共查询到20条相似文献，搜索用时 109 毫秒
1.
Isabelle Mourand Pauline Malissart Cyril Dargazanli Erika Nogue Stephane Bouly Nicolas Gaillard Yassine Boukriche Lucas Corti Marie-Christine Picot Olivier Beaufils Mohamed Chbicheb Denis Sablot Alain Bonafe Vincent Costalat Caroline Arquizan 《Journal of stroke and cerebrovascular diseases》2019,28(2):259-266
Background
Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship).Methods
We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH).Results
Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P?=?.562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P?=?.256), and sICH (7.0% versus 9.7%, P?=?.515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5points?=?1.59, P?=?.010), absence of diabetes (OR?=?3.35, P?=?.075), and the delay magnetic resonance imagining-puncture (OR -30min?=?1.16, P?=?.048).Conclusions
Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC. 相似文献2.
Wenchen Li Shang Wang Shijun Li Xin Chen Yunyun Xiong 《Journal of stroke and cerebrovascular diseases》2019,28(1):31-37
Background
Thrombectomy is the first choice for cardioembolism due to atrial fibrillation (AF), however, whether valvular AF and nonvalvular AF had different safety and functional outcomes has not been reported yet. We aimed to investigate the differences between patients with valvular AF and patients with nonvalvular AF on safety and functional outcomes in acute large artery occlusion undergoing thrombectomy.Methods
Valvular AF refers to patients with mitral stenosis or artificial heart valves and valve repair. Rate of symptomatic intracerebral hemorrhage [sICH], modified Rankin Scale Score (mRS), and death at 90 days were compared between valvular AF and nonvalvular AF groups. Univariate and multivariable logistic regression was performed to identify the predictors for unfavorable functional outcome (mRS 3-6).Results
18.8% (51/271) of AF were valvular AF. The valvular AF group had significantly higher proportion of mRS 0-2 (49% [25/51] versus 33.3% [73/219], P?=?.04) and less death (21.6% [11/51] versus 38.4% [84/219], P?=?.02) comparing with nonvalvular AF group. The rates of sICH between both groups were nonsignificantly different (21.5% [47/219] for nonvalvular AF versus 13.7% [7/51] for valvular AF, P?=?.46). Valvular AF was not an independent predictor for unfavorable functional outcome (odds ratio .67, 95% confidence interval: .24-1.84) with age, collateral flow, chronic heart failure, NIHSS at admission, recanalization status, glucose at admission, occlusion site, ASPECTS, and ICH as covariates.Conclusions
Valvular AF and nonvalvular AF have similar safety and functional outcomes in patients with acute anterior circulation large artery occlusion undergoing thrombectomy. 相似文献3.
Jin Liu Qiuyan Shi Yuan Sun Jingyuan He Bin Yang Chunyang Zhang Rui Guo 《Journal of stroke and cerebrovascular diseases》2019,28(4):1126-1132
Objective
To evaluate the efficacy of tirofiban administered at different time points within 24 hours of intravenous thrombolysis with alteplase in acute ischemic stroke.Methods
Patients who underwent intravenous thrombolysis with alteplase and fulfilled other inclusion criteria were randomly divided into 4 groups according to the time points of tirofiban administration: Group A (2 h), Group B (2-12 h), Group C (12-24 h), and Group D (control). The changes in National Institutes of Health Stroke Scale score, modified Rankin Scale score, and adverse events were analyzed.Results
At 7 ± 1 day, the efficacy in Group A was better than that in Group C (P?=?.006) and Group D (P?=?.001), but there was no significant difference in the efficacy between Groups A and B (P?=?.268). Similarly, at 14 ± 2 d, the efficacy in Group A was better than that in Group C (P?=?.026) and Group D (P?=?.001), but there was no significant difference in the efficacy between Groups A and B (P?=?.394). As evaluated by the modified Rankin Scale, the prognosis in Groups A, B, and C was better than that in Group D (P?=?.042, .008, .027, respectively), which was unrelated to the time points of tirofiban administration. There was no significant difference in the incidence of adverse events among the four groups.Conclusions
Tirofiban combined with alteplase is effective and safe, and particularly beneficial when administered at 2 hour and 2-12 hours after intravenous thrombolysis with alteplase in acute ischemic stroke. 相似文献4.
