Stroke (Hoboken, N.J.)最新文献

{"title":"Intravenous Thrombolysis Is Associated With Better Outcomes in Large‐Vessel Occlusion Requiring Endovascular Therapy","authors":"D. Isenberg, Joseph Herres, E. Brandler, Huaqing Zhao, C. Kraus, Daniel Ackerman, A. Sigal, Alexander Kuc, J. Nomura, D. Cooney, Michael T. Mullen, J. Shahan, K. Murphy, T. Deaner, S. Wojcik, N. Gentile","doi":"10.1161/svin.122.000814","DOIUrl":"https://doi.org/10.1161/svin.122.000814","url":null,"abstract":"\u0000 \u0000 Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are both important treatments for large‐vessel occlusion stroke. However, it is still unclear how the timing of IVT, EVT, and the need for transfer of a patient to an endovascular stroke center for EVT affect outcomes. In this investigation, we study the interaction between IVT, rapidity to EVT, and need for transfer among patients with large‐vessel occlusion stroke.\u0000 \u0000 \u0000 \u0000 \u0000 This investigation is an analysis of the OPUS‐REACH (Optimizing the Use Prehospital Stroke Systems of Care–Reacting to Changing Paradigms) registry of patients with large‐vessel occlusion stroke from 9 endovascular centers in the United States. Using the database, we extracted baseline characteristics of patients, whether the patient received IVT, and time intervals in the patients’ care. Patient demographics and characteristics were compared between 2 groups using the χ\u0000 2\u0000 test for categorical variables and 2‐sample\u0000 t\u0000 ‐tests or Wilcoxon rank‐sum tests for continuous variables. Multivariable logistic regression was performed to determine the adjusted associations of the variables with 90‐day dichotomized modified Rankin Scale outcome.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 1171 patients were included in the final analysis, and 38.9% had good functional outcome at 90 days. Male sex and lower initial National Institutes of Health Stroke Scale score were nonmodifiable factors associated with good clinical outcomes. We saw no differences in outcome whether a patient underwent primary or secondary transport. On multiple variable analysis, the receipt of IVT was the only modifiable factor associated with good outcomes. We found no overall effect of time from last known well to EVT on 90‐day outcomes unless the patient received IVT.\u0000 \u0000 \u0000 \u0000 In this investigation, receipt of IVT was independently associated with improved outcomes at 90 days with an odds ratio of 1.51. Neither shorter time from last known well to EVT nor direct transport to an endovascular stroke center versus transfer to an endovascular stroke center was associated with improved outcomes. We therefore conclude that prehospital algorithms must account for the timely administration of IVT over time to EVT.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45450376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior circulation","authors":"Arpita Lakhotia","doi":"10.1161/svin.123.000898","DOIUrl":"https://doi.org/10.1161/svin.123.000898","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45119660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage","authors":"Wendy Dusenbury, G. Tsivgoulis, Jason J. Chang, N. Goyal, Victoria Swatzell, A. Alexandrov, P. Lyden, A. Alexandrov","doi":"10.1161/svin.123.000834","DOIUrl":"https://doi.org/10.1161/svin.123.000834","url":null,"abstract":"\u0000 \u0000 We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes.\u0000 \u0000 \u0000 \u0000 \u0000 We prospectively collected clinical assessments, imaging, and outcome data in consecutive patients with intracerebral hemorrhage, and determined the ability of GCS and NIHSS to predict poor functional outcome (modified Rankin scale 3–6) and hematoma volume >30 cm\u0000 3\u0000 using receiver operating characteristics analysis, C‐statistics, and the DeLong test.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 We studied 672 patients with intracerebral hemorrhage (mean age 62±14 years; 56% men; median intracerebral hemorrhage score=1, interquartile range (IQR) 0–2; median intracerebral hemorrhage volume 7 cm\u0000 3\u0000 , IQR 2–19) with median NIHSS of 8 (IQR 3–18) and GCS 15 (IQR 7–15). NIHSS correlated strongly to GCS (r=−0.773;\u0000 P\u0000 <0.001). Admission NIHSS (C‐statistic: 0.91; 95% CI, 0.89–0.93) predicted better than GCS (0.78; 95% CI, 0.75–0.81) discharge poor functional outcome (DeLong test\u0000 P\u0000 <0.001). NIHSS (0.82; 95% CI, 0.78–0.86) also discriminated better than GCS (0.78; 95% CI, 0.73–0.83) patients with large hematoma volume (DeLong test\u0000 P\u0000 =0.029).