Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2019
Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models.
Thrombolytic therapy with intravenous alteplase (IV-rtPA) has a known risk of symptomatic intracerebral hemorrhage (sICH). We aim to identify factors with a significant association with the development of sICH post-IV-rtPA. We also aim to perform an external validation of sICH predicting scores in our patient population. ⋯ We found that presenting MAP, presence of early infarct signs on CT Head and blood glucose greater than or equal to 185 mg/dL upon a patient's presentation have a significant association with sICH post-IV-rtPA when the ECASS-II definition was used, while presenting MAP and verify Aspirin less than 500 upon a patient's presentation have a significant association with sICH post-IV-rtPA when the NINDS definition was used. Our study found that HAT and DRAGON scores had the highest AUC, and they were the most valid in predicting the development of sICH in our independent cohort. Patients with these risk factors should receive more intensive neurological monitoring.
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J Stroke Cerebrovasc Dis · Nov 2019
Acute Ischemic Stroke with Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center.
Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) can prevent severe disability and mortality. There is currently limited data on the epidemiology of LVO strokes and ET eligibility. We aim to determine the incidence of intracranial vessel occlusion (IVO) strokes eligible for ET per 2018 American Heart Association (AHA) guidelines and characteristics of an AHA ineligible population at a comprehensive stroke center (CSC). ⋯ At a CSC, 1 in 4 AISs harbor an IVO. Seven in 100 acute ischemic strokes, 3 in 10 strokes with vessel occlusion, and 1 in 2 strokes with internal carotid or middle cerebral artery M1 occlusion are thrombectomy eligible per AHA 2018 guidelines. These data highlight that current guidelines render a majority of strokes thrombectomy ineligible and a large window of opportunity exists for clinical investigation.
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J Stroke Cerebrovasc Dis · Nov 2019
Randomized Controlled TrialEducating Stroke/TIA Patients about Obstructive Sleep Apnea after Stroke: A Randomized Feasibility Study.
Obstructive sleep apnea (OSA) occurs in about 70% of stroke and transient ischemic attack (TIA) patients and is associated with poor function and recurrent vascular events. Continuous Positive Airway Pressure (CPAP) has been shown to improve poststroke/TIA outcomes but adherence is generally poor. This study aimed to develop and conduct a preliminary assessment of educational materials for poststroke/TIA OSA. ⋯ The educational program was feasible and easy to understand amongst stroke/TIA patients but did not lead to a significant change in outcomes or CPAP use. The lessons learned can be used to facilitate future development of educational materials and plan an adequately-powered trial.
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J Stroke Cerebrovasc Dis · Nov 2019
Multicenter Study Observational StudyTemporal Trends in Clinical Characteristics and Door-to-Needle Time in Patients Receiving Intravenous Tissue Plasminogen Activator: A Retrospective Study of 4 Hospitals in Japan.
Intravenous recombinant tissue plasminogen activator (rt-PA) has become a common treatment for acute ischemic stroke and has highly time-dependent benefits. We aimed to clarify temporal trends regarding the frequency and characteristics of patients receiving rt-PA and explore factors associated with door-to-needle time (DNT) in Japanese emergency hospitals. ⋯ Intravenous rt-PA was widely adopted in Japanese emergency hospitals. Characteristics of patients receiving intravenous rt-PA have changed over the past decade. Several factors, including the year of treatment, were associated with DNT, which has shortened over time.
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J Stroke Cerebrovasc Dis · Nov 2019
Causes, Predictors, and Trends of Unplanned Readmissions after Elective Endovascular Embolization of Cerebral Aneurysms.
30- and 90-day readmissions (dRA) are being increasingly scrutinized as quality metrics for hospital and provider performances. Little information regarding risk factors for readmission after elective endovascular treatment (EVT) of an unruptured cerebral aneurysm (UCA) is available. ⋯ Readmission rates after elective EVT of UCAs decreased between 2010 and 2014. We identified several novel risk factors for both 30dRAs and 90dRAs that can be used to identify patients who are at highest risk of readmission.