Rebecca S.Y. Teng Benjamin Y.Q. Tan Samuel Miny Nicholas L. Syn Andrew F.W. Ho Nicholas J.H. Ngiam Leonard L.L. Yeo Andrew M. Choong Vijay K. Sharma 《Journal of stroke and cerebrovascular diseases》2019,28(4):906-919
Background
Blood pressure (BP) is an important determinant of functional outcome in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA). Current guidelines recommend a BP target of 185/110 mmHg before IV-tPA bolus and maintaining it at less than 180/105 mmHg for the first 24 hours. However, the effect of blood pressure on various outcome measures after systemic thrombolysis remains unclear.Methods
Following a systematic search of Medline and EMBASE, all observational studies reporting effect of pretreatment BP on 90-day functional outcome as measured by the modified Rankin Scale (mRS) and/ or incidence of symptomatic intracranial hemorrhage (sICH) in AIS patients receiving thrombolytic therapy were included.Results
Of 2181 studies screened, 26 studies, involving 38,937 subjects, met inclusion criteria. Higher prethrombolysis systolic BP was significantly-associated with poorer 90-day functional outcome (Mean difference 3.87 mmHg; 95% confidence interval [CI] 1.18-6.56) and increased incidence of sICH (Mean difference 5.31; 95% CI 2.22-8.40). When studies were stratified by different cut-offs for functional outcome (mRS 0-1 versus 0-2) and definitions of sICH used (Randomized controlled trials or SITS-MOST), there was no significant difference in mean difference between the subgroups.Conclusions
Our data showed that higher prethrombolysis SBP was associated with poorer outcomes in thrombolysed acute ischemic stroke patients. This may suggest that more aggressive lowering of BP below the current recommendations prior to thrombolysis could be beneficial. The effect of early BP trends after tPA infusion could not be evaluated due to limited available data. Ongoing randomized clinical trials, like ENCHANTED, may provide further insights into the current guidelines and optimal BP levels. 相似文献5.
Diana Baptista Pedro Abreu Elsa Azevedo Rui Magalhães Manuel Correia 《Journal of stroke and cerebrovascular diseases》2018,27(11):3115-3123
Background and Aim
Stroke is a major health problem. Several studies reported sex differences regarding stroke. We aim to study this issue in an incidence stroke study.Methods
Data were retrieved from a community-based prospective register of patients that had a first ever stroke in a life time between October 2009 and September 2011. We studied sex differences regarding demographic data, vascular risk factors, stroke type, stroke severity (NIHSS), disability at 28days (modified Rankin scale (mRS)), and case fatality at 30 and 90days.Results
From 720 stroke patients, 45.3% were men. Women were older (75.0 ± 13.6 versus 67.2 ± 14.9 years), had a worse premorbid mRS (39.3% versus 25.5%, P < .001), and a higher prevalence of hypertension (P?=?.004) and atrial fibrillation (P < .001). Previous myocardial infarction was more frequent in men (P?=?.001), as well as smoking habits (P < .001). Ischemic stroke was more common in women than men (87.6% versus 81.3%, P?=?.038). The 28 days’ outcome was worse in women (mRS ≥ 2, 77.2% versus 70.6%, P?=?.044). No differences were found in initial stroke severity (median NIHSS?=?4) and case fatality at 30 and 90days, after adjusting for age and premorbid mRS.Conclusion
No differences were found in stroke initial severity and mortality at 30 and 90days between men and women, despite the sex differences pertaining to the stroke profile—age, vascular risk factors, stroke type, and outcome. Our results are somewhat discrepant from those described in the literature; more research is needed to understand if this may be due to changes in stroke standard of care. 相似文献6.
