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1.
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2.
Rajan Gadhia David McCane Jason Lee Ken Chyuan Ling Kevin Jiang David Chiu 《Journal of stroke and cerebrovascular diseases》2018,27(11):2973-2976
Background
We present a single institution registry with the novel feature of 90-day outcome assessments on all hospitalized acute stroke patients, inclusive of every patient with a primary discharge diagnosis of transient ischemic attack (TIA), acute ischemic stroke (AIS), nontraumatic subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH).Methods
Patient data obtained in the HOPES registry include demographics, comorbid diagnoses, medications, health behaviors, laboratory values, imaging studies, vital signs, and outcome measures, most notably the modified Rankin Scale (mRS) at 90days.Results
From May 2016 to December 31, 2017, 1607 patients were enrolled in the HOPES registry. 90-day outcome assessments were captured on 1555 patients (97%): 1096 AIS, 230 ICH, 110 SAH, and 119 TIA patients. Mortality rates and 90-day outcomes were most favorable for TIA patients. Mortality and 90-day disability scores were poorest for patients in the ICH group.Conclusions
The inclusion of 90-day outcomes data will allow HOPES to stand apart among stroke registries as a new standard for stroke outcomes research. The registry will provide the necessary comprehensive data that the field needs as we transition our focus of stroke research to poststroke recovery. 相似文献3.
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4.
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
Objective
Leukocytes play a crucial role in inflammation and immune response. This study aims to demonstrate the value of changes in leukocytes levels 24 hours after intravenous thrombolysis to predict prognosis in acute ischemic stroke (AIS).Methods
From Jan 2016 to Oct 2017, the patients who suffered AIS to our center within 4.5 hours of symptom onset were all treated with recombinant tissue-type plasminogen activator. Data from 213 AIS patients were analyzed. Patients were divided into 4 groups: persistent leukocytosis (PL), transient leukocytosis (TL), leukocytosis 24 hours (L24H) and no leukocytosis (NL). By comparison, the factors with statistically significant were selected in pairwise multiple comparisons. Good clinical outcome was defined as the Modified Rankin Scale score of 2 or lower. Multivariate logistic regression was used to assess the association of the indicators with clinical outcome.Results
By pairwise multiple comparisons, PL and L24H had higher baseline National Institutes of Health Stroke Scale (NIHSS) score than NL and were likely to lead poor clinical outcomes. TL had a better prognosis than L24H. As the results of multivariable analyses shown, PL and L24H were risk factors to poor functional outcomes (odds ratio [OR] = 2.668, 95% confidence interval [CI] = 1.139-6.249, P = .024; OR?=?6.648, 95%CI?=?2.048-21.584, P = .002).Conclusion
Persistent leukocytosis and leukocytosis 24 hours both had higher baseline NIHSS scores, more serious stroke and were more likely to lead to unfavorable outcome. Therefore, changes in leukocytes levels 24 hours after intravenous thrombolysis could be predicted the short-term functional outcome of AIS patients. 相似文献5.
