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Mennema Å, Vliet Vlieland TPM, Achterberg WP, Oosterveer DM. Functioning and recovery during stroke rehabilitation: a comparison between pre-stroke frail and non-frail patients. Eur Geriatr Med 2023; 14:1343-1351. [PMID: 37935943 PMCID: PMC10754730 DOI: 10.1007/s41999-023-00885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Pre-stroke frailty in older adults is associated with adverse outcomes after stroke in community-based and hospital-based populations. The aim of our study was to investigate the prevalence of pre-stroke frailty among older stroke survivors receiving medical specialistic rehabilitation and its association with outcomes and recovery. METHODS Pre-stroke frailty was measured by the Groningen Frailty Indicator (GFI, score ≥ 4 indicates frailty) in patients ≥ 65 years receiving stroke medical specialistic rehabilitation. Baseline, follow-up and change (i.e. recovery) scores of the Barthel index (BI), Stroke Impact Scale (SIS) 'mobility', 'communication', and 'memory and thinking', Hospital Anxiety and Depression Scale (HADS) and the EuroQoL-5 dimensions (EQ-5D) were compared between frail and non-frail patients with a multivariable regression model adjusting for confounders. RESULTS Of 322 included patients (34.2% females, median age 70 years), 43 (13.4%) patients reported pre-stroke frailty. There were no differences in BI or in destination of discharge between pre-stroke frail and non-frail stroke survivors receiving inpatient rehabilitation. However, pre-stroke frailty was associated with worse follow-up scores for all other measures. Recovery in pre-stroke frail patients was less favorable compared to non-frail patients for SIS mobility, HADS subscales and EQ-5D index and visual analogue scale. CONCLUSION Pre-stroke frailty was present in a minority of older stroke survivors receiving medical specialistic rehabilitation. BI and destination of discharge did not differ. Nevertheless, pre-stroke frailty was associated with worse functioning at follow-up for most measures of health status and with smaller improvements in mobility, mood and quality of life.
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Affiliation(s)
- Åsa Mennema
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands.
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
| | - Thea P M Vliet Vlieland
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Primary Care and Public Health, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlla M Oosterveer
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rehabilitation, Alrijne Hospital, Leiden, The Netherlands
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Dallas J, Liu KQ, Wenger TA, Lin M, Ding L, Attenello FJ, Mack WJ. The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment. Clin Neurol Neurosurg 2023; 233:107982. [PMID: 37729801 DOI: 10.1016/j.clineuro.2023.107982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION COVID-19 has had innumerable impacts on the healthcare system, both by worsening patient illness and impeding effective and efficient care. Further, COVID-19 has been tied to increased rates of ischemic stroke, particularly among young patients. We utilized a national database to assess associations of COVID-19 with thrombectomy rates, mortality, and discharge disposition among stroke patients. METHODS Patients were identified from the National Inpatient Sample (NIS, 2020). Inclusion criteria selected for adult ischemic stroke patients; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition. Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Statistical analysis was performed via multivariable logistic regression and log-binary regression. RESULTS 54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. COVID-19 was associated with lower rates of mechanical thrombectomy (OR 0.94, p < 0.0001), higher rates of in-hospital mortality (OR 1.14, p < 0.0001), and unfavorable discharge disposition (OR 1.08, p < 0.0001), even when controlling for illness severity. Other relationships, such as a male predominance among stroke patients with COVID-19, were also identified. CONCLUSION This study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed, including mechanical thrombectomy rates, in-hospital mortality, and discharge disposition. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.
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Affiliation(s)
- Jonathan Dallas
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Kristie Q Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Talia A Wenger
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Li Ding
- Departement of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Liu P, Hao J, Zhang Y, Wang L, Liu C, Wang J, Feng J, Zhang Y, Hou H, Zhang L. Acute Ischemic Stroke Comorbid with Type 2 Diabetes: Long-Term Prognosis Determinants in a 36-Month Prospective Study for Personalized Medicine. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:451-460. [PMID: 35917518 DOI: 10.1089/omi.2022.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ischemic stroke (IS) is often comorbid with type 2 diabetes mellitus (T2DM) wherein the determinants of long-term outcomes, beyond the acute stroke phase, are not adequately known. This study identified the determinants of long-term outcomes for diabetic IS patients through a prospective nested case-control study in 624 patients treated with conservative measures (38.60% females, mean age: 63.85 years). After 36-month follow-up, 117 (18.8%) patients with poor outcome were enrolled in the case group. The poor outcome was defined with a modified Rankin Scale (mRS) score ≥3. Meanwhile, 374 (59.9%) patients with good outcome, defined as (mRS score <3), were included in the control group. Patients who died (n = 32) or lost to follow-up (n = 101) were excluded in analysis. Poor prognostic outcome was positively associated with (1) the pulse rate at admission, (2) diastolic blood pressure (DBP), and (3) fasting blood glucose (FBG) during follow-up, whereas physical activity and lipid-lowering treatment during follow-up were negatively associated. Importantly, a forecasting model with these indicators distinguished the patients with good versus poor outcomes with 70.1% sensitivity and 73.5% specificity. Health care professionals and laboratory medicine scholars may want to monitor an increase in DBP and FBG during follow-up, as well as physical activity and lipid-lowering treatment, in relationship to the prognosis of IS with comorbid T2DM after conservative therapies. The proposed predictive model for personalized/precision medicine requires field testing in independent studies, and might help risk stratification with theranostic tests for patients with acute IS who also have a diagnosis of T2DM.
