioration (OR, 2.65; 95% CI, 1.09–6.45; P=0.032). ConclusionssLA is a significant negative predictor of early neurological improvement and is an independent predictor of early neurological deterioration in patients without symptomatic intracranial hemorrhage.

Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study.

Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. Stroke Prognosis in Intensive Care (SPICE) is a prospective multicenter cohort study which will be conducted in 34 intensive care units (ICUs) in the Paris, France area. Patients will be eligible if they meet all of the following inclusion criteria: (1) age of 18years or older; (2) acute stroke (i.e., ischemic stroke, intracranial hemorrhage, or subarachnoid hemorrhage) diagnosed on neuroimaging; (3) ICU admission within 7days before or after stroke onset; and (4) need for mechanical ventilation for a duration of at least 24h. Patients will be excluded if they meet any of the following: (1) stroke of traumatic origin; (2) refusal to participate; and (3) privation of liberty by administrative or judicial decision. The primary endpoint is poor functional outcome at 1year, defined by a score of 4 to 6 on the modified Rankin scale (mRS), indicating severe disability or death. Main secondary endpoints will include decisions to withhold or withdraw care, mRS scores at 3 and 6months, and health-related quality of life at 1year. The SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation. NCT03335995.

Abstract WP240: Urinary Biomarker of Kidney Tubular Function, Risk of Acute Kidney Injury, and Mortality in Acute Stroke Patients

Background and Purpose: Urinary liver-type fatty-acid binding protein (L-FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI) and cardiovascular disease outcomes. However, no evidence to date has indicated whether kidney tubule injury has any potential for predictor of AKI and mortality in acute stroke patients. The aim of the present study was to accurately determine the prevalence of AKI and effect on clinical outcome of acute stroke patients assessed by urinary L-FABP. Methods: Acute ischemic stroke and intracerebral hemorrhage patients hospitalized in the stroke care unit (SCU) within 24 h after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We evaluated the association among urinary L-FABP, AKI, and 3-months mortality using multivariate logistic analysis adjusted for baseline estimated glomerular filtration rate (eGFR), albuminuria, stroke risk factors, and neurological severity. Results: In total, 601 acute stroke patients (390 males; median age 72 years, ischemic stroke 476 cases and intracranial hemorrhage 125 cases) were enrolled to the study. AKI occurred in 32 acute stroke patients (5.3%). In the univariate analysis, high urinary L-FABP level had positive associations with AKI (25.4 μg/g Cr vs. 3.6 μg/g Cr, P<0.001) and 3 months mortality (13.4 μg/g Cr vs. 3.8 μg/g Cr, P<0.001). In the multivariate analysis, elevated urinary L-FABP level was independently associated with AKI (OR 1.015; 95% CI, 1.008-1.023, P<0.001) and 3-months mortality (OR 1.012; 95% CI, 1.001-1.023, P=0.032). Moreover, AKI also increased the risk of 3-months mortality after stroke (OR 7.053, 95% CI, 1.771-28.087, P=0.006). Conclusion: Biomarker of tubular dysfunction is independent predictor of AKI and mortality in acute stroke patients.

Abstract WMP58: The Smoker’s Paradox After Acute Ischemic Stroke, is it Real or a Cloud of Smoke?

Background: Although tobacco use, the majority of which is cigarette smoking, increases the risk of incident stroke, there are inconsistent data regarding the effect of tobacco use on neurological outcomes after acute ischemic stroke. Several prior studies have suggested that smoking could be protective after stroke, which has been termed the "smoker’s paradox." Methods: We pooled three data sources to explore the effect of tobacco use on neurologic outcome in acute stroke patients. The first was the Blood Pressure after EVT in Stroke (BEST) study, the second was the NINDS tPA trial, and the third was the Interventional Management of Stroke (IMS) III trial. The primary outcome is 90-day mRS 0-2 (good outcome). We fit logistic regression models to good outcome, both unadjusted and adjusted for patient age, NIHSS, and sICH. Results: Our pooled cohort had 1,671 acute stroke patients, of which 480 (28.7%) used tobacco. In an unadjusted model, tobacco use was associated with good outcome (OR 1.42, 95% CI 1.15-1.76, p=0.001). However, in the adjusted model, this association was no longer significant (aOR 0.98, 95% CI 0.76-1.25, p=0.868). If we stratify by placebo-treated (n=310), tPA-treated (n=513), and EVT-treated (n=836), we continue to find that tobacco use is not associated with good neurologic outcome in adjusted analyses specific to these subgroups. An additional subgroup analysis of the EVT-treated patients that adjusted for successful procedural recanalization (TICI 2b-3) was not significant. Patients who used tobacco were younger (mean age, 60.5 vs. 69.2 years, p<0.001). Adjusting for age alone rendered the association between tobacco use and good outcome insignificant (aOR 1.05, 95% CI 0.84-1.32, p=0.666). Conclusions: This is the first adjusted analysis to examine the association between tobacco use and neurologic outcome in EVT-treated patients. We find that tobacco use is not protective after acute ischemic stroke that is untreated or treated with tPA or EVT. The univariate association of tobacco use with good outcome is accounted for by tobacco users being younger.