Upper Limb Ischemic Postconditioning as Adjunct Therapy in Acute Stroke Patients: A Randomized Pilot
Yuejuan Li Keke Liang Long Zhang Yamei Hu Yunli Ge Jianhua Zhao 《Journal of stroke and cerebrovascular diseases》2018,27(11):3328-3335
Objective
This study aims to observe the clinical effect of upper limb ischemic postconditioning (LIPostC) as an adjunct to treatment with acute stroke patients, possibly due to increased cerebral perfusion.Methods
We perform a randomized blinded placebo controlled trial in nonthrombolysis patients with acute ischemic stroke, within 72hours of ictus, divided into the LIPostC group and control group. The LIPostC group is induced by 4 cycles of intermittent repeated limb ischemia: alternating 5 minutes inflation (20mm Hg above systolic blood pressure) and 5 minutes deflation performed manually using a standard upper arm blood pressure cuff in the nonparetic arm. The control group receives a sham procedure (cuff inflation to 30mm Hg). Patients underwent the intervention from the time of enrollment to Day 14. Comparison of National Institutes of Health Stroke Scale (NIHSS) score, cerebral infarction volume, relative Perfusion weighted imaging (PWI) parameters (regional relative cerebral blood flow, regional relative mean transit time; preintervention [day 0], day 14, day 90), modified Rankin Scale (mRS; the preintervention score [day 0], the curative ratio at day 90 [we define 0-1 score as close to recovery or full recovery]).Results
Sixty eligible patients with acute stroke (29 LIPostC and 31 control) are recruited age 65years (SD 12.22), blood pressure 156/74mm Hg (SD 14/10), and NIHSS score 5.98 (SD 3.35), mRS score 2.25 (SD .79). Only 1 in the LIPostC group is intolerant the first cycle to give up. All patients tolerate the sham procedure. Two patients experience recurrent stroke versus none in the LIPostC group. Day 90, compared with the control group, there is a significant decrease the NIHSS score, regional relative mean transit time (P < .05) and increase the curative ratio of mRS, regional relative cerebral blood flow(P < .05) in the LIPostC group, which infarct volume decreased by 31.3% (P < .05).Conclusions
LIPostC after acute stroke is well tolerated and appears safe and feasible. LIPostC may improve neurological outcome, and protective mechanisms may be increased cerebral blood flow to improve cerebral perfusion. A larger trial is warranted. 相似文献6.
Shashvat M. Desai Marcelo Rocha Matthew Starr Bradley J. Molyneaux Cynthia L. Kenmuir Bradley A. Gross Brian T. Jankowitz Tudor G. Jovin Ashutosh P. Jadhav 《Journal of stroke and cerebrovascular diseases》2018,27(11):3172-3176
Objective
Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) is offered to select patients meeting strict criteria. One of the criteria is stroke severity as indicated by the National Institute of Health Stroke Scale (NIHSS). Inherently, NIHSS is biased towards left hemisphere strokes (LHS) with median NIHSS score 4 points higher than right hemisphere strokes (RHS). This may potentially affect clinical decision making and thrombectomy eligibility. We sought to test this hypothesis.Methods
Data were analyzed from consecutive AIS patients with LVO admitted to our comprehensive stroke center (June 2015-December 2016). Following variables were studied: NIHSS score, occlusion location, time to presentation, and treatment received.Results
Three hundred and fifty-one proximal-anterior circulation LVOs (ACLVO) were identified. 211 patients harboring a proximal ACLVO, were treated <24-hour from symptom onset, had a baseline mRS 0-1, ASPECTS ≥6, and NIHSS score ≥6. One hundred and twelve (53%) were LHS and 99 (47%) were RHS. ET was performed in 87% of LHS and 78% of RHS (P = .09). In the NIHSS score >12 range, 88% of LHS and RHS received ET (P = .93). In the NIHSS score 6-12 range, 81% of LHS and 52% of RHS received ET (P = .03).Conclusions
We find comparable rates of ET between right and LHS in patients with high NIHSS but lower rates of ET of RHS than LHS in patients at lower NIHSS. A hemisphere-laterality based adjustment to the NIHSS may better identify the full extent of patients that may benefit from ET. 相似文献7.
Edgar A. Samaniego Jorge A Roa Kaustubh Limaye Harold P. Adams 《Journal of stroke and cerebrovascular diseases》2018,27(10):2555-2571
Background
The treatment of acute ischemic stroke due to large vessel occlusion (LVO) has revolutionized in the last decade. We sought to compile the most relevant literature published about the evolution in treating this disabling and fatal disease.Methods
A literature review of recent studies describing early treatment options like intravenous tissue plasminogen activator to the latest mechanical thrombectomy (MT) techniques was performed. We described in a chronological order the evolution of LVO treatment.Results
Recanalization rates with newer techniques and MT devices approach a 90% of effectiveness. Timely interventions have also resulted in better clinical outcomes with approximately 50% of patient achieving functional independence at 90 days. At least 14 new third generation thrombectomy devices are currently being evaluated in in vitro and clinical studies.Conclusions
The treatment of LVO with MT is feasible and safe. MT is standard of care in treating acute ischemic stroke due to LVO. 相似文献8.