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Affiliation(s)
- Pengcheng Liu
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Jiheng Hao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Yichun Zhang
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Lu Wang
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Chao Liu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Jingjun Feng
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Yanbo Zhang
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Haifeng Hou
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
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Kamo A, Nozoe M, Kubo H, Shimada S. Care-needs certification in the national long-term care insurance is useful for assessment of premorbid function in older Japanese patients with stroke. J Stroke Cerebrovasc Dis 2022; 31:106493. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 11/30/2022] Open
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Al Alawi AM, Al Busaidi I, Al Shibli E, Al-Senaidi AR, Al Manwari S, Al Busaidi I, Muhanna F, Al Qassabi A. Health outcomes after acute ischemic stroke:retrospective and survival analysis from Oman. Ann Saudi Med 2022; 42:269-275. [PMID: 35933604 PMCID: PMC9357299 DOI: 10.5144/0256-4947.2022.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke mortality and related functional disability have been declining over the last two decades, but stroke continues to represent the second leading cause of cardiovascular death worldwide and the number one cause for acquired long-term disability. OBJECTIVES Assess short- and long-term health outcomes after acute ischemic stroke and analyze factors associated with poor survival and functional outcomes. DESIGN Retrospective and survival analysis SETTING: Inpatient unit at a tertiary care referral hospital. PATIENTS AND METHODS All patients admitted with acute ischemic stroke from 1 January 2017 to 31 August 2018 were included in the study. Functional status was assessed using the modified Rankin Scale (mRS). Other demographic and clinical variables were obtained from medical records. Data were analyzed by multivariable logistic regression, Cox proportional hazards, and the Kaplan-Meier method. Long-term follow-up data, including mortality and mRS was collected by follow-up phone call. MAIN OUTCOME MEASURES Functional dependency and factors associated with mortality. SAMPLE SIZE AND CHARACTERISTICS 110 with mean age of 67.0 (14.7) years; 59 patients (53.6%) were males. RESULTS Hypertension (75.5%), diabetes mellitus (54.6%), and dyslipidemia (29.1%) were common. Sixty-five patients (59.1%) had mRS >2 upon discharge including 18 patients (16.4%) who died during the hospital stay. The cumulative mortality rate was 25.4% (28/110) at 12 months and 30.0% (33/110) at 24 months. Twenty-nine stroke survivors (29/70, 41.4%) remained physically dependent (mRS >2) at the end of follow-up. Old age, atrial fibrillation, history of prior stroke, chronic kidney disease, and peripheral arterial disease were associated with increased mortality and functional dependence. CONCLUSIONS Patients in Oman with acute ischemic stroke tend to have a high comorbidity burden, and their functional dependency and mortality are higher compared to patients from developed countries. Therefore, evidence-based measures such as establishing stroke units are essential to improve the health outcomes of patients with acute ischemic stroke. LIMITATIONS Retrospective at single center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Abdullah M Al Alawi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman.,From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Ikhlas Al Busaidi
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Emaad Al Shibli
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Al-Reem Al-Senaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahd Al Manwari
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibtisam Al Busaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fatema Muhanna
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ahmed Al Qassabi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
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Kumi F, Bugri AA, Adjei S, Duorinaa E, Aidoo M. Quality of acute ischemic stroke care at a tertiary Hospital in Ghana. BMC Neurol 2022; 22:28. [PMID: 35039001 PMCID: PMC8762857 DOI: 10.1186/s12883-021-02542-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Information on the quality of acute ischemic stroke care provided in lower-to-middle income countries is limited. Objective This study was undertaken to examine the quality of acute ischemic stroke care provided at Tamale Teaching Hospital in Ghana. Methods The medical records of patients admitted into the medical ward of the hospital between January to October 2021 were reviewed retrospectively. Extent of compliance to 15 stroke performance indicators were determined. Results Under the study period, 105 patients were admitted at the hospital with acute ischemic stroke. The mean (±SD) age was 65 ± 12 years; 38.1% were males; 65.7% had National Health Insurance Scheme coverage. Glasgow Coma Scale was the only functional stroke rating scale used by physicians to rate stroke severity. About a quarter of the patients had CT scan performed within 24 h of admission. Less than a quarter of the patients had a last known well time documented. Rate of thrombolytic administration was 0%. Less than a quarter of the patients were prescribed venous thromboembolism prophylaxis on the day of admission or day after. Only 13.8% of patients had documented reasons for not being prescribed venous thromboembolism prophylaxis. Antiplatelet therapy was prescribed to 33.3% of the patients by the end of day 2 of admission. Anticoagulation was prescribed to all patients who had comorbid condition of atrial fibrillation as part of the discharge medications. More than half of the patients were discharged to go home with statin medications. Documented stroke education was provided to 31.4% caretakers or patients. Slightly less than half of the patients were assessed for or received rehabilitation. Less than a quarter had documented dysphagia screening within 24 h of admission. None of the patient had their stroke severity rated with National Institutes of Health Stroke Scale on arrival. No patient obtained carotid imaging assessment by end of day 2. Conclusion There were several gaps in the quality of acute ischemic stroke care provided to patients at the Tamale Teaching Hospital. With the exception of discharging patients on statin medications, there was poor adherence to all other stroke performance indicators.