Eyad Almallouhi Sami Al Kasab Jillian B. Harvey Christopher Reardon Ali Alawieh Tarun Girotra Patricia Aysse Raymond D. Turner Christine A. Holmstedt 《Journal of stroke and cerebrovascular diseases》2019,28(1):185-190
Objective
To assess the long-term functional outcome of stroke in patients treated with mechanical thrombectomy (MT) performed during work hours (on-hours) versus after-hours, weekends, and official holidays (off-hours).Methods
Data on all patients receiving MT at a comprehensive stroke center was collected between December 2014-December 2016. Our primary outcomes were the discharge and 90-day modified Rankin Scale (mRS). We developed propensity scores for off-hours treatment and used inverse probability of treatment weights to address confounding. We estimated logistic regression to assess the relationship between off-hours treatment and favorable patient outcomes. Independent variables include receiving thrombectomy during the off-hours, admission National Institute of Health Stroke Scale (NIHSS), door to groin time in minutes, age, and race.Results
During the study period, 80 (41%) patients underwent thrombectomy during on-hours and 116 (59%) during off-hours. Mean age was 69.1 years for the on-hours group and 64.1 years for the off-hours group (P?=?.02). There were no statistically significant differences in median admission NIHSS, rate of alteplase administration, mean time from last known well to thrombectomy, rate of revascularization, and rate of hemorrhagic transformation between the 2 groups. Logistic regression analysis showed the probability of a favorable outcome at discharge (mRS ≤ 2) is 12.6 % lower for off-hours patients (P?=?.038, [95%CI ?.25 to ?.01]). For patients with a 90-day mRS (n?=?117), the probability of a favorable outcome was 18.7% lower for those treated during the off-hours (P?=?.029, [95%CI ?.36 to ?.02]).Conclusions
There is a higher probability of a good functional outcome in acute ischemic stroke patients who receive MT when performed during regular work hours. 相似文献7.
Wenwen Zhang Skye Coote Tanya Frost Helen M. Dewey Philip M.C. Choi 《Journal of stroke and cerebrovascular diseases》2018,27(10):2707-2711
Background
Thrombolytic therapy in patients with pre-existing disability presenting with acute ischemic stroke (AIS) is controversial because of concerns regarding poor outcomes and futility of treatment. We hypothesized that a similar proportion of patients with and without pre-existing disability would return to their premorbid functional status following thrombolysis.Methods
This was a retrospective study at a single high-volume academic primary stroke center. All patients with AIS treated with intravenous alteplase between January 2005 and July 2016 were included. Premorbid functional status was assessed using modified Rankin scale (mRS) and dichotomized as independent premorbid (mRS 0-1) or disabled premorbid (mRS 2-4) groups for comparison. Functional outcome was assessed by mRS at 90 days and compared between groups.Results
Six hundred eighty patients independent premorbid (mean age 71.8 ± 13.1 years, 57.9% male) and 140 disabled premorbid (mean age 82.1 ± 8.7 years, 40.7% male) were included. Patients with pre-existing disability were older and had more vascular risk factors and more severe stroke on presentation (P < 0.05). A greater proportion of patients in the disabled premorbid group were dead at 90 days (35.7% versus 12.8%, P < 0.05). At 90 days, among patients with premorbid mRS 0, 1, 2, 3, and 4: 25%, 38%, 32%, 30%, and 25% of them returned to their respective premorbid mRS status.Conclusions
Irrespective of premorbid functional level, approximately one fourth to one third of thrombolyzed patients had returned to their premorbid functional levels at 90 days. Thrombolytic treatment should be considered in patients with mild-to-moderate pre-existing disability, taking into account the value placed on the chance of a return to premorbid functional status. 相似文献8.
