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Rodriguez-Calienes A, Galecio-Castillo M, Vivanco-Suarez J, Mohamed GA, Toth G, Sarraj A, Pujara D, Chowdhury AA, Farooqui M, Ghannam M, Samaniego EA, Jovin TG, Ortega-Gutierrez S. Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis. J Neurointerv Surg 2024; 16:670-676. [PMID: 37355251 DOI: 10.1136/jnis-2023-020443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Different studies have demonstrated the benefit of endovascular treatment (EVT) up to 24 hours after acute ischemic stroke (AIS) onset. Recent cohort observational studies suggest that patients with large vessel occlusion AIS may benefit from EVT beyond 24 hours from the last known well (LKW) when adequately selected. We aimed to examine the safety and efficacy of EVT beyond 24 hours from LKW using a meta-analysis of all the literature available. METHODS A systematic search from inception to April 2023 was conducted for studies including AIS patients with EVT beyond 24 hours from LKW in Medline, Embase, Scopus, and Web of Science. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Data were pooled using a random-effects model. RESULTS Twelve studies with 894 patients were included. The rate of favorable functional outcome was 40% (95% CI 31% to 49%; I2=76%). The rate of successful reperfusion was 83% (95% CI 80% to 85%; I2=0%). The sICH rate was 7% (95% CI 5% to 9%; I2=0%) and the 90-day mortality rate was 28% (95% CI 24% to 33%; I2=0%). There was no significant difference in favorable outcomes (OR=0.69; 95% CI 0.41 to 1.14) and 90-day mortality (OR=1.35; 95% CI 0.90 to 2.00) among patients who underwent EVT <24 hours versus >24 hours. CONCLUSIONS EVT beyond 24 hours from LKW may achieve favorable clinical outcomes and high reperfusion rates, with acceptable intracranial hemorrhage rates in selected patients. Considering the current certainty of the evidence and heterogenous individual study results, larger prospective trials are warranted.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru
| | | | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amrou Sarraj
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Deep Pujara
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Aj A Chowdhury
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Malik Ghannam
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edgar A Samaniego
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Chen F, Dai L, Dong J, Zhu L, Li Y, Zhang L, Zhao D. A Study on the Efficacy of Thrombectomy in Patients with Atherosclerotic and Cardioembolic Basilar Artery Occlusion. J Neurol Surg B Skull Base 2024; 85:234-240. [PMID: 38721366 PMCID: PMC11076097 DOI: 10.1055/a-2065-9562] [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: 10/01/2022] [Accepted: 03/27/2023] [Indexed: 06/04/2024] Open
Abstract
Background Studies on basilar artery occlusion are relatively few compared with those of anterior circulation stroke. The aim of the present study was to compare the efficacy of endovascular therapy (EVT) in patients with basilar artery occlusion classified as large artery atherosclerosis (LAA) and cardioembolism (CE), and to analyze the independent risk factors affecting the prognosis of EVT. Methods A total of 123 people were assigned to the LAA and CE groups (97 to the LAA and 26 to the CE). The primary outcome was a modified Rankin Scale (mRS) score of 2 or lower at 90 days. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial hemorrhage and reinfarction. Multiple logistic regression was used to screen out independent risk factors for EVT prognosis of the LAA and CE groups. Results In the analysis, the patients with LAA stroke had better collateral circulation (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology [SIR] score of 2-4; 61.9 vs. 19.2%, p = 0.000), and higher angioplasty rate (32.0 vs. 3.8%, p = 0.002). The proportions of patients with a 90-day mRS score of 0 to 2 and 90-day mortality were not found to be statistically significant between the two groups. Multivariate logistic regression analysis indicated that age, SIR, white blood cell, blood glucose, and modified thrombolysis in cerebral infarction were independent risk factors for the poor prognosis of EVT in the LAA group. Conclusion Although there were differences in clinical characteristics and imaging features between LAA and CE, there was no evidence of a significant difference in prognosis after EVT. In addition, the National Institutes of Health Stroke Scale score was not among the independent risk factors affecting the prognosis of the LAA group.
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Affiliation(s)
- Fulei Chen
- Department of Neurosurgery, First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China
| | - Linzhi Dai
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jiangtao Dong
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Licang Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Yang Li
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Lei Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Dong Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Shihezi University, Shihezi, China
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Halúsková S, Herzig R, Mikulík R, Bělašková S, Reiser M, Jurák L, Václavík D, Bar M, Klečka L, Řepík T, Šigut V, Tomek A, Hlinovský D, Šaňák D, Vyšata O, Vališ M, Investigators OBOTCSITS. Intravenous Thrombolysis in Posterior versus Anterior Circulation Stroke: Clinical Outcome Differs Only in Patients with Large Vessel Occlusion. Biomedicines 2024; 12:404. [PMID: 38398006 PMCID: PMC10887309 DOI: 10.3390/biomedicines12020404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The safety and efficacy of intravenous thrombolysis (IVT) are well established in anterior circulation stroke (ACS) but are much less clear for posterior circulation stroke (PCS). The aim of this study was to evaluate the occurrence of parenchymal hematoma (PH) and 3-month clinical outcomes after IVT in PCS and ACS. In an observational, cohort multicenter study, we analyzed data from ischemic stroke patients treated with IVT prospectively collected in the SITS (Safe Implementation of Treatments in Stroke) registry in the Czech Republic between 2004 and 2018. Out of 10,211 patients, 1166 (11.4%) had PCS, and 9045 (88.6%) ACS. PH was less frequent in PCS versus ACS patients: 3.6 vs. 5.9%, odds ratio (OR) = 0.594 in the whole set, 4.4 vs. 7.8%, OR = 0.543 in those with large vessel occlusion (LVO), and 2.2 vs. 4.7%, OR = 0.463 in those without LVO. At 3 months, PCS patients compared with ACS patients achieved more frequently excellent clinical outcomes (modified Rankin scale [mRS] 0-1: 55.5 vs. 47.6%, OR = 1.371 in the whole set and 49.2 vs. 37.6%, OR = 1.307 in those with LVO), good clinical outcomes (mRS 0-2: 69.9 vs. 62.8%, OR = 1.377 in the whole set and 64.5 vs. 50.5%, OR = 1.279 in those with LVO), and had lower mortality (12.4 vs. 16.6%, OR = 0.716 in the whole set and 18.4 vs. 25.5%, OR = 0.723 in those with LVO) (p < 0.05 in all cases). In PCS versus ACS patients, an extensive analysis showed a lower risk of PH both in patients with and without LVO, more frequent excellent and good clinical outcomes, and lower mortality 3 months after IVT in patients with LVO.
