scholarly journals Bolus-Infusion Delays of Alteplase during Thrombolysis in Acute Ischaemic Stroke and Functional Outcome at 3 Months

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Acheampong ◽  
Margaret T. May ◽  
Gary A. Ford ◽  
Anand K. Dixit
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Medical Records ◽  
Functional Independence ◽  
Time Dependent ◽  
Single Centre ◽  
Bolus Infusion ◽  
Baseline Characteristics ◽  
The Impact ◽  
The Relationship

Background. The efficacy of alteplase in acute ischaemic stroke (AIS) is highly time dependent. Hence, alteplase is administered as soon as possible with a bolus followed by an infusion. Delays between bolus and infusion may occur, but the extent of these delays and the impact on outcome are unclear.Aims. We investigated the extent of bolus-infusion delays and the relationship between delays and stroke outcome.Method. We reviewed medical records of 276 patients who received alteplase for AIS at our centre between April, 2008, and June, 2013. Complete demographic and clinical data including 3-month modified Rankin Score (mRS) from 229 patients were analysed comparing delays of 0–8 and >8 minutes.Results. Overall mean (SD) bolus-infusion delay was 9 (7) minutes. Baseline characteristics were similar apart from more severe strokes in delays >8 minutes. Three-month outcomes were not significantly different although delays >8 minutes had lower functional independence rate (mRS 0-1: 23.1% versus 28.1%; adjusted OR 1.2 (95% CI 0.6 to 2.4,P=0.68)) and higher mortality rate (18% versus 11%, OR 1.0, 95% CI 0.6 to 1.7,P=0.95).Conclusions. In this single centre series, bolus-infusion delays of alteplase in AIS were common and no effect of bolus-infusion delays on independence and mortality was found.

Early reperfusion and clinical outcomes in patients with M2 occlusion: pooled analysis of the PROACT II, IMS, and IMS II studies

2014 ◽  
Vol 121 (6) ◽  
pp. 1354-1358 ◽  
Author(s):  
Ralph Rahme ◽  
Sharon D. Yeatts ◽  
Todd A. Abruzzo ◽  
Lincoln Jimenez ◽  
Liqiong Fan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Functional Independence ◽  
Pooled Analysis ◽  
Modified Rankin Scale ◽  
Early Reperfusion ◽  
Glucose Levels ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
The Impact

Object The role of endovascular therapy in patients with acute ischemic stroke and a solitary M2 occlusion remains unclear. Through a pooled analysis of 3 interventional stroke trials, the authors sought to analyze the impact of successful early reperfusion of M2 occlusions on patient outcome. Methods Patients with a solitary M2 occlusion were identified from the Prolyse in Acute Cerebral Thromboembolism (PROACT) II, Interventional Management of Stroke (IMS), and IMS II trial databases and were divided into 2 groups: successful reperfusion (thrombolysis in cerebral infarction [TICI] 2–3) at 2 hours and failed reperfusion (TICI 0–1) at 2 hours. Baseline characteristics and clinical outcomes were compared. Results Sixty-three patients, 40 from PROACT II and 23 from IMS and IMS II, were identified. Successful early angiographic reperfusion (TICI 2–3) was observed in 31 patients (49.2%). No statistically significant difference in the rates of intracerebral hemorrhage (60.9% vs 47.6%, p = 0.55) or mortality (19.4% vs 15.6%, p = 0.75) was observed. However, there was a trend toward higher incidence of symptomatic hemorrhage in the TICI 2–3 group (17.4% vs 0%, p = 0.11). There was also a trend toward higher baseline glucose levels in this group (151.5 mg/dl vs 129.6 mg/ dl, p = 0.09). Despite these differences, the rate of functional independence (modified Rankin Scale Score 0–2) at 3 months was similar (TICI 2–3, 58.1% vs TICI 0–1, 53.1%; p = 0.80). Conclusions A positive correlation between successful early reperfusion and clinical outcome could not be demonstrated for patients with M2 occlusion. Irrespective of reperfusion status, such patients have better outcomes than those with more proximal occlusions, with more than 50% achieving functional independence at 3 months.

Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single-centre experience from Turkey

2014 ◽  
Vol 10 (7) ◽  
pp. 876-883 ◽  
Author(s):  
Omer Goktekin ◽  
Abdurrahman Tasal ◽  
Huseyin Uyarel ◽  
Mehmet Akif Vatankulu ◽  
Osman Sonmez ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Single Centre ◽  
Single Centre Experience

scholarly journals Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027561 ◽  
Author(s):  
Russell Chabanne ◽  
Charlotte Fernandez-Canal ◽  
Vincent Degos ◽  
Anne-Claire Lukaszewicz ◽  
Lionel Velly ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
General Anaesthesia ◽  
Endovascular Therapy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Acute Pulmonary Oedema ◽  
Anterior Circulation ◽  
Randomised Controlled

IntroductionEndovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.Methods and analysisAnesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.Ethics and disseminationThe AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.Trial registration numberNCT03229148.

scholarly journals Impact of interhospital transfer on patients undergoing endovascular thrombectomy for acute ischaemic stroke in an Australian setting

2020 ◽  
Vol 2 (1) ◽  
pp. e000030 ◽  
Author(s):  
Leon Stephen Edwards ◽  
Christopher Blair ◽  
Dennis Cordato ◽  
Alan McDougall ◽  
Nathan Manning ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Onset ◽  
Endovascular Thrombectomy ◽  
Interhospital Transfer ◽  
Significant Difference ◽  
The Impact

ObjectiveTo assess the impact of interhospital transfer on the interplay between functional outcome, mortality, reperfusion rates and workflow time metrics in patients undergoing endovascular thrombectomy (EVT) for acute ischaemic stroke due to large vessel occlusion (LVO) in the anterior cerebral circulation.Design, setting and participantsThis is an analysis of a prospective database of consecutive patients undergoing EVT for LVO presenting between January 2017 and December 2018 at a single Australian comprehensive stroke centre (CSC). Patients presented directly or were transferred to the CSC from 21 sites across New South Wales and the Australian Capital Territory.Main outcome measuresThe main outcome measures were rate of good 90-day functional outcome (modified Rankin Scale 0–2), successful reperfusion (Thrombolysis in Cerebral Infarction scale grade 2b or 3), symptomatic intracerebral haemorrhage (sICH) and 90-day mortality. Key workflow time metric milestones were examined.Results154 of 213 (72%) patients were interhospital transfers. There was no significant difference in baseline characteristics including age, National Institutes of Health Stroke Scale score, intravenous thrombolysis administration or procedure time between transferred and direct presenters (all p>0.05). Transferred patients had worse 90-day functional outcome (39.6% vs 61.0%, OR 0.42, 95% CI 0.23 to 0.78), higher mortality (25.3% vs 6.8%, OR 4.66, CI 1.59 to 13.70) and longer stroke onset to treatment (groin puncture) time (298 min vs 205 min, p<0.01). Successful reperfusion rates and sICH were similar between the cohorts (96.8% vs 98.3%, and 7.8% vs 3.4%).ConclusionInterhospital transfer is associated with longer stroke onset to treatment, worse 90-day functional outcome and higher mortality compared with patients presenting directly to the CSC.

scholarly journals The relationship of neuropsychological functioning to adaptation outcome in adolescents with spina bifida

2008 ◽  
Vol 14 (5) ◽  
pp. 793-804 ◽  
Author(s):  
AMY K. HEFFELFINGER ◽  
JENNIFER I. KOOP ◽  
PHILIP S. FASTENAU ◽  
TIMOTHY J. BREI ◽  
LISA CONANT ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Executive Functioning ◽  
Protective Factors ◽  
Protective Factor ◽  
Ecological Model ◽  
Neuropsychological Functioning ◽  
Executive Dysfunction ◽  
Functional Independence ◽  
The Impact ◽  
The Relationship

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12–21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence. (JINS, 2008, 14, 793–804.)

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