首页 > 最新文献

European Stroke Journal最新文献

英文 中文
Risk factors for intracerebral hemorrhage by five specific bleeding sites: Japan Public Health Center-based Prospective Study. 按五个特定出血部位划分的脑内出血风险因素:日本公共卫生中心前瞻性研究。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-17 DOI: 10.1177/23969873241290680
Kenichi Ariyada, Kazumasa Yamagishi, Tomomi Kihara, Isao Muraki, Hironori Imano, Yoshihiro Kokubo, Isao Saito, Hiroshi Yatsuya, Hiroyasu Iso, Shoichiro Tsugane, Norie Sawada

Background: Evaluating the risk factors for intracerebral hemorrhage is indispensable for primary prevention. However, the pathogenesis varies depending on the bleeding site, and few prospective studies have explored risk factors in detail for each site.

Participants and methods: The Japan Public Health Center-based Prospective Study is a prospective study comprising a population-based sample of Japanese adults in 1990 (Cohort I) and in 1993 (Cohort II). A total of 34,137 participants (11,907 men and 22,230 women) were enrolled in this study and followed up until 2009 for Cohort I and until 2012 for Cohort II. The association between risk factors (age, sex, blood pressure, serum cholesterol, triglycerides, blood glucose, body mass index, smoking, and drinking status) and intracerebral hemorrhage by its bleeding site (lobes, putamen, thalamus, cerebellum, and brainstem) was assessed using Cox proportional hazards analysis.

Results: During a median 20-year follow-up, 571 intracerebral hemorrhage events occurred. Hypertension was associated with an increased risk of total intracerebral hemorrhage, but not lobar hemorrhage. The multivariable hazard ratio (95% confidence intervals) was 2.09 (1.75-2.50) for total intracerebral hemorrhage. In contrast, a low serum total cholesterol level was associated only with lobar hemorrhage (1.73 (1.01-2.96)). Heavy drinking was associated with the risk of total and putamen hemorrhage, and obesity was associated with the risk of putamen hemorrhage.

Discussion and conclusion: The present study identified different risk factors depending on the bleeding site of intracerebral hemorrhage.

背景:评估脑出血的危险因素对于一级预防是必不可少的。然而,不同出血部位的发病机理各不相同,很少有前瞻性研究对每个部位的风险因素进行详细探讨:日本公共卫生中心前瞻性研究是一项前瞻性研究,包括 1990 年(队列 I)和 1993 年(队列 II)的日本成年人人群样本。共有 34,137 名参与者(男性 11,907 人,女性 22,230 人)参加了这项研究,其中队列 I 的随访至 2009 年,队列 II 的随访至 2012 年。研究采用 Cox 比例危险度分析法评估了风险因素(年龄、性别、血压、血清胆固醇、甘油三酯、血糖、体重指数、吸烟和饮酒状况)与出血部位(脑叶、普特曼、丘脑、小脑和脑干)之间的关系:结果:在中位 20 年的随访期间,共发生了 571 例脑出血。高血压与总脑出血风险增加有关,但与脑叶出血无关。总脑出血的多变量危险比(95% 置信区间)为 2.09(1.75-2.50)。相比之下,血清总胆固醇水平低仅与脑叶出血有关(1.73(1.01-2.96))。大量饮酒与全脑出血和普鲁士脑出血的风险有关,肥胖与普鲁士脑出血的风险有关:本研究根据脑内出血的出血部位确定了不同的风险因素。
{"title":"Risk factors for intracerebral hemorrhage by five specific bleeding sites: Japan Public Health Center-based Prospective Study.","authors":"Kenichi Ariyada, Kazumasa Yamagishi, Tomomi Kihara, Isao Muraki, Hironori Imano, Yoshihiro Kokubo, Isao Saito, Hiroshi Yatsuya, Hiroyasu Iso, Shoichiro Tsugane, Norie Sawada","doi":"10.1177/23969873241290680","DOIUrl":"https://doi.org/10.1177/23969873241290680","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the risk factors for intracerebral hemorrhage is indispensable for primary prevention. However, the pathogenesis varies depending on the bleeding site, and few prospective studies have explored risk factors in detail for each site.</p><p><strong>Participants and methods: </strong>The Japan Public Health Center-based Prospective Study is a prospective study comprising a population-based sample of Japanese adults in 1990 (Cohort I) and in 1993 (Cohort II). A total of 34,137 participants (11,907 men and 22,230 women) were enrolled in this study and followed up until 2009 for Cohort I and until 2012 for Cohort II. The association between risk factors (age, sex, blood pressure, serum cholesterol, triglycerides, blood glucose, body mass index, smoking, and drinking status) and intracerebral hemorrhage by its bleeding site (lobes, putamen, thalamus, cerebellum, and brainstem) was assessed using Cox proportional hazards analysis.</p><p><strong>Results: </strong>During a median 20-year follow-up, 571 intracerebral hemorrhage events occurred. Hypertension was associated with an increased risk of total intracerebral hemorrhage, but not lobar hemorrhage. The multivariable hazard ratio (95% confidence intervals) was 2.09 (1.75-2.50) for total intracerebral hemorrhage. In contrast, a low serum total cholesterol level was associated only with lobar hemorrhage (1.73 (1.01-2.96)). Heavy drinking was associated with the risk of total and putamen hemorrhage, and obesity was associated with the risk of putamen hemorrhage.</p><p><strong>Discussion and conclusion: </strong>The present study identified different risk factors depending on the bleeding site of intracerebral hemorrhage.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The presence of a ghost infarct core is associated with fast core growth in acute ischemic stroke. 在急性缺血性脑卒中中,幽灵梗死核心的存在与核心的快速生长有关。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-13 DOI: 10.1177/23969873241289320
Mikito Saito, Hiroyuki Kawano, Takuya Adachi, Miho Gomyo, Kenichi Yokoyama, Yoshiaki Shiokawa, Teruyuki Hirano