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Affiliation(s)
- Simona Halúsková
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic; (S.H.)
- Department of Neurology, Faculty of Health Studies, Pardubice University and Pardubice Hospital, 532 10 Pardubice, Czech Republic
| | - Roman Herzig
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic; (S.H.)
- Department of Neurology, Comprehensive Stroke Center, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
- Research Institute for Biomedical Science, 500 02 Hradec Králové, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center, St. Anne’s University Hospital in Brno, 602 00 Brno, Czech Republic
| | - Silvie Bělašková
- International Clinical Research Center, St. Anne’s University Hospital in Brno, 602 00 Brno, Czech Republic
| | - Martin Reiser
- Department of Neurology, Comprehensive Stroke Center, Hospital České Budějovice, 370 01 České Budějovice, Czech Republic
| | - Lubomír Jurák
- Neurocenter, Regional Hospital Liberec, 460 63 Liberec, Czech Republic
| | - Daniel Václavík
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic; (S.H.)
- Department of Neurology, Comprehensive Stroke Center, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, 708 00 Ostrava, Czech Republic
- Research and Training Institute Agel, Stroke Center, Department of Neurology, Hospital Ostrava Vítkovice, 703 00 Ostrava, Czech Republic
| | - Michal Bar
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, 708 52 Ostrava, Czech Republic
| | - Lukáš Klečka
- Stroke Center, Department of Neurology, City Hospital Ostrava, 703 00 Ostrava, Czech Republic
| | - Tomáš Řepík
- Department of Neurology, Comprehensive Stroke Center, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Vladimír Šigut
- Stroke Center, Department of Neurology, Krnov Hospital, 794 01 Krnov, Czech Republic
| | - Aleš Tomek
- Department of Neurology, Comprehensive Stroke Center, Charles University 2nd Faculty of Medicine, Motol University Hospital, 150 06 Prague, Czech Republic
| | - David Hlinovský
- Stroke Center, Department of Neurology, Thomayer University Hospital, 140 59 Prague, Czech Republic
| | - Daniel Šaňák
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Oldřich Vyšata
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic; (S.H.)
- Department of Neurology, Comprehensive Stroke Center, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic
| | - Martin Vališ
- Research Institute for Biomedical Science, 500 02 Hradec Králové, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital in Brno, 602 00 Brno, Czech Republic
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Nikles F, Kerkeni H, Zamaro E, Korda A, Wagner F, Sauter TC, Kalla R, Morrison M, Mantokoudis G. Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity. Eur J Neurol 2024; 31:e16066. [PMID: 37738525 PMCID: PMC11235630 DOI: 10.1111/ene.16066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. METHODS As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. RESULTS Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. CONCLUSIONS A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
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Affiliation(s)
- Florence Nikles
- Department of Otorhinolaryngology, Head and Neck Surgery, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Hassen Kerkeni
- Department of Neurology, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Roger Kalla
- Department of Neurology, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
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Rodriguez-Calienes A, Vivanco-Suarez J, Sequeiros JM, Galecio-Castillo M, Zevallos CB, Farooqui M, Ortega-Gutierrez S. Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:e460-e467. [PMID: 36797050 DOI: 10.1136/jnis-2022-019975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND There is limited evidence on the indication and role of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs). The aim of this systematic review and meta-analysis was to evaluate all the evidence available on the efficacy and safety of MT techniques (stent retriever, aspiration) in primary and secondary DMVOs. METHODS Five databases were searched from inception to January 2023 for studies of MT in primary and secondary DMVOs. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Prespecified subgroup meta-analyses according to the specific MT technique and to the vascular territory (distal M2-M5, A2-A5, P2-P5) were also performed. RESULTS A total of 29 studies with 1262 patients were included. For primary DMVOs (n=971 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 84% (95% confidence interval (CI) 76 to 90%), 64% (95% CI 54 to 72%), 12% (95% CI 8 to 18%), and 6% (95% CI 4 to 10%), respectively. For secondary DMVOs (n=291 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 82% (95% CI 73 to 88%), 54% (95% CI 39 to 69%), 11% (95% CI 5 to 20%), and 3% (95% CI 1 to 9%), respectively. Subgroup analyses by MT technique and by vascular territory showed no differences in primary and secondary DMVOs. CONCLUSION Our findings suggest that MT using aspiration or stent retriever techniques appears to be effective and safe in primary and secondary DMVOs. However, given the level of evidence of our results, further confirmation in well-designed randomized controlled trials is needed.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joel M Sequeiros
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Department of Neuroloy, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Roushdy T, Abdel Nasser A, Nasef A, Elbassiouny A, George J, Aref H. A clinical comparative analysis between expanded NIHSS and original NIHSS in posterior circulation ischemic stroke. J Clin Neurosci 2023; 114:77-80. [PMID: 37329663 DOI: 10.1016/j.jocn.2023.06.006] [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: 04/14/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The NIHSS is used routinely but has drawbacks. One of them is its inefficiency in detecting all signs of posterior circulation strokes. Since its declaration as a possible substitute for NIHSS in posterior circulation strokes in 2016; the expanded NIHSS (e-NIHSS) has not been paid much attention. The current study assesses clinically the value of e-NIHSS over NIHSS in posterior circulation strokes as regards the percentage of cases with different/higher scores, the significance of such scoring on management decisions, the weight of baseline e-NIHSS as a prognostic tool on 90 days functional outcome and its cut off value. METHODS The current longitudinal observational study was conducted on 79 cases after formal written consent who presented with posterior circulation strokes and confirmed by brain imaging. RESULTS In Comparison to NIHSS; the e-NIHSS score was higher in 36 cases at baseline and in 30 cases on discharge. The e-NIHSS median was two points higher at baseline and 24 h and was one point higher on discharge P < 0.001. A baseline moderate/moderate-severe was more common with e-NIHSS (n 50, 63.3%). In terms of 90 days outcome; a less favorable outcome (>2) was evident in cases with different scoring (e-NIHSS > NIHSS) indicating more sensitivity of e-NIHSS in prognosing 90 days outcome. ROC curve showed 82% sensitivity and 81% specificity with a significant area under the curve (=0.858) on scoring ≥ 8 in e-NIHSS. CONCLUSION e-NIHSS is diagnostically and prognostically relevant tool in posterior circulation strokes and ought to be considered in future guidelines.
