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Outcomes of Mild Stroke and High-Risk Transient Ischemic Attack in Current Clinical Practice. 当前临床实践中轻度脑卒中和高危短暂性脑缺血发作的结局。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-01-01 DOI: 10.1159/000526969
Apiluk Wesanonthawech, Pornpatr A Dharmasaroja

Introduction: Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. This study aimed to evaluate the outcomes of these patients and identify the predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke.

Methods: Patients with mild ischemic stroke (NIHSS ≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 h of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed.

Results: 254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95% CI: 1.06-5.81), cardioembolism (OR 3.34, 95% CI: 1.26-8.87), and brainstem stroke (OR 2.78, 95% CI: 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95% CI: 3.31-100), moderate to severe white matter lesions (OR 2.90, 95% CI: 1.44-5.84), clinical progression (OR 12.5, 95% CI: 5.08-31.25), and recurrent stroke (OR 8.47, 95% CI: 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95% CI: 2.35-19.02), diabetes mellitus (OR 2.59, 95% CI: 1.07-6.27), and smoking (OR 4.26, 95% CI: 1.52-11.95) were related to recurrent stroke.

Conclusion: Implementation of the up-to-date standard care in clinical practice would bring good clinical outcomes to the patients with mild stroke and high-risk TIA.

介绍:建议专家对轻度脑卒中和短暂性脑缺血发作(TIA)患者进行早期评估和处理。本研究旨在评估这些患者的预后,并确定临床进展、不良预后和卒中复发的预测因素。方法:对轻度缺血性脑卒中(NIHSS≤5)及高危TIA患者进行研究。所有患者均在卒中发作后24小时内由卒中专家进行治疗。观察患者3个月及最终随访结果。分析临床进展、不良结局和卒中复发的预测因素。结果:254例患者纳入研究。38例(15%)患者在入院时出现临床进展。大动脉粥样硬化(OR 2.49, 95% CI: 1.06-5.81)、心脏栓塞(OR 3.34, 95% CI: 1.26-8.87)和脑干卒中(OR 2.78, 95% CI: 1.28-6.01)与临床进展相关。在中位22个月的最后随访中,81例患者(32%)出现不良结果。既往残疾(OR 1.81, 95% CI: 3.31-100)、中度至重度白质病变(OR 2.90, 95% CI: 1.44-5.84)、临床进展(OR 12.5, 95% CI: 5.08-31.25)和卒中复发(OR 8.47, 95% CI: 3.21-22.72)与不良结局相关。11例(4%)患者在3个月内卒中复发,31例(12%)患者在最后随访时卒中复发。年龄较大(OR 6.68, 95% CI: 2.35-19.02)、糖尿病(OR 2.59, 95% CI: 1.07-6.27)和吸烟(OR 4.26, 95% CI: 1.52-11.95)与卒中复发有关。结论:在临床实践中实施最新的标准护理对轻度脑卒中高危TIA患者具有良好的临床效果。
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引用次数: 0
Serum Prealbumin Levels on Admission as a Prognostic Marker in Stroke Patients Treated with Mechanical Thrombectomy. 入院时血清白蛋白前水平作为机械取栓治疗的脑卒中患者的预后指标。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-01-01 DOI: 10.1159/000526354
Begoña López, Maria Castañón-Apilánez, Javier Molina-Gil, Santiago Fernández-Gordón, Gemma González, Antía Reguera Acuña, Jose Maria Jimenez, Davinia Larrosa Campo, Montserrat González Delgado, Lorena Benavente-Fernández, Maria Rico-Santos, Carmen García-Cabo, Sergio Calleja Puerta, Elena López-Cancio

Introduction: Prealbumin is a marker of malnutrition and inflammation. It has been associated with poor prognosis in cardiovascular disease, but less is known in stroke patients. Our objective was to evaluate the association of prealbumin levels at admission with prognosis in patients with stroke treated with mechanical thrombectomy.

Methods: Retrospective study of a prospective database of consecutive patients treated with mechanical thrombectomy. Clinical, radiological, and blood parameters including serum prealbumin, and prognostic variables such as respiratory infection, in-hospital mortality, and the modified Rankin scale at 3 months were collected.

Results: We included 319 patients between 2018 and 2019. Prealbumin levels were significantly lower in patients older than 80 years, women, patients with a prestroke Rankin score >2, a glomerular filtrate rate <60 mL/min, and in those with atrial fibrillation. Regarding prognostic variables, prealbumin levels were not associated with respiratory infection. Low prealbumin levels were associated with poor functional prognosis (Rankin score >2), in-hospital mortality, and 3-month mortality. In multivariate analysis, prealbumin was an independent risk factor associated with mortality at 3 months, OR 0.92 [0.86-0.98], p = 0.019.

