scholarly journals Clinical Outcomes and Identification of Patients With Persistent Penumbral Profiles Beyond 24 Hours From Last Known Well

Stroke ◽  
2021 ◽  
Vol 52 (3) ◽  
pp. 838-849 ◽  
Author(s):  
Amrou Sarraj ◽  
Michael Mlynash ◽  
Jeremy Heit ◽  
Deep Pujara ◽  
Maarten Lansberg ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Functional Independence ◽  
Residue Function ◽  
National Institutes Of Health ◽  
Lesion Volume ◽  
Imaging Evaluation ◽  
Clinical Imaging

Background and Purpose: DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) infarct volumes at 24 hours did not significantly differ in the endovascular thrombectomy (EVT) versus medical management (MM) only groups. We hypothesized that this was due to underestimation of the final infarct volume among patients with persistent penumbral tissue 24 hours after randomization that subsequently progressed to infarction. We sought to assess the clinical outcomes in patients with persistent penumbral profile >24 hours from last known well and identify them based on the Persistent Penumbra Index (PPI, time-to-maximum of the residue function >6 s perfusion lesion divided by diffusion-weighted magnetic resonance imaging lesion volume on 24-hour postrandomization imaging). Methods: Patients were stratified into those with a 24-hour postrandomization penumbral (PPI>1) versus a nonpenumbral (PPI≤1) profile. The primary outcome was 90-day–modified Rankin Scale. Results: One hundred eighty-two patients were randomized (EVT: 92, MM: 90). Twenty-four–hour postrandomization time-to-maximum of the residue function and infarct volumes were assessable for 144 (EVT: 75, MM: 69). Infarct volumes did not differ between EVT and MM (median [interquartile range] mL: 35.0 [17.6–81.6] versus 41.0 [25.4–106.2], P =0.185). Thirty-two patients had persistent penumbral profile (PPI>1), of these 29 (91%) received MM. PPI was 0 (0–0.07) for EVT, and 0.77 (0.23–1.79) for MM, P <0.001. Patients with clinical-imaging mismatch (more severe strokes and smaller infarct volumes) were more likely to have persistent penumbral profile (PPI>1; adjusted odds ratio, 1.20 [1.11–1.30] for every 1-point National Institutes of Health Stroke Scale-increment and adjusted odds ratio, 0.977 [0.964–0.990] for every 10 cc smaller infarct volume, P <0.001). Patients with nonpenumbral profile (PPI≤1) had higher odds of achieving functional independence (39% versus 9%; adjusted odds ratio, 9.9[95% CI, 2.3–42.8], P =0.002), a trend towards lower mortality (12% versus 34%, P =0.002; adjusted odds ratio, 0.34 [95% CI, 0.11–1.03], P =0.057) and early clinical improvement (24-hour National Institutes of Health Stroke Scale—decrease ≥8 points or 0–1): 29% vs 9%, P =0.034) which persisted at discharge and 90-day follow-up. For a given volume, patients with PPI≤1 had significantly higher likelihood of functional independence as compared to those with PPI>1. Conclusions: Patients with persistent penumbral profile who have salvageable tissue beyond 24 hours from last known well can be identified by PPI and clinical-imaging mismatch. They have a poor prognosis and may benefit from very late window reperfusion therapies. Clinical trials in these patients are warranted. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.

scholarly journals Ischemic Core Overestimation on Computed Tomography Perfusion

Stroke ◽  
2021 ◽  
Author(s):  
Álvaro García-Tornel ◽  
Daniel Campos ◽  
Marta Rubiera ◽  
Sandra Boned ◽  
Marta Olivé-Gadea ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Intensity Ratio ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Residue Function ◽  
Interquartile Range ◽  
Large Vessel ◽  
Imaging Time ◽  
Ischemic Core ◽  
Large Vessel Stroke