Yang Liu Xue Liang Xiaomin Xu Meixue Dong Shiyu Jia Changqi Lu Youdong Wei 《Journal of stroke and cerebrovascular diseases》2019,28(1):21-25
Background
Stroke is one of the most common causes of disability and death. Higher alkaline phosphatase (ALP) levels have been associated with poor functional outcomes and mortality in previous studies. We investigated alterations in serum ALP concentrations and functional outcomes in patients with acute ischemic stroke (AIS).Methods
Patients with first-ever AIS were recruited to participate in the study. Serum ALP levels were measured using a Cobas Integra 400 Plus automatic biochemical analyzer, and severity of stroke was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Functional outcome was measured using the modified Rankin scale 1 year after admission.Results
Serum ALP concentration was increased in patients with AIS (81.75 ± 20.49 versus 69.93 ± 16.12 U/L, P?=?.000) and the optimal ALP cutoff point for diagnosing patients with AIS was 81.50 U/L, with a sensitivity of 49.5% and specificity of 78.9%. However, there was no significant correlation between ALP and NIHSS scores (r?=?.170, P?=?.085) and ALP was not significantly different between favorable and unfavorable functional outcomes (81.76 ± .60 versus 81.70 ± 20.54 U/L, P?=?.802).Conclusions
Serum ALP concentration, which was increased in patients with AIS, might represent a low-potency biomarker for the diagnosis of AIS. However, this was not significantly correlated with NIHSS scores or the functional outcome after 1 year. 相似文献9.
Haifeng Mao Qianyi Wu Peiyi Lin Junrong Mo Huilin Jiang Shaopeng Lin Timothy H. Rainer Xiaohui Chen 《Journal of stroke and cerebrovascular diseases》2019,28(1):133-141
Background
Efficient assessment of patients after ischemic stroke has important reference value for doctors to choose appropriate treatment for patients. Our study aimed to develop a new prognostic model for predicting outcomes 3 months after ischemic stroke among Chinese Population.Methods
A prospective observational cohort study among ischemic stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to June 2013. Demographic data of ischemic stroke patients, assessment of NIHSS and laboratory results were collected. Based on 3-month modified Rankin Scale (mRS) ischemic stroke patients were divided into either favorable outcome (mRS: 0-2) or unfavorable outcome groups (mRS: 3-6). The variables closely associated with prognosis of ischemic stroke were selected to develop the new prognostic model (NAAP) consisted of 4 parameters: NIHSS, age, atrial fibrillation, and prealbumin. The prognostic value of the modified prognostic model was then compared with NIHSS alone.Results
A total of 454 patients with suspected stroke were recruited. One hundred eighty-six patients with ischemic stroke were included in the final analysis. A new prognostic model, NAAP was developed. The area under curve (AUC) of NAAP was .861 (95%confidence interval: .803-.907), whilst the AUC of NIHSS was .783 (95%CI: .717-.840), (P?=?.0048). Decision curve analysis showed that NAAP had a higher net benefit for threshold probabilities of 65% for predictive risk of poor outcomes.Conclusions
The modified prognostic model, NAAP may be a better prognostic tool for predicting 3-month unfavorable outcomes for ischemic stroke than NIHSS alone. 相似文献10.
