Pub Date : 2023-01-01Epub Date: 2022-12-08DOI: 10.1159/000528515
Naveen Kumar Paramasivan, Padmavathy N Sylaja, Shivanesan Pitchai, Unnikrishnan Madathipat, Sapna Erat Sreedharan, Sajith Sukumaran, Jissa Vinoda Thulaseedharan
Introduction: Carotid endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from low- and middle-income countries are sparse on CEA and its outcomes. We aimed to describe the profile of our patients and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute.
Methods: Retrospective review of patients with symptomatic carotid stenosis (50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analyzed.
Results: Of the 319 patients (77% males) with a mean age of 64 years (SD±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high-grade stenosis (≥70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD±36); however, only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (≥50%) tandem intracranial atherosclerosis (n = 77, 24%) or contralateral occlusion (n = 24, 7.5%) did not influence the periprocedural stroke risk.
Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high-grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.
导言：颈动脉内膜剥脱术（CEA）是治疗无症状颈动脉狭窄患者的标准方法。中低收入国家关于 CEA 及其结果的数据很少。我们的目的是描述在我院接受CEA的无症状颈动脉狭窄患者的概况以及与围手术期脑缺血事件相关的因素：对2011年1月至2021年12月期间接受CEA手术的无症状颈动脉狭窄（50-99%）患者进行回顾性研究。分析了临床和影像学参数及其对围手术期脑缺血事件的影响：结果：在平均年龄为 64 岁（SD±8.6）的 319 名患者（77% 为男性）中，有 207 人（65%）在中风后才就诊。大多数患者（85%）有症状的颈动脉高度狭窄（≥70%）。CEA的平均手术时间为50天（SD±36），但只有26名患者（8.2%）在2周内接受了手术。轻微中风和 TIA 发生率为 2.2%，而严重中风和死亡发生率为 4.1%。临床或影像学参数均无法预测围手术期脑缺血事件。同时存在明显（≥50%）串联颅内动脉粥样硬化（77例，24%）或对侧闭塞（24例，7.5%）并不影响围手术期卒中风险：结论：接受CEA治疗无症状颈动脉狭窄的患者存在延迟。结论：因症状性颈动脉狭窄而接受 CEA 治疗的患者存在延迟现象，大多数患者颈动脉狭窄程度较高，且在发生中风后才就诊，这反映出患者缺乏相关意识。即使是颅内有明显串联狭窄和对侧颈动脉闭塞的患者，也可以安全地实施 CEA。
{"title":"Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country.","authors":"Naveen Kumar Paramasivan, Padmavathy N Sylaja, Shivanesan Pitchai, Unnikrishnan Madathipat, Sapna Erat Sreedharan, Sajith Sukumaran, Jissa Vinoda Thulaseedharan","doi":"10.1159/000528515","DOIUrl":"10.1159/000528515","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from low- and middle-income countries are sparse on CEA and its outcomes. We aimed to describe the profile of our patients and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute.</p><p><strong>Methods: </strong>Retrospective review of patients with symptomatic carotid stenosis (50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analyzed.</p><p><strong>Results: </strong>Of the 319 patients (77% males) with a mean age of 64 years (SD±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high-grade stenosis (≥70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD±36); however, only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (≥50%) tandem intracranial atherosclerosis (n = 77, 24%) or contralateral occlusion (n = 24, 7.5%) did not influence the periprocedural stroke risk.</p><p><strong>Conclusion: </strong>There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high-grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"56-62"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9278777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Purpose: The COVID-19 pandemic has been continuing its global spread ever since its onset, and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions, and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. Methods: This is a retrospective, comparative study of all adult stroke patients admitted between pre-COVID-19 (February 2019–January 2020) and COVID-19 periods (February 2020–January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID-19 and during COVID-19 were analyzed in the study. Results: There is a decrease in total number of stroke admissions from 597 in the pre-COVID-19 period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from the onset of stroke symptoms, and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID-19 pandemic to 13% during the pandemic. Conclusions: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There were a significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic, and more stroke patients have died compared before the COVID-19 pandemic.
