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1.
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2.
Xiaopeng Chu Yongxin Yang Fushan Zhang Ruidiong Ye Wenzheng Chu 《Journal of stroke and cerebrovascular diseases》2018,27(11):3261-3265
Background
To validate iScore and PLAN score in acute anterior circulation large vessel occlusion stroke patients undergoing thrombectomy.Methods
iScore and PLAN score were calculated for consecutive acute ischemic stroke undergoing thrombectomy were included and death at 1 month and death at 3 months were recorded. The area under the receiver operating characteristic curve was used to assess the discrimination ability of the scales for death.Results
Two hundred and twenty-nine patients were included, 25.3% (58 of 229) of patient died at 1 month after thrombectomy and 25.8% (59 of 229) of them died at 3 months after thrombectomy. The receiver operator curve analysis found that iScore (area under the curve [AUC] = .76, 95% confidence interval [CI] .69-.83) was numerically better than PLAN score (AUC?=?.73, 95% CI .66-.81) for predicting death at day 90. The cut-off for iScore is 193, with sensitivity 64%, specificity 79%, positive predictive value 75% and negative predictive value 69%.Conclusions
The iScore scale is a valid predictive tool for death in anterior circulation large vessel occlusions undergoing thrombectomy. 相似文献3.
Takahiro Ota Keigo Shigeta Tatsuo Amano Masayuki Ueda Teruyuki Hirano Yuji Matsumaru Yoshiaki Shiokawa 《Journal of stroke and cerebrovascular diseases》2018,27(11):3350-3355
Background and Purpose
To improve results of acute thrombectomy, the time from stroke onset to efficient recanalization must be minimized. Studies have confirmed the importance of rapid treatment, workflow, and efficient team-based care for acute thrombectomy in large vessel occlusion. This study examined the challenges facing mechanical thrombectomy in the Tama area (population, 4.3 million), a densely populated urban area of Tokyo, Japan, and analyzed retrospective data from the Tama-REgistry of Acute endovascular Thrombectomy.Methods
This study was a retrospective observational study using data from Tama-REgistry of Acute endovascular Thrombectomy, a multicenter registry of mechanical thrombectomy for acute ischemic stroke in the Tama area of Tokyo. The survey covered 396 patients with large vessel occlusion who underwent acute thrombectomy between January 2015 and March 2017. Participating facilities are 12 of the 13 recanalization therapy-capable stroke centers.Results
We analyzed 326 cases for which modified Rankin Scale score at 90days was available, of which 264 cases were directly admitted, and 62 cases were transferred from other stroke centers. Median time from stroke onset to hospital arrival was 111 minutes, and from arrival to efficient recanalization was 135 minutes. Efficient recanalization was achieved in 257 cases (78.8%), symptomatic hemorrhage developed in 19 cases (5.8%), and modified Rankin Scale 0-2 at 90days was seen in 129 cases (39.6%). The vast majority of patients (n?=?299, 94.3%) were transferred within 10km to the enrolling hospital.Conclusions
These results provide useful information about the emergent transfer system for patients with large vessel occlusion in a densely populated urban area. 相似文献4.