Charlotte Lützhøft Rath Niklas Rye Jørgensen Troels Wienecke 《Journal of stroke and cerebrovascular diseases》2018,27(10):2683-2690
Background
Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS.Methods
We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period.Results
A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis.Conclusions
Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients. 相似文献9.
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10.
Han-Jin Cho Kyung-Hye Kim Eun-Joo Kim Tae Hong Lee Sang Min Sung Ji Hoe Heo Dae Soo Jung 《Journal of stroke and cerebrovascular diseases》2018,27(12):3591-3598
Background
Using high-resolution magnetic resonance imaging (HR-MRI), we investigated the impact of basilar artery plaques that were not detected by magnetic resonance angiography (MRA) on the functional outcomes of patients with acute pontine infarction.Methods
A total of 40 patients with acute pontine infarction and normal basilar findings on MRA prospectively underwent HR-MRI for detection of basilar artery plaques. A relevant plaque was defined as one on the dorsal side of basilar artery, the same side of the ischemic lesion, and the same axial slices of the ischemic lesion. We analyzed the relationship between the relevant basilar artery plaques and the functional outcomes at 3 months.Results
The initial National Institutes of Health Stroke Scale score (3.5 versus 2.0, P?=?.012), and the incidences of neurological deterioration (42.9% versus 6.3%, P?=?.031) and unfavorable functional outcome (71.4% versus 12.5%, P?=?.001) were higher in patients with relevant basilar artery plaques than in those without. On multiple regression analysis, the relevant basilar artery plaque was a significant and independent predictor of unfavorable functional outcome (odds ratio, 6.662; 95% confidence interval, 1.117-39.735; P?=?.037).Conclusions
The presence of a relevant basilar artery plaque was closely related with unfavorable functional outcome in patients with acute pontine infarction even if the patients’ MRA showed normal basilar findings. 相似文献11.
Yongwoo Kim Mohammad Faysel Clotilde Balucani Daohai Yu Nadege Gilles Steven R Levine 《Journal of stroke and cerebrovascular diseases》2018,27(12):3419-3424
Objects
To identify predictors of acute ischemic stroke (AIS) among patients presenting to the Emergency Department (ED) with dizziness, imbalance, or vertigo (DIV) based on demographic and clinical characteristics.Methods
We identified patients admitted to the hospital after presenting to the ED with DIV from the Statewide Planning and Research Cooperative System database of New York from 2010 to 2014. Demographic and clinical characteristics were systematically collected. Multivariable logistic regression was used to determine predictors of a discharge diagnosis of AIS.Results
Among 77,993 patients with DIV, 3857 (4.9%) had a discharge diagnosis of AIS. Admission presentation of imbalance, African-American race, history of hypertension, diabetes mellitus, hypercholesterolemia, tobacco use, atrial fibrillation, and prior AIS due to extracranial artery atherosclerosis were each positively associated with an AIS diagnosis independently. Factors negatively associated with an AIS discharge diagnosis included: admission presentation of vertigo, female sex, age > 81, history of anemia, coronary artery disease, asthma, depressive disorders, and anxiety disorders.Conclusions
Multiple potential positive and negative predictive AIS risk factors were identified. Combining with currently available centrally-caused dizziness prediction tools, these newly identified factors could provide more accurate AIS risk stratifying method for DIV patients. 相似文献12.