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Affiliation(s)
- Frank Kumi
- Pharmacy Unit, King's Medical Center, Tamale, Ghana.
| | - Amos A Bugri
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Stephen Adjei
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Elvis Duorinaa
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Matthew Aidoo
- Department of Pharmacology, University for Development Studies, Tamale, Ghana
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Tiamkao S, Ienghong K, Cheung LW, Celebi I, Suzuki T, Apiratwarakul K. Stroke Incidence, Rate of Thrombolytic Therapy, Mortality in Thailand from 2009 to 2021. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Thrombolytic treatment is the main treatment of acute ischemic stroke. Thailand started thrombolytic treatment in 2008 only at university hospitals in Bangkok and gradually increased services in large provincial hospitals until widespread in 2014. However, no studies regard the services in stroke management in Thailand.
AIM: This study aims to present data: incidence, rate of thrombolytic treatment, mortality rate of acute stroke in Thailand for 13 years
METHODS: A study from the National Health Security Office's database between 2009 and 2021 was reported using percentage statistics, and the number of patients per 100,000 population.
RESULTS: The overall incidence of acute stroke patients aged 15 years and over was 172.33- 328.00 per 100,000 population. The incidence of acute ischemic stroke patients aged 15 years and over was 90.37-222.73 per 100,000 population. The incidence of non-traumatic intracerebral hemorrhage patients aged 15 years and over was 55.77-87.63 per 100,000 population. Rate of acute ischemic stroke patients who treated with thrombolytic treatment was 0.18-8.04%. Mortality rate of acute stroke patients was 10.24-14.77%. Mortality rate of acute ischemic stroke patients who treated with thrombolytic treatment was 3.97-10.53%.
CONCLUSIONS: Stroke incidence tends to increase over 13 years. Acute ischemic stroke patients receiving thrombolytic treatment tends to increase in number. The mortality rate in patients with acute stroke tends to decline. Especially in patients with acute ischemic stroke, the mortality rate was greatly reduced.
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8
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Oosterveer DM, Wermer MJH, Volker G, Vlieland TPMV. Are There Differences in Long-Term Functioning and Recovery Between Hemorrhagic and Ischemic Stroke Patients Receiving Rehabilitation? J Stroke Cerebrovasc Dis 2022; 31:106294. [PMID: 35021151 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106294] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Previous research suggested better recovery in functioning of patients with hemorrhagic as compared to ischemic stroke. Now that more effective acute treatment for ischemic stroke, i.e. thrombolysis and thrombectomy, has become available, this observational cohort study aimed to examine if current rehabilitation outcomes differ between patients with hemorrhagic and ischemic stroke. MATERIALS AND METHODS The Barthel Index, 4 domains of the Stroke Impact Scale (SIS) and the EuroQol 5Dimensions were completed in all consecutive patients who received stroke rehabilitation at start of rehabilitation and during follow-up (for Barthel Index at discharge, SIS and EuroQol 5D after three and six months). Outcomes and recovery (i.e. change of scores between baseline and last follow-up) were compared between patients with hemorrhagic stroke and ischemic stroke (total and categorized by initial hospital treatment) using the Kruskall Wallis test. In addition, recovery was compared between ischemic and hemorrhagic stroke in multiple regression analyses with bootstrapping. RESULTS Baseline functioning did not differ between 117 patients with a hemorrhagic stroke, 118 ischemic stroke patient treated with reperfusion therapy, and 125 ischemic stroke patients without reperfusion therapy. There were no differences in functioning at follow-up nor in recovery concerning the Barthel Index, SIS domains 'mobility', 'communication', 'memory and thinking' and 'mood and emotions', and EuroQoL 5D between the three categories. CONCLUSIONS In a rehabilitation population the recovery and functioning at three or six months did not differ between ischemic stroke patients and hemorrhagic stroke patients, regardless of the hospital treatment they had received.
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Affiliation(s)
- Daniëlla M Oosterveer
- Department of Rehabilitation, Leiden/the Hague, Wassenaarseweg 501, Basalt, Leiden 2333 AL, the Netherlands.
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard Volker
- Department of Rehabilitation, Leiden/the Hague, Wassenaarseweg 501, Basalt, Leiden 2333 AL, the Netherlands
| | - Thea P M Vliet Vlieland
- Department of Rehabilitation, Leiden/the Hague, Wassenaarseweg 501, Basalt, Leiden 2333 AL, the Netherlands; Department of Orthopedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
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Measuring the effect of thrombosis, thrombus maturation and thrombolysis on clot mechanical properties in an in-vitro model. J Biomech 2021; 129:110731. [PMID: 34601216 DOI: 10.1016/j.jbiomech.2021.110731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 01/05/2023]
Abstract
Changes in acute ischemic stroke thrombi structure and composition may result in significant differences in treatment responsiveness. Ischemic stroke patients are often treated with a thrombolytic agent to dissolve thrombi, however these patients may subsequently undergo mechanical thrombectomy to remove the occlusive clot. We set out to determine if rt-PA thrombolysis treatment of blood clots changes their mechanical properties, which in turn may impact mechanical thrombectomy. Using a design-of-experiment approach, ovine clot analogues were prepared with varying composition and further exposed to different levels of compaction force to simulate the effect of arterial blood pressure. Finally, clots were treated with three r-tPA doses for different durations. Clot mass and mechanical behaviour was analysed to assess changes due to (i) Platelet driven contraction (ii) Compaction force and (iii) Thrombolysis. Clots that were exposed to r-tPA for longer duration showed significant reduction in clot mass (p < 0.001). Exposure time to r-tPA (p < 0.001) was shown to be an independent predictor of lower clot stiffness. A decrease in energy dissipation ratio during mechanical compression was associated with longer exposure time in r-tPA (p = 0.001) and a higher platelet concentration ratio (p = 0.018). The dose of r-tPA was not a significant factor in reducing clot mass or changing mechanical properties of the clots. Fibrinolysis reduces clot stiffness which may explain increased distal clot migration observed in patients treated with r-tPA and should be considered as a potential clot modification factor before mechanical thrombectomy.