John W. Liang Laura Cifrese Lili Velickovic Ostojic Syed O. Shah Mandip S. Dhamoon 《Neurocritical care》2018,29(3):336-343
Objective
To estimate rates of all-cause and potentially preventable readmissions up to 90 days after discharge for aneurysmal subarachnoid hemorrhage (SAH) and medical comorbidities associated with readmissionsBackground
Readmission rate is a common metric linked to compensation and used as a proxy to quality of care. Prior studies in SAH have reported 30-day readmission rates of 7–17% with a higher readmission risk among those with the higher SAH severity, ≥?3 comorbidities, and non-home discharge. Intermediate-term rates, up to 90-days, and the proportion of these readmissions that are potentially preventable are unknown. Furthermore, the specific medical comorbidities associated with readmissions are unknown.Methods
Index SAH admissions were identified from the 2013 Nationwide Readmissions Database. All-cause readmissions were defined as any readmission during the 30-, 60-, and 90-day post-discharge period. Potentially preventable readmissions were identified using Prevention Quality Indicators developed by the US Agency for Healthcare Research and Quality. Unadjusted and adjusted Poisson models were used to identify factors associated with increased readmission rates.Results
Out of 9987 index admissions for SAH, 7949 (79%) survived to discharge. The percentage of 30-, 60-, and 90-day all-cause readmissions were 7.8, 16.6, and 26%, respectively. Up to 14% of readmissions in the first 30 days were considered potentially preventable and acute conditions (dehydration, bacterial pneumonia, and urinary tract infections) accounted for over half, whereas acute cerebrovascular disease was the most common cause for neurological return. In multivariable analysis, significant predictors of a higher readmission rate included diabetes (rate ratio [RR] 1.09, 95% confidence interval [CI] 1.03–1.15), congestive heart failure (RR 1.09, 1.003–1.18), and renal impairment (RR 1.35, 1.13–1.61). Only discharge home was associated with a lower readmission rate (RR 0.89, 0.85–0.93).Conclusions
SAH has a 30-day readmission rate of 7.8% which continues to rise into the intermediate-term. A low but constant proportion of readmissions are potentially preventable. Several chronic medical comorbidities were associated with readmissions. Prospective studies are warranted to clarify causal relationships.5.
Kamal Narayan Arya Shanta Pandian Vinod Puri 《Journal of stroke and cerebrovascular diseases》2018,27(11):3236-3246
Background
Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects.Methods Design
Randomized controlled trial.Setting
Functional therapy laboratory of Rehabilitation Institute.Participants
Thirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand.Outcome Measure
Semmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery).Intervention
The experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups.Results
Post intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04).Conclusion
MT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands. 相似文献6.
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7.
Edmund Cheong Peta Toner Gill Dowie Jim Jannes Tim Kleinig 《Journal of stroke and cerebrovascular diseases》2018,27(12):3436-3442
Objective
We designed a computed tomography angiography (CTA)-based algorithm for patients presenting to hospital with a transient ischemic attack (TIA) which identified high-risk patients, as well as inpatient versus semiurgent outpatient management following MRI, and we hypothesised that this would be effective.Methods
Patients seen in the ED at the Royal Adelaide Hospital from March 3, 2012 to November 30, 2016 with TIA-like symptoms were assessed for a cardioembolic source (clinical assessment, electrocardiogram) and underwent intra and extracranial CTA. Patients with a referable >50% stenosis were admitted and given dual antiplatelets. Most high-risk cardiac source patients were also admitted and anticoagulated. Other patients were loaded with aspirin, or changed to clopidogrel if on aspirin, and reviewed as outpatients following semiurgent MRI (3-4 days). We assessed the 90-day recurrent stroke risk in this cohort as a whole, and in those with a final cerebrovascular diagnosis.Results
1167 patients were diagnosed in Emergency as TIA and referred via our algorithm. A total of 150 were admitted, 78 had “high-risk” features. A total of 1017 patients were reviewed in the TIA clinic. The average age of the total cohort was 65.8 years old. Final diagnosis was TIA/minor stroke in 69% admitted patients and 30% clinic patients (P value < .0001). The 90-day recurrent stroke risk in these patients was 2.0% (5.8% admitted vs .7% clinic patients, P value < .0001). In those with noncerebrovascular diagnoses, there were no recurrent strokes within 90 days.Conclusions
Stroke risk is very low using CTA guided semiurgent clinic review algorithm. 相似文献8.