Abstract WP103: Re-Examining the Exclusion Criterion of Early Recurrent Ischemic Stroke in Intravenous Thrombolysis: A Meta-Analysis

Background: Current guidelines for intravenous tissue plasminogen activator for acute ischemic stroke preclude the administration of the drug in patients with a history of recent stroke. Objectives: Our meta-analysis aims to determine the safety and efficacy of thrombolysis in patients with early recurrent ischemic stroke (within 3 months of initial stroke). Methods: Pubmed, Cochrane, Scopus, Embase, Clinicaltrials.gov , and HERDIN were searched for studies comparing the outcomes of acute stroke patients undergoing intravenous thrombolysis between those with early recurrent stroke (ERS) and those without. Random-effects meta-analysis was used to evaluate the outcomes in terms of symptomatic intracranial hemorrhage, mortality and good functional outcomes at 3 months (modified Rankin Score < 2 ) Results: Three observational studies with a total of 48,459 thrombolysed patients (824 with ERS and 47,635 without) were included in the study. There was no significant difference between patients with ERS and those without in terms of symptomatic intracranial hemorrhage (OR 1.39, 95% Confidence Interval [CI] 0.75-2.58), mortality (OR 1.36, 95% CI 0.60-3.09) and good functional outcomes at 3 months (OR 0.74, 95% CI 0.47-1.16). Conclusion: Our meta-analysis suggests that there is insufficient evidence to substantiate excluding patients with ERS from receiving thrombolysis. Further studies to re-examine ERS as an exclusion criterion for receiving thrombolysis are warranted.

Abstract TMP3: One-stop Management of 230 Consecutive Acute Stroke Patients Report of Procedural Times and Clinical Outcome

Introdruction: Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Methods: We performed a single center, observational study from June 2016 to November 2018. Imaging was acquired with the latest generation angiography suite at a comprehensive stroke center. Two-hundred-thirty consecutive adults with suspected acute stroke presenting within 6 hours after symptom onset with a moderate to severe National Institutes of Health Stroke Scale (≥ 10 in 2016; ≥ 7 since January 2017) were directly transported to the angiography suite by bypassing multidetector CT. Noncontrast flat-detector CT and biphasic flat-detector CT angiography were acquired with an angiography system. In case of a large vessel occlusion patients remained in the angiography suite, received intravenous rtPA therapy and underwent thrombectomy. As primary endpoints, door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management. Results: A total of 230 patients (123 women, median age of 78 years (IQR 69-84)) were included. Median symptom-to-door time was 130 min (IQR 70-195). Large vessel occlusion was diagnosed in 166/230 (72%) patients; 64/230 (28%) had conditions not suitable for thrombectomy. Median door-to-reperfusion time for M1 occlusions was 64 min (IQR 56-87). Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85-117) to 68 min (IQR 53-89; P <0.001). Rate of good functional outcome was significantly better in the one-stop management group ( P =0.029). Safety parameters (mortality, sICH, any hemorrhage) did not differ significantly between groups. Conclusions: One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting.

Improved multi-parametric prediction of tissue outcome in acute ischemic stroke patients using spatial features.

IntroductionIn recent years, numerous methods have been proposed to predict tissue outcome in acute stroke patients using machine learning methods incorporating multiparametric imaging data. Most methods include diffusion and perfusion parameters as image-based parameters but do not include any spatial information although these parameters are spatially dependent, e.g. different perfusion properties in white and gray brain matter. This study aims to investigate if including spatial features improves the accuracy of multi-parametric tissue outcome prediction.Materials and methodsAcute and follow-up multi-center MRI datasets of 99 patients were available for this study. Logistic regression, random forest, and XGBoost machine learning models were trained and tested using acute MR diffusion and perfusion features and known follow-up lesions. Different combinations of atlas coordinates and lesion probability maps were included as spatial information. The stroke lesion predictions were compared to the true tissue outcomes using the area under the receiver operating characteristic curve (ROC AUC) and the Dice metric.ResultsThe statistical analysis revealed that including spatial features significantly improves the tissue outcome prediction. Overall, the XGBoost and random forest models performed best in every setting and achieved state-of-the-art results regarding both metrics with similar improvements achieved including Montreal Neurological Institute (MNI) reference space coordinates or voxel-wise lesion probabilities.ConclusionSpatial features should be integrated to improve lesion outcome prediction using machine learning models.