Introduction: The overestimation of ischemic core volume by CT perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed a ghost infarct core (GIC). Core growth rate (CGR) is an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR.

Patients and methods: Consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy in our institute from March 2017 to July 2022 were enrolled. The initial ischemic core volume (IICV) was measured by pretreatment CTP, and the final infarct volume (FIV) was measured by diffusion-weighted imaging. A GIC was defined by IICV minus FIV > 10 ml. The CGR was calculated by dividing the IICV by the time from onset to CTP. Univariable analysis and a multivariable logistic regression model were used to evaluate the association between GIC-positive and CGR.

Results: Of all 91 patients, 21 (23.1%) were GIC-positive. The GIC-positive group had higher CGR (14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h, p = 0.02) and complete recanalization (n = 15 (71.4%) vs 29 (41.4%), p = 0.02) compared to the GIC-negative group. On receiver-operating characteristic curve analysis, the optimal cutoff point of CGR to predict GIC-positive was 22 ml/h (sensitivity, 0.48; specificity, 0.85; AUC, 0.67). Multivariable logistic regression analysis showed that CGR ⩾ 22 ml/h (OR 6.44, 95% CI [1.59-26.10], p = 0.01) and complete recanalization (OR 3.72, 95% CI [1.14-12.08], p = 0.02) were independent predictors of GIC-positive.

Conclusions: A GIC was associated with fast CGR in acute ischemic stroke. Overestimation of the initial ischemic core may be determined by core growth speed.