Bin Qin Ming-Jun Zhao Hong Chen Huixun Qin Libo Zhao Lin Fu Cheng Qin Mingxiu Yang Wen Gao 《Journal of stroke and cerebrovascular diseases》2018,27(12):3542-3548
Background
Evidence from outside the typical clinical research setting, such as the real-world setting, complements evidence coming from randomized controlled trials. The purpose of this study was to evaluate all available evidence from the real-world observational trials about long-term outcomes of treatment with intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) compared with not treated with IV rt-PA (non-rt-PA) in patients with acute ischemic stroke.Methods
We searched PubMed and Embase until March 1, 2018 for observational studies reporting matched or adjusted results comparing IV rt-PA versus non-rt-PA in patients with acute ischemic stroke. Outcomes assessed included all-cause mortality, hospital readmission rates, and independence rates. Hazard ratios with 95% confidence intervals were used as a measure of comparing between patients treated with IV rt-PA and non-rt-PA.Results
Six observational trials with 16,399 participants were identified. The use of IV rt-PA in acute ischemic stroke patients was associated with a lower risk of mortality (hazard ratio .61; 95% confidence interval, .52-.70; P < .00001), and there was no heterogeneity across trials. There was no evidence of an effect on hospital readmission rates and independence rates.Conclusions
IV rt-PA is associated with reduced long-term mortality in acute ischemic stroke patients. 相似文献11.
Dominique A. Cadilhac Monique F. Kilkenny Natasha A. Lannin Helen M. Dewey Christopher R. Levi Kelvin Hill Brenda Grabsch Rohan Grimley David Blacker Amanda G. Thrift Sandy Middleton Craig S. Anderson Geoffrey A. Donnan 《Journal of stroke and cerebrovascular diseases》2019,28(5):1302-1310
Background
The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia.Aims
To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards.Methods
Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke.Results
Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient?=?0.01, 95% CI –0.06-0.09, P?=?.78). Patients managed in SUs more often received recommended management (e.g. swallowing screening).Conclusion
The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required. 相似文献12.
Satoshi Suda Takashi Shimoyama Koichiro Nagai Masafumi Arakawa Junya Aoki Takuya Kanamaru Kentaro Suzuki Yuki Sakamoto Yuho Takeshi Noriko Matsumoto Yasuhiro Nishiyama Chikako Nito Masahiro Mishina Kazumi Kimura 《Journal of stroke and cerebrovascular diseases》2018,27(10):2804-2809
Background and Purpose
The association between thyroid hormone levels and long-term clinical outcome in patients with acute stroke has not yet been thoroughly studied. The purpose of the present study was to test the hypothesis that thyroid hormone levels are associated with 3-month functional outcome and mortality after acute stroke.Methods
We retrospectively analyzed 702 consecutive patients with acute stroke (251 women; median age, 73 years) who were admitted to our department. General blood tests, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were performed on admission. Neurological severity was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores on admission and modified Rankin Scale (mRS) scores at 3 months after stroke onset. Poor outcome was defined as an mRS score of 3-5 or death. The impact of thyroid function on 3-month outcome was evaluated using multiple logistic regression analysis.Results
Poor functional outcome was observed in 295 patients (42.0%). Age (P < .0001), female sex (P < .0001), admission NIHSS score (P < .0001), smoking (P?=?.0026), arterial fibrillation (P?=?.0002), preadmission mRS (P < .0001), estimated glomerular filtration rate (P?=?.0307), and ischemic heart disease (P?=?.0285) were significantly associated with poor functional outcome, but no relationship between FT4, TSH, and poor functional outcome was found. A multivariate logistic regression analysis showed that low FT3 values (<2.00 pg/mL) were independently associated with poor functional outcome (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.60-6.24) and mortality (OR, 2.55; 95% CI, 1.33-4.91) at 3 months after stroke onset.Conclusions
Our data suggest that a low FT3 value upon admission is associated with a poor 3-month functional outcome and mortality in patients with acute stroke. 相似文献13.