COMPARISON OF OUTCOMES AND COGNITIVE FUNCTION IN ACUTE STROKE PATIENTS TREATED AT THE STROKE CORNER OF H. ADAM MALIK GENERAL HOSPITAL MEDAN WITH THOSE TREATED IN WARD OF KESDAM BUKIT BARISAN HOSPITAL MEDAN

Background: Stroke is a serious neurological problem that is mostly found in the world, and cognitive impairment is often found in the first few weeks after a stroke, where disturbances in the perception and executive functions are mostly found. Aim: To find out the comparison of outcomes and cognitive function in acute stroke patients treated at the Stroke Corner of H. Adam Malik General Hospital Medan with those treated in the Ward of Kesdam Bukit Barisan Hospital Medan. Methods: This research is descriptive analytic with cross sectional data collection method with primary data source obtained from 44 patients who suffered an acute stroke and was treated at the Stroke Corner of H.Adam Malik General Hospital in Medan and Ward at Kesdam Bukit Barisan Hospital. Then MMSE and CDT were examined to assess cognitive function and NIHSS at initial and day 14 to assess patient outcomes. To assess the comparison of cognitive functions and patient outcomes, a bivariate analysis was performed. Normality test with the Komogrov-Smirnov test, then the Chi Square test was performed and was declared significant if p values <0.05 were obtained. Results: After Chi Square test, it was seen that there were significant differences in cognitive function as measured by MMSE and CDT scores between patients treated at the two hospitals with p value = 0.012 (p <0.05) and p value = 0.004 (p < 0.05), respectively. Then, with the chi square test found significant differences in patient outcomes as measured by the initial NIHSS score and day 14 with p value = 0.018 (p <0.05) and p value = 0.011 (p <0.05), respectively. Conclusions: Significant differences in cognitive function and outcome in acute stroke patients were found between treatment at Stroke Corner H. Adam Malik General Hospital Medan and Ward at Kesdam Bukit Barisan Hospital Medan.

Factors Predicting Functional Outcome in Acute Stroke Patients

Factors Predicting Functional Outcome in Acute Stroke Patients

Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low: A retrospective study.

The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA2DS2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA2DS2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA2DS2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA2DS2-VASc scores ≤ 2) and high-risk (CHA2DS2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA2DS2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA2DS2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.

One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome.

Background and purpose: Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Methods: We performed a single center, observational study from June 2016 to November 2018. Imaging was acquired with the latest generation angiography suite at a comprehensive stroke center. Two-hundred-thirty consecutive adults with suspected acute stroke presenting within 6 h after symptom onset with a moderate to severe National Institutes of Health Stroke Scale (≥10 in 2016; ≥7 since January 2017) were directly transported to the angiography suite by bypassing multidetector CT. Noncontrast flat-detector CT and biphasic flat-detector CT angiography were acquired with an angiography system. In case of a large vessel occlusion patients remained in the angiography suite, received intravenous rtPA therapy and underwent thrombectomy. As primary endpoints, door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management. Results: A total of 230 patients (123 women, median age of 78 years (Interquartile Range (IQR) 69–84)) were included. Median symptom-to-door time was 130 min (IQR 70–195). Large vessel occlusion was diagnosed in 166/230 (72%) patients; 64/230 (28%) had conditions not suitable for thrombectomy. Median door-to-reperfusion time for M1 occlusions was 64 min (IQR 56–87). Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85–117) to 68 min (IQR 53–89; p < 0.001). Rate of good functional outcome was significantly better in the one-stop management group (p = 0.029). Safety parameters (mortality, sICH, any hemorrhage) did not differ significantly between groups. Conclusions: One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting.

The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa\xa0Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study

BackgroundAdmission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.MethodsA prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.ResultsA total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.ConclusionsHyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

What can DTI add in acute ischemic stroke patients?