Background and Purpose: Different studies have pointed that CT perfusion (CTP) could overestimate ischemic core in early time window. We aim to evaluate the influence of time and collateral status on ischemic core overestimation. Methods: Retrospective single-center study including patients with anterior circulation large-vessel stroke that achieved reperfusion after endovascular treatment. Ischemic core and collateral status were automatically estimated on baseline CTP using commercially available software. CTP-derived core was considered as tissue with a relative reduction of cerebral blood flow <30%, as compared with contralateral hemisphere. Collateral status was assessed using the hypoperfusion intensity ratio (defined by the proportion of the time to maximum of tissue residue function >6 seconds with time to maximum of tissue residue function >10 seconds). Final infarct volume was measured on 24 to 48 hours noncontrast CT. Ischemic core overestimation was considered when CTP-derived core was larger than final infarct. Results: Four hundred and seven patients were included in the analysis. Median CTP-derived core and final infarct volume were 7 mL (interquartile range, 0–27) and 20 mL (interquartile range, 5–55), respectively. Median hypoperfusion intensity ratio was 0.46 (interquartile range, 0.23–0.59). Eighty-three patients (20%) presented ischemic core overestimation (median overestimation, 12 mL [interquartile range, 41–5]). Multivariable logistic regression analysis adjusted by CTP-derived core and confounding variables showed that poor collateral status (per 0.1 hypoperfusion intensity ratio increase; adjusted odds ratio, 1.41 [95% CI, 1.20–1.65]) and earlier onset to imaging time (per 60 minutes earlier; adjusted odds ratio, 1.14 [CI, 1.04–1.25]) were independently associated with core overestimation. No significant association was found with imaging to reperfusion time (per 30 minutes earlier; adjusted odds ratio, 1.17 [CI, 0.96–1.44]). Poor collateral status influence on core overestimation differed according to onset to imaging time, with a stronger size of effect on early imaging patients( P interaction <0.01). Conclusions: In patients with large-vessel stroke that achieve reperfusion after endovascular therapy, poor collateral status might induce higher rates of ischemic core overestimation on CTP, especially in patients in earlier window time. CTP reflects a hemodynamic state rather than tissue fate; collateral status and onset to imaging time are important factors to consider when estimating core on CTP.

scholarly journals Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits

Stroke ◽  
2021 ◽  
Author(s):  
Tomas Dobrocky ◽  
Eike I. Piechowiak ◽  
Bastian Volbers ◽  
Nedelina Slavova ◽  
Johannes Kaesmacher ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Scale Score ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
National Institutes Of Health ◽  
Neurological Deficits ◽  
Minor Stroke ◽  
Modified Rankin Scale ◽  
Stroke Patients

Background and Purpose: Treatment in stroke patients with M2 segment occlusion of the middle cerebral artery presenting with mild neurological deficits is a matter of debate. The main purpose was to compare the outcome in patients with a minor stroke and a M2 occlusion. Methods: Consecutive intravenous thrombolysis (IVT) eligible patients admitted to the Bernese stroke center between January 2005 and January 2020 with acute occlusion of the M2 segment and National Institutes of Health Stroke Scale score ≤5 were included. Outcome was compared between IVT only versus endovascular therapy (EVT) including intra-arterial thrombolysis and mechanical thrombectomy (MT; ±IVT) and between IVT only versus MT only. Results: Among 169 patients (38.5% women, median age 70.2 years), 84 (49.7%) received IVT only and 85 (50.3%) EVT (±IVT), the latter including 39 (45.9%) treated with MT only. Groups were similar in sex, age, vascular risk factors, event cause, or preevent independency. Compared with IVT only, there was no difference in favorable outcome (modified Rankin Scale score, 0−2) for EVT (adjusted odds ratio, 0.96; adjusted P =0.935) or for MT only (adjusted odds ratio, 1.12; adjusted P =0.547) groups. Considering only patients treated after 2015, there was a significantly better 3-month modified Rankin Scale shift (adjusted P =0.032) in the EVT compared with the IVT only group. Conclusions: Our study demonstrates similar effectiveness of IVT only versus EVT (±IVT), and of IVT only versus MT only in patients with peripheral middle cerebral artery occlusions and minor neurological deficits and indicates a possible benefit of EVT considering only patients treated after 2015. There is an unmet need for randomized controlled trials in this stroke field, including imaging parameters, and more sophisticated evaluation of National Institutes of Health Stroke Scale score subitems, neurocognition, and quality of life neglected by the standard outcome scales such as modified Rankin Scale and National Institutes of Health Stroke Scale score.

scholarly journals Early Thrombectomy Protects the Internal Capsule in Patients With Proximal Middle Cerebral Artery Occlusion

Stroke ◽  
2021 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Mirjam Kaesmacher ◽  
Maria Berndt ◽  
Christian Maegerlein ◽  
Sebastian Mönch ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Internal Capsule ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Proximal Middle Cerebral Artery ◽  
Lenticulostriate Artery