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Affiliation(s)
- Tamer Roushdy
- Neurology Department, Faculty of Medicine, Ain Shams University, Egypt.
| | - Azza Abdel Nasser
- Neurology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Ayman Nasef
- Neurology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Ahmed Elbassiouny
- Neurology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - John George
- Neurology specialist, Nasr City Insurance Hospital, Cairo, Egypt
| | - Hany Aref
- Neurology Department, Faculty of Medicine, Ain Shams University, Egypt
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Lin G, Liu F, Xu H, Bao G. Development of a model to predict the risk of cerebral infarction in acute vestibular syndrome. Heliyon 2023; 9:e14852. [PMID: 37095950 PMCID: PMC10121405 DOI: 10.1016/j.heliyon.2023.e14852] [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: 10/13/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
Objectives This study aimed to develop a model to predict the risk of cerebral infarction in acute vestibular syndrome and assist emergency physicians in quickly identifying patients with cerebral infarction. Materials and methods We looked at 262 patients who were split into cerebral infarction and peripheral vertigo groups. Stepwise regression and Lasso's approach were used to screen for variables, and Boothstrap's method was used to evaluate the model's discrimination and calibration. The model's performance was compared against TriAGe+, ABCD2, and PCI scores using the area under the receiver operator characteristic curve. Clinical decision-making was aided by the use of clinical impact and decision curves. Results In the end, nine risk factors were chosen for model 2, and ten risk factors were chosen for model 1. Model 2 was adopted as the final model. The areas under the receiver operator curve value of the model2 were 0.910(P = 0.000), much higher than the areas under the receiver operator curve value of the TriAGe + scores system and that of the PCI scores system. The clinical decision curve shows that when the threshold probability is 0.05, using the nomogram to predict cerebral infarction has more benefits than either the treat-all-patients scheme or the treat-none scheme. The clinical impact curve shows that when the threshold probability is 0.6 the model predicts disease occurrence in general agreement with the occurrence of the real disease. Conclusion This study model can help emergency room physicians quickly triage and treat patients by accurately identifying cerebral infarction patients.
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Affiliation(s)
- Guiming Lin
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China
| | - Fangfang Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China
| | - Hengshi Xu
- Department of Blood Transfusion, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China
- Corresponding author. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China.
| | - Guanshui Bao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China
- Corresponding author. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Mohe Road280, Baoshan District, Shanghai, China.
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Optimization of Large Vessel Occlusion Detection in Acute Ischemic Stroke Using Machine Learning Methods. Life (Basel) 2022; 12:life12020230. [PMID: 35207517 PMCID: PMC8877679 DOI: 10.3390/life12020230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/18/2022] Open
Abstract
The early detection of large-vessel occlusion (LVO) strokes is increasingly important as these patients are potential candidates for endovascular therapy, the availability of which is limited. Prehospital LVO detection scales mainly contain symptom variables only; however, recent studies revealed that other types of variables could be useful as well. Our aim was to comprehensively assess the predictive ability of several clinical variables for LVO prediction and to develop an optimal combination of them using machine learning tools. We have retrospectively analysed data from a prospectively collected multi-centre stroke registry. Data on 41 variables were collected and divided into four groups (baseline vital parameters/demographic data, medical history, laboratory values, and symptoms). Following the univariate analysis, the LASSO method was used for feature selection to select an optimal combination of variables, and various machine learning methods (random forest (RF), logistic regression (LR), elastic net method (ENM), and simple neural network (SNN)) were applied to optimize the performance of the model. A total of 526 patients were included. Several neurological symptoms were more common and more severe in the group of LVO patients. Atrial fibrillation (AF) was more common, and serum white blood cell (WBC) counts were higher in the LVO group, while systolic blood pressure (SBP) was lower among LVO patients. Using the LASSO method, nine variables were selected for modelling (six symptom variables, AF, chronic heart failure, and WBC count). When applying machine learning methods and 10-fold cross validation using the selected variables, all models proved to have an AUC between 0.736 (RF) and 0.775 (LR), similar to the performance of National Institutes of Health Stroke Scale (AUC: 0.790). Our study highlights that, although certain neurological symptoms have the best ability to predict an LVO, other variables (such as AF and CHF in medical history and white blood cell counts) should also be included in multivariate models to optimize their efficiency.