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van Leeuwen KG, Meijer FJA, Schalekamp S, Rutten MJCM, van Dijk EJ, van Ginneken B, Govers TM, de Rooij M. Cost-effectiveness of artificial intelligence aided vessel occlusion detection in acute stroke: an early health technology assessment. Insights Imaging 2021; 12:133. [PMID: 34564764 PMCID: PMC8464539 DOI: 10.1186/s13244-021-01077-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Limited evidence is available on the clinical impact of artificial intelligence (AI) in radiology. Early health technology assessment (HTA) is a methodology to assess the potential value of an innovation at an early stage. We use early HTA to evaluate the potential value of AI software in radiology. As a use-case, we evaluate the cost-effectiveness of AI software aiding the detection of intracranial large vessel occlusions (LVO) in stroke in comparison to standard care. We used a Markov based model from a societal perspective of the United Kingdom predominantly using stroke registry data complemented with pooled outcome data from large, randomized trials. Different scenarios were explored by varying missed diagnoses of LVOs, AI costs and AI performance. Other input parameters were varied to demonstrate model robustness. Results were reported in expected incremental costs (IC) and effects (IE) expressed in quality adjusted life years (QALYs). Results Applying the base case assumptions (6% missed diagnoses of LVOs by clinicians, $40 per AI analysis, 50% reduction of missed LVOs by AI), resulted in cost-savings and incremental QALYs over the projected lifetime (IC: − $156, − 0.23%; IE: + 0.01 QALYs, + 0.07%) per suspected ischemic stroke patient. For each yearly cohort of patients in the UK this translates to a total cost saving of $11 million. Conclusions AI tools for LVO detection in emergency care have the potential to improve healthcare outcomes and save costs. We demonstrate how early HTA may be applied for the evaluation of clinically applied AI software for radiology. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01077-4.
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Affiliation(s)
- Kicky G van Leeuwen
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Frederick J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Steven Schalekamp
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Matthieu J C M Rutten
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Prognostic Factors in Neurorehabilitation of Stroke: A Comparison among Regression, Neural Network, and Cluster Analyses. Brain Sci 2021; 11:brainsci11091147. [PMID: 34573168 PMCID: PMC8466358 DOI: 10.3390/brainsci11091147] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic factors, the literature lacks a rigorous comparison among classical regression, neural network, and cluster analysis. Moreover, the three methods have rarely been tested on a sample independent from that in which prognostic factors have been identified. This study aims at providing this comparison on a wide sample of data (1522 patients) and testing the results on an independent sample (1000 patients) using 30 variables. The accuracy was similar among regression, neural network, and cluster analyses on the analyzed sample (76.6%, 74%, and 76.1%, respectively), but on the test sample, the accuracy of neural network decreased (70.1%). The three models agreed in identifying older age, severe impairment, unilateral spatial neglect, and total anterior circulation infarcts as important prognostic factors. The binary regression analysis also provided solid results in the test sample, especially in terms of specificity (81.8%). Cluster analysis also showed a high sensitivity in the test sample (82.6%) and allowed a meaningful easy-to-use classification tree to be obtained.
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12
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Holodinsky JK, Onaemo VN, Whelan R, Hunter G, Graham BR, Hamilton J, Schwartz L, Latta L, Peeling L, Kelly ME. Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan. BMJ Open Qual 2021; 10:bmjoq-2020-001214. [PMID: 34385186 PMCID: PMC8362703 DOI: 10.1136/bmjoq-2020-001214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 07/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background For ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial stroke strategy in place. Methods A quality improvement project was undertaken to create and evaluate a provincial stroke strategy. The Saskatchewan Acute Stroke Pathway was created using a multidisciplinary team of experts, piloted at five stroke centres and then implemented provincially. The number of stroke alerts, door-to-imaging, door-to-needle, door-to-groin puncture times and treatment rates were collected at all centres. Improvements over time were analysed using run charts and individuals control charts. Results The number of stroke alerts province-wide trended upwards in the last 6 months of the study. There were no clear trends or shifts in the proportion of stroke alerts treated with alteplase or endovascular therapy. Across the province, the weighted mean door-to-imaging time decreased from 21 to 15 min, the weighted mean door-to-needle time decreased from 62 to 47 min and the mean door-to-groin puncture time decreased from 83 to 70 min. There was high variability in the degree of improvement from centre to centre. Conclusions The implementation of a province wide acute stroke pathway has led to improvement in stroke care on a provincial basis. Further work addressing intercentre variability is ongoing.