Conclusion: Lower prealbumin levels at admission behaved as an independent predictor of long-term mortality in patients treated with mechanical thrombectomy. These results should be replicated in other cohorts.

白蛋白前是营养不良和炎症的标志。它与心血管疾病的预后不良有关,但对中风患者的预后了解较少。我们的目的是评估接受机械取栓治疗的脑卒中患者入院时白蛋白前水平与预后的关系。方法:对机械取栓术患者的前瞻性数据库进行回顾性研究。收集临床、放射学和血液参数,包括血清白蛋白前,以及预后变量,如呼吸道感染、住院死亡率和3个月时的改良Rankin量表。结果:我们在2018年至2019年期间纳入了319例患者。80岁以上、女性、卒中前Rankin评分>2、肾小球滤过率2、住院死亡率和3个月死亡率的患者中,白蛋白前水平显著降低。在多因素分析中,白蛋白前是与3个月死亡率相关的独立危险因素,OR为0.92 [0.86-0.98],p = 0.019。结论:入院时较低的白蛋白前水平是机械取栓患者长期死亡率的独立预测因子。这些结果应该在其他队列中得到重复。
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引用次数: 1
Ten Years of Cerebrovascular Diseases EXTRA 脑血管病十年特刊
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-03-26 DOI: 10.1159/000515830
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引用次数: 0
Short-Vessel Occlusion Might Indicate Higher Possibility of Success in Reperfusion following Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion. 急性大脑中动脉闭塞患者机械取栓后,短血管闭塞可能提示再灌注成功的可能性更高。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-11-12 DOI: 10.1159/000519556
Tomoyuki Yoshihara, Ryuzaburo Kanazawa, Takanori Uchida, Tetsuhiro Higashida, Hidenori Ohbuchi, Naoyuki Arai, Yuichi Takahashi

Background: The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy.

Methods: This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared.

Results: We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5-1.9] vs. 1.2 [1.2-1.5] mm, p = 0.007) and shorter length (7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90).

Conclusion: In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.

背景:急性大血管闭塞时闭塞血管的长度对机械取栓成功再灌注的影响尚不清楚。本研究评估急性大脑中动脉(MCA)闭塞血管的直径和长度是否与机械取栓后成功再灌注有关。方法:本回顾性研究纳入了急性MCA闭塞患者,他们接受主动脉内注射造影剂,通过配备血管造影系统的平板计算机断层扫描(FD-CT)获得最大强度投影(MIP)图像。所有患者均接受机械取栓,并分为再灌注成功组(Thrombolysis in Cerebral Infarction [TICI] 2b/3)和再灌注失败组。我们比较了两组间闭塞血管的直径和长度。在使用支架回收器患者的亚分析中,比较闭塞血管长度与活动区长度的比例。结果:我们纳入了29例患者(中位年龄:73岁,M1闭塞:51%,支架回收器使用率:72%)。18例患者达到TICI 2b/3,闭塞血管远端直径明显增大(1.7[四分位数间距:1.5-1.9]比1.2 [1.2-1.5]mm, p = 0.007),长度明显缩短(7.1[4.9-9.7]比12.3 [7.2-15.8]mm, p = 0.043)。21例患者的亚分析显示,闭塞血管与支架回收器活动区(曲线下受者工作特征面积:0.90)之比为TICI 2b/3再灌注的临界值为0.32。结论:在急性MCA闭塞中,FD-CT MIP图像显示远端直径越大,闭塞血管长度越短,机械取栓后达到TICI 2b/3的可能性越大。
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引用次数: 1
Burden of Stroke in Myanmar. 缅甸的中风负担。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-05-10 DOI: 10.1159/000515123
Narayanaswamy Venketasubramanian, Yee Mon Khine, Ohnmar Ohnmar, Myat Po Po Kyaw Khin, Min Thit Win

Myanmar is home to over 51 million people. The age- and sex-standardized mortality rate due to stroke is 165.4/100,000, while the rate of age- and sex-standardized disability-adjusted life years lost due to stroke is 2971.3/100,000. The prevalence of stroke among adults aged 40-99 years is 1.5%. Stroke is the leading cause of morbidity and mortality and comprises 20% of the neurological workload. There are only 10 stroke units in the whole country. Doctors are aware of the importance of hypertension in stroke prevention and the need for physiotherapy after stroke, but, until recently and in rural areas, they also tend to use steroids and neuroprotectants, and lower blood pressure aggressively acutely after stroke; antiplatelets are not widely used. Thrombolysis service is available at some tertiary centers but mechanical thrombectomy is not yet available.