Ichiro Deguchi Norio Tanahashi Masaki Takao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2627-2631
Background
Anticoagulant therapy is indicated for management of ischemic stroke patients with nonvalvular atrial fibrillation. We retrospectively investigated how oral anticoagulants were selected for ischemic stroke patients with nonvalvular atrial fibrillation.Methods
This study included 297 stroke patients with nonvalvular atrial fibrillation admitted to our hospital between September 2014 and December 2017, and who were subsequently transferred to other institutions or discharged home. Baseline clinical characteristics were compared between patients prescribed warfarin and those prescribed direct-acting oral anticoagulants.Results
In total, 280 of 297 (94.3%) patients received oral anticoagulant therapy, including 36 with warfarin, while 244 received direct oral anticoagulants. Age, percentage of heart failure, CHADS2 score before stroke onset, percentage of treatment with warfarin on admission, percentage of feeding tube at hospital discharge, and modified Rankin Scale at hospital discharge were significantly higher in the warfarin group versus the direct oral anticoagulants group, while creatinine clearance was significantly higher in the direct oral anticoagulant group. By multiple logistic regression, taking warfarin at admission and higher modified Rankin Scale at hospital discharge were associated with warfarin selection, while higher creatinine clearance was associated with direct oral anticoagulant selection (warfarin: odds ratio [OR] 7.10 [95% confidence interval {CI} 2.83-17.81]; modified Rankin Scale at hospital discharge: [OR] 1.47 [95% {CI} 1.06-2.04]; creatinine clearance: [OR] .97 [95% {CI} .95-.99]).Conclusions
Selection of oral anticoagulants in acute ischemic stroke patients with nonvalvular atrial fibrillation was influenced by warfarin use at admission, clinical severity at hospital discharge, and renal function. 相似文献13.
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14.
Cyrielle Tomich Sabrina Debruxelles Yahsou Delmas Sharmila Sagnier Mathilde Poli Stéphane Olindo Pauline Renou François Rouanet Igor Sibon 《Journal of stroke and cerebrovascular diseases》2018,27(11):3163-3171
Introduction
Immune thrombotic thrombocytopenic purpura (i-TTP), related to acquired ADAMTS-13 dysfunction, can lead to various neurological symptoms including ischemic stroke. To date the clinical, radiological, and biological characteristics of patients having a stroke as the inaugural manifestation of i-TTP are largely unknown.Methods
Probable immune-TTP was defined by a low ADAMTS-13 activity associated with the presence of ADAMTS-13 inhibitors and/or favorable clinicobiological response under immunological treatments. The clinical, radiological, biological data and outcome under treatment are described in a cohort of 17 patients coming from 3 local cases and a literature review.Results
Fourteen of the 17 patients were female and the mean age was 41 years. None of the patients had the classical pentad of TTP. Only 41% had a combination of thrombocythemia and hemolysis. Stroke was multifocal in 35% and included large artery strokes. No adverse event was observed following intravenous thrombolysis. Refractory and relapsing forms were observed in 47%.Discussion
The clinical, radiological, and biological presentation of patients with stroke as the inaugural presentation of i-TTP is heterogeneous. This diagnosis should be discussed in every young adult with ischemic stroke of undetermined source. 相似文献15.
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16.
Hannah Pressler Arno Reich Jörg Bernhard Schulz Omid Nikoubashman Klaus Willmes Pardes Habib Jan-Philipp Bach 《Journal of stroke and cerebrovascular diseases》2018,27(10):2669-2676
Background
Access to reperfusion therapies in patients with large vessel occluding acute ischemic stroke demands process reorganization and optimization. Neurovascular networks are being built up to provide 24/7 endovascular stroke therapy service. In times of an increasingly complex stroke rescue chain little is known about patients’ and their relatives’ treatment awareness.Methods
All patients, who received any kind of acute reperfusion treatment between January and August 2017 in the university hospital Aachen, and their proxies, were included in the survey. Patients were either primarily or secondarily transferred.Results
For all questions regarding stroke treatment patients and their caregivers provided concurring answers. 40% of both patients and caregivers did not understand the treatment that was performed. Finally, patients who perceived on their own that stroke detection was delayed had significantly longer onset to door times than patients who did not have this impression.Conclusions
This study showed that patients’ and proxies’ answers correlated significantly. In case of patients’ unavailability extrapolation of treatment satisfaction from answers by proxies might be permitted. High percentages of patients and caregivers do not understand relevant information, possibly due to limits of communication in an emergency setting or deficits in communication during the hospital stay. More emphasis should be laid on providing further information during the hospital stay. 相似文献17.