\u0000 \u0000 \u0000 \u0000 \u0000 The NIHSS has a greater discriminative power than GCS to identify patients at risk of poor early functional outcomes and large hematoma volumes.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45268280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls of Randomized Controlled Trials in Stroke: How Can We Do Better?","authors":"S. Yaghi, J. Siegler, Thanh N. Nguyen","doi":"10.1161/svin.123.000807","DOIUrl":"https://doi.org/10.1161/svin.123.000807","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43069676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vessel Wall Magnetic Resonance Imaging of Bilateral Distal Internal Carotid Artery Stenosis in Intracranial Giant Cell Arteritis","authors":"How-Chung Cheng, P. Mosimann, Patrick K. Nicholson, J. Schaafsma, E. J. Hendriks","doi":"10.1161/svin.123.000918","DOIUrl":"https://doi.org/10.1161/svin.123.000918","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46086491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Angioscopy for the Detection of Mobile Carotid Artery Lesions","authors":"Kenji Fukutome, S. Aketa, Takaaki Mitsui, Yukiyo Shiraishi, Hiromichi Hayami, Yasutaka Murakami, Ryuta Matsuoka, Mikio Shiba, Rinsei Tei, Y. Shin, Y. Motoyama","doi":"10.1161/svin.123.000879","DOIUrl":"https://doi.org/10.1161/svin.123.000879","url":null,"abstract":"\u0000 \u0000 A 78‐year‐old man with a mobile lesion was diagnosed with thrombus using carotid ultrasonography, but the lesion was not completely resolved with dual antiplatelet and anticoagulation therapy. Direct visualization by angioscopy showed a white mobile plaque. The carotid artery was stented with a double‐layered stent, as the plaque persisted despite continuing the medical treatment and was linked to an increased risk of cerebral embolism. The plaque was attached to the arterial wall, and it subsequently disappeared. The patient recovered well and no further emboli were observed.\u0000 \u0000 \u0000 \u0000 Angioscopy is effective for identifying lesions under direct vision. The characteristics and dynamics of plaques may be viewed via angioscopy, which aids in making treatment‐related decisions, particularly in the case of carotid artery plaques.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41493997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Drug Use‐Associated Endocarditis Leads to Increased Intracranial Hemorrhage and Neurological Comorbidities","authors":"A. Hoang, Varun S. Shah, J. Granger, D. Iii, P. Youssef, C. Powers, O. Tanweer, L. McCullough, S. Nimjee","doi":"10.1161/svin.122.000806","DOIUrl":"https://doi.org/10.1161/svin.122.000806","url":null,"abstract":"\u0000 \u0000 The United States is experiencing a rapidly increasing rate of opioid drug abuse. Intravenous drug use (IVDU)‐related endocarditis can lead to significant neurological complications with high morbidity and mortality. When patient care necessitates anticoagulation, the standards for radiographic screening and the risk for intracranial hemorrhage are not clearly elucidated.\u0000 \u0000 \u0000 \u0000 We conducted a retrospective cohort study involving patients treated for infective endocarditis at a single institution from 2014 to 2018. Patients were grouped based in history of IVDU and their demographics and clinical predictors for intracranial hemorrhage were analyzed.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 351 patients met inclusion criteria for this study, of whom 170 patients (48%) had a history of IVDU‐associated endocarditis. IVDU was associated with an increased prevalence of intracranial hemorrhage (25.9% versus 13.9%;\u0000 P\u0000 =0.005), including intraparenchymal hemorrhage (12.4% versus 5.1%;\u0000 P\u0000 =0.012), subarachnoid hemorrhage (17.6 versus 4.4%;\u0000 P\u0000 =0.001), and cerebral microbleeds (14.1% versus 7.2%;\u0000 P\u0000 =0.022). IVDU was also associated with an increased incidence of infectious intracranial aneurysm (10.6% versus 1.8%;\u0000 P\u0000 =0.001) and brain abscesses (4.7% versus 1.1%;\u0000 P\u0000 =0.025). Multivariate analysis showed that the presence of intracranial septic emboli (odds ratio [OR], 18.47 [8.4–40.250];\u0000 P\u0000 =0.001) and infectious intracranial aneurysm (OR, 12.38 [3.24–47.28];\u0000 P\u0000 =0.001) as significant predictive factors for intracranial hemorrhage after presenting with endocarditis.