{"title":"Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital","authors":"L. E. Quiles, P. A. Diamante, J. Pascual","doi":"10.1159/000525057","DOIUrl":"https://doi.org/10.1159/000525057","url":null,"abstract":"Background and Purpose: The COVID-19 pandemic has been continuing its global spread ever since its onset, and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions, and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. Methods: This is a retrospective, comparative study of all adult stroke patients admitted between pre-COVID-19 (February 2019–January 2020) and COVID-19 periods (February 2020–January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID-19 and during COVID-19 were analyzed in the study. Results: There is a decrease in total number of stroke admissions from 597 in the pre-COVID-19 period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from the onset of stroke symptoms, and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID-19 pandemic to 13% during the pandemic. Conclusions: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There were a significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic, and more stroke patients have died compared before the COVID-19 pandemic.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"76 - 84"},"PeriodicalIF":1.9,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49599532","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}
Mukaish Kumar, A. Larson, M. S. Jabal, L. Rinaldo, L. Savastano, G. Lanzino, F. Meyer, V. Lehman, J. Klaas
Background: Risk factors for stroke in symptomatic and asymptomatic moyamoya disease (MMD) patients have recently been reported in a Japanese cohort. Such information in a North American population is lacking. Objective: We sought to elucidate the prevalence of stroke risk factors among North American patients with ischemic, hemorrhagic, and asymptomatic MMD. Methods: We retrospectively reviewed our institution’s database between 1990 and 2021. We excluded cases of moyamoya syndrome. We divided 119 patients into 3 groups based on the onset pattern; ischemic, hemorrhagic, and asymptomatic. We compared the prevalence of well-known stroke risk factors (diabetes, hypertension, etc.) between these three groups of patients. In the asymptomatic group, we analyzed the prevalence of cerebrovascular events on follow-up from the time of diagnosis. Results: Overall, 119 patients with MMD were available with predominately White ethnicity (80.7%). The mean age was 39 years, and 73.9% were female. Patients presented with ischemic stroke (82%) and hemorrhagic stroke (11%); 7% of patients were asymptomatic. The prevalence of stroke risk factors did not differ among ischemic, hemorrhagic, or asymptomatic MMD patients. In 8 asymptomatic patients, there was 81.8 months (SD ±51.0) of follow-up, and none of them developed any cerebrovascular events. Conclusions: No significant differences in the prevalence of stroke risk factors between MMD cohorts were found, corroborating evidence provided in a recent Japanese-based study. There were no apparent associations between stroke risk factors and interval cerebrovascular events in an asymptomatic group of MMD patients.
{"title":"Comparison of Stroke Risk Factors between Symptomatic and Asymptomatic Patients in a North American Moyamoya Disease Cohort","authors":"Mukaish Kumar, A. Larson, M. S. Jabal, L. Rinaldo, L. Savastano, G. Lanzino, F. Meyer, V. Lehman, J. Klaas","doi":"10.1159/000525098","DOIUrl":"https://doi.org/10.1159/000525098","url":null,"abstract":"Background: Risk factors for stroke in symptomatic and asymptomatic moyamoya disease (MMD) patients have recently been reported in a Japanese cohort. Such information in a North American population is lacking. Objective: We sought to elucidate the prevalence of stroke risk factors among North American patients with ischemic, hemorrhagic, and asymptomatic MMD. Methods: We retrospectively reviewed our institution’s database between 1990 and 2021. We excluded cases of moyamoya syndrome. We divided 119 patients into 3 groups based on the onset pattern; ischemic, hemorrhagic, and asymptomatic. We compared the prevalence of well-known stroke risk factors (diabetes, hypertension, etc.) between these three groups of patients. In the asymptomatic group, we analyzed the prevalence of cerebrovascular events on follow-up from the time of diagnosis. Results: Overall, 119 patients with MMD were available with predominately White ethnicity (80.7%). The mean age was 39 years, and 73.9% were female. Patients presented with ischemic stroke (82%) and hemorrhagic stroke (11%); 7% of patients were asymptomatic. The prevalence of stroke risk factors did not differ among ischemic, hemorrhagic, or asymptomatic MMD patients. In 8 asymptomatic patients, there was 81.8 months (SD ±51.0) of follow-up, and none of them developed any cerebrovascular events. Conclusions: No significant differences in the prevalence of stroke risk factors between MMD cohorts were found, corroborating evidence provided in a recent Japanese-based study. There were no apparent associations between stroke risk factors and interval cerebrovascular events in an asymptomatic group of MMD patients.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"72 - 75"},"PeriodicalIF":1.9,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42271879","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}