BackgroundCerebrovascular stroke is one of the leading causes of death worldwide. Imaging with conventional MR techniques cannot provide reliable information as regard the integrity of the white matter tracts and therefore limiting its ability to predict the clinical outcome. While prediction of the motor outcome becomes more crucial for determining the specific rehabilitation strategies and final clinical outcomes, the purpose of this study was to assess the value of diffusion tensor MR imaging in patients with acute ischemic stroke as a prognostic imaging modality to predict the clinical outcome.ResultsA significant statistical association was found between the tractography findings and the clinical score at admission (p 0.0005) and the clinical recovery after 3 months (p 0.001). Residual neurological deficits were found in patients with disrupted tracts; on the other hand, near complete clinical recovery was found in patients with non-disrupted tracts. Also, significant statistical association was found between the degree of FA reduction in the affected tracts and the clinical score at admission (p 0.001) and the clinical recovery after 3 months (p 0.01). Correlation between the FA values at the site of infarctions and the corresponding area of the brain on the contralateral side revealed significant statistical difference.ConclusionDTI offers a potential tool for prediction of the clinical outcome of acute stroke patients as it can detect the microstructural changes in the white matter tracts affected by the ischemic lesions which cannot be detected by conventional MRI and therefore can help in determining the rehabilitation strategy

The role of ASPECTs in patient selection for endovascular therapy – CTA source images versus noncontrast CT

The Alberta Stroke Program Early Computed Tomography Score (ASPECTs) on noncontrast CT (NCCT) is widely used for the decision of endovascular therapy (ET) in randomized controlled trials. CT angiography source images (CTA-SI) is another method to evaluate ischemic brain damage. We aimed to evaluate the association between pretreatment ASPECTs on CTA-SI and post-treatment clinical and radiological outcomes in acute stroke patients treated with ET. The association between both scores along with final infarct and outcome were analyzed. A total of 90 patients with successful recanalization were included in the study. The mean age was 59 ± 11.8. According to the results, CTA-SI ASPECTs was better correlated with final infarct than NCCT ASPECTs (p < 0.001). In univariate analyzes, factors associated with good outcome were age, baseline NIHSS score, and presence of diabetes mellitus (p = 0.001, p = 0.002, p = 0.034, respectively). On the other hand, when an analysis differentiating patients by age was performed, 40 patients below 60 years of age had significantly better outcomes despite having higher baseline NIHSS scores (p = 0.002). Finally, in multivariate analyzes, only age and baseline NIHSS score were found to be independent predictors of good outcome (p = 0.003 for both). In conclusion, CTA-SI ASPECTs in patient selection for ET seems to be more useful than NCCT ASPECTs. However, both scoring modalities were not found to be independent predictors of good outcome. Outcomes are changeable for the younger population who could continue their lives with mild or no deficits despite having a relatively low initial ASPECTs.

Diagnostic Accuracy of Positive Airway Pressure Device for Sleep Apnea Detection in Acute Stroke Patients.

Background and Purpose- Sleep apnea has been associated with a poor outcome in acute stroke patients. Polysomnography is the gold standard diagnostic method for sleep apnea, but it is not feasible as a routine in the acute stroke setting. The current generation of positive airway pressure (PAP) devices can detect the different types of respiratory events. This study aimed to compare the algorithms used in PAP device to manually scored events on polysomnography in patients with acute stroke. Methods- A sleep study was performed with standard polysomnography and PAP device, simultaneously, within the first 48 hours after acute stroke onset. Results- We prospectively evaluated 29 patients with acute stroke (59.5±12.1 years). The area under the receiver operating characteristic curve for each apnea-hypopnea index value was above 0.90 by PAP device. There was a good correlation of apnea-hypopnea index (rs=0.92; P<0.001), hypopnea index (rs=0.89; P<0.001), and apnea index (rs=0.70; P<0.001) between device-detected events and manually scored polysomnography. Conclusions- Given the high frequency of sleep apnea during the acute phase of stroke and the complexity of a full polysomnography study in this setting, PAP device on diagnostic mode can be used as an alternative tool for sleep apnea detection in acute stroke patients.

Diffusion-weighted imaging volume and diffusion-weighted imaging volume growth in acute stroke: associations with fluid-attenuated inversion recovery hyperintensities-diffusion-weighted imaging mismatch and functional outcome.