\u0000 \u0000 \u0000 \u0000 \u0000 The opioid epidemic has increased the incidence of infective endocarditis and resultant neurovascular complications. IVDU‐associated endocarditis is associated with increased hemorrhagic stroke and more frequent neurodiagnostic imaging.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44668477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Surgery Revascularization of Chronic Cervical Carotid Occlusions: Systematic Review and Meta‐Analysis","authors":"S. Ortega‐Gutierrez, M. Galecio-Castillo, Cynthia B. Zevallos, A. Rodriguez-Calienes, J. Vivanco-Suarez, J. Weng, E. Samaniego, M. Farooqui, C. Derdeyn","doi":"10.1161/svin.123.000882","DOIUrl":"https://doi.org/10.1161/svin.123.000882","url":null,"abstract":"Chronic symptomatic internal carotid artery occlusion is an important cause of ischemic strokes. Medical management alone remains suboptimal for secondary prevention, and randomized controlled trials failed to demonstrate the efficacy and safety of extracranial‐intracranial vascular bypass. Carotid occlusion endovascular surgery (COES) is a promising technique, yet its efficacy and safety remain unclear. This systematic review and meta‐analysis included studies in which patients with chronic symptomatic internal carotid artery occlusion underwent treatment with COES and medical management. Primary outcomes included successful reperfusion rates and periprocedural ischemic and hemorrhagic events rates. Secondary outcomes included rates of ischemic events recurrence, other periprocedural events, and mortality. Studies contained at least one of the treatment groups and outcomes of interest. Twenty‐two studies were selected for systematic review, with 18 of them for meta‐analysis. From 14 studies (N=561) the rate of successful recanalization was achieved in 74% of all patients undergoing COES. Thirteen studies (N=534) showed that the rate of COES was 2% both for periprocedural ischemic and hemorrhagic events. At long‐term follow‐up, the COES cohort included a total of 10 studies (N=311) and had a 12% rate of ischemic events, while the medical management group, which included 5 studies (N=313), showed a rate of 19%, with nonsignificant subgroup differences ( P =0.09, I 2 , 12%). Rates of other periprocedural mortality were 4% and 1%, respectively. This meta‐analysis supports the use of COES as a promising and innovative technique for the secondary prevention of symptomatic internal carotid artery occlusion. Our findings suggest that COES may be superior to medical management alone, although further research is needed to fully evaluate its efficacy and safety.","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47221187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon‐Expandable Stenting as a Bridging Therapy in Patients With Acute Stroke and Tandem Occlusions","authors":"N. Rodriguez-villatoro, D. Rodríguez-Luna, M. Muchada, O. Pancorbo, M. Deck, P. Lozano, S. Boned, Á. García‐Tornel, M. Olivé, J. Juega, J. Pagola, M. Rubiera, D. Hernández, C. Molina, C. Piñana, Isabel Rodríguez, M. de Dios, J. Cuevas, M. Requena, L. Gramegna, M. Ribó, A. Tomasello","doi":"10.1161/svin.122.000825","DOIUrl":"https://doi.org/10.1161/svin.122.000825","url":null,"abstract":"\u0000 \u0000 Stenting extracranial internal carotid artery (ICA) lesions in acute ischemic stroke with tandem lesions is technically challenging. Its safety is highly debated because of the requirement of dual‐antiplatelet therapy. The optimal stenting device, timing, and periprocedural antiplatelet therapy for extracranial ICA stenting in the setting of acute tandem occlusion are still unclear.