Claudia-Alexandrina Irimie Mihai Vârciu Marius Irimie Petru-Iulian Ifteni Dan-Ioan Minea 《Journal of stroke and cerebrovascular diseases》2018,27(10):2731-2737
Background
Several studies have shown that high level of plasma C-reactive protein (CRP) is associated with stroke outcomes and future vascular events, and a decrease in serum triiodothyronine (T3) was reported to be associated with stroke severity and poor prognosis.Objective
The goal of this study is to evaluate CRP and T3 as independent predictors of poor functional and cognitive outcomes in patients with acute ischemic stroke at hospital discharge.Methods
This study evaluated 120 patients who were admitted to the Clinical Hospital of Neurology and Psychiatry Brasov, between July 2016 and January 2017. The patients were evaluated for clinical stroke severity (National Institutes of Health Stroke Scale) and serum CRP and total T3 were evaluated on admission. Functional outcome and cognitive outcome were evaluated at discharge.Results
The severity of NIHHS scores were associated with higher CRP levels (β?=?.583, P = .000) and lower T3 concentration (β = ?.185, P?=?.043). Poor cognitive prognosis was associated with CRP levels (β?=?.441, P?=?.000) but not with T3 concentrations (P?=?.142). Poor functional outcome was associated with higher CRP levels (β?=?.457, P?=?.000), but not with T3 concentrations (P?=?.100). Using CRP and T3 as prognostic factors resulted in a probability of 53.5% to predict a poor functional outcome and of 80.42% to predict a poor cognitive outcome in stroke patients at discharge.Conclusions
The study showed that higher CRP and lower T3 levels were associated with stroke severity on admission. Functional outcome is likely secondary to stroke severity but functional outcome at discharge was associated with higher CRP levels and not with T3 concentration. Cognitive outcome was associated with higher CRP levels and not with T3 concentration. 相似文献14.
Yitzchok S. Lederman Clotilde Balucani Leah R. Steinberg Charles Philip Jason M. Lazar Jeremy Weedon Gautam Mirchandani Sarah Z. Weingast Giovanna Viticchi Lorenzo Falsetti Mauro Silvestrini James J. Gugger David Aharonoff Pirouz Piran Zachary Adler Steven R. Levine 《Journal of stroke and cerebrovascular diseases》2019,28(1):44-48
Background
QT dispersion, maximal interlead difference in QT interval on 12-lead electrocardiogram (ECG), measures cardiac repolarization abnormalities. Data are conflicting whether QT dispersion predicts adverse outcome in acute ischemic stroke (AIS) patients. Our objective is to determine if QT dispersion predicts: (1) short-term clinical outcome in AIS, and (2) stroke location (insular versus noninsular cortex).Methods
Admission ECGs from 412 consecutive patients with acute stroke symptoms from 2 university-based stroke centers were reviewed. QT dispersion was measured. A neuroradiologist reviewed brain imaging for insular cortex involvement. Favorable clinical outcomes at discharge were modified Rankin Scale (mRS) score of 0-1, discharge National Institutes of Health Stroke Scale (NIHSS) score less than 2, and discharge to home. Multiple logistic regressions were performed for each outcome measure and to determine the association between insular infarct and QT dispersion.Results
Of 145 subjects in the final analysis, median age was 65 years (interquartile range [IQR] 56-75), male patients were 38%, black patients were 68%, median QT dispersion was 78 milliseconds (IQR 59-98), and median admission NIHSS score was 4 (IQR 2-6). QT dispersion did not predict short-term clinical outcome for mRS score (odds ratio [OR] = 1.001, 95% confidence interval [CI] .99-1.01, P = .85), NIHSS at discharge (OR = .994, 95% CI .98-1.01, P = .30), or discharge disposition (OR?=?1.001, 95% CI .99-1.01, P = .81). Insular cortex involvement did not correlate with QT dispersion magnitude (OR?=?1.009, 95% CI .99-1.02, P = .45).Conclusions
We could not demonstrate that QT dispersion is useful in predicting short-term clinical outcome at discharge in AIS. Further, the magnitude of QT dispersion did not predict insular cortical stroke location. 相似文献15.