Background and Purpose: Proximal middle cerebral artery (MCA) occlusions impede blood flow to the noncollateralized lenticulostriate artery territory. Previous work has shown that this almost inevitably leads to infarction of the dependent gray matter territories in the striate even if perfusion is restored by mechanical thrombectomy. Purpose of this analysis was to evaluate potential sparing of neighboring fiber tracts, ie, the internal capsule. Methods: An observational single-center study of patients with proximal MCA occlusions treated with mechanical thrombectomy and receiving postinterventional high-resolution diffusion-weighted imaging was conducted. Patients were classified according to internal capsule ischemia (IC+ versus IC−) at the postero-superior level of the MCA lenticulostriate artery territory (corticospinal tract correlate). Associations of IC+ versus IC− with baseline variables as well as its clinical impact were evaluated using multivariable logistic or linear regression analyses adjusting for potential confounders. Results: Of 92 included patients with proximal MCA territory infarctions, 45 (48.9%) had an IC+ pattern. Longer time from symptom-onset to groin-puncture (adjusted odds ratio, 2.12 [95% CI, 1.19–3.76] per hour), female sex and more severe strokes were associated with IC+. Patients with IC+ had lower rates of substantial neurological improvement and functional independence (adjusted odds ratio, 0.26 [95% CI, 0.09–0.81] and adjusted odds ratio, 0.25 [95% CI, 0.07–0.86]) after adjustment for confounders. These associations remained unchanged when confining analyses to patients without ischemia in the corona radiata or the motor cortex and here, IC+ was associated with higher National Institutes of Health Stroke Scale motor item scores (β, +2.8 [95% CI, 1.5 to 4.1]) without a significant increase in nonmotor items (β, +0.8 [95% CI, −0.2 to 1.9). Conclusions: Rapid mechanical thrombectomy with successful reperfusion of the lenticulostriate arteries often protects the internal capsule from subsequent ischemia despite early basal ganglia damage. Salvage of this eloquent white matter tract within the MCA lenticulostriate artery territory seems strongly time-dependent, which has clinical and pathophysiological implications.

scholarly journals Noncontrast Computed Tomography e-Stroke Infarct Volume Is Similar to RAPID Computed Tomography Perfusion in Estimating Postreperfusion Infarct Volumes

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 634-641 ◽  
Author(s):  
Mehdi Bouslama ◽  
Krishnan Ravindran ◽  
George Harston ◽  
Gabriel M. Rodrigues ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Noncontrast Computed Tomography ◽  
Core Volume

Background and Purpose: The e-Stroke Suite software (Brainomix, Oxford, United Kingdom) is a tool designed for the automated quantification of The Alberta Stroke Program Early CT Score and ischemic core volumes on noncontrast computed tomography (NCCT). We sought to compare the prediction of postreperfusion infarct volumes and the clinical outcomes across NCCT e-Stroke software versus RAPID (IschemaView, Menlo Park, CA) computed tomography perfusion measurements. Methods: All consecutive patients with anterior circulation large vessel occlusion stroke presenting at a tertiary care center between September 2010 and November 2018 who had available baseline infarct volumes on both NCCT e-Stroke Suite software and RAPID CTP as well as final infarct volume (FIV) measurements and achieved complete reperfusion (modified Thrombolysis in Cerebral Infarction scale 2c-3) post-thrombectomy were included. The associations between estimated baseline ischemic core volumes and FIV as well as 90-day functional outcomes were assessed. Results: Four hundred seventy-nine patients met inclusion criteria. Median age was 64 years (55–75), median e-Stroke and computed tomography perfusion ischemic core volumes were 38.4 (21.8–58) and 5 (0–17.7) mL, respectively, whereas median FIV was 22.2 (9.1–56.2) mL. The correlation between e-Stroke and CTP ischemic core volumes was moderate (R=0.44; P <0.001). Similarly, moderate correlations were observed between e-Stroke software ischemic core and FIV (R=0.52; P <0.001) and CTP core and FIV (R=0.43; P <0.001). Subgroup analysis showed that e-Stroke software and CTP performance was similar in the early and late (>6 hours) treatment windows. Multivariate analysis showed that both e-Stroke software NCCT baseline ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) and RAPID CTP ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) were independently and comparably associated with good outcome (modified Rankin Scale score of 0–2) at 90 days. Conclusions: NCCT e-Stroke Suite software performed similarly to RAPID CTP in assessing postreperfusion FIV and functional outcomes for both early- and late-presenting patients. NCCT e-Stroke volumes seems to represent a viable alternative in centers where access to advanced imaging is limited. Moreover, the future development of fusion maps of NCCT and CTP ischemic core estimates may improve upon the current performance of these tools as applied in isolation.

scholarly journals Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3205-3214
Author(s):  
Sophie A. van den Berg ◽  
Simone M. Uniken Venema ◽  
Maxim J.H.L. Mulder ◽  
Kilian M. Treurniet ◽  
Noor Samuels ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Lower Probability ◽  
Modified Rankin Scale ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. Methods: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. Results: We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04–1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03–1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94–0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99–1.13]). Results for DBP were largely similar. Conclusions: In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.

