Procedural Complications During Early Versus Late Endovascular Treatment in Acute Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Errikos Maslias ◽  
Stefania Nannoni ◽  
Federico Ricciardi ◽  
Bruno Bartolini ◽  
Davide Strambo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Time Window ◽  
National Institutes Of Health ◽  
Late Time ◽  
Short Term ◽  
Term Outcome ◽  
Stroke Registry ◽  
Short Term Outcome ◽  
Procedural Complications

Background and Purpose: Endovascular treatment (EVT) in acute ischemic stroke is effective in the late time window in selected patients. However, the frequency and clinical impact of procedural complications in the early versus late time window has received little attention. Methods: We retrospectively studied all acute ischemic strokes from 2015 to 2019 receiving EVT in the Acute Stroke Registry and Analysis of Lausanne. We compared the procedural EVT complications in the early (<6 hours) versus late (6–24 hours) window and correlated them with short-term clinical outcome. Results: Among 695 acute ischemic strokes receiving EVT (of which 202 were in the late window), 113 (16.3%) had at least one procedural complication. The frequency of each single, and for overall procedural complications was similar for early versus late EVT (16.2% versus 16.3%, P adj =0.90). Procedural complications lead to a significantly less favorable short-term outcome, reflected by the absence of National Institutes of Health Stroke Scale improvement in late EVT (delta-National Institutes of Health Stroke Scale-24 hours, −2.5 versus 2, P adj =0.01). Conclusions: In this retrospective analysis of consecutive EVT, the frequency of procedural complications was similar for early and late EVT patients but very short-term outcome seemed less favorable in late EVT patients with complications.

scholarly journals Comparison between different modalities of Endovascular treatment in Carotid Cavernous Fistula (CCF) and its short term outcome – Our Experience

2019 ◽  
Vol 8 (2) ◽  
pp. 68-76
Author(s):  
Mst Shamima Sultana ◽  
Md Shafiqul Islam ◽  
Md Sumon Rana ◽  
Kanij Fatema Ishrat Zahan Rifat ◽  
Md Abul Kalam Azad ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Carotid Cavernous Fistula ◽  
Short Term ◽  
Term Outcome ◽  
Invasive Approach ◽  
Cavernous Fistula ◽  
Short Term Outcome ◽  
Choice Of Treatment ◽  
Glue Embolization ◽  
Carotid Cavernous Fistulas

Introduction: Endovascular treatment offers different technique (Balloon assisted coiling / simple coiling, glue embolization) to treat Carotid Cavernous Fistula (CCF). This less invasive approach avoids morbidity and residual fistulas. The choice of treatment depends on the anatomy of the fistulas and cost effectiveness. Objective: To describe different endovascular treatment option of Carotid Cavernous fistulas (CCF), its short term outcome (clinical and angiographical) and to compare between trans-venous coiling and trans-arterial balloon assisted sinus coiling. Method: We have treated nine (9) cases of CCF during a period of three years. Out of them eight patients had direct CCF and one had indirect CCF. In two patients simple coiling done through trans-venous route and in another three patients through trans-arterial route. Balloon assisted coiling through trans-arterial route done in three patients. In two patients trans-arterial glue embolization was done. Results: Successful obliteration of fistula was achieved in all cases. Vision was improved in eight (8) patients. Postoperatively some proptosis remains in two patients. In one patient there was reappearance of proptosis two months after treatment, then balloon assisted coiling was done. One patient died from complication of glue (NBCA). Conclusion: Endovascular treatment is the mainstay of treatment in CCF. Trans-venous is the treatment of choice but recently balloon assisted sinus coiling through trans-arterial route is adopted. Bang. J Neurosurgery 2019; 8(2): 68-76

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

2020 ◽  
Vol 83 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Naveed Akhtar ◽  
Mahesh Kate ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Contributory Factors ◽  
Short Term Outcome