Introduction: Early restoration of blood flow in stroke patients can be achieved by reducing the door-to-computed tomography (DTC) time. Previous research has proposed several methods to reduce the DTC time, but the implementation costs limit its transferability. This study aimed to propose a novel, simple, and low-cost method for reducing the DTC time by providing feedback on each patient’s DTC time to a small group of medical workers and physicians. Methods: A field experiment was conducted for 233 days, and the DTC time of 249 patients with stroke symptoms who were transported via ambulance to a medium-sized university hospital in Japan within 24 h after stroke onset was obtained. The first and second feedback reports on the 59th day and 154th day, respectively, were provided at the beginning of the field experiment. Using the data collected during the first 58 days as baseline data, the baseline data were compared with the post-intervention data. As part of the intervention, feedback on the DTC time for each patient was provided to six medical workers and physicians during regular meetings. The primary outcome was a continuous measure of DTC time (in min). The feedback effect hypothesis was formulated prior to data collection. Results: In a sample of 68 patients at baseline, the mean DTC time was 18.16 min with a standard deviation of 7.38 min. As a result of the two feedback reports, in the sample with outliers, the mean and standard deviation decreased to 15.64 min and 5.97 min, respectively. The difference in means was 2.51 min (p = 0.021 in t tests). Results of the test of the equality of the standard deviations suggested that the two standard deviations were not equal (p = 0.065). Conclusions: The low-cost interventions successfully reduced both the mean DTC time and variation, suggesting an improvement in the quality and consistency of medical services. The result of our fine-grained analysis with a field-experiment design supports the role of feedback in achieving early treatment as suggested in the Target: Stroke initiative.
{"title":"Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time","authors":"T. Mitsuhashi, J. Tokugawa, H. Mitsuhashi","doi":"10.1159/000524725","DOIUrl":"https://doi.org/10.1159/000524725","url":null,"abstract":"Introduction: Early restoration of blood flow in stroke patients can be achieved by reducing the door-to-computed tomography (DTC) time. Previous research has proposed several methods to reduce the DTC time, but the implementation costs limit its transferability. This study aimed to propose a novel, simple, and low-cost method for reducing the DTC time by providing feedback on each patient’s DTC time to a small group of medical workers and physicians. Methods: A field experiment was conducted for 233 days, and the DTC time of 249 patients with stroke symptoms who were transported via ambulance to a medium-sized university hospital in Japan within 24 h after stroke onset was obtained. The first and second feedback reports on the 59th day and 154th day, respectively, were provided at the beginning of the field experiment. Using the data collected during the first 58 days as baseline data, the baseline data were compared with the post-intervention data. As part of the intervention, feedback on the DTC time for each patient was provided to six medical workers and physicians during regular meetings. The primary outcome was a continuous measure of DTC time (in min). The feedback effect hypothesis was formulated prior to data collection. Results: In a sample of 68 patients at baseline, the mean DTC time was 18.16 min with a standard deviation of 7.38 min. As a result of the two feedback reports, in the sample with outliers, the mean and standard deviation decreased to 15.64 min and 5.97 min, respectively. The difference in means was 2.51 min (p = 0.021 in t tests). Results of the test of the equality of the standard deviations suggested that the two standard deviations were not equal (p = 0.065). Conclusions: The low-cost interventions successfully reduced both the mean DTC time and variation, suggesting an improvement in the quality and consistency of medical services. The result of our fine-grained analysis with a field-experiment design supports the role of feedback in achieving early treatment as suggested in the Target: Stroke initiative.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"63 - 71"},"PeriodicalIF":1.9,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43434554","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}
S. Kobayashi, T. Osanai, N. Fujima, A. Hamaguchi, T. Sugiyama, Toshitaka Nakamura, K. Hida, M. Fujimura
Introduction: The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. Materials and Methods: We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization (“puncture to recanalization time”) and the time from the admission to recanalization (“door to recanalization time”), between the groups. Results: MRA-based road mapping significantly reduced the “puncture to recanalization time” (52.0 min vs. 70.0 min; p = 0.019) and the “door to recanalization time” (146 min vs. 183 min; p = 0.013). Conclusion: MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.