This study assessed the association between diffusion-weighted imaging (DWI) volume and fluid-attenuated inversion recovery vascular hyperintensity (FVH)-DWI mismatch, functional outcome in patients with acute stroke patients receiving endovascular therapy, as well as the value of DWI volume in predicting functional outcome with stroke patients. In 38 stroke patients who received endovascular therapy, FVH-DWI mismatch, DWI volume on admission, DWI volume on follow-up, DWI volume growth, the functional outcome at 3 months [modified Rankin scale (mRS)], and other clinical data were collected. Statistical analysis was performed to compare the associations with the above variables and predict functional outcome after stroke. Compared with no FVH-DWI mismatch group (n = 15), FVH-DWI mismatch group (n = 23) had a smaller DWI volume on admission (t = -2.980; P = 0.008), smaller DWI volume on follow-up (t = -2.911; P = 0.009), lower DWI volume growth (t = -2.328; P = 0.031). The 3-month outcome (1.87 ± 0.92) in patients with FVH-DWI mismatch was better than that (2.93 ± 1.62) of patients with no FVH-DWI mismatch (t = -2.307; P = 0.032). Spearman's rank correlation analysis revealed that FVH-DWI mismatch (r = 0.327; P = 0.045), DWI volume on admission (r = 0.414; P = 0.010), DWI volume on follow-up (r = 0.486; P = 0.002), and DWI volume growth (r = 0.467; P = 0.003) were positively correlated with mRS at 3 months. ROC analysis showed when the optimal cutoff value of DWI volume on admission was 33.50, the sensitivity and specificity for predicting functional outcome was 60 and 95.65%, respectively. Evaluating DWI volume on admission, DWI volume on follow-up as well as DWI volume growth comprehensively may be useful in predicting the functional outcome of acute stroke patients after thrombectomy.

Shorter Times to Endovascular Reperfusion Therapy Lead to Better Outcomes for Acute Stroke Patients

Shorter Times to Endovascular Reperfusion Therapy Lead to Better Outcomes for Acute Stroke Patients

Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study.

Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. To determine associations between a "brief" screen and "detailed" assessment of dysphagia on clinical outcomes in acute stroke patients. A prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3-6) at 90 days. Overall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to "screen-pass" patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18-4.10) and death or disability (aOR = 1.66, 95% CI = 1.41-1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72-9.54). Failing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.

Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy.

Background and Purpose- The effect of endovascular thrombectomy (EVT) cumulative case volume (EVT-CCV) on outcomes of acute stroke patients has not been studied. This study investigated whether EVT-CCV was associated with outcomes. Methods- We identified all patients who underwent EVT for anterior circulation large vessel occlusion. Patients who met enrollment criteria were grouped into 5 based on the number of previous cases at each hospital. The number of cases that were recruited from each hospital and then assigned to each group (n) was designed to increase by the function of 10×2(n-1); group 1 consisted of cases 1 to 10 at each hospital, group 2 was cases 11 to 30, group 3 was cases 31 to 70, group 4 was cases 71 to 150, and group 5 was cases ≥151. We tested whether EVT-CCV group was associated with procedural and clinical outcomes. Results- Nine hundred fifty-five patients fulfilled the enrollment criteria. Recanalization and good outcome positively correlated with EVT-CCV group ( P<0.001 [correlation coefficient, r=0.122] for recanalization; P=0.002 [ r=0.099] for good outcome), whereas symptomatic intracranial hemorrhage and mortality negatively correlated ( P=0.039 [ r=-0.067] for symptomatic intracranial hemorrhage; P=0.016 [ r=-0.078] for mortality). EVT-CCV group was independently associated with recanalization (odds ratio, 1.182; 95% CI, 1.029-1.358) and good outcome (odds ratio, 1.187; 95% CI, 1.053-1.337). Conclusions- With increased EVT-CCV, recanalization and good outcome increased, whereas symptomatic intracranial hemorrhage and mortality decreased. Increased EVT-CCV was independently associated with recanalization and good outcome.

The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study).

Bridging therapy with endovascular therapy (EVT) and intravenous thrombolysis (IVT) has been reported to improve outcomes for acute stroke patients with large-vessel occlusion in the anterior circulation. While the IVT may increase the reperfusion rate, the risk of hemorrhagic complications increases. Whether EVT without IVT (direct EVT) is equally effective as bridging therapy in acute stroke remains unclear. This randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator for acute stroke with ICA and M1 occlusion aims to clarify the efficacy and safety of direct EVT compared with bridging therapy. This is an investigator-initiated, multicenter, prospective, randomized, open-treatment, blinded-endpoint clinical trial. The target patient number is 200, comprising 100 patients receiving direct EVT and 100 receiving bridging therapy. The primary efficacy endpoint is a modified Rankin Scale score of 0-2 at 90 days. Safety outcome measures are any intracranial hemorrhage at 24 h. This trial may help determine whether direct EVT should be recommended as a routine clinical strategy for ischemic stroke patients within 4.5 h from onset. Direct EVT would then become the choice of therapy in stroke centers with endovascular facilities. UMIN000021488.