\u0000 \u0000 \u0000 \u0000 We performed a retrospective study of patients with acute ischemic stroke attributable to tandem lesions who underwent endovascular treatment during a 5‐year period receiving either conventional self‐expanding carotid stents (SX) or balloon‐expandable carotid stent (BX). BX stents were restented with an SX in the subacute phase. Primary outcomes of interest were extracranial ICA patency at follow‐up and symptomatic intracranial hemorrhage.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 112 patients admitted from April 2016 to April 2021 were included. Dual‐antiplatelet therapy immediately following endovascular treatment was more frequently administered in the SX group (35/39 [89.7%]) compared with the BX group (20/73 [27.4%]) (\u0000 P\u0000 <0.001). Patients in the BX stent group (3/73 [4.1%]) developed a lower rate of symptomatic intracranial hemorrhage compared with patients in the SX stent group (7/39 [17.9%]) (\u0000 P\u0000 =0.031). No differences in extracranial ICA high‐grade restenosis or reocclusion were found between groups at 24 hours after procedure (BX: 20/73 [27.4%]; SX: 9/39 [23.1%];\u0000 P\u0000 =0.673).\u0000 \u0000 \u0000 \u0000 \u0000 In patients with acute ischemic stroke and tandem occlusions, a bridging therapy including BX stents with less‐aggressive antiplatelet therapy and subsequent definitive SX stenting to treat extracranial ICA lesions resulted in a lower rate of symptomatic hemorrhagic transformation and no differences in stent patency.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42355004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Accuracy of N20 Somatosensory Potential in Patients With Acute Ischemic Stroke and Endovascular Thrombectomy","authors":"A. Martinez‐Piñeiro, G. Lucente, M. Hernández-Pérez, Jordi Cortés, A. Arbex, N. Pérez de la Ossa, A. Ramos‐Fransi, M. Almendrote, M. Millán, M. Gomis, L. Dorado, C. Castaño, S. Remollo, P. Cuadras, A. Garrido, Nicolau Guanyabens, Joaquim Broto, E. López‐Cancio, J. Coll‐Cantí, A. Dávalos","doi":"10.1161/svin.122.000735","DOIUrl":"https://doi.org/10.1161/svin.122.000735","url":null,"abstract":"\u0000 \u0000 Somatosensory evoked potentials may add substantial prognostic value in patients with acute ischemic stroke and contribute to the selection of patients who may benefit from revascularization therapies beyond the accepted therapeutic time windows. We aimed to study the prognostic accuracy of the N20 somatosensory evoked potential component of the ischemic hemisphere in patients with anterior large‐vessel occlusion undergoing endovascular thrombectomy (EVT).\u0000 \u0000 \u0000 \u0000 Presence and amplitude of the N20 response were recorded before and after EVT. Its adjusted predictive value for functional independence (modified Rankin scale score, ≤2) at day 7 was analyzed by binary logistic regression adjusting by age, mean arterial blood pressure, National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, and serum glucose. N20 predictive power was compared with that of clinical and imaging models by using receiver operating characteristics curve analysis.\u0000 \u0000 \u0000 \u0000 A total of 223 consecutive patients were studied (mean age, 70 years; median National Institute of Health Stroke Scale score, 18). Somatosensory evoked potential recordings identified the presence of N20 in 110 (49.3%), absence in 58 (26%), and not assessable in 55 patients due to radiofrequency interferences in the angiography room. Before EVT, N20 predicted functional independence with a sensitivity of 93% (95% CI, 78%–98%) and negative predictive value of 93% (95% CI, 80%–98%). The adjusted odds ratio for functional independence was 9.9 (95% CI, 3.1–44.6). In receiver operating characteristics curve analysis, N20 amplitude showed a higher area under the curve than prehospital or in‐hospital variables, including advanced imaging. Sensitivity increased to 100% (95% CI, 0.85–1) when N20 was present after EVT.\u0000 \u0000 \u0000 \u0000 Somatosensory evoked potential monitoring is a noninvasive and bedside technique that could help eligibility of patients with acute ischemic stroke for EVT and predict functional recovery.\u0000","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41862925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}