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Affiliation(s)
- Jessalyn K Holodinsky
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vivian N Onaemo
- Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | - Ruth Whelan
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brett R Graham
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jessica Hamilton
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Laura Schwartz
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lori Latta
- Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | - Lissa Peeling
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael E Kelly
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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13
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Deng PP, Wu N, Chen XJ, Chen FL, Xu HS, Bao GS. NIHSS-the Alberta Stroke Program Early CT Score mismatch in guiding thrombolysis in patients with acute ischemic stroke. J Neurol 2021; 269:1515-1521. [PMID: 34318373 PMCID: PMC8315493 DOI: 10.1007/s00415-021-10704-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/20/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Objective This study investigates the mismatch between the National Institutes of Health Stroke Scale (NIHSS) score and the computed tomography (CT) findings measured by the Alberta Stroke Program Early CT Score (ASPECTS) for predicting the functional outcome and safety of intravenous thrombolysis (IVT) treatment in patients with acute ischemic stroke (AIS). Methods This prospective observational study includes patients with AIS who underwent CT imaging within 4.5 h of the onset of symptoms. Patients were divided into the NIHSS–ASPECTS mismatch (NAM)-positive and NAM-negative groups (group P and N, respectively). The clinical outcome was assessed using the Modified Rankin Scale (mRS). Safety outcomes included progression, symptomatic intracerebral hemorrhage (sICH), intracerebral hemorrhage (ICH), adverse events, clinical adverse events, and mortality. Results A total of 208 patients were enrolled in the study. In group P, IVT treatment was associated with a good functional outcome at 3 months (p = 0.005) and 1 year (p = 0.001). A higher percentage of patients with favorable mRS (0–2) (p = 0.01) and excellent mRS (0–1) (p = 0.011) functional outcomes was obtained at 1 year in group P with IVT treatment. Group N did not benefit from the same treatment (p = 0.352 and p = 0.480 at 3 months and 1 year, respectively). There were no statistically significant differences in sICH, ICH, mortality rates, or other risks between the IVT and conventional treatment groups. Conclusion IVT treatment is associated with a good functional outcome in patients with NAM, without increasing the risks of sICH, ICH, mortality, or other negative outcomes. NAM promises to be an easily obtained indicator for guiding the treatment decisions of AIS.
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Affiliation(s)
- Pan-Pan Deng
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 280 of Mohe street, Baoshan District, Shanghai, 201999, China
| | - Na Wu
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiao-Jie Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 280 of Mohe street, Baoshan District, Shanghai, 201999, China
| | - Feng-Ling Chen
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201999, China
| | - Heng-Shi Xu
- Department of Blood Transfusion, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 280 of Mohe Street, Baoshan District, Shanghai, 201999, China.
| | - Guan-Shui Bao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 280 of Mohe street, Baoshan District, Shanghai, 201999, China.
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Wnuk M, Derbisz J, Drabik L, Malecki M, Slowik A. Fasting Normoglycemia after Intravenous Thrombolysis Predicts Favorable Long-Term Outcome in Non-Diabetic Patients with Acute Ischemic Stroke. J Clin Med 2021; 10:3005. [PMID: 34300171 PMCID: PMC8306150 DOI: 10.3390/jcm10143005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Only a few studies evaluated the role of fasting glucose levels after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Importantly, formal analysis concerning the prognostic role of fasting glucose levels in these patients with and without diabetes mellitus (DM) was not performed. Therefore, we assessed whether fasting normoglycemia (FNG) next morning after AIS treated with IVT was associated with 90-day functional outcome in diabetic and non-diabetic patients. METHODS We retrospectively analyzed 362 AIS patients treated with IVT at The University Hospital in Krakow. FNG was defined as glucose below 5.5 mmol/L. A favorable outcome was defined as modified Rankin score (mRS) of 0-2 at day 90 after AIS onset. RESULTS At 3-month follow-up, FNG was associated with favorable outcome (87.5% vs. 60.8%, p < 0.001) and decreased risk of death (3.1% vs. 18.1%, p = 0.002). Independent predictors of a favorable outcome for the whole group were: younger age (HR 0.92, 95%CI 0.89-0.95), lower NIHSS score after IVT (HR 0.70, 95%CI 0.65-0.76), lower maximal systolic blood pressure within 24 h after IVT (HR 0.92, 95%CI 0.89-0.95) and FNG (HR 4.12, 95%CI 1.38-12.35). Association between FNG and mortality was found in univariable (HR 1.47, 95%CI 0.04-0.62) but not in multivariable analysis (HR 0.23, 95%CI 0.03-1.81). In subgroup analyses, FNG was an independent predictor of favorable outcome (HR 5.96, 95%CI 1.42-25.1) only in patients without DM. CONCLUSIONS FNG next morning after IVT is an independent protective factor for a favorable long-term outcome in non-diabetic AIS patients.
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Affiliation(s)
- Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (J.D.); (A.S.)
- The University Hospital in Krakow, 30-688 Krakow, Poland;
| | - Justyna Derbisz
- Department of Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (J.D.); (A.S.)