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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10. Life (Basel) 2021; 11:life11121423. [PMID: 34947955 PMCID: PMC8703711 DOI: 10.3390/life11121423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion ("functional" BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0-0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0-0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33-16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16-3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.
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Ždraljević M, Pekmezović T, Stanarčević P, Vukašinović I, Berisavac I, Ercegovac M, Vitošević F, Nestorović D, Cvetić V, Padjen V, Budimkić MS, Medjedović TŠ, Jovanović DR. Influence of Thrombocytopenia on the Outcome of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 31:106240. [PMID: 34915307 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Mechanical thrombectomy (MT) has become leading treatment option for acute ischemic stroke (AIS) due to large vessels occlusion (LVO). Platelet counts may affect outcome in patients with AIS or transient ischemic attack. The aim of our study was to determine the influence of thrombocytopenia on the safety and efficacy of MT in patients with AIS due to anterior circulation LVO. MATERIALS AND METHODS This study included 127 consecutive adult patients with AIS due to anterior circulation LVO who underwent MT. The patients were divided into 2 groups based on initial platelet count: with thrombocytopenia (<150 × 109/L) and without thrombocytopenia (≥150 × 109/L). Primary safety outcome was symptomatic intracerebral haemorrhage (SICH), while secondary safety outcome was stroke-related mortality. Efficacy outcome was functional independence, defined as modified Rankin Scale (mRS) score 0-2. Follow- up time was 90 days. RESULTS Initial thrombocytopenia (<150 × 109/L) was detected in 19 (15%) patients. Multivariable analysis showed that initial thrombocytopenia did not increase the risk of SICH and did not affect the short-term functional outcome (p = 0.587). However, initial thrombocytopenia increased the risk for stroke-related mortality (aOR 3.639, 95% CI 1.079-12.641, p = 0.037). The main cause of mortality in the group with thrombocytopenia was malignant cerebral infarction (44.4%). CONCLUSIONS Thrombocytopenia does not affect the efficacy and the risk of SICH in patients with AIS caused by anterior circulation LVO treated with MT. However, the risk of mortality is higher in patients with thrombocytopenia, mainly due to malignant cerebral infarction.
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Affiliation(s)
- Mirjana Ždraljević
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Tatjana Pekmezović
- Institute of Epidemiology, Faculty of Medicine, Višegradska Street 26, 11 000 Belgrade, Serbia
| | - Predrag Stanarčević
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Ivan Vukašinović
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Ivana Berisavac
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Marko Ercegovac
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Filip Vitošević
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Dragoslav Nestorović
- Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Vladimir Cvetić
- Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Dr Koste Todorovića Street 6, 11 000 Belgrade, Serbia
| | - Višnja Padjen
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia
| | - Maja Stefanović- Budimkić
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Tamara Švabić Medjedović
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia
| | - Dejana R Jovanović
- Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia.
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Taha NA, El Khawas H, Tork MA, Roushdy TM. Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intravenous thrombolysis (IVT) with alteplase is the first-line therapy for acute ischemic anterior and posterior circulation strokes (ACS and PCS).
Knowledge about safety and efficacy of IVT in posterior circulation stroke is deficient as most of the Egyptian studies either assessed IVT outcome in comparison to conservative therapy or its outcome in anterior circulation stroke only.
Therefore, our aim was to compare the relative frequency and outcome after intravenous thrombolysis in anterior versus posterior circulation stroke patients presenting to stroke centers of Ain Shams University hospitals (ASUH).
Results
A total of 238 anterior circulation stroke and 61 posterior circulation strokes were enrolled, onset-to-door and door-to-needle time were statistically insignificant.
NIHSS showed comparable difference at all time points despite higher scores along anterior circulation stroke; 90-day modified Rankin Scale (mRS) showed significant improvement in both groups from mRS >2 to ≤2 with a better percentage along posterior circulation stroke patients.
There was insignificant difference for either incidence of death or intracranial hemorrhage (ICH) between the two groups.
Conclusion
IVT significantly reduced NIHSS for both anterior and posterior circulation stroke along different studied time points. Meanwhile, a higher percentage of patients with posterior circulation stroke had a better mRS outcome at 90 days.
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Pohl M, Hesszenberger D, Kapus K, Meszaros J, Feher A, Varadi I, Pusch G, Fejes E, Tibold A, Feher G. Ischemic stroke mimics: A comprehensive review. J Clin Neurosci 2021; 93:174-182. [PMID: 34656244 DOI: 10.1016/j.jocn.2021.09.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ischemic stroke is the leading cause of disability and one of the leading causes of death. Ischemic stroke mimics (SMs) can account for a noteble number of diagnosed acute strokes and even can be thrombolyzed. METHODS The aim of our comprehensive review was to summarize the findings of different studies focusing on the prevalence, type, risk factors, presenting symptoms, and outcome of SMs in stroke/thrombolysis situations. RESULTS Overall, 61 studies were selected with 62.664 participants. Ischemic stroke mimic rate was 24.8% (15044/60703). Most common types included peripheral vestibular dysfunction in 23.2%, toxic/metabolic in 13.2%, seizure in 13%, functional disorder in 9.7% and migraine in 7.76%. Ischemic stroke mimic have less vascular risk factors, younger age, female predominance, lower (nearly normal) blood pressure, no or less severe symptoms compared to ischemic stroke patients (p < 0.05 in all cases). 61.7% of ischemic stroke patients were thrombolysed vs. 26.3% among SMs (p < 0.001). (p < 0.001). Overall intracranial hemorrhage was reported in 9.4% of stroke vs. 0.7% in SM patients (p < 0.001). Death occurred in 11.3% of stroke vs 1.9% of SM patients (p < 0.001). Excellent outcome was (mRS 0-1) was reported in 41.8% ischemic stroke patients vs. 68.9% SMs (p < 0.001). Apart from HINTS manouvre or Hoover sign there is no specific method in the identification of mimics. MRI DWI or perfusion imaging have a role in the setup of differential diagnosis, but merit further investigation. CONCLUSION Our article is among the first complex reviews focusing on ischemic stroke mimics. Although it underscores the safety of thrombolysis in this situation, but also draws attention to the need of patient evaluation by physicians experienced in the diagnosis of both ischemic stroke and SMs, especially in vertigo, headache, seizure and conversional disorders.