缅甸人口超过5100万。中风导致的年龄和性别标准化死亡率为165.4/10万,而中风导致的年龄和性别标准化残疾调整生命年损失率为2971.3/10万。40-99岁的成年人中风患病率为1.5%。中风是发病率和死亡率的主要原因,占神经负荷的20%。全国只有10个中风单位。医生们意识到高血压在卒中预防中的重要性和卒中后物理治疗的必要性,但直到最近,在农村地区,他们还倾向于使用类固醇和神经保护剂,并在卒中后急剧降低血压;抗血小板药物没有被广泛使用。一些三级中心提供溶栓服务,但尚未提供机械取栓。
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引用次数: 1
The Benefit of Endovascular Thrombectomy for Stroke on Functional Outcome Is Sustained at 12 Months. 血管内血栓切除术对脑卒中患者功能预后的益处持续了12个月。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-08-06 DOI: 10.1159/000517929
Balaki Parameshwaran, Dennis Cordato, Mark Parsons, Andrew Cheung, Nathan Manning, Jason Wenderoth, Cecilia Cappelen-Smith

Background and purpose: The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life.

Methods: Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018-Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L).

Results: Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (n = 64) of patients were functionally independent (mRS 0-2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving.

Conclusion: Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.

背景和目的:血管内取栓术(EVT)治疗急性缺血性卒中(AIS)的短期益处已被广泛报道,但没有足够的证据表明这种益处可以长期持续。我们的目的是确定EVT在3个月时对功能结局的益处是否在12个月时保持,以及与功能独立性和生活质量相关的因素。方法:分析数据来自一个综合卒中中心(2018年10月- 2019年9月)连续接受EVT患者的前瞻性登记。对患者进行了为期12个月的电话访谈。功能结局采用改良Rankin量表(mRS)评估。生活质量通过返回通常的居住地、工作地点或开车来确定,并使用欧洲生活质量5维度问卷(EQ-5D-3L)计算健康效用指数。结果:在研究期间接受EVT的151例患者中,有145例(96%)进行了12个月的随访。12个月时,44% (n = 64)的患者功能独立(mRS 0-2),而3个月时为48%。12个月时的死亡率为26%,而3个月时为17%。12个月时功能独立性的显著预测因子是年龄更小和基线较低的美国国立卫生研究院卒中量表。较好的生活质量与返回常住地和驾车显著相关。结论:3个月的功能独立性在12个月时持续,表明EVT对AIS患者在较长期内仍然有益。
{"title":"The Benefit of Endovascular Thrombectomy for Stroke on Functional Outcome Is Sustained at 12 Months.","authors":"Balaki Parameshwaran,&nbsp;Dennis Cordato,&nbsp;Mark Parsons,&nbsp;Andrew Cheung,&nbsp;Nathan Manning,&nbsp;Jason Wenderoth,&nbsp;Cecilia Cappelen-Smith","doi":"10.1159/000517929","DOIUrl":"https://doi.org/10.1159/000517929","url":null,"abstract":"<p><strong>Background and purpose: </strong>The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life.</p><p><strong>Methods: </strong>Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018-Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L).</p><p><strong>Results: </strong>Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (n = 64) of patients were functionally independent (mRS 0-2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving.</p><p><strong>Conclusion: </strong>Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"81-86"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/26/cee-0011-0081.PMC8460944.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39377298","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}
引用次数: 1
Stroke Burden and Services in the Philippines. 菲律宾的中风负担与服务。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-05-11 DOI: 10.1159/000516238
Jose C Navarro, Narayanaswamy Venketasubramanian
{"title":"Stroke Burden and Services in the Philippines.","authors":"Jose C Navarro, Narayanaswamy Venketasubramanian","doi":"10.1159/000516238","DOIUrl":"10.1159/000516238","url":null,"abstract":"","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"52-54"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/3e/cee-0011-0052.PMC8216023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38901346","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}
引用次数: 0
Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis. 利用超声和炎症改善缺血性脑卒中的预测:动脉粥样硬化多民族研究的二次分析。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 DOI: 10.1159/000514373
Hediyeh Baradaran, Alen Delic, Ka-Ho Wong, Nazanin Sheibani, Matthew Alexander, J Scott McNally, Jennifer J Majersik, Adam De Havenon

Introduction: Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.

Methods: In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.

Results: We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.

Conclusions: In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.