- The University Hospital in Krakow, 30-688 Krakow, Poland;
| | - Leszek Drabik
- Department of Pharmacology, Jagiellonian University Medical College, 31-531 Krakow, Poland;
- John Paul II Hospital, 31-202 Krakow, Poland
| | - Maciej Malecki
- The University Hospital in Krakow, 30-688 Krakow, Poland;
- Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (J.D.); (A.S.)
- The University Hospital in Krakow, 30-688 Krakow, Poland;
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15
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Zhou Y, Shi J, Zhang Y, Zhang X, Dai A, Feng S, Luo C, Huang Z, Huang G. Study for cerebral central network mechanism of acupuncture stimulation quantity based on changes of cerebral functional connection of fMRI. Medicine (Baltimore) 2021; 100:e25480. [PMID: 33832167 PMCID: PMC8036113 DOI: 10.1097/md.0000000000025480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ischemic stroke is a major chronic noninfectious disease that seriously endangers health. Acupuncture is effective for ischemic stroke and less adverse reactions. However, there is not enough clinical trial data and solid evidence could confirm how acupuncture work to cerebral functional connectivity changes, and whether the changes is related to the different stimulation quantity. DESIGN This is a multicenter, central-randomized, controlled, double-blind, noninferiority, 2 factors and 3 levels orthogonal clinical trial. A total of 100 participants with ischemic stroke aged from 40 to 80 were randomized into experimental group and control group, the experimental group was divided into 9 groups (A1-A9) according to different factors or levels, and each group have 10 participants. The whole study period is 17 days, including 1 week for baseline observation, 3 days treatment and observation, and 1 week follow-up. Primary outcome is the fMRI based on blood oxygenation level dependent. Secondary outcomes included National Institute of Health Stroke Scale, Modified Barthel Index, Brunnstrom stroke recovery, stroke Chinese medicine symptom. Clinical assessments will be evaluated at before and the 0 hour, 24 hours, 36 hours after treatment, and 1 week follow-up. The primary outcome of the postacupuncture effect were investigated by paired T-test, and the continuous outcome variables will be analyzed with univariate repetitive measurement deviation analysis. Adverse events will be noted and recorded for the safety evaluation. CONCLUSION The purpose of this study was to evaluate the central mechanism of acupuncture stimulation quantity using time and frequency as control conditions. This study will provide reasonable stimulation parameters and strong mechanism evidence of cerebral central network for the use of acupuncture for ischemic stroke. CHICTR REGISTRATION NUMBER ChiCTR1900023169. Registered 15 May 2019.
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Affiliation(s)
- Yihao Zhou
- Yunnan University of Traditional Chinese Medicine
| | - Jing Shi
- The First Clinical Medical College of Yunnan University of Traditional Chinese Medicine, Kunming
| | - Yi Zhang
- Qingdao Central Hospital, Qingdao, China
| | | | - Anhong Dai
- Yunnan University of Traditional Chinese Medicine
| | - Sifeng Feng
- The First Clinical Medical College of Yunnan University of Traditional Chinese Medicine, Kunming
| | - Chunhong Luo
- Yunnan University of Traditional Chinese Medicine
| | - Zhilin Huang
- Yunnan University of Traditional Chinese Medicine
| | - Gan Huang
- Yunnan University of Traditional Chinese Medicine
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16
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Jiao J, Geng L, Zhang Z. Do We Need to Distinguish Thrombolysis and Nonthrombolysis Patients When Applying Stroke-Associated Pneumonia Predicting Scores? An External Validation from a 2-Center Database. Med Sci Monit 2020; 26:e924129. [PMID: 32921786 PMCID: PMC7513614 DOI: 10.12659/msm.924129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Due to the lack of validation for predictive scoring of stroke-associated pneumonia in both thrombolysis- and nonthrombolysis-treated ischemic stroke (IS) patients, this study aimed to evaluate 4 scoring methods in the 2 subgroups. MATERIAL AND METHODS The CerebroVascular Database Project database included data from patients with cerebral IS that were admitted in 2 hospitals from February 2016 to January 2018. A total of 138 thrombolysis-treated and 138 nonthrombolysis-treated IS patients were enrolled. Area under receiver operating characteristic curves (AUROC) were performed to examine the discrimination of the 4 scores, and Hosmer-Lemeshow test was used to evaluate the goodness of fit. RESULTS The incidence of stroke-associated pneumonia was 24.8%. The thrombolysis and nonthrombolysis subgroups were not significantly different with regard to sex, present smoking, chronic obstructive pulmonary disease history, atrial fibrillation history, blood pressure, or glucose level on admission. However, significant differences were found in National Institutes of Health Stroke Scale scores (P<0.001), Glascow Coma Scale scores (P<0.001), Oxfordshire Community Stroke Project classification (P<0.001), dysphagia (P<0.001), and white blood cell counts (P=0.039). The AUROC for the Age, Atrial fibrillation, Dysphagia, male Sex, stroke Severity, National Institutes of Health Stroke Scale; Preventive ANtibacterial THERapy in acute Ischemic Stroke; Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS); and Independence, Sex, Age, National Institutes of Health Stroke Scale scores in total population were 0.80 (0.74-0.84), 0.75 (0.69-0.80), 0.80 (0.76-0.85), and 0.76 (0.71-0.81). The goodness of fit was 0.22, 0.22, 0.27, and 0.17, respectively. The AUROC of 4 scores between subgroups were not statistically significant. CONCLUSIONS The AIS-APS had the highest AUC and goodness of fit in our population. All 4 scores can be applied regardless of whether thrombolysis has been performed on patients.