{"title":"Efficacy of the MRA-Based Road Mapping of the Para-Aortic Access Route before Mechanical Thrombectomy in Patients with Acute Ischemic Stroke","authors":"S. Kobayashi, T. Osanai, N. Fujima, A. Hamaguchi, T. Sugiyama, Toshitaka Nakamura, K. Hida, M. Fujimura","doi":"10.1159/000524112","DOIUrl":"https://doi.org/10.1159/000524112","url":null,"abstract":"Introduction: The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. Materials and Methods: We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization (“puncture to recanalization time”) and the time from the admission to recanalization (“door to recanalization time”), between the groups. Results: MRA-based road mapping significantly reduced the “puncture to recanalization time” (52.0 min vs. 70.0 min; p = 0.019) and the “door to recanalization time” (146 min vs. 183 min; p = 0.013). Conclusion: MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"47 - 52"},"PeriodicalIF":1.9,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43073440","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}
Yangchen Yangchen, T. Tenzin, Narsingh Rai, S. Yangzom, N. Venketasubramanian
Developing nations face the double burden of communicable and noncommunicable diseases. Bhutan is a developing country and has achieved significant milestones in its health indicators. Increasing burden of stroke and the lack of evidence-based stroke care system in the country’s hospitals are proving to be a challenge to provide quality stroke care. Despite the logistical challenge of referring stroke patients on time, lack of trained health care professionals and resources, Bhutan has recently started various initiatives to improve stroke care with the help of WHO-SEARO, WHO-Geneva, and Christian Medical College, Ludhiana, India.
{"title":"Improving Stroke Care in Bhutan","authors":"Yangchen Yangchen, T. Tenzin, Narsingh Rai, S. Yangzom, N. Venketasubramanian","doi":"10.1159/000523903","DOIUrl":"https://doi.org/10.1159/000523903","url":null,"abstract":"Developing nations face the double burden of communicable and noncommunicable diseases. Bhutan is a developing country and has achieved significant milestones in its health indicators. Increasing burden of stroke and the lack of evidence-based stroke care system in the country’s hospitals are proving to be a challenge to provide quality stroke care. Despite the logistical challenge of referring stroke patients on time, lack of trained health care professionals and resources, Bhutan has recently started various initiatives to improve stroke care with the help of WHO-SEARO, WHO-Geneva, and Christian Medical College, Ludhiana, India.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"33 - 35"},"PeriodicalIF":1.9,"publicationDate":"2022-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42285212","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}
H. Kpoda, L. Savadogo, D. R. S. Samadoulougou, I. Traoré, S. Somda, D. Lemogoum, I. Sombié, A. Millogo, M. Dramaix, P. Donnen
Introduction: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.
{"title":"Prognostic Factors of the Lethality of Stroke at the Sourô Sanou University Teaching Hospital of Burkina Faso","authors":"H. Kpoda, L. Savadogo, D. R. S. Samadoulougou, I. Traoré, S. Somda, D. Lemogoum, I. Sombié, A. Millogo, M. Dramaix, P. Donnen","doi":"10.1159/000523888","DOIUrl":"https://doi.org/10.1159/000523888","url":null,"abstract":"Introduction: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"36 - 46"},"PeriodicalIF":1.9,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44815574","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}
Pub Date : 2022-01-01Epub Date: 2022-08-10DOI: 10.1159/000525598
Katarzyna Wójtowicz, Łukasz Przepiórka, Przemysław Kunert, Andrzej Marchel
Introduction: Pure arterial malformations (PAMs) are rare vascular abnormalities defined as dilated, tortuous arterial loops without any associated venous compartment. PAMs are thought to be benign developmental anomalies that can be safely managed conservatively.