目前缺血性卒中风险预测主要基于临床因素,而不是影像学或实验室标志物。我们检查了基线超声和炎症测量与随后的原发性缺血性卒中风险之间的关系。方法:在这项多民族动脉粥样硬化研究(MESA)的次要分析中,主要结局是随访期间缺血性卒中的发生。预测变量为基线研究访问时的9项颈动脉超声测量和6项血清炎症测量。我们用Cox回归模型拟合缺血性脑卒中的预后。基线模型包括患者年龄、高血压、糖尿病、总胆固醇、吸烟和收缩压。评估拟合优度统计,将基线模型与超声和炎症预测变量的模型进行比较,这些变量添加到基线模型后仍然显着。结果:我们纳入了5918名参与者。105例患者的主要结局为缺血性卒中,平均随访时间为7.7年。在Cox模型中,我们发现颈动脉扩张性(CD)、颈动脉狭窄(CS)和血清白介素-6 (IL-6)与卒中事件相关。根据拟合优度统计,将CD、IL-6和CS类别的分位数添加到包含传统临床血管危险因素的基线模型中,模型拟合优于单独使用传统危险因素。结论:在基线时无脑血管疾病的多种族患者队列中,我们发现CD、CS和IL-6有助于预测原发性缺血性卒中的发生。未来的研究可以评估这些基本的超声和血清测量是否对一级预防工作或临床试验纳入标准有影响。
{"title":"Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis.","authors":"Hediyeh Baradaran,&nbsp;Alen Delic,&nbsp;Ka-Ho Wong,&nbsp;Nazanin Sheibani,&nbsp;Matthew Alexander,&nbsp;J Scott McNally,&nbsp;Jennifer J Majersik,&nbsp;Adam De Havenon","doi":"10.1159/000514373","DOIUrl":"https://doi.org/10.1159/000514373","url":null,"abstract":"<p><strong>Introduction: </strong>Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.</p><p><strong>Methods: </strong>In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.</p><p><strong>Results: </strong>We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.</p><p><strong>Conclusions: </strong>In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 1","pages":"37-43"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000514373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295451","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}
引用次数: 4
Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort. 模拟院前分诊对真实生活点滴和船舶机械取栓的城市患者队列的影响。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-11-25 DOI: 10.1159/000520078
Stavros Matsoukas, Brian Giovanni, Liorah Rubinstein, Shahram Majidi, Laura K Stein, Johanna T Fifi

Objective: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.

Methods: We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) ("actual" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times ("actual" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.

Results: Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.

Conclusions: Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.