Bart M. Demaerschalk Erica L. Boyd Kevin M. Barrett Dale M. Gamble Sarah Sonchik Meghan M. Comer Judith Wieser Joseph G. Hentz Dennis Fitz-Patrick Yu-Hui H. Chang 《Journal of stroke and cerebrovascular diseases》2018,27(11):2940-2942
Purpose
To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care.Methods
Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics.Results
There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96% [95% confidence interval (CI): 94%-97%] versus 97% [95% CI: 95%-98%]; P?=?0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21% versus, 35%; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46% versus 63%; P < 0.01), were less likely to have received antithrombotic therapy (85% versus 90%; P?=?.02), were less likely to be discharged on anticoagulation when indicated (56% versus 64%; P?=?.01), and were less likely to be prescribed cholesterol reducing treatment (68% versus 72%; P < .001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P < .001).Conclusion
The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital. 相似文献16.
Toshiyuki Tony Watanabe Masahiko Ichijo Tomoyuki Kamata 《Journal of stroke and cerebrovascular diseases》2019,28(1):70-75
Background
Intravenous thrombolysis with recombinant tissue plasminogen activator and endovascular mechanical thrombectomy are known to be the most effective treatments in the acute phase of ischemic stroke. However, the safety of intravenous systemic thrombolysis with recombinant tissue plasminogen and endovascular mechanical thrombectomy during pregnancy is not well-confirmed. We describe a case of an uneventful pregnancy and delivery after thrombolysis plus endovascular mechanical thrombectomy for acute ischemic stroke.Materials and Methods
The patient's medical records were reviewed retrospectively. A comprehensive systemic literature search of the PubMed database was conducted.Case Presentation
A 36-year-old woman at 21 weeks gestation presented with a sudden headache, dysarthria, and right hemiparesis. Magnetic resonance angiography revealed occlusion of the left internal carotid artery. Recombinant tissue plasminogen activator was administered intravenously 193 minutes after symptom onset, and endovascular mechanical thrombectomy was started immediately. Recanalization of her left internal carotid artery was achieved. The patient continued to experience mild hemiparesis after the initial treatment and started rehabilitation. The fetus remained in satisfactory condition during the pregnancy and was delivered at 38 weeks without obvious maternal or neonatal complications. No apparent abnormality has been observed in the newborn in the first year of life.Conclusions
Intravenous recombinant tissue plasminogen and endovascular mechanical thrombectomy could be considered as treatment for acute ischemic stroke during pregnancy unless high risks of hemorrhage or preterm labor are expected. 相似文献17.
Jun-Chao Xie Ying-Ying Lin Xiao-Hui Liu Yi-Chen Zhao Xiao-Ye Ma Jia Yu Xue-Yuan Liu Yan-Xin Zhao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2650-2656
Background
Considerable researches suggest that high level of homocysteine (Hcy) is associated with the risk of ischemic stroke. Ambulatory blood pressure monitoring (ABPM) parameters have also been confirmed associated with cardio-cerebrovascular events. However, the relationship between Hcy and ABPM parameters remains unclear in patients with acute ischemic stroke. In this study, we aim to investigate the association between Hcy level and ABPM parameters in patients with acute ischemic stroke.Methods
We enrolled 60 patients with acute ischemic stroke who received ABPM. We calculated ABPM parameters like morning blood pressure surge (MBPS), ambulatory arterial stiffness index, blood pressure variability, and night dipping patterns.Results
Multivariate logistic regression analysis indicated that patients in the top quartile of Hcy level tended to have a higher level of prewaking and sleep-trough MBPS compared with patients in the lower 3 quartiles after adjusted for age and gender (P?=?.028 and P?=?.030, respectively). When treating Hcy as a continuous variable, the linear regression showed the association between Hcy level and both MBPS parameters remained significant (prewaking MBPS, r?=?.356, P?=?.022; sleep-trough MBPS, r?=?.365, P?=?.017, respectively). However, there is no association between Hcy level and ambulatory arterial stiffness index, blood pressure variability or night dipping patterns (P?=?.635, P?=?.348 and P?=?.127 respectively).Conclusions
There is a relationship between the 2 major cerebrovascular risk factors: MBPS and Hcy. 相似文献18.