Setareh Salehi Omran Srikanth Reddy Boddu Aaron M. Gusdon Benjamin Kummer Hediyeh Baradaran Praneil Patel Iván Díaz Babak B. Navi Ajay Gupta Hooman Kamel Athos Patsalides 《Journal of stroke and cerebrovascular diseases》2018,27(11):3124-3130
Background and Purpose
Risk factors for hemorrhagic transformation of ischemic stroke after mechanical thrombectomy (MT) are not well established. We conducted a study to determine if prominent angiographic cerebral vascularity following recanalization with thrombectomy (angiographic blush) is associated with hemorrhagic transformation.Methods
Using the Cornell AcutE Stroke Academic Registry, we identified stroke patients who had thrombectomy and achieved recanalization of anterior circulation large-vessel occlusion between 2012 and 2015. The exposure variable was presence of angiographic blush after recanalization, defined as capillary blush with or without early venous drainage. The primary outcome was volume of hemorrhagic transformation on brain imaging after thrombectomy, as determined by semiautomated volumetric analysis on computed tomography or magnetic resonance imaging among those adjudicated to have hemorrhagic conversion by neuroradiology investigators blinded to angiography results. Using a doubly robust estimator with propensity scores and outcome regression adjusting for demographics and known risk factors for hemorrhagic transformation, we evaluated whether angiographic blush after recanalization is associated with an increased volume of hemorrhagic transformation.Results
Among 48 eligible patients, 31 (64.6%) had angiographic blush and 26 (54.2%) had radiographic hemorrhagic transformation (mean volume, 7.6 ml). Patients with angiographic blush averaged lower thrombolysis in cerebral infarction scores and more often received intravenous thrombolysis. In adjusted analysis, angiographic blush was associated with an increased volume of hemorrhagic transformation: mean volume, 10.3ml (95% CI, 3.7-16.9 ml) with blush versus 1.8ml (95% Confidence Interval (CII = Confidence Interval), 0.1-3.4 ml) without (P?=?.01).Conclusions
Presence of angiographic blush after MT was independently associated with the volume of hemorrhagic transformation. 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.
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11.
Haihua Yang Ning Ma Lian Liu Feng Gao Dapeng Mo Xuan Sun Zhongrong Miao 《Journal of stroke and cerebrovascular diseases》2018,27(10):2822-2828
Background
The diffusion-weighted imaging (DWI) brain stem score (BSS) is an easy to use and can predict the clinical outcome of acute basilar artery occlusion (BAO) who underwent endovascular thrombectomy. The purpose of the current study was to validate its performance in Chinese acute BAO patients treated with mechanical thrombectomy.Methods
Fifty consecutive patients with acute BAO who received early magnetic resonance imaging and treated with mechanical thrombectomy in a single-center were included. Early ischemic damage on DWI was evaluated by applying BSS system. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the score system and multivariate logistic regression analysis was performed to identify predictor of clinical outcome.Results
Favorable outcomes were achieved in 38% patients (19 of 50 patients). Recanalization was successful in 92% patients (46 of 50 patients). Mortality rate was 26% (n?=?13/50). In ROC curve analysis, the area under ROC curve of BSS .864 (95% confidence interval [CI], .738-.945) to predict favorable and .769 (95% CI, .628-.877) to predictor mortality. In logistic regression adjusted for age, baseline National Institute of Health Stroke Scale and time to puncture, DWI BSS ≤2 (odds ratio [OR], 12.416; 95% CI, 2.520-61.179; P?=?.002) and DWI BSS >3 (OR, 7.871; 95% CI, 1.353-45.797; P?=?.022) were the independent predictor for favorable outcome and mortality at 3 months respectively.Conclusions
The results of this study suggest that the DWI BSS can be used to predict clinical outcome in patients with acute BAO treated with mechanical thrombectomy at 3 months. 相似文献12.