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Affiliation(s)
- Marietta Pohl
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | | | - Krisztian Kapus
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Janos Meszaros
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | | | - Imre Varadi
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | | | | | - Antal Tibold
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gergely Feher
- Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary; Neurology Outpatient Clinic, EÜ-MED KFT, Komló, Hungary.
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Koh S, Lee SE, Jung WS, Choi JW, Lee JS, Hong JM, Lee SJ. Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion. Front Neurol 2021; 12:696042. [PMID: 34594293 PMCID: PMC8476904 DOI: 10.3389/fneur.2021.696042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/12/2021] [Indexed: 01/12/2023] Open
Abstract
Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups. Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group. Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4-154.4]) and reperfusion failure (eTICI < 2b67 (OR, 5.0 [95% CI, 1.3-19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1-2.0]), stroke onset-to-door time <24 h (OR, 5.3 [95% CI, 1.1-2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2-19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0-2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1-2.2]) were predictive of END-IP. Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.
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Affiliation(s)
- Seungyon Koh
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Sung Eun Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.,Department of Emergency Medicine, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
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Brechtel L, Poupore N, Monroe M, Knisely K, Sanders C, Edrissi C, Rathfoot C, Nathaniel TI. Role of dyslipidemia in ischemic stroke patients treated in the telestroke network. Adv Med Sci 2021; 66:254-261. [PMID: 33940526 DOI: 10.1016/j.advms.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The relationship between the telestroke technology and clinical risk factors in a dysplipidemic ischemic stroke population and neurologic outcomes is not fully understood. This issue was investigated in this study. PATIENTS AND METHODS We analyzed retrospective data collected from a regional stroke registry to identify demographic and clinical risk factors in patients with improving (NIHSS ≤ 7) or worsening (NIHSS > 7) neurologic outcome in dyslipidemic ischemic stroke population. We used logistic multivariate models to identify independent predictors of improving or worsening outcome based on dyslipidemia disease status in ischemic stroke patients. RESULTS In the adjusted analysis for dyslipidemic ischemic stroke population, cholesterol reducer use (odd ratio; [OR] = 0.393, 95% confidence interval [CI], 0.176-0.879, P = 0.023) and direct admission (OR = 0.435, 95% CI, 0.199-0.953, P = 0.037) were more likely to be associated with neurologic improvement and no clinical or demographic factors were associated with poor neurologic outcome in dyslipidemic ischemic stroke patients treated in the telestroke network. For the ischemic stroke population without dyslipidemia, increasing age (OR = 1.070, 95% CI, 1.031-1.109, P < 0.001), coronary artery disease (OR = 3.633, 95% CI, 1.307-10.099, P = 0.013), history of drug or alcohol abuse (OR = 6.548, 95% CI, 1.106-38.777, P = 0.038), and improvement in ambulatory outcome (OR = 2.880, 95% CI, 1.183-7.010, P = 0.020) were associated with worsening neurological functions, while being Caucasian (OR = 0.294, 95% CI, 0.098-0.882, P = 0.029) was associated with improving neurologic functions. CONCLUSION Demographic and clinical risk factors among the dysplipidemic ischemic stroke population in the telestroke network were not associated with worsening neurologic functions.
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Baron R, Steenerson KK, Alyono J. Acute Vestibular Syndrome and ER Presentations of Dizziness. Otolaryngol Clin North Am 2021; 54:925-938. [PMID: 34294435 DOI: 10.1016/j.otc.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute vestibular syndrome (AVS) describes sudden onset, severe, continuous dizziness that persists for more than 24 hours. Its wide differential presents a diagnostic challenge. Vestibular neuritis is the most common cause, but stroke, trauma, medication effects, infectious, and inflammatory causes all present similarly. The TiTrATE model (Timing, Triggers, And Targeted Exam) is systematic way to evaluate these patients, and the HINTS Plus exam (Head Impulse, Nystagmus, Test of Skew, plus hearing loss) is critical in differentiating central and peripheral causes. The importance of recognizing risk factors for stroke and the role of imaging is also discussed.
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Affiliation(s)
- Richard Baron
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Kristen K Steenerson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA; Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Jennifer Alyono
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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Impact of revascularization therapies on outcome of posterior circulation ischemic stroke: The Indo-US stroke project. J Neurol Sci 2021; 427:117499. [PMID: 34029753 DOI: 10.1016/j.jns.2021.117499] [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: 11/29/2020] [Revised: 04/23/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Posterior circulation strokes (PCS) have been less extensively studied than anterior circulation strokes (ACS), especially regarding revascularization therapies. We analyzed the differences in baseline stroke characteristics, revascularization therapy and 3-month outcomes between PCS and ACS in a large prospective multicentre Indian stroke registry. METHODS Patients with acute ischemic stroke recruited in the Indo-US collaborative stroke project from January 2012 to August 2014 were classified into PCS and ACS based on imaging-confirmed infarct location. Demographics, stroke severity, risk factors, and mechanisms were compared. We further compared these parameters in the subgroups who received revascularization therapies (RT) and no revascularization therapies (NRT). The primary outcome was 3-month modified Rankin scale (mRS). RESULTS Of 1889 patients (1270 males), 1478 (78.2%) had ACS and 411 (21.8%) PCS. The median NIHSS was lower in PCS (7 vs 11, p < 0.001). Diabetes mellitus and hypertension were more common in PCS and rheumatic heart disease in ACS. Small artery occlusion was higher in PCS (23.8% vs 12.9%, p < 0.001). Only 28 (6.8%) PCS received RT compared to 213 (14.4%) ACS. At 90 days, a good functional outcome (mRS 0-2) was more common in PCS (56.4% vs 45.9%, p < 0.001) in NRT group, while no significant difference was noted in RT group. Stroke territory was not an independent predictor of 3-month outcome in regression analysis. In-hospital mortality was not different between the groups. CONCLUSIONS The 3-month functional outcome and in-hospital mortality were not different between ACS and PCS. Compared to ACS, PCS received revascularization therapies less often.