简介CT 灌注(CTP)会高估缺血核心容积,这是选择再灌注疗法候选者的关键问题。这种现象被称为幽灵梗死核心(GIC)。核心生长率(CGR)是缺血严重程度的指标。我们旨在阐明 GIC 与 CGR 之间的关联:纳入 2017 年 3 月至 2022 年 7 月期间在我院接受机械血栓切除术的急性缺血性卒中连续患者。初始缺血核心容积(IICV)通过治疗前 CTP 测量,最终梗死容积(FIV)通过弥散加权成像测量。GIC 的定义是 IICV 减去 FIV > 10 毫升。CGR 的计算方法是用 IICV 除以从发病到 CTP 的时间。采用单变量分析和多变量逻辑回归模型评估 GIC 阳性与 CGR 之间的关系:在所有 91 名患者中,21 人(23.1%)为 GIC 阳性。与 GIC 阴性组相比,GIC 阳性组的 CGR(14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h,P = 0.02)和完全再通率(n = 15 (71.4%) vs 29 (41.4%),P = 0.02)更高。根据接收器运行特征曲线分析,预测 GIC 阳性的最佳 CGR 切点为 22 ml/h(灵敏度为 0.48;特异性为 0.85;AUC 为 0.67)。多变量逻辑回归分析显示,CGR ⩾ 22 ml/h(OR 6.44,95% CI [1.59-26.10],p = 0.01)和完全再通畅(OR 3.72,95% CI [1.14-12.08],p = 0.02)是 GIC 阳性的独立预测因素:结论:GIC 与急性缺血性卒中的快速 CGR 相关。结论:GIC 与急性缺血性卒中的快速 CGR 相关。
{"title":"The presence of a ghost infarct core is associated with fast core growth in acute ischemic stroke.","authors":"Mikito Saito, Hiroyuki Kawano, Takuya Adachi, Miho Gomyo, Kenichi Yokoyama, Yoshiaki Shiokawa, Teruyuki Hirano","doi":"10.1177/23969873241289320","DOIUrl":"https://doi.org/10.1177/23969873241289320","url":null,"abstract":"<p><strong>Introduction: </strong>The overestimation of ischemic core volume by CT perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed a ghost infarct core (GIC). Core growth rate (CGR) is an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR.</p><p><strong>Patients and methods: </strong>Consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy in our institute from March 2017 to July 2022 were enrolled. The initial ischemic core volume (IICV) was measured by pretreatment CTP, and the final infarct volume (FIV) was measured by diffusion-weighted imaging. A GIC was defined by IICV minus FIV > 10 ml. The CGR was calculated by dividing the IICV by the time from onset to CTP. Univariable analysis and a multivariable logistic regression model were used to evaluate the association between GIC-positive and CGR.</p><p><strong>Results: </strong>Of all 91 patients, 21 (23.1%) were GIC-positive. The GIC-positive group had higher CGR (14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h, <i>p</i> = 0.02) and complete recanalization (<i>n</i> = 15 (71.4%) vs 29 (41.4%), <i>p</i> = 0.02) compared to the GIC-negative group. On receiver-operating characteristic curve analysis, the optimal cutoff point of CGR to predict GIC-positive was 22 ml/h (sensitivity, 0.48; specificity, 0.85; AUC, 0.67). Multivariable logistic regression analysis showed that CGR ⩾ 22 ml/h (OR 6.44, 95% CI [1.59-26.10], <i>p</i> = 0.01) and complete recanalization (OR 3.72, 95% CI [1.14-12.08], <i>p</i> = 0.02) were independent predictors of GIC-positive.</p><p><strong>Conclusions: </strong>A GIC was associated with fast CGR in acute ischemic stroke. Overestimation of the initial ischemic core may be determined by core growth speed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database. 使用层次聚类分析法分析急性缺血性中风患者的中风-心脏综合征和早期死亡率:来自 VISTA 数据库的单个患者数据汇总分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-13 DOI: 10.1177/23969873241290440
Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Gregory Y H Lip, Azmil H Abdul-Rahim

Background: The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk.

Methods: We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles.

Results: We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('elderly and AF'), Profile 2 ('young and smoker'), Profile 3 ('young'), Profile 4 ('cardiac comorbidities') and Profile 5 ('hypertension with atherosclerotic comorbidities'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4.

Conclusions: Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.

背景:近期急性缺血性卒中(AIS)后早期心脏并发症风险特别高的患者临床表型,即卒中-心脏综合征(SHS),仍未得到很好的界定。我们利用分层聚类分析确定了与这种风险相关的特定表型特征:我们从虚拟国际卒中试验档案(一个全球临床试验数据储存库)中收集了 AIS 患者的数据。我们研究了卒中后 30 天内的心脏并发症,包括急性冠状动脉综合征、心力衰竭、心律失常和心肺骤停。我们采用分层聚类分析来确定不同的表型风险特征。结果:我们共纳入了 12,482 名患者(占总人数的 12%):我们纳入了 12,482 名患者(平均年龄 69 ± 12 岁;55% 为男性),得出了五种表型:特征 1("老年和房颤")、特征 2("年轻和吸烟")、特征 3("年轻")、特征 4("心脏合并症")和特征 5("高血压和动脉粥样硬化合并症")。特征 4 和特征 1 的 SHS 风险最高(与特征 3 相比,调整后 HR(95% CI)分别为 2.01(1.70-2.38)和 1.26(1.05-1.51)),特征 5 和特征 2 的风险适中,特征 3 的风险最低。虽然特征 1 和特征 4 在大多数 SHS 表现中风险最高,但特征 5 的心肺骤停风险最高(调整后 HR (95% CI):2.99 (1.22-7.34))。90 天死亡风险按表型进行了分层,在表型 5 和表型 4 中观察到的风险最高:层次聚类分析有效地确定了AIS患者中SHS和早期死亡风险最高的表型。
{"title":"Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database.","authors":"Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Gregory Y H Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241290440","DOIUrl":"https://doi.org/10.1177/23969873241290440","url":null,"abstract":"<p><strong>Background: </strong>The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk.</p><p><strong>Methods: </strong>We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles.</p><p><strong>Results: </strong>We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('<i>elderly and AF</i>'), Profile 2 ('<i>young and smoker</i>'), Profile 3 ('<i>young</i>'), Profile 4 ('<i>cardiac comorbidities</i>') and Profile 5 ('<i>hypertension with atherosclerotic comorbidities</i>'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4.</p><p><strong>Conclusions: </strong>Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10). 对于中低度症状(美国国立卫生研究院卒中量表 < 10)的基底动脉闭塞,血管内治疗与药物治疗的比较。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-13 DOI: 10.1177/23969873241290442
Cyril Dargazanli, Isabelle Mourand, Mehdi Mahmoudi, Laurence Poirier, Julien Labreuche, David Weisenburger-Lile, Benjamin Gory, Sébastien Richard, Célina Ducroux, Michel Piotin, Raphael Blanc, Ludovic Lucas, Gaultier Marnat, Mathilde Aubertin, Caroline Arquizan, Romain Bourcier, Lili Detraz, Stéphane Vannier, Maud Guillen, François Eugene, Gregory Walker, Ronda Lun, Dariush Dowlatshahi, Michel Shamy, Arturo Consoli, Vincent Costalat, Bertrand Lapergue, Benjamin Maïer, Adrien Guenego, Robert Fahed