Wanhong Chen Fang Huang Min Li Yongjun Jiang Jianbo He Huiqi Li Zheng Dai Wei Shi Mingyue Zhu Guanghui Chen Fang Yang Renliang Zhang 《Journal of stroke and cerebrovascular diseases》2018,27(11):3030-3035
Background
The incidence and predictors for in-stent restenosis (ISR) was not fully explored. We aim to investigate the incidence and predictors of ISR after stenting at the origin of vertebral artery.Materials and Methods
Two hundred and six patients with 229 stents implantation between July 1, 2005 and July 31, 2015 were included in the study. All patients underwent conventional clinical and angiographic (digital subtraction angiography) follow-up at around 6 months post procedure. ISR was defined as greater than 50% stenosis within or immediately (within 5 mm) adjacent to the stent. Multivariate Cox regression analyses were utilized to investigate the predictors for ISR.Results
The ISR was found in 30 patients (30/206, 14.6%) with 31 lesions (31/229, 13.5%) with the mean follow-up duration of 11.1-month (range: 3 - 92 months). Stent diameter (hazard ratio 0.504, 95% confidence interval 0.294 - 0.864) was an independent predictor for ISR.Conclusion
ISR rate after Vertebral artery ostium stent placement is acceptable, which was conversely associated with the stent diameter. 相似文献13.
Amélie Gabet Christine de Peretti France Woimant Maurice Giroud Yannick Béjot Alexis Schnitzler Valérie Olié 《Journal of stroke and cerebrovascular diseases》2018,27(12):3443-3450
Goal
We studied time trends of admission in neurological rehabilitation units (NRU) among patients hospitalised for stroke from 2010 to 2014 and compared prognostic factors of functional gain, home return and inpatient survival.Methods
Patients hospitalized for Stroke from 2010 to 2014 were selected from the French national hospital databases. Admission in rehabilitation was searched till 3 months. Predictive factors of functional gain, home return, in-patient survival, and the corresponding trends were studied using logistic regression.Results
In 2014, global rehabilitation rate was 36.3% with 15.8 discharged in a NRU. The rate of patients managed in NRU rose between 2010 and 2014. An increase in the proportion of home return (+4%) and inpatient survival rate (+7%) were observed between 2010 and 2014. Almost 40% of patients with severe functional deficits benefited of a partial or complete recovery after their rehabilitation stay. NRU admission was associated with higher probability of functional gain (OR [odds ratio] =1.76 [confidence interval {CI} 95% 1.67-1.85]), home return (OR?=?1.38 [CI 95% 1.29-1.47]) and inpatient survival (OR?=?3.15 [CI 95% 2.83-3.52]).Conclusions
A greater proportion of patients were admitted in NRU along with an increase of home return and in-patient survival, but too many patients remained excluded. 相似文献14.
Suzanne Babyar Taiza Santos Tenysson Will-Lemos Suleimy Mazin Dylan Edwards Michael Reding 《Journal of stroke and cerebrovascular diseases》2018,27(12):3621-3625
Objective
To compare the effects of Transcranial Direct Current Stimulation (tDCS) versus Galvanic Vestibular Stimulation (GVS) on Lateropulsion following stroke.Methods
Patients with Stroke and Burke Lateropulsion Scale (BLS) scores greater than or equal to 2 gave informed consent to receive sinusoidal 1 Hz DC (0-2 mA) anodal stimulation over the affected parietal cortex versus similar GVS with ipsilesional mastoidal anode. Seated haptic center of pressure (COP-X) was measured using an AMTI analog-to-digital forceplate. An inclinometer (Biopac ) measured lateral thoracic tilt. COP-X Power Spectra were analyzed over 3 frequency intervals: 0-.3 Hz, .3-1 Hz, and 1-3 Hz.Results
Six males/4 females age 66 ± 9.5 standard deviation with admission BLS scores of 5.4 ± 3.7 within 8.6 ± 8.1 days poststroke were enrolled. COP-X medial-lateral speed increased for both the tDCS and the GVS protocols compared to sham condition. Fourier Analysis of COP-X velocity for 0-.3 Hz responses showed a significant increase for tDCS stimulation. The .3-1 Hz responses for the tDCS condition were decreased from baseline. Lateral thoracic tilt showed significant improvement for tDCS compared to Sham stimulation at 10 minutes and for GVS versus Sham at 15 minutes.Discussion
Anodal tDCS over the ipsilesional PIVC increases low frequency postural responses usually attributed to visual control with down regulation of median frequency vestibular responses, biasing postural control toward more dependence on visual as opposed to vestibular control.Conclusions
2 mA sinusoidal 1 Hz anodal tDCS over the ipsi-lesional PIVC or similar ipsi-lesional anodal GVS improve Lateropulsion following stroke. 相似文献15.