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Wiśniewski A, Filipska K, Puchowska M, Piec K, Jaskólski F, Ślusarz R. Validation of a Polish version of the National Institutes of Health Stroke Scale: Do moderate psychometric properties affect its clinical utility? PLoS One 2021; 16:e0249211. [PMID: 33798218 PMCID: PMC8018641 DOI: 10.1371/journal.pone.0249211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The National Institutes of Health Stroke Scale (NIHSS) is a validated tool for assessing the severity of stroke. It has been adapted into several languages; however, a Polish version with large-scale psychometric validation, including repeatability and separate assessments of anterior and posterior stroke, has not been developed. We aimed to adapt and validate a Polish version of the NIHSS (PL-NIHSS) while focusing on the psychometric properties and site of stroke. METHODS The study included 225 patients with ischemic stroke (102 anterior and 123 posterior circulation stroke). Four NIHSS-certified researchers estimated stroke severity using the most appropriate scales to assess the psychometric properties (including internal consistency, homogeneity, scalability, and discriminatory power of individual items) and ultimately determine the reliability, repeatability, and validity of the PL-NIHSS. RESULTS The PL-NIHSS achieved Cronbach's alpha coefficient of 0.6885, which indicates moderate internal consistency and homogeneity. Slightly more than half of the individual items provided sufficient discriminatory power (r > 0.3). A favorable coefficient of repeatability (0.6267; 95% confidence interval: 0.5737-0.6904), narrow limits of inter-rater agreement, and excellent intraclass correlation coefficients or weighted kappa values (> 0.90), demonstrated high reliability of PL-NIHSS. Highly significant correlations with other tools confirmed the validity and predictive value of the PL-NIHSS. In posterior stroke, the PL-NIHSS achieved the required Cronbach's alpha coefficient (0.71070). Additionally, stroke location did not affect other psychometric features or instrument reliability and validity. CONCLUSIONS We developed a valid and reliable tool for assessing stroke severity in Polish-speaking participants. Moderate psychometric features were emphasized without limiting its clinical applications.
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Affiliation(s)
- Adam Wiśniewski
- Department of Neurology, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Karolina Filipska
- Department of Neurological and Neurosurgical Nursing, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Marlena Puchowska
- Department of Neurology, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Katarzyna Piec
- Department of Neurology, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Filip Jaskólski
- Department of Neurology, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Ślusarz
- Department of Neurological and Neurosurgical Nursing, Laboratory for Experimental Biotechnology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Introducing Adam's Scale of Posterior Stroke (ASPOS): A Novel Validated Tool to Assess and Predict Posterior Circulation Strokes. Brain Sci 2021; 11:brainsci11040424. [PMID: 33810516 PMCID: PMC8065750 DOI: 10.3390/brainsci11040424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study was to design a validated tool, termed Adam's Scale of Posterior Stroke (ASPOS), for better assessment and prediction of posterior stroke. METHODS This prospective, observational study involved 126 posterior circulation ischemic stroke subjects. Four researchers, previously trained in ASPOS, randomized the stroke severity using a novel tool and other appropriate stroke scales (The National Institute of Health Stroke Scale-NIHSS, modified Rankin Scale-mRS, Glasgow Coma Scale, Barthel Index, or Israeli Vertebrobasilar Stroke Scale-IVBSS) to assess the psychometric properties, reliability, and validity of ASPOS and investigate its predictive value. RESULTS ASPOS reached a Cronbach's alpha coefficient of 0.7449, indicating good internal consistency. The Bland-Altman analysis showed a good coefficient of repeatability (CR) of 0.46, a 95% confidence interval (CI) of 0.41-0.53, and excellent intraclass correlation coefficients or weighted kappa values (>0.90), reflecting high reliability and reproducibility. Highly significant correlations with other scales confirmed the construct and predictive validity of ASPOS. A total ASPOS score of three points indicated a significantly increased probability of severe stroke based on the NIHSS, compared to a total ASPOS of 1-2 points (odds ratio (OR) 141; 95% CI: 6.72-2977.66; p = 0.0014). CONCLUSIONS We developed a novel, valid, and reliable tool to assess posterior circulation strokes. This can contribute to a more comprehensive estimation of posterior stroke and, additionally, due to its predictive properties, it can be used to more accurately select candidates for specific treatments.
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Acute Management Should Be Optimized in Patients with Less Specific Stroke Symptoms: Findings from a Retrospective Observational Study. J Clin Med 2021; 10:jcm10051143. [PMID: 33803204 PMCID: PMC7963148 DOI: 10.3390/jcm10051143] [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: 01/25/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase; p = 0.036, and by 24.56 ± 8.42 min; p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min; p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min; p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min; p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min; p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min; p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms.