Methods: We present a case of life-threatening hemorrhage in a patient with a PAM associated with two aneurysms and review the literature describing hemorrhages associated with PAMs.
Results: A 65-year-old female presented with subarachnoid and intraventricular hemorrhage. A digital subtraction angiography revealed a posterior inferior cerebellar artery PAM associated with two saccular aneurysms, which were subsequently microsurgically clipped. At the 1-year follow-up, the patient was neurologically intact. In our literature review, we identified 21 papers describing a total of 37 PAMs. Patients were predominantly female (64.9%) and their median age was 35 years. Almost half (48.6%) of PAMs were associated with aneurysms. In the group of PAMs that were not associated with an aneurysm, the intracranial hemorrhage rate was 15.8%, while in cases of coexisting PAM and aneurysm it was 44.4% (p = 0.0789).
Conclusions: PAM natural history remains unknown, particularly in cases of coexistence with aneurysms. Patients so affected require careful observation. The description of PAMs as benign vascular malformations should be revised. Surgical management of hemorrhagic PAMs coexisting with aneurysms is possible and should be considered.
{"title":"Subarachnoid and Intraventricular Hemorrhage in a Patient with a Pure Arterial Malformation and Two Associated Aneurysms in the Posterior Inferior Cerebellar Artery: A Case Report and Literature Review.","authors":"Katarzyna Wójtowicz, Łukasz Przepiórka, Przemysław Kunert, Andrzej Marchel","doi":"10.1159/000525598","DOIUrl":"10.1159/000525598","url":null,"abstract":"<p><strong>Introduction: </strong>Pure arterial malformations (PAMs) are rare vascular abnormalities defined as dilated, tortuous arterial loops without any associated venous compartment. PAMs are thought to be benign developmental anomalies that can be safely managed conservatively.</p><p><strong>Methods: </strong>We present a case of life-threatening hemorrhage in a patient with a PAM associated with two aneurysms and review the literature describing hemorrhages associated with PAMs.</p><p><strong>Results: </strong>A 65-year-old female presented with subarachnoid and intraventricular hemorrhage. A digital subtraction angiography revealed a posterior inferior cerebellar artery PAM associated with two saccular aneurysms, which were subsequently microsurgically clipped. At the 1-year follow-up, the patient was neurologically intact. In our literature review, we identified 21 papers describing a total of 37 PAMs. Patients were predominantly female (64.9%) and their median age was 35 years. Almost half (48.6%) of PAMs were associated with aneurysms. In the group of PAMs that were not associated with an aneurysm, the intracranial hemorrhage rate was 15.8%, while in cases of coexisting PAM and aneurysm it was 44.4% (p = 0.0789).</p><p><strong>Conclusions: </strong>PAM natural history remains unknown, particularly in cases of coexistence with aneurysms. Patients so affected require careful observation. The description of PAMs as benign vascular malformations should be revised. Surgical management of hemorrhagic PAMs coexisting with aneurysms is possible and should be considered.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 3","pages":"117-122"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/cb/cee-0012-0116.PMC9710451.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10782727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bence Gunda, Ain Neuhaus, Ildikó Sipos, Rita Stang, Péter Pál Böjti, Tímea Takács, Dániel Bereczki, Balázs Kis, István Szikora, George Harston
Background: Patient selection for reperfusion therapies requires significant expertise in neuroimaging. Increasingly, machine learning-based analysis is used for faster and standardized patient selection. However, there is little information on how such software influences real-world patient management.
Aims: We evaluated changes in thrombolysis and thrombectomy delivery following implementation of automated analysis at a high volume primary stroke centre.