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16.
Claudia Rodríguez-López Federico Ballenilla Marco Jaime Díaz Guzmán 《Journal of stroke and cerebrovascular diseases》2018,27(12):3652-3656
Background
Both acute single intracranial and tandem occlusions are managed with intravascular thrombectomy with success, but little evidence exists about the differences in their mid-term outcome. We aim to compare the outcome at 3 months after tandem (extracranial internal carotid and/or middle cerebral artery) and single intracranial (M1 division) occlusions, and to identify the factors, which determine such prognosis.Methods
A total of 66 patients (33 with tandem and 33 with singleM1 occlusions) who underwent emergent intravascular therapy in our center between November of 2013 and November of 2016 were collected. Patients’ medical histories were reviewed for clinical and radiological variables. A modified Rankin Scale of 3 or more was considered as bad outcome. An interobserver concordance analysis evaluated the quality of collaterals in the initial computed tomography through the Maas, Miteff, and CGS (collateral grading scale) scales.Results
No differences were found in theprognosis of tandem versus single M1 occlusions (P?=?.30). The kappa index for the Maas scale was .77 (95% confidence interval [CI] .59-.94) and bad collaterals were defined by a score of 1 or 2. The factors independently associated with a worse prognosis were the presence of bad collaterals (adjusted odds ratio [OR] 6.03, 95% CI 1.01-35.9, P?=?.048) and an incomplete revascularization (adjusted OR 6.01, 95% CI 1.01-35.7, p?=?.049).Conclusions
The outcome of patients with acute stroke secondary to tandem or M1 occlusions has not been found to depend on their localization. The bad quality of collaterals is the main factor related to an unfavorable prognosis. 相似文献17.
Greeshma Rajeev-Kumar Umut Sarpel Mandip S. Dhamoon 《Journal of stroke and cerebrovascular diseases》2018,27(11):3311-3319
Background
Cancer treatment, specifically surgical intervention, as a possible stroke trigger is understudied.Methods
Using the Nationwide Readmissions Database and validated diagnosis and procedure codes, we identified adults with index admissions for colorectal surgery for colorectal adenocarcinoma (Group A) and compared them to admissions for colorectal surgery for benign conditions (Group B) and hepatobiliary or pancreatic surgery for benign conditions (Group C). Within the colorectal cancer cohort, we further identified patients who underwent open versus laparoscopic surgery. The primary outcome was readmission for ischemic or hemorrhagic stroke up to 1 year. Cumulative risk of ischemic stroke was calculated using risk survival statistics, and hazard ratios (HR) were calculated using adjusted Cox regression.Results
Patients in Group A had higher 3-month readmission rates for ischemic and hemorrhagic strokes than those in Groups B and C. Higher risk of ischemic stroke (HR 1.46, 95% confidence interval [CI] 1.20-1.79) in Group A compared to Group B was eliminated following adjustments for illness severity and vascular risk factors. Comparing types of colorectal surgical intervention for cancer, there was significantly greater risk of ischemic stroke with open versus laparoscopic surgery, despite adjusting for vascular risk factors (HR 1.70, 95% CI 1.15-2.52).Conclusions
We found elevated risk of ischemic stroke up to 1 year following open surgery for colorectal adenocarcinoma compared to laparoscopic. More research is necessary to clarify the underlying surgery-related mechanisms that contribute to elevated risk. 相似文献18.
19.
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20.
Yongwoo Kim Mohammad Faysel Clotilde Balucani Daohai Yu Nadege Gilles Steven R Levine 《Journal of stroke and cerebrovascular diseases》2018,27(12):3419-3424