Background: Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.

Methods: We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.

Results: One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04-6.90; p = 0.041).

Conclusion: Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877.

背景:急性基底动脉闭塞(BAO急性基底动脉闭塞(BAO)和中低度症状(美国国立卫生研究院卒中量表[NIHSS])的患者:我们比较了所有首次出现 NIHSS 的连续患者的数据:共纳入 127 例患者:64 例患者接受了血栓切除术(平均 ± SD 年龄:63.4 ± 16.1),63 例患者接受了 BMT 治疗(平均 ± SD 年龄:69.0 ± 14.3)。两组患者的 3 个月良好预后率和死亡率无明显差异。经过倾向分数调整后,血栓切除术与3个月后的良好预后(mRS 0-1或等于卒中前值;调整后OR,2.68;95%CI,1.04-6.90;p = 0.041)的几率显著增加相关:我们的研究表明,对中低度症状(NIHSS
{"title":"Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10).","authors":"Cyril Dargazanli, Isabelle Mourand, Mehdi Mahmoudi, Laurence Poirier, Julien Labreuche, David Weisenburger-Lile, Benjamin Gory, Sébastien Richard, Célina Ducroux, Michel Piotin, Raphael Blanc, Ludovic Lucas, Gaultier Marnat, Mathilde Aubertin, Caroline Arquizan, Romain Bourcier, Lili Detraz, Stéphane Vannier, Maud Guillen, François Eugene, Gregory Walker, Ronda Lun, Dariush Dowlatshahi, Michel Shamy, Arturo Consoli, Vincent Costalat, Bertrand Lapergue, Benjamin Maïer, Adrien Guenego, Robert Fahed","doi":"10.1177/23969873241290442","DOIUrl":"https://doi.org/10.1177/23969873241290442","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.</p><p><strong>Methods: </strong>We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.</p><p><strong>Results: </strong>One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04-6.90; <i>p</i> = 0.041).</p><p><strong>Conclusion: </strong>Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis. 神经重症卒中患者遵循指南推荐的基本参数:观察性多中心个体参与者数据分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-13 DOI: 10.1177/23969873241289360
Anne Mrochen, Omar Alhaj Omar, Johann O Pelz, Dominik Michalski, Hermann Neugebauer, Dominik Lehrieder, Benjamin Knier, Corinna Ringmaier, Henning Stetefeld, Silvia Schönenberger, Min Chen, Hauke Schneider, Angelika Alonso, Hendrik Lesch, Andreas Totzek, Friedrich Erdlenbruch, Benedikt Hiller, Norma J Diel, André Worm, Christian Claudi, Stefan T Gerner, Hagen B Huttner, Patrick Schramm

Introduction: Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care.

Patients and methods: This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60-90 mmHg), glucose levels (80-180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO2) 80-120 mmHg und partial arterial pressure of carbon dioxide (PaCO2) 35-45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals.

Results: Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO2 (65.2%), PaCO2 (75.0%) and blood glucose (80.7%).

Discussion and conclusion: This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.