Methods: We retrospectively collected data on consecutive stroke patients admitted to a large university stroke centre from two identical 7-month periods in 2017 and 2018 between which the e-Stroke Suite (Brainomix, Oxford, UK) was implemented to analyse non-contrast CT and CT angiography results. Delivery of stroke care was otherwise unchanged. Patients were transferred to a hub for thrombectomy. We collected the number of patients receiving intravenous thrombolysis and/or thrombectomy, the time to treatment; and outcome at 90 days for thrombectomy.
Results: 399 patients from 2017 and 398 from 2018 were included in the study. From 2017 to 2018, thrombolysis rates increased from 11.5% to 18.1% with a similar trend for thrombectomy (2.8-4.8%). There was a trend towards shorter door-to-needle times (44-42 min) and CT-to-groin puncture times (174-145 min). There was a non-significant trend towards improved outcomes with thrombectomy. Qualitatively, physician feedback suggested that e-Stroke Suite increased decision-making confidence and improved patient flow.
Conclusions: Use of artificial intelligence decision support in a hyperacute stroke pathway facilitates decision-making and can improve rate and time of reperfusion therapies in a hub-and-spoke system of care.
{"title":"Improved Stroke Care in a Primary Stroke Centre Using AI-Decision Support.","authors":"Bence Gunda, Ain Neuhaus, Ildikó Sipos, Rita Stang, Péter Pál Böjti, Tímea Takács, Dániel Bereczki, Balázs Kis, István Szikora, George Harston","doi":"10.1159/000522423","DOIUrl":"https://doi.org/10.1159/000522423","url":null,"abstract":"<p><strong>Background: </strong>Patient selection for reperfusion therapies requires significant expertise in neuroimaging. Increasingly, machine learning-based analysis is used for faster and standardized patient selection. However, there is little information on how such software influences real-world patient management.</p><p><strong>Aims: </strong>We evaluated changes in thrombolysis and thrombectomy delivery following implementation of automated analysis at a high volume primary stroke centre.</p><p><strong>Methods: </strong>We retrospectively collected data on consecutive stroke patients admitted to a large university stroke centre from two identical 7-month periods in 2017 and 2018 between which the e-Stroke Suite (Brainomix, Oxford, UK) was implemented to analyse non-contrast CT and CT angiography results. Delivery of stroke care was otherwise unchanged. Patients were transferred to a hub for thrombectomy. We collected the number of patients receiving intravenous thrombolysis and/or thrombectomy, the time to treatment; and outcome at 90 days for thrombectomy.</p><p><strong>Results: </strong>399 patients from 2017 and 398 from 2018 were included in the study. From 2017 to 2018, thrombolysis rates increased from 11.5% to 18.1% with a similar trend for thrombectomy (2.8-4.8%). There was a trend towards shorter door-to-needle times (44-42 min) and CT-to-groin puncture times (174-145 min). There was a non-significant trend towards improved outcomes with thrombectomy. Qualitatively, physician feedback suggested that e-Stroke Suite increased decision-making confidence and improved patient flow.</p><p><strong>Conclusions: </strong>Use of artificial intelligence decision support in a hyperacute stroke pathway facilitates decision-making and can improve rate and time of reperfusion therapies in a hub-and-spoke system of care.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 1","pages":"28-32"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/db/cee-0012-0028.PMC9082202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10245477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolas Poupore, Camron Edrissi, Mareshah Sowah, Madison Stanley, Jonah Joffe, Donovan Lewis, Teanda Cunningham, Carolyn Breauna Sanders, Krista Knisely, Chase Rathfoot, Thomas I Nathaniel
Introduction: This study investigates gender differences among stroke patients treated in the telestroke network using specific risk factors that contribute to stroke severity.
Methods: We examined gender differences in stroke severity among 454 patients hospitalized with acute ischemic stroke (AIS). The logistic regression model was used to predict clinical risk factors associated with stroke severity in men and women AIS patients.