目的:本研究的目的是利用来自多医院系统的真实数据,模拟急诊大血管闭塞(ELVO)到血管内功能中心(ECC)的院前分诊对取栓和静脉溶栓时机的影响。方法:我们选择了一组77例连续卒中患者,这些患者由急诊医疗服务(EMS)带到无血管内功能中心,然后转移到ECC进行机械取栓(MT)(“实际”滴注和船[DS]队列)。我们创建了一个假设的场景(旁路模型[BM]),基于患者的初始EMS取车地址和最近的ECC,对患者直接转移到ECC进行建模。在另一组73例连续患者中,我们计算了平均门到针和门到动脉穿刺(AP)时间(“实际”母舰[MS]队列),这些患者直接被EMS送到ECC并接受血管内介入治疗。将实际MS队列和实际DS队列的时间与BM队列的时间进行比较。结果:DS组从首次医疗接触(FMC)到静脉溶栓的中位时间为87.5分钟(四分位数间距[IQR] = 38),而BM组为78.5分钟(IQR = 8.96), p = 0.1672。在DS组和BM组中,FMC到AP的中位时间分别为244分钟(IQR = 97)和147分钟(IQR = 8.96) (p < 0.001), FMC到TICI 2B+的中位时间分别为299分钟(IQR = 108.5)和197分钟(IQR = 8.96) (p < 0.001)。结论:ELVO患者的模拟EMS院前分诊结果缩短了MT时间,而没有改变溶栓时间。随着分诊工具的敏感性和特异性的提高,EMS分诊方案将改善患者的预后。
{"title":"Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort.","authors":"Stavros Matsoukas,&nbsp;Brian Giovanni,&nbsp;Liorah Rubinstein,&nbsp;Shahram Majidi,&nbsp;Laura K Stein,&nbsp;Johanna T Fifi","doi":"10.1159/000520078","DOIUrl":"https://doi.org/10.1159/000520078","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.</p><p><strong>Methods: </strong>We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) (\"actual\" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times (\"actual\" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.</p><p><strong>Results: </strong>Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.</p><p><strong>Conclusions: </strong>Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"137-144"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/30/cee-0011-0137.PMC8740215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39771116","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}
引用次数: 0
Stroke Burden and Stroke Services in Bangladesh. 孟加拉国的中风负担和中风服务。
IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2021-01-01 Epub Date: 2021-07-09 DOI: 10.1159/000517234
Narayanaswamy Venketasubramanian, Muzharul Mannan
Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, and south by the Bay of Bengal [1]. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, and life expectancy is 72.3 years; 74% live in rural areas. Stroke is a major cause of death and disability in the region, with an ageand sex-standardized mortality rate of 54.8 per 100,000 and disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh [2]. The prevalence of stroke at approximately 1–2% of those aged over 20 years [3] is similar in males and females, and urban and rural areas [4], but increases with age such that the ratio of infarction to hemorrhage is 2.91 in the community [5]. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, and the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, and 5%, respectively [6]; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, and there is a clear seasonal variation in the frequency of hemorrhagic stroke [7, 8]. The high stroke mortality among Bangladeshi populations may be due to the high frequency of the conventional atherosclerotic risk factors, especially of hypertension and diabetes mellitus [9]; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, and the combined effect of smoking and tobacco chewing [10]. Stroke mortality might be related to stroke severity, delayed diagnosis, and stroke care gaps discussed further below. Medical services are free in the community [11]. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary level care is provided at district hospitals; tertiary level care is provided at medical college hospitals and super-specialty hospitals. There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh. Acute care for stroke patients is available in 2 government and 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country and 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) [12] and out-patients (24%) [13]. The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients
{"title":"Stroke Burden and Stroke Services in Bangladesh.","authors":"Narayanaswamy Venketasubramanian,&nbsp;Muzharul Mannan","doi":"10.1159/000517234","DOIUrl":"https://doi.org/10.1159/000517234","url":null,"abstract":"Bangladesh, with a population of 165.6 million people, is located in the northwest region of South Asia, bordered on the west, north, and east by India, southeast by Myanmar, and south by the Bay of Bengal [1]. The per-capita income is USD 1,909, poverty rate is 20.5%, literacy (7+ years) is 73.2%, and life expectancy is 72.3 years; 74% live in rural areas. Stroke is a major cause of death and disability in the region, with an ageand sex-standardized mortality rate of 54.8 per 100,000 and disability-adjusted life years lost of 888.1 per 100,000 in Bangladesh [2]. The prevalence of stroke at approximately 1–2% of those aged over 20 years [3] is similar in males and females, and urban and rural areas [4], but increases with age such that the ratio of infarction to hemorrhage is 2.91 in the community [5]. Stroke incidence has not been studied in adequate epidemiological studies. In a large multicenter hospital study, 72% had ischemic stroke, and the frequency of hypertension, smoking, diabetes mellitus, ischemic heart disease, and dyslipidemia was 58%, 45%, 23%, 17%, and 5%, respectively [6]; these are not from population-based studies. Small-vessel “lacunar” disease was the most common type of ischemic stroke, and there is a clear seasonal variation in the frequency of hemorrhagic stroke [7, 8]. The high stroke mortality among Bangladeshi populations may be due to the high frequency of the conventional atherosclerotic risk factors, especially of hypertension and diabetes mellitus [9]; there is a strong belief over the importance of betel nut chewing, squatting and straining during defecation, chronic infection, vitamin D deficiency, and the combined effect of smoking and tobacco chewing [10]. Stroke mortality might be related to stroke severity, delayed diagnosis, and stroke care gaps discussed further below. Medical services are free in the community [11]. Community clinics are available at villages at ward levels, while small hospital services are located at the union and upazila levels. Secondary level care is provided at district hospitals; tertiary level care is provided at medical college hospitals and super-specialty hospitals. There are 2,213 hospitals with 45,723 registered physicians, but only 160 trained neurologists through training programs only provided at Dhaka Medical College (DMC) and Bangabandhu Sheikh Mujib Medical University (BSMMU). There are 2,300 technologists operating 250 CT scans and 80 MRIs in Bangladesh. Acute care for stroke patients is available in 2 government and 5 private hospitals, all situated in Dhaka, the capital city, while subacute care provided by neurologists is available in 23 government hospitals located in most parts of the country and 7 private hospitals. Stroke is the most common condition among neurology in-patients (48%) [12] and out-patients (24%) [13]. The Bangladesh Rehabilitation Assistance Committee (BRAC), a nongovernmental organization (NGO), provides stroke rehabilitation services to patients ","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"69-71"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000517234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173802","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}
引用次数: 1
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Cerebrovascular Diseases Extra
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