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Validation of a Polish version of the Israeli Vertebrobasilar Stroke Scale - An attempt to more accurately assess posterior Stroke. Clin Neurol Neurosurg 2021; 202:106543. [PMID: 33571784 DOI: 10.1016/j.clineuro.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Posterior circulation stroke, in contrast to anterior circulation stroke, has a greater complexity and variability of clinical symptoms. This could be responsible for delayed diagnosis and treatment time and, as a consequence, worse prognosis. Certain blame in this respect can also be attributed to the clinimetric scales used to assess stroke severity, which are characterized by significantly lower accuracy than with anterior strokes. The Israeli Vertebrobasilar Stroke Scale (IVBSS) was the first attempt dedicated to posterior strokes and was devised for better measurement of clinical condition. We aimed to develop a Polish version of the IVBSS (PL-IVBSS) to assess the reliability, validity and psychometric properties of the tool to confirm its clinical utility. METHODS We enrolled 126 posterior circulation ischemic stroke subjects. Four researchers estimated stroke severity using appropriate and widely accepted devices (the modified Rankin Scale - mRS, the National Institutes of Health Stroke Scale - NIHSS, the Barthel Index, and the Glasgow Coma Scale - GCS) and compared with the PL-IVBSS. We analyzed inter- and intrarater agreements, repeatability, concurrent and predictive validity, internal consistency, scalability and homogeneity, reflecting the psychometric features of a validated instrument. RESULTS Cronbach's alpha coefficient was 0.67, and the median inter-item correlation coefficient was 0.22, indicating moderate internal consistency and insufficient homogeneity. A total of 63.6% of the individual items obtained required discriminatory power (r > 0.3), showing moderate scalability. The PL-IVBSS achieved a good coefficient of repeatability (CR = 1.21 95%CI 1.08-1.38) and narrow limits of agreement in Bland-Altman analysis, emphasizing the accuracy and high reproducibility. Excellent intraclass correlation coefficients and weighted kappa values (all >0.90) underlined the high reliability of the PL-IVBSS. Highly significant correlations with other relevant devices (all r > 0.5, p < 0.0001) highlighted the satisfactory concurrent and predictive validity of a validated clinimetric tool. CONCLUSION We devised a validated version of the IVBSS, indicating the high reproducibility, repeatability and accuracy of the PL-IVBSS and confirming its clinical utility. Despite moderate psychometric properties, our findings support the need for its clinical application and widespread use in stroke units for a reliable assessment of posterior stroke severity.
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21
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Noorian AR. Prehospital EMS Triage for Acute Stroke Care. Semin Neurol 2021; 41:5-8. [PMID: 33506476 DOI: 10.1055/s-0040-1722725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute stroke has had major advances over the last two decades due to the introduction of pharmacologic and endovascular revascularization, which can improve functional outcome. Stroke systems of care have been developed to provide faster, more efficient care for stroke patients. A major part of these care pathways is prehospital care, when patients are triaged to appropriate levels of care. It is essential that prehospital scales are used accurately and effectively by emergency medical services to assist them with the triage process. New technologies including mobile stroke units, telemedicine, and wearable technology have been introduced as options for optimization of this emergent process.
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Affiliation(s)
- Ali Reza Noorian
- Department of Neurology, Kaiser Permanente Orange County, Irvine, California
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22
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Nazir T, Sharief M, Farthing J, Ahmed IM. Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation. BMJ Case Rep 2020; 13:13/8/e234661. [PMID: 32843400 DOI: 10.1136/bcr-2020-234661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.
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Affiliation(s)
- Tahir Nazir
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Mohiuddin Sharief
- Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - James Farthing
- Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Irfan M Ahmed
- Department of Cardiology, Royal Preston Hospital, Preston, UK
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23
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Meyer L, Papanagiotou P, Politi M, Kastrup A, Kraemer C, Hanning U, Kniep H, Broocks G, Pilgram-Pastor SM, Wallocha M, Chapot R, Fiehler J, Stracke CP, Leischner H. Feasibility and safety of thrombectomy for isolated occlusions of the posterior cerebral artery: a multicenter experience and systematic literature review. J Neurointerv Surg 2020; 13:217-220. [PMID: 32527938 DOI: 10.1136/neurintsurg-2020-016059] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Substantial clinical evidence supporting the benefit of mechanical thrombectomy (MT) for distal occlusions within the posterior circulation is still missing. This study aims to investigate the procedural feasibility and safety of MT for isolated occlusions of the posterior cerebral artery. METHODS We retrospectively reviewed patients from three stroke centers with acute ischemic stroke attributed to isolated posterior cerebral artery occlusion (IPCAOs) who underwent MT between January 2014 and December 2019. Procedural and safety assessment included successful recanalization rates (defined as Thrombolysis in Cerebral Infarction Scale (TICI) ≥2b), number of MT attempts and first-pass effect (TICI 3), intracranial hemorrhage (ICH), mortality, and intervention-related serious adverse events. Treatment effects were evaluated by the rate of early neurological improvement (ENI) and early functional outcome was assessed with the modified Rankin Scale (mRS) at discharge. A systematic literature review was conducted to identify and summarize previous reports on MT for IPCAOs. RESULTS Forty-three patients with IPCAOs located in the P1 (55.8%, 24/43), P2 (37.2%, 16/43), and P3 segment (7%, 3/43) were analyzed. The overall rate of successful recanalization (TICI ≥2b) was 86% (37/43), including a first pass-effect of 48.8% (21/43) leading to TICI 3. sICH occurred in 7% (3/43) and there were two cases with iatrogenic vessel dissection and one perforation. ENI was observed in 59% (23/39) and excellent functional outcome (mRS ≤1) in 46.2% (18/39) of patients who were discharged. The in-hospital mortality rate was 9.3% (4/43). CONCLUSION Our study suggests the technical feasibility and safety of thrombectomy for IPCAOs. Further studies are needed to investigate safety and long-term functional outcomes with posterior circulation stroke-adjusted outcome assessment.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany.,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | | | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Marta Wallocha
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Poupore N, Strat D, Mackey T, Brown K, Snell A, Nathaniel TI. Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients. Lipids Health Dis 2020; 19:84. [PMID: 32375780 PMCID: PMC7201805 DOI: 10.1186/s12944-020-01270-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated. METHODS Retrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Improving (NIHSS score ≤ 7) or worsening (NIHSS score > 7) of neurologic functions were the determined measures of treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or improving neurologic functions. RESULTS Adjusted multivariate analysis showed that in an AIS population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. CONCLUSION A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions. While combining statin with rtPA treatment may facilitate worsening neurologic functions in elderly AIS patients with atrial fibrillation, they should not be denied of this therapy. The decision to combine statin and rtPA for AIS patients with atrial fibrillation can be done after clinical stabilization following appropriate clinical management.