Abstract 6: Identifying Late Progressing Patients With Persistent Penumbra in DEFUSE 3 With the 24-Hour Tmax/DWI Ratio

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
Maarten Lansberg ◽  
Michael P Marks ◽  
Michael Mlynash ◽  
Jeremy J Heit ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Medical Management ◽  
Poor Prognosis ◽  
Primary Outcome ◽  
Infarct Volume ◽  
Mortality Rates ◽  
Functional Independence ◽  
Therapeutic Interventions ◽  
Lesion Volume ◽  
Large Improvement

Background: DEFUSE 3 infarct volumes at 24 hours did not significantly differ in the EVT vs. medical management only (MM) groups. We hypothesized that this lack of difference was due underestimation of the final infarct volume among patients who had persistent penumbral tissue 24 hrs after randomization that subsequently progressed to infarction. Furthermore, these patients could be identified based on a persistent Tmax>6s perfusion lesion that was larger than the 24 hr DWI lesion volume (Tmax/DWI >1). Methods: Patients were stratified into those with 24 hr post-randomization Tmax/DWI < 1 vs ≥ 1. The primary outcome was 90-day mRS. We correlated and compared the 24 hr Tmax/DWI ratio to other reperfusion parameters (mTICI ≥ 2b, 24hrs >90% reduction in Tmax and/or recanalization on CTA/MRA). Results: 182 patients, 92 were randomized to EVT, 90 to MM. 24 hr post-randomization Tmax and DWI volume were assessable for 75 EVT and 69 MM. DWI volumes did not differ between EVT and MM median (IQR) ml 35.0 (17.6-81.6) vs 41.0(25.4-106.2), P=0.185. The Tmax/DWI 24 hrs ratio was 0 (0-0.07) for EVT and 0.77(0.23-1.79) for MM, p<0.001. Patients with Tmax/DWI < 1 had a higher odds of achieving functional independence (39% vs. 9%, aOR=9.9 (95%CI=2.3-42.8, p=0.002), a trend towards lower mortality rates (12% vs 34%, p=0.002; aOR=0.34 (95% CI 0.11-1.03), p=0.057 (Fig 1) and early large improvement (24 hrs NIHSS decrease ≥ 8 points or 0-1): 29% vs. 9%, p=0.034. Patients were more likely to have a ratio < 1 following mTICI ≥ 2b reperfusion (96% vs. 62%) or >90% reduction in Tmax (100% vs. 56%), p<0.001. As compared with other reperfusion parameters, the Tmax/DWI ratio had a comparable correlation with 90 days functional independence adjusted AUC: Tmax/DWI ratio=0.85; mTICI=0.86 vs 90%; Tmax reduction=0.88). Conclusion: The Tmax/DWI ratio 24-hours after EVT vs medical therapy identifies patients with persistent penumbra who have a poor prognosis and may benefit from additional therapeutic interventions.

Abstract 333: Hypothyroidism As a Predictor of Worse Clinical Outcomes After Percutaneous Coronary Interventions: 1 Year Follow Up Study

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Maninder Singh ◽  
Abhishek Mishra ◽  
Mayanka Kamboj ◽  
Sweta Chaudhary ◽  
Edo Kaluski ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Thyroid Function ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Thyroid Function Tests ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Hypothyroid Patients