Kei Kawada Tsuyoshi Ohta Koudai Tanaka Mitsuhiko Miyamura Satoshi Tanaka 《Journal of stroke and cerebrovascular diseases》2019,28(1):142-148
Background and Purpose
Delirium in acute stroke is associated with poor clinical outcome. The purpose of this study was to examine the effect of sleep medications on sleep quality and delirium in acute stroke.Methods
In this retrospective cohort study, sleep disturbances, and delirium were investigated in acute stroke patients treated in April 2013-March 2017 who were prescribed ramelteon plus either an alpha-aminobutyric acid receptor (GABAR) agonist or a selective dual orexin receptor antagonist (suvorexant).Results
Of the patients included, 104 received a GABAR agonist and 128 received suvorexant in addition to ramelteon. Patient characteristics did not differ significantly between the groups, except for a higher proportion of cerebral infarction in suvorexant group (P?=?.033). Subjective sleep quality was significantly improved in suvorexant group compared to GABAR agonist group (difficulty staying asleep: 6.3% versus 34%, P < .001; daytime sleepiness: 33% versus 63%, P < .001). Delirium was significantly less frequent in suvorexant group than GABAR agonist group (7.0% versus 31%, P < .001). The length of hospital stay was significantly shorter in suvorexant group than in GABAR agonist group (in days, 21 [15-29] versus 25 [18-33]; P?=?.019). Multivariable logistic regression analysis revealed that the addition of suvorexant was significantly associated with a reduced occurrence of delirium (odds ratios .19, 95% confidence interval .085-.43, P < .001).Conclusions
Addition of suvorexant to ramelteon therapy, rather than a GABA receptor agonist, can improve subjective sleep quality without inducing delirium in acute stroke patients. 相似文献19.
Mohsen Saleh ElAlfy Fatma Soliman Elsayed Ebeid Tarek Mostafa Kamal Deena Samir Eissa Eman Abdel Rahman Ismail Samar Hassan Mohamed 《Journal of stroke and cerebrovascular diseases》2019,28(2):441-449
Background
Cerebrovascular stroke is a common critical complication of sickle cell disease (SCD). Angiotensinogen (AGT) M235T gene polymorphism is associated with risk of ischemic stroke and cardiovascular disease.Aim
We investigated the potential association between angiotensinogen M235T gene polymorphism and susceptibility to cerebrovascular and cardiopulmonary complications in adolescents with SCD.Methods
Forty-six patients with SCD in steady state were studied stressing on history of stroke, hydroxyurea/chelation therapy, hematological profile, and echocardiographic findings. Polymerase chain reaction-based restriction fragment length polymorphism analysis was used to detect AGT M235T gene polymorphism. Fifty sex- and age-matched healthy controls were enrolled for assessment of M235T gene polymorphism pattern.Results
The distribution of AGT M235T gene polymorphism was similar between SCD patients and healthy controls. The frequency of T allele of AGT M235T gene polymorphism (TT and MT genotypes) was significantly higher among patients with history of manifest stroke (P < .001). Patients with TT and MT genotypes had higher incidence of cardiopulmonary complications (P?=?.041) as well as higher percentage of HbS (P < .001) and lower hemoglobin level (P?=?.008) compared with those with MM genotype. Serum ferritin, liver iron concentration, and cardiac T2* were not related to T alleles or genotypes. Logistic regression analysis revealed that M235T genotype was a significant independent factor related to the occurrence of stroke among patients with SCD (Odds Ratio 14.05, 95% confidence interval 3.82-28.91; P?=?.001).Conclusion
AGT M235T gene polymorphism may represent a genetic modifier to vascular morbidities in Egyptian patients with SCD. 相似文献20.
Jie Chen Zengrui Zhang Luyun Chen Xiaowen Feng Wangwang Hu Wanqian Ge Xianmei Li Pingping Jin Bei Shao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2857-2862