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center

2019 ◽  
Vol 12 (9) ◽  
pp. 842-847 ◽  
Author(s):  
Stefania Nannoni ◽  
Davide Strambo ◽  
Gaia Sirimarco ◽  
Michael Amiguet ◽  
Peter Vanacker ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Selection Criteria ◽  
Time Window ◽  
Real Life ◽  
Good Health ◽  
Late Time ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background and purposeThe real-life application of DAWN and DEFUSE-3 trials has been poorly investigated. We aimed to identify the proportion of patients with acute ischemic stroke (AIS) eligible for late endovascular treatment (EVT) in our stroke center based on trial and more liberal selection criteria.MethodsAll consecutive patients in our stroke registry (2003–2017) admitted within 5–23 hours of last proof of good health were selected if they had complete clinical and radiological datasets. We calculated the proportion of patients eligible for late EVT according to trial (DAWN and/or DEFUSE-3) and more liberal clinical/imaging mismatch criteria (including lower admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score for core estimation).ResultsOf 1705 patients with AIS admitted to our comprehensive stroke center in the late time window, we identified 925 patients with complete clinical and radiological data. Among them, the proportions of late EVT eligibility were 2.5% (n=23) with DAWN, 5.1% (n=47) with DEFUSE-3, and 11.1% (n=103) with more liberal criteria. Considering late-arriving patients with large vessel occlusion (n=221), the percentages of eligible patients were 10.4%, 21.3%, and 46.6%, respectively. A favorable outcome was observed at comparable rates in treated patients selected by trial or liberal criteria (67% vs 58%, p=0.49).ConclusionsIn a long-term stroke registry, the proportion of late EVT eligibility varied greatly according to selection criteria and referral pattern. Among late-arriving patients referred to our comprehensive stroke center, we found 5.6% eligible according to trial (DAWN/DEFUSE-3) and 11.1% according to liberal criteria. These data indicate that late EVT could be offered to a larger population of patients if more liberal criteria are applied.

scholarly journals Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3625-3627 ◽  
Author(s):  
Vojtech Novotny ◽  
Andrej N. Khanevski ◽  
Anna T. Bjerkreim ◽  
Christopher E. Kvistad ◽  
Annette Fromm ◽  
...  
Keyword(s):  
Cerebral Infarct ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Cerebral Infarcts ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Stroke Population ◽  
Cerebral Ischemic ◽  
Acute Cerebral Infarct

Background and Purpose— Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory. Methods— We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier. Results— A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1–7] versus 1 [0–4]) and modified Rankin Scale (3 [1–4] versus 2 [1–3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI. Conclusions— In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.

scholarly journals Short term outcome of patients with hyperglycemia and acute stroke

2017 ◽  
Vol 5 (3) ◽  
pp. 93-98 ◽  
Author(s):  
Ahmed Al-Weshahy ◽  
Rania El-Sherif ◽  
Khaled Abd Al-Wahhab Selim ◽  
Ayman Heikal
Keyword(s):  
Acute Stroke ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

scholarly journals THE REASONS ACUTE STROKE PATIENTS NOT RECEIVING THROMBOLYSIS IN AN INDONESIAN REFERRAL HOSPITAL

2019 ◽  
pp. 43-46
Author(s):  
AL RASYID ◽  
SALIM HARRIS ◽  
MOHAMMAD KURNIAWAN ◽  
TAUFIK MESIANO ◽  
RAKHMAD HIDAYAT ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
General Hospital ◽  
Time Window ◽  
National Institutes Of Health ◽  
Common Reason ◽  
Stroke Patients ◽  
Nihss Score ◽  
Stroke Registry ◽  
Activation Criteria

Objective: The aim of this study was to identify reasons acute stroke patients did not receive thrombolysis despite meeting Code Stroke activation criteria in Cipto Mangunkusumo General Hospital during November 2015 until February 2019. Methods: This study retrospectively collected data of adult (aged>18 y old) acute stroke patients admitted to Cipto Mangunkusumo General Hospital from November 2015 to February 2019 who met criteria for Code Stroke activation but did not undergo thrombolysis. Patient’ data were collected from Code Stroke Registry of Cipto Mangunkusumo General Hospital. Results: There were 518 acute stroke patients who had Code Stroke activated in Cipto Mangunkusumo General Hospital from November 2015 to February 2019. 76.3% of acute stroke patients did not receive thrombolytic therapy (n=395). Hemorrhage on computed tomography (CT) scan was the most common reason patients did not receive thrombolysis. The following most common reasons were low or improved National Institutes of Health Stroke Scale (NIHSS) score, family refusal, and exceedance of time window. Conclusion: Hemorrhage on CT scan was the most common reason patients did not receive thrombolysis following by low or improved NIHSS score, family refusal, and exceedance of time window.

scholarly journals Association of neuroimaging markers of cerebral small vessel disease with short-term outcomes in patients with minor cerebrovascular events

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuemei Chen ◽  
Lin Wang ◽  
Junying Jiang ◽  
Yuanyuan Gao ◽  
Rui Zhang ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Small Vessel Disease ◽  
National Institutes Of Health ◽  
Stroke Recurrence ◽  
Short Term ◽  
Poor Functional Outcome ◽  
Term Outcome ◽  
Vessel Disease ◽  
Short Term Outcome ◽  
Cerebrovascular Events

Abstract Background Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods Consecutive first-ever stroke patients (n = 546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition (National Institutes of Health Stroke Scale Score ≤ 3) and exclusion criteria. MRI scans were performed within 7 days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS), SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0–1) and poor outcome (mRS 2–6). Secondary outcomes were stroke progression and stroke recurrence. Results Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P < 0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020–1.770; P = 0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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