Background: Although hypothyroidism (HT) is known to be associated with worse cardiovascular outcomes, little data exists on its influence on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI). Methods: In this prospective observational registry at a single center, we studied 1317 patients who underwent successful PCI (without complications) from ‘01-'12 and had thyroid function tests performed within 1 year prior to PCI. We excluded patients with cardiogenic shock at index PCI. We compared 1-year mortality and major adverse cardioascular events (MACE) between HT (both subclinical and overt hypothyroid patients, defined as TSH ≥5.5, n=78) and Euthyroid (ET) (TSH <5.5, n=1239) groups. Results: Both the groups were similar in baseline clinical and angiographic characteristics except for higher prevalence of prior myocardial infarction (MI) and thyroid supplement use in HT group (table 1). At 1-year, HT was associated with higher all cause mortality as compared to ET group (14%[11/78] Vs 6.7%[83/1239], p=0.014) and remained an independent predictor of mortality in the multivariate analysis (adjusted odds ratio=2.6, 95% CI: 1.2-5.3, p=0.011). There was a trend towards higher MACE in the HT vs ET group, although this was not statistically significant. (21% [16/78] Vs 16% [203/1239]respectively, p=0.342, adjusted odds ratio=1.3, 95%CI: 0.7-2.3, p=0.455) Individual 1-yr outcomes are shown in Figure 1. Conclusion: Although there was no difference in MACE, HT was associated with higher all cause mortality after PCI. We suggest monitoring of thyroid function for patients who undergo PCI. Treatment may improve survival in hypothyroid patients post PCI, however further outcome studies are needed.

Rescue of Neglect and Language Impairment After Stroke Thrombectomy

Stroke ◽  
2021 ◽  
Author(s):  
Shashvat M. Desai ◽  
Konark Malhotra ◽  
Guru Ramaiah ◽  
Daniel A. Tonetti ◽  
Waqas Haq ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Language Impairment ◽  
Functional Independence ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Lower Mortality ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
The Impact

BACKGROUND AND PURPOSE: Although National Institutes of Health Stroke Scale scores provide an objective measure of clinical deficits, data regarding the impact of neglect or language impairment on outcomes after mechanical thrombectomy (MT) is lacking. We assessed the frequency of neglect and language impairment, rate of their rescue by MT, and impact of rescue on clinical outcomes. Methods: This is a retrospective analysis of a prospectively collected database from a comprehensive stroke center. We assessed right (RHS) and left hemispheric strokes (LHS) patients with anterior circulation large vessel occlusion undergoing MT to assess the impact of neglect and language impairment on clinical outcomes, respectively. Safety and efficacy outcomes were compared between patients with and without rescue of neglect or language impairment. Results: Among 324 RHS and 210 LHS patients, 71% of patients presented with neglect whereas 93% of patients had language impairment, respectively. Mean age was 71±15, 56% were females, and median National Institutes of Health Stroke Scale score was 16 (12–20). At 24 hours, MT resulted in rescue of neglect in 31% of RHS and rescue of language impairment in 23% of LHS patients, respectively. RHS patients with rescue of neglect (56% versus 34%, P <0.001) and LHS patients with rescue of language impairment (64 % versus 25%, P <0.01) were observed to have a higher rate of functional independence compared to patients without rescue. After adjusting for confounders including 24-hour National Institutes of Health Stroke Scale, rescue of neglect among RHS patients was associated with functional independence ( P =0.01) and lower mortality ( P =0.01). Similarly, rescue of language impairment among LHS patients was associated with functional independence ( P =0.02) and lower mortality ( P =0.001). ConclusionS: Majority of LHS-anterior circulation large vessel occlusion and of RHS-anterior circulation large vessel occlusion patients present with the impairment of language and neglect, respectively. In comparison to 24-hour National Institutes of Health Stroke Scale, rescue of these deficits by MT is an independent and a better predictor of functional independence and lower mortality.

Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis

Neurology ◽  
2019 ◽  
Vol 93 (3) ◽  
pp. e283-e292 ◽  
Author(s):  
Chushuang Chen ◽  
Mark W. Parsons ◽  
Christopher R. Levi ◽  
Neil J. Spratt ◽  
Ferdinand Miteff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Clinical Severity ◽  
Lesion Volume ◽  
Lower Odds ◽  
Excellent Outcome ◽  
Ischemic Core ◽  
Core Volume ◽  
Excellent Clinical Outcome

ObjectiveTo assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO).MethodsEVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes.ResultsFrom INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0–1 odds ratio 0.01, p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals (p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0–1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008).ConclusionFrom this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.

scholarly journals Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Aaron J Tande ◽  
Elie F Berbari ◽  
Priya Ramar ◽  
Shiva P Ponamgi ◽  
Umesh Sharma ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Infectious Diseases ◽  
Health System ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Consultative Service ◽  
Control Study

Abstract We performed a case–control study to evaluate an electronic, asynchronous infectious diseases consultative service at 2 rural hospitals within our health system. Patients with consultation via this platform (n = 100) had a significantly decreased odds of death at 30 days compared with propensity-matched controls (n = 300; adjusted odds ratio, 0.3; 95% confidence interval, 0.2–0.7; P = .003).

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