简介:患有神经血管疾病的神经重症监护患者往往面临长期治疗效果不佳的问题,这凸显了循证干预措施的关键作用。尽管国际指南强调对体温、血糖、血压和血氧水平等基本生理参数进行管理,但医生对这些目标的依从性仍不确定。本研究旨在评估神经重症监护中基于指南的基本生理参数治疗目标的依从性:这项多中心观察性研究在德国八家三级大学医院进行,分析了 474 名需要机械通气的患者(2021 年 1 月 1 日至 12 月 31 日)。住院初期的 96 小时内,以 4 小时为间隔,测量收缩压(情况适应)、平均血压(MAP,60-90 mmHg)、血糖水平(80-180 mg/dl)、体温(2)80-120 mmHg 和二氧化碳动脉分压(PaCO2)35-45 mmHg 的治疗范围内的依从性:总体而言,70.7%的测量值在预定的治疗范围内,包括SBP(71.3%)、体温(68.3%)、MAP(71.4%)、PaO2(65.2%)、PaCO2(75.0%)和血糖(80.7%):这项多中心研究表明,神经重症监护病房坚持以指南为基础的治疗目标,强调了神经重症监护病房所坚持的高标准。我们的研究为了解德国神经重症监护患者对基于指南的治疗目标的依从性提供了宝贵的见解。为了改善患者护理并优化神经血管疾病的治疗策略,还需要进一步研究这些依从性参数对长期疗效的影响。
{"title":"Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis.","authors":"Anne Mrochen, Omar Alhaj Omar, Johann O Pelz, Dominik Michalski, Hermann Neugebauer, Dominik Lehrieder, Benjamin Knier, Corinna Ringmaier, Henning Stetefeld, Silvia Schönenberger, Min Chen, Hauke Schneider, Angelika Alonso, Hendrik Lesch, Andreas Totzek, Friedrich Erdlenbruch, Benedikt Hiller, Norma J Diel, André Worm, Christian Claudi, Stefan T Gerner, Hagen B Huttner, Patrick Schramm","doi":"10.1177/23969873241289360","DOIUrl":"https://doi.org/10.1177/23969873241289360","url":null,"abstract":"<p><strong>Introduction: </strong>Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care.</p><p><strong>Patients and methods: </strong>This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60-90 mmHg), glucose levels (80-180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO<sub>2</sub>) 80-120 mmHg und partial arterial pressure of carbon dioxide (PaCO<sub>2</sub>) 35-45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals.</p><p><strong>Results: </strong>Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO<sub>2</sub> (65.2%), PaCO<sub>2</sub> (75.0%) and blood glucose (80.7%).</p><p><strong>Discussion and conclusion: </strong>This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mechanical thrombectomy practices in Europe: Insights from a survey of European neuroradiologists from the ESMINT. 欧洲的机械血栓切除术实践:来自 ESMINT 的欧洲神经放射科医师调查的启示。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1177/23969873241286000
Géraud Forestier, Uta Hanning, Johannes Kaesmacher, Grégoire Boulouis, Kamil Zeleňák, Anne-Christine Januel, Zsolt Kulcsár, Jens Fiehler, Aymeric Rouchaud

Background and purpose: Mechanical thrombectomy (MT) has revolutionized the prognosis of acute ischemic stroke. Indications for MT are constantly expanding across countries, presenting healthcare professionals, and institutions with the challenge of offering MT to the entire population despite geographic constraints, while also training enough interventional neuroradiologists (INR) for this highly technical-level procedure. We aimed to provide an overview of current European MT practices and organizations in 2021.

Materials and methods: Members of the European Society of Minimally Invasive Neurological Therapy (ESMINT) were invited to complete two different online surveys from March to November 2021 to collect data on MT practice.

Results: A total of 240 individual responses from INR (from 33 European countries) were received. These included information from 56 thrombectomy-capable stroke centers (TCSC) data (across 26 European countries). The mean number of INR per center was 3.8 ± 1.43, median 4 (IQR, 3-4.5). Half of the centers (28/56, 50.00%) performed less than 150 MT per year. Most INR used a balloon guide catheter in less than 50% of cases (160/240, 66.67%), and limited the number of recanalization attempts to six passes to restore flow (209/240, 87.08%). Additionally, 37.92% of the respondents (91/240, 37.92%) indicated that they already performed MT for distal occlusions (M3, M4) as part of their routine practice. Other details of the MT procedure, anesthetic management, and patient selection are also presented and discussed.

Conclusions: This European survey emphasizes the differences between TCSC and INR in modern thrombectomy practices. Even if most centers remain understaffed to meet current and future MT needs, most European TCSCs are actively training young INR.