Results: In the adjusted analysis among women patients, increasing age (odds ratio [OR] = 1.05, 95% CI: 1.017-1.085, p = 0.003) and higher heart rate (OR = 1.031, 95% CI: 1.005-1.058, p = 0.021) were associated with worsening neurological functions, while direct admission (OR = 0.191, 95% CI: 0.079-0.465, p < 0.001) was associated with improving neurologic functions. Among men, hypertension (OR = 3.077, 95% CI: 1.060-8.931, p = 0.039) and higher international normalized ratio (INR) (OR = 21.959, 95% CI: 1.489-323.912, p = 0.024) were associated with worsening neurologic functions, while Caucasian (OR = 0.181, 95% CI: 0.062-0.526, p = 0.002) and obesity (OR = 0.449, 95% CI: 0.203-0.99, p = 0.047) were associated with neurologic improvement.
Conclusion: Increasing age and heart rate in women, hypertension and greater INR in men contribute to worsening neurologic functions. There is a need to develop strategies to improve the care of both men and women in the telestroke network.
简介:本研究利用影响脑卒中严重程度的特定危险因素，调查在脑卒中网络中接受治疗的脑卒中患者的性别差异。方法:对454例急性缺血性脑卒中(AIS)住院患者的脑卒中严重程度进行性别差异分析。采用logistic回归模型预测与男性和女性AIS患者脑卒中严重程度相关的临床危险因素。结果:在女性患者的校正分析中，年龄增加(优势比[OR] = 1.05, 95% CI: 1.017-1.085, p = 0.003)和心率升高(OR = 1.031, 95% CI: 1.005-1.058, p = 0.021)与神经功能恶化相关，而直接入院(OR = 0.191, 95% CI: 0.079-0.465, p < 0.001)与神经功能改善相关。在男性中，高血压(OR = 3.077, 95% CI: 1.060-8.931, p = 0.039)和较高的国际标准化比值(INR) (OR = 21.959, 95% CI: 1.489-323.912, p = 0.024)与神经功能恶化相关，而高加索(OR = 0.181, 95% CI: 0.062-0.526, p = 0.002)和肥胖(OR = 0.449, 95% CI: 0.203-0.99, p = 0.047)与神经功能改善相关。结论:女性年龄和心率的增加、男性高血压和INR的升高会导致神经功能的恶化。有必要制定战略，以改善远程中风网络中男性和女性的护理。
{"title":"Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network.","authors":"Nicolas Poupore, Camron Edrissi, Mareshah Sowah, Madison Stanley, Jonah Joffe, Donovan Lewis, Teanda Cunningham, Carolyn Breauna Sanders, Krista Knisely, Chase Rathfoot, Thomas I Nathaniel","doi":"10.1159/000525099","DOIUrl":"https://doi.org/10.1159/000525099","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates gender differences among stroke patients treated in the telestroke network using specific risk factors that contribute to stroke severity.</p><p><strong>Methods: </strong>We examined gender differences in stroke severity among 454 patients hospitalized with acute ischemic stroke (AIS). The logistic regression model was used to predict clinical risk factors associated with stroke severity in men and women AIS patients.</p><p><strong>Results: </strong>In the adjusted analysis among women patients, increasing age (odds ratio [OR] = 1.05, 95% CI: 1.017-1.085, p = 0.003) and higher heart rate (OR = 1.031, 95% CI: 1.005-1.058, p = 0.021) were associated with worsening neurological functions, while direct admission (OR = 0.191, 95% CI: 0.079-0.465, p < 0.001) was associated with improving neurologic functions. Among men, hypertension (OR = 3.077, 95% CI: 1.060-8.931, p = 0.039) and higher international normalized ratio (INR) (OR = 21.959, 95% CI: 1.489-323.912, p = 0.024) were associated with worsening neurologic functions, while Caucasian (OR = 0.181, 95% CI: 0.062-0.526, p = 0.002) and obesity (OR = 0.449, 95% CI: 0.203-0.99, p = 0.047) were associated with neurologic improvement.</p><p><strong>Conclusion: </strong>Increasing age and heart rate in women, hypertension and greater INR in men contribute to worsening neurologic functions. There is a need to develop strategies to improve the care of both men and women in the telestroke network.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"12 2","pages":"93-101"},"PeriodicalIF":1.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/c0/cee-0012-0093.PMC9574206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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