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18.
Jung-Soo Park Hyo-Sung Kwak Gyung Ho Chung Seungbae Hwang 《Journal of stroke and cerebrovascular diseases》2018,27(10):2797-2803
Background
The objective of this study was to investigate the prognostic value of computed tomographic angiography (CTA) based on leptomeningeal collateral (LMC) status and other parameters in acute ischemic stroke (AIS) patients with internal carotid artery (ICA) terminus occlusion treated with endovascular treatment (EVT).Methods
All eligible patients from January 2013 to December 2017 undergoing EVT were retrospectively reviewed. The regional leptomeningeal score was used to assess the LMCs on baseline CTA. The collateral status measured by the LMC score (0-20) was trichotomized into 3 groups: good (17-20), intermediate (11-16), and poor (0-10).Results
Our sample included a total of 119 eligible patients (60 males; mean age, 73 years) with a median baseline National Institute of Health Stroke Scale (NIHSS) score of 14. Patients with a good LMC score had a lower baseline mean NIHSS score, a higher mean Alberta Stroke Program Early CT score, and a higher mean clot burden score (CBS). Baseline NIHSS score <15 (odds ratio [OR] 3.69 95% confidence ratio [CI]: 1.32-10.29, P?=?.013), CBS ≥ 6 (OR 3.97 95%CI: 1.05-14.99, P?=?.042), good LMC score (OR 5.14 95%CI: 1.62-16.26, P?=?.005) and successful recanalization (OR 11.55 95%CI: 2.72-48.99 P?=?.001) were independent predictors of good clinical outcomes.Conclusions
CTA-based LMC status and CBS are powerful predictors of clinical outcomes in patients with an acute ICA terminus occlusion treated with EVT. 相似文献19.
Satoru Kashima Takahiro Shimizu Hisanao Akiyama Yasuhiro Hasegawa 《Journal of stroke and cerebrovascular diseases》2018,27(12):3613-3620
Background and Purpose
This study aimed to investigate factors associated with stroke recurrence and new-onset atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS).Methods
Between January 2005 and March 2012, a total of 1514 consecutive patients were admitted to our hospital with a diagnosis of acute ischemic stroke within 7 days after onset. Of these, 236 patients met the diagnostic criteria for ESUS. A retrospective analysis was performed of the following characteristics of these ESUS patients: medical history, comorbidities, and magnetic resonance imaging (MRI) findings including the deep and subcortical white matter hyperintensity (DSWMH) grade, drugs used for preventing recurrence, and clinical information such as NIH Stroke Scale scores on admission and outcomes evaluated by modified Rankin scale. The rate of recurrence after discharge and the frequency of new-onset AF were also determined.Results
There were 236 ESUS patients (141 men, mean age 70.2 ± 12.1 years). During the follow-up period, ranging from 7 days to 12.9 years (median 54.3 months), 32 (13.6%) and 44 (18.6%) of these patients had a recurrent ischemic stroke and new-onset AF, respectively. The most prevalent subtype of recurrent ischemic stroke was ESUS itself; this type of stroke occurred in 19 (59.3%) patients. AF was observed at stroke recurrence, but only 2 patients were diagnosed with cardioembolism. Multivariate analysis with a Cox proportional hazard model demonstrated that DSWMH grade greater than or equal to 3 was significantly associated with both recurrent ischemic stroke (hazard ratio 3.66, 95% confidence interval 1.69-7.92, P = .001) and new-onset AF (2.00, 1.03-3.90, .04).Conclusions
MRI classification of white matter hyperintensity could be effectively used as a predictor for recurrent ischemic stroke and new-onset AF in patients with ESUS. 相似文献20.
Greeshma Rajeev-Kumar Umut Sarpel Mandip S. Dhamoon 《Journal of stroke and cerebrovascular diseases》2018,27(11):3311-3319