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Affiliation(s)
- Jiao Jiao
- Medical School of Southeast University, Nanjing, Jiangsu, China (mainland).,Neuropsychiatric Institute of Southeast University, Nanjing, Jiangsu, China (mainland).,Neurological Department of Zhongda Hospital Affiliated with Southeast University, Nanjing, Jiangsu, China (mainland)
| | - Leiyu Geng
- Medical School of Southeast University, Nanjing, Jiangsu, China (mainland).,Neuropsychiatric Institute of Southeast University, Nanjing, Jiangsu, China (mainland).,Neurological Department of Zhongda Hospital Affiliated with Southeast University, Nanjing, Jiangsu, China (mainland)
| | - Zhijun Zhang
- Medical School of Southeast University, Nanjing, Jiangsu, China (mainland).,Neuropsychiatric Institute of Southeast University, Nanjing, Jiangsu, China (mainland).,Neurological Department of Zhongda Hospital Affiliated with Southeast University, Nanjing, Jiangsu, China (mainland)
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Sun L, Fan Y, Fan W, Sun J, Ai X, Qiao H. Efficacy and safety of scalp acupuncture in improving neurological dysfunction after ischemic stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21783. [PMID: 32846808 PMCID: PMC7447452 DOI: 10.1097/md.0000000000021783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Scalp acupuncture is remarkable in improving neurological dysfunction of ischemic stroke patients. This study aims to systematically evaluate the efficacy and safety of scalp acupuncture in improving neurological dysfunction of ischemic stroke patients. METHODS Randomized controlled trials of scalp acupuncture against ischemic stroke patients will be searched in PubMed, Web of Science, Embase, Cochrane Library, the Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database, China National Knowledge Infrastructure, and Wanfang database from inception to July, 2020. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS This study will summarize the present evidence by exploring the efficacy and safety of scalp acupuncture in improving neurological dysfunction in ischemic stroke patients. CONCLUSIONS The findings of the study will help to determine potential benefits of scalp acupuncture against ischemic stroke at different stage. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/T26P8.
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Affiliation(s)
- Lei Sun
- Shaanxi University of Chinese Medicine, Shaanxi Province
| | - Yihua Fan
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wei Fan
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Sun
- Shaanxi University of Chinese Medicine, Shaanxi Province
| | - Xia Ai
- Shaanxi University of Chinese Medicine, Shaanxi Province
| | - Haifa Qiao
- Shaanxi University of Chinese Medicine, Shaanxi Province
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18
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Wu S, Zheng T, Du J, Yuan Y, Shi Q, Wang Z, Liu D, Liu J, Wang X, Liu L. Neuroprotective effect of low-intensity transcranial ultrasound stimulation in endothelin-1-induced middle cerebral artery occlusion in rats. Brain Res Bull 2020; 161:127-135. [PMID: 32439337 DOI: 10.1016/j.brainresbull.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ischemic stroke is one of the leading causes of death and disability worldwide. Low-intensity transcranial ultrasound stimulation (LITUS) is a promising neuroprotective treatment for ischemic stroke. Diffusion-weighted imaging (DWI) can be highly sensitive in the detection of ischemic brain injury. Relative apparent diffusion coefficient (rADC) values can be used to evaluate the effect of LITUS on ischemic stroke. PURPOSE The aim of this study was to determine the neuroprotective effect of LITUS at different time points using endothelin-1-induced middle cerebral artery occlusion in rats as a model of ischemic stroke. METHODS Endothelin-1 (ET-1) was injected into the cerebral parenchyma near the middle cerebral artery, which induced focal, reversible, low-flow ischemia in rats. After occlusion of the middle cerebral artery for 30 min, 120 min, and 240 min, LITUS stimulation was used respectively. DWI was performed at 1, 3, 6, 12, 18, 24, 48, and 72 h after ischemia using a 3 T scanner. The rADC values were calculated, and functional outcomes assessed using neurobehavioral scores after ischemia. Nissl staining and estimation of Na+-K+-ATPase activity were used to assess the neuropathology after completing the last Magnetic Resonance Imaging (MRI) examination. RESULTS Endothelin-1-induced occlusion of the middle cerebral artery resulted in significant dysfunction and neuronal damage in rats. Rats that received LITUS exhibited reduced damage of the affected brain tissue after cerebral ischemia. The greatest protective effect was found when LITUS stimulation occurred 30 min after cerebral ischemia. CONCLUSIONS Imaging, behavioral, and histological results suggested that LITUS stimulation after an ischemic stroke produced significant neuroprotective effects.