背景和目的:机械性血栓切除术(MT)彻底改变了急性缺血性中风的预后。机械取栓术的适应症在各国不断扩大,这给医护人员和医疗机构带来了挑战,他们既要克服地域限制为所有人群提供机械取栓术,又要为这种高技术水平的手术培训足够的介入神经放射医师(INR)。我们旨在概述目前欧洲的 MT 实践和 2021 年的组织情况:我们邀请欧洲微创神经治疗学会(ESMINT)成员在2021年3月至11月期间完成两项不同的在线调查,以收集有关MT实践的数据:结果:共收到来自 33 个欧洲国家的 240 份 INR 个人回复。其中包括来自 56 个具备血栓切除能力的中风中心 (TCSC) 的数据信息(横跨 26 个欧洲国家)。每个中心的 INR 平均数量为 3.8 ± 1.43,中位数为 4(IQR,3-4.5)。半数中心(28/56,50.00%)每年进行的 MT 少于 150 例。大多数 INR 在不到 50% 的病例中使用球囊导引导管(160/240,66.67%),并将再通气尝试次数限制在六次以内以恢复血流(209/240,87.08%)。此外,37.92% 的受访者(91/240,37.92%)表示,他们已经在日常工作中对远端闭塞(M3、M4)实施了 MT。此外,还介绍并讨论了 MT 手术、麻醉管理和患者选择的其他细节:这项欧洲调查强调了 TCSC 和 INR 在现代血栓切除术实践中的差异。即使大多数中心仍然人手不足,无法满足当前和未来的 MT 需求,但大多数欧洲 TCSC 正在积极培训年轻的 INR。
{"title":"Mechanical thrombectomy practices in Europe: Insights from a survey of European neuroradiologists from the ESMINT.","authors":"Géraud Forestier, Uta Hanning, Johannes Kaesmacher, Grégoire Boulouis, Kamil Zeleňák, Anne-Christine Januel, Zsolt Kulcsár, Jens Fiehler, Aymeric Rouchaud","doi":"10.1177/23969873241286000","DOIUrl":"https://doi.org/10.1177/23969873241286000","url":null,"abstract":"<p><strong>Background and purpose: </strong>Mechanical thrombectomy (MT) has revolutionized the prognosis of acute ischemic stroke. Indications for MT are constantly expanding across countries, presenting healthcare professionals, and institutions with the challenge of offering MT to the entire population despite geographic constraints, while also training enough interventional neuroradiologists (INR) for this highly technical-level procedure. We aimed to provide an overview of current European MT practices and organizations in 2021.</p><p><strong>Materials and methods: </strong>Members of the European Society of Minimally Invasive Neurological Therapy (ESMINT) were invited to complete two different online surveys from March to November 2021 to collect data on MT practice.</p><p><strong>Results: </strong>A total of 240 individual responses from INR (from 33 European countries) were received. These included information from 56 thrombectomy-capable stroke centers (TCSC) data (across 26 European countries). The mean number of INR per center was 3.8 ± 1.43, median 4 (IQR, 3-4.5). Half of the centers (28/56, 50.00%) performed less than 150 MT per year. Most INR used a balloon guide catheter in less than 50% of cases (160/240, 66.67%), and limited the number of recanalization attempts to six passes to restore flow (209/240, 87.08%). Additionally, 37.92% of the respondents (91/240, 37.92%) indicated that they already performed MT for distal occlusions (M3, M4) as part of their routine practice. Other details of the MT procedure, anesthetic management, and patient selection are also presented and discussed.</p><p><strong>Conclusions: </strong>This European survey emphasizes the differences between TCSC and INR in modern thrombectomy practices. Even if most centers remain understaffed to meet current and future MT needs, most European TCSCs are actively training young INR.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intensified post-stroke care improves long-term dysphagia recovery after acute ischemic stroke: Results from the STROKE CARD trial. 加强卒中后护理可改善急性缺血性卒中后吞咽困难的长期恢复:STROKE CARD试验的结果。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1177/23969873241284123
Anel Karisik, Vincent Bader, Kurt Moelgg, Lucie Buergi, Benjamin Dejakum, Silvia Komarek, Christian Boehme, Thomas Toell, Lukas Mayer-Suess, Simon Sollereder, Sonja Rossi, Patricia Meier, Gudrun Schoenherr, Johann Willeit, Peter Willeit, Wilfried Lang, Stefan Kiechl, Michael Knoflach, Raimund Pechlaner

Introduction: Dysphagia is common after acute ischemic stroke and entails considerable morbidity and mortality. Here, we investigated the impact of intensified care on swallowing recovery after stroke.