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Affiliation(s)
- Nicolas Poupore
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Dan Strat
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Tristan Mackey
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Katherine Brown
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Ashley Snell
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA.
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25
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Chiu AH, Hince DA, McAuliffe W. Glasgow Coma Scale on Presentation Predicts Outcome in Endovascular Treatment for Acute Posterior Large-Vessel Occlusion. AJNR Am J Neuroradiol 2020; 41:645-649. [PMID: 32217549 DOI: 10.3174/ajnr.a6497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/19/2020] [Indexed: 11/07/2022]
Abstract
Use of mechanical thrombectomy for stroke has increased since the publication of trials describing outcome improvement when used in the anterior circulation. These results, however, cannot be directly translated to the posterior circulation. While a high NIHSS score has demonstrated an association with poor outcomes in posterior stroke, the NIHSS is weighted toward hemispheric disease, and complex scores potentially delay definitive imaging diagnosis. We performed a retrospective analysis to ascertain whether any rapidly obtainable demographic or clinical and imaging data have a correlation with patient outcome postthrombectomy. Seventy-three cases were audited between September 2010 and October 2017. Presenting with a Glasgow Coma Scale score of >13 meant that the odds of reaching the primary end point of functional independence (defined as a 90-day modified Rankin Scale score of 0-2) were 5.70 times greater; similarly, presenting with a posterior circulation ASPECTS of >9 resulted in the odds of reaching the primary end point being 4.03 times greater. Older age correlated to a lower odds of independence (0.97, p = .04).
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Affiliation(s)
- A H Chiu
- From the Neurological Intervention and Imaging Service of Western Australia (A.H.C., W.M.), Western Australia Health, Sir Charles Gairdner, Royal Perth, and Fiona Stanley Hospitals, Perth, Australia .,Medical School, Division of Medicine (A.H.C., W.M.), University of Western Australia, Perth, Australia
| | - D A Hince
- Institute for Health Research (D.A.H.), University of Notre Dame, Fremantle, Australia
| | - W McAuliffe
- From the Neurological Intervention and Imaging Service of Western Australia (A.H.C., W.M.), Western Australia Health, Sir Charles Gairdner, Royal Perth, and Fiona Stanley Hospitals, Perth, Australia.,Medical School, Division of Medicine (A.H.C., W.M.), University of Western Australia, Perth, Australia
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26
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Sun Y, Su Y, Chen Z, He Y, Zhang Y, Chen H. Contrast Extravasation After Endovascular Treatment in Posterior Circulation Stroke. World Neurosurg 2019; 130:e583-e587. [PMID: 31254696 DOI: 10.1016/j.wneu.2019.06.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Endovascular treatment (EVT) is a promising clinical technology. However, some patients with posterior circulation stroke might not experience neurological function recovery after EVT. We reviewed the recent experience with EVT to clarify the clinical and radiographic factors that contribute to optimal neurological outcomes. METHODS We analyzed the data from 108 consecutive patients with acute posterior circulation stroke who had undergone EVT from January 2016 to December 2018. A favorable outcome was defined as a modified Rankin scale score of 0-3 at 3 months. We evaluated the association and predictive value of the clinical and radiographic factors that contribute to good neurological outcomes. RESULTS Of the 108 included patients, 43 had a favorable clinical outcome at day 90. Univariate analysis revealed a significant association between the 90-day favorable outcome and the baseline values of systolic blood pressure, time of stroke onset, contrast extravasation, symptomatic intracranial hemorrhage, general anesthesia, Alberta stroke program early computed tomography score for the posterior circulation, and the National Institutes of Health stroke scale (NIHSS) score. Contrast extravasation (odds ratio [OR], 5.094; 95% confidence interval [CI], 1.22-21.261), symptomatic intracranial hemorrhage (OR, 11.24; 95% CI, 1.309-96.517), general anesthesia (OR, 5.094; 95% CI, 1.22-21.26), and baseline NIHSS score (OR, 1.087; 95% CI, 1.023-1.309) were found to be independent predictors of a favorable outcome at day 90. Contrast extravasation alone predicted for unfavorable clinical outcomes and mortality with high specificity. CONCLUSION In the present retrospective case series, contrast extravasation, symptomatic intracranial hemorrhage, the use of general anesthesia, and baseline NIHSS score were related to a favorable prognosis for patients with posterior circulation stroke after EVT. Contrast extravasation was an independent and strong predictor of unfavorable clinical outcomes.
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Affiliation(s)
- Yijia Sun
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
| | - Zhongyun Chen
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yanbo He
- Department of Neurology, Beijing Moslem People Hospital, Beijing, China
| | - Yingbo Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Affiliated With Tsinghua University, Beijing, China
| | - Hongbo Chen
- Department of Neurology, Liangxiang Hospital of Beijing, Beijing, China
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