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Affiliation(s)
- Shuo Wu
- Graduate School of Hebei Medical University, China
| | - Tao Zheng
- Qinhuangdao Municipal No. 1 Hospital, China
| | - Juan Du
- Qinhuangdao Municipal No. 1 Hospital, China
| | - Yi Yuan
- Institute of Electrical Engineering, Yanshan University, China
| | - Qinglei Shi
- Scientific Clinical Specialist, Siemens Ltd., China
| | | | - Defeng Liu
- Qinhuangdao Municipal No. 1 Hospital, China
| | - Jian Liu
- Northeastern University, School of Information Science and Engineering, China
| | - Xiaohan Wang
- Graduate School of Chengde Medical University, China
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Utilization of Intravenous Tissue Plasminogen Activator and Reasons for Nonuse in Acute Ischemic Stroke in Saudi Arabia. J Stroke Cerebrovasc Dis 2020; 29:104761. [PMID: 32173225 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/11/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recombinant tissue plasminogen activator (rt-PA, alteplase) within 4.5 hours of symptom onset decreases the rate of disability after acute ischemic stroke (AIS). Due to various reasons, alteplase remains underutilized in certain regions (∼3% in low- and middle-income countries). AIMS We aimed to estimate the alteplase utilization rate and identify the reasons for nonuse in Saudi Arabia. METHODS We retrospectively reviewed all patients admitted with suspected stroke in the past 24 hours to the stroke unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia from February 2016 to July 2018. We estimated the alteplase utilization rate among patients with AIS who could be treated within 4.5 hours of symptoms onset (≤225 minutes, allowing 45 minutes for door to needle time). We examined potential predictors of alteplase use using multivariable logistic regression analyses. Study was approved by local IRB. RESULTS Of 1366 patients with suspected stroke, 819 (60%) had AIS. The alteplase utilization rates were 8.6% and 29% for all AIS and AIS arrived within the therapeutic window, respectively. The most common reason for no alteplase treatment was late arrival. Only 244 (29.8%) of AIS patients arrived within the time window for treatment. Among patients with sudden neurological deficit who arrived within the therapeutic time window, the most common reasons were mild neurological deficit (National Institutes of Health Stroke Scale score <5, 29.9%), stroke mimics (16.6%), and hemorrhagic stroke (8.1%). CONCLUSIONS Our study showed a comparable alteplase utilization rate with most international estimates. The low utilization rate was mainly attributed to late patient arrival. Urgent interventions are needed to improve public awareness of stroke recognition and prehospital stroke care.
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20
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Kim HJ, Lee SB, Choi JW, Jeon YS, Lee HJ, Park JJ, Kim EY, Kim IS, Lee TJ, Jung YJ, Ryu SY, Chun YI, Lee JS, Roh HG. Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke. Radiology 2020; 295:192-201. [PMID: 32068506 DOI: 10.1148/radiol.2020191712] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Collateral circulation determines tissue fate and affects treatment result in acute ischemic stroke. A precise method for collateral estimation in an optimal imaging protocol is necessary to make an appropriate treatment decision for acute ischemic stroke. Purpose To verify the value of multiphase collateral imaging data sets (MR angiography collateral map) derived from dynamic contrast material-enhanced MR angiography for predicting functional outcomes after acute ischemic stroke. Materials and Methods This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to occlusion or stenosis of the unilateral internal carotid artery and/or M1 segment of the middle cerebral artery who were evaluated within 8 hours of symptom onset. Data were obtained from March 2016 through August 2018. The collateral grading based on the MR angiography collateral map was estimated by using six-scale MR acute ischemic stroke collateral (MAC) scores. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, collateral grade, mode of treatment, and early reperfusion were evaluated with multiple logistic regression analyses. Results One hundred fifty-four participants (mean age ± standard deviation, 69 years ± 13; 99 men) were evaluated. Younger age (odds ratio [OR], 0.45; 95% confidence interval [CI]: 0.29, 0.70; P < .001), lower baseline NIHSS score (OR, 0.85; 95% CI: 0.78, 0.94; P < .001), MAC score of 3 (OR, 27; 95% CI: 4.0, 179; P < .001), MAC score of 4 (OR, 17; 95% CI: 2.1, 134; P = .007), MAC score of 5 (OR, 27; 95% CI: 2.5, 306; P = .007), and successful early reperfusion (OR, 7.5; 95% CI: 2.6, 22; P < .001) were independently associated with favorable functional outcomes in multivariable analysis. There was a linear negative association between collateral perfusion grades and functional outcomes (P < .001). Conclusion An MR angiography collateral map was clinically reliable for collateral estimation in patients with acute ischemic stroke. This map provided patient-specific pacing information for ischemic progression. © RSNA, 2020.
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Affiliation(s)
- Hyun Jeong Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Sang Bong Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Jin Woo Choi
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Yoo Sung Jeon
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Hyung Jin Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Jeong Jin Park
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Eung Yeop Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - In Seong Kim
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Taek Jun Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Yu Jin Jung
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Seon Young Ryu
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Young Il Chun
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Ji Sung Lee
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Hong Gee Roh
- From the Department of Radiology (H.J.K.), Neurology (S.B.L., T.J.L., Y.J.J., S.Y.R.), and Neurosurgery (H.J.L.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Departments of Radiology (J.W.C., H.G.R.), Neurosurgery (Y.S.J., Y.I.C.), and Neurology (J.J.P.), Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul 05030, Korea; Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (E.Y.K.); Siemens Healthineers Ltd, Seoul, Korea (I.S.K.); and Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
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The global burden of cerebral small vessel disease related to neurological deficit severity and clinical outcomes of acute ischemic stroke after IV rt-PA treatment. Neurol Sci 2019; 40:1157-1166. [DOI: 10.1007/s10072-019-03790-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/22/2019] [Indexed: 12/18/2022]
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