Patients and methods: In this secondary analysis of STROKE-CARD, a randomized intervention trial of intensified post-stroke care, dysphagia was assessed by speech therapists at admission for acute ischemic stroke, at hospital discharge, and after 12-months. Patients randomized to STROKE-CARD care additionally received a detailed dysphagia follow-up at 3-months, including a standardized dysphagia examination, instructions on further exercises and compensation mechanisms and, if necessary, referral for further speech therapy.

Results: Dysphagia was present initially after stroke in 236 (16.6%; median age 82 (73-88), 44.1% female) of 1419 patients, with similar prevalence in both study groups at hospital admission (p = 0.239) and discharge (p = 0.870). At follow up, 14 (9.5%) of 147 in the intervention group and 18 (20.2%) of 89 in the control group suffered from persistent dysphagia (p = 0.020). There was better dysphagia recovery in the intervention group also under multivariable adjustment for age, sex, functional disability at 12-months, severe dysphagia at hospitalization, mode of feeding, cognitive impairment, thrombolysis, and stroke localization (odds ratio, 0.41, 95% confidence interval: 0.17 to 0.96).

Discussion and conclusion: Intensified post-stroke care improved dysphagia recovery within 1 year after acute ischemic stroke, highlighting the potential of targeted interventions for enhancing stroke outcomes.

导言:吞咽困难是急性缺血性中风后的常见病,会导致相当高的发病率和死亡率。在此,我们研究了强化护理对中风后吞咽功能恢复的影响:STROKE-CARD 是一项卒中后强化护理的随机干预试验,在该试验的二次分析中,语言治疗师对急性缺血性卒中患者入院时、出院时和 12 个月后的吞咽困难情况进行了评估。随机接受 STROKE-CARD 护理的患者还在 3 个月后接受了详细的吞咽困难随访,包括标准化吞咽困难检查、进一步锻炼和补偿机制指导,以及必要时转诊接受进一步言语治疗:1419 名患者中有 236 人(16.6%;中位年龄 82(73-88)岁,44.1% 为女性)在卒中后初期出现吞咽困难,两组患者入院时(p = 0.239)和出院时(p = 0.870)的吞咽困难发生率相似。随访时,干预组 147 人中有 14 人(9.5%)出现持续性吞咽困难,对照组 89 人中有 18 人(20.2%)出现持续性吞咽困难(p = 0.020)。在对年龄、性别、12 个月时的功能障碍、住院时的严重吞咽困难、喂食方式、认知障碍、溶栓和卒中定位进行多变量调整后,干预组的吞咽困难恢复情况也更好(几率比 0.41,95% 置信区间:0.17 至 0.96):讨论与结论:加强卒中后护理可改善急性缺血性卒中后 1 年内吞咽困难的恢复,突出了有针对性的干预措施在改善卒中预后方面的潜力。
{"title":"Intensified post-stroke care improves long-term dysphagia recovery after acute ischemic stroke: Results from the STROKE CARD trial.","authors":"Anel Karisik, Vincent Bader, Kurt Moelgg, Lucie Buergi, Benjamin Dejakum, Silvia Komarek, Christian Boehme, Thomas Toell, Lukas Mayer-Suess, Simon Sollereder, Sonja Rossi, Patricia Meier, Gudrun Schoenherr, Johann Willeit, Peter Willeit, Wilfried Lang, Stefan Kiechl, Michael Knoflach, Raimund Pechlaner","doi":"10.1177/23969873241284123","DOIUrl":"https://doi.org/10.1177/23969873241284123","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia is common after acute ischemic stroke and entails considerable morbidity and mortality. Here, we investigated the impact of intensified care on swallowing recovery after stroke.</p><p><strong>Patients and methods: </strong>In this secondary analysis of STROKE-CARD, a randomized intervention trial of intensified post-stroke care, dysphagia was assessed by speech therapists at admission for acute ischemic stroke, at hospital discharge, and after 12-months. Patients randomized to STROKE-CARD care additionally received a detailed dysphagia follow-up at 3-months, including a standardized dysphagia examination, instructions on further exercises and compensation mechanisms and, if necessary, referral for further speech therapy.</p><p><strong>Results: </strong>Dysphagia was present initially after stroke in 236 (16.6%; median age 82 (73-88), 44.1% female) of 1419 patients, with similar prevalence in both study groups at hospital admission (<i>p</i> = 0.239) and discharge (<i>p</i> = 0.870). At follow up, 14 (9.5%) of 147 in the intervention group and 18 (20.2%) of 89 in the control group suffered from persistent dysphagia (<i>p</i> = 0.020). There was better dysphagia recovery in the intervention group also under multivariable adjustment for age, sex, functional disability at 12-months, severe dysphagia at hospitalization, mode of feeding, cognitive impairment, thrombolysis, and stroke localization (odds ratio, 0.41, 95% confidence interval: 0.17 to 0.96).</p><p><strong>Discussion and conclusion: </strong>Intensified post-stroke care improved dysphagia recovery within 1 year after acute ischemic stroke, highlighting the potential of targeted interventions for enhancing stroke outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window. 通过目测 ASPECTS 界定的大面积缺血核心在 6-24 小时窗口期预测功能预后的准确性可与自动 CT 灌注相媲美。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-07 DOI: 10.1177/23969873241286691
Tolga D Dittrich, Anh Nguyen, Peter B Sporns, Anna M Toebak, Lilian F Kriemler, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Filip Barinka, Martin Hänsel, Henrik Gensicke, Raoul Sutter, Christian H Nickel, Mira Katan, Nils Peters, Lars Michels, Zsolt Kulcsár, Grzegorz M Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H Bonati, Marios Psychogios, Gian Marco De Marchis

Introduction: Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.

Patients and methods: Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0-5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0-2) at 3 months.

Results: Of 210 patients, 11.4% had ASPECTS 0-5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27-2.70, p = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0-2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74-0.86] vs aCTP core 0.79 [95%CI 0.72-0.85]).

Discussion and conclusion: In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.

简介:自动 CT 灌注(aCTP)通常用于选择前循环大血管闭塞(aLVO)患者进行血管内治疗(EVT)。目测评估的非对比 CT 阿尔伯塔卒中计划早期 CT 评分(ASPECTS)和基于 CTP 的选择在预测良好功能预后方面的等效性仍不确定:对瑞士卒中登记处(2014-2021 年)的成人 aLVO 患者进行回顾性多中心研究,这些患者在卒中发生 6-24 小时后接受了 EVT 或最佳药物治疗。我们在非对比 CT 上直观评估了 ASPECTS,在 aCTP 上评估了缺血核心体积,定义了 ASPECTS 0-5 和 aCTP CBF 结果:在 210 名患者中,11.4% 的患者 ASPECTS 为 0-5,12.9% 的患者 aCTP 核心容积⩾50 mL。在同一模型中,ASPECTS 而非 aCTP 核心体积与良好的预后相关(ASPECTS:acOR 1.85,95%CI 1.27-2.70,p = 0.001)。ROC 曲线分析表明,在预测 3 个月后的良好功能预后(mRS 0-2)方面,诊断准确性相当(ROC 区域:ASPECTS 0.80 [95%CI 1.27-2.70,P = 0.001):讨论与结论:讨论与结论:在aLVO患者中,目测ASPECTS与自动生成的CTP核心体积在预测3个月后功能预后方面的准确性至少相当。
{"title":"Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window.","authors":"Tolga D Dittrich, Anh Nguyen, Peter B Sporns, Anna M Toebak, Lilian F Kriemler, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Filip Barinka, Martin Hänsel, Henrik Gensicke, Raoul Sutter, Christian H Nickel, Mira Katan, Nils Peters, Lars Michels, Zsolt Kulcsár, Grzegorz M Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H Bonati, Marios Psychogios, Gian Marco De Marchis","doi":"10.1177/23969873241286691","DOIUrl":"https://doi.org/10.1177/23969873241286691","url":null,"abstract":"<p><strong>Introduction: </strong>Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.</p><p><strong>Patients and methods: </strong>Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0-5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0-2) at 3 months.</p><p><strong>Results: </strong>Of 210 patients, 11.4% had ASPECTS 0-5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27-2.70, <i>p</i> = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0-2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74-0.86] vs aCTP core 0.79 [95%CI 0.72-0.85]).</p><p><strong>Discussion and conclusion: </strong>In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Home and workforce reintegration one year after thrombectomy in acute stroke patients. 急性中风患者血栓切除术一年后重返家庭和工作岗位。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-03 DOI: 10.1177/23969873241282875
Felix J Bode, Nina A Zadon, Hannah Asperger, Niklas M Beckonert, Taraneh Ebrahimi, Louisa Nitsch, Julia Nordsiek, Julius N Meissner, Omid Shirvani, Sebastian Stösser, Christian Thielscher, Franziska Dorn, Nils C Lehnen, Gabor C Petzold, Johannes M Weller

Introduction: Endovascular thrombectomy (EVT) combined with intravenous thrombolysis is the current standard treatment for acute large-vessel occlusion stroke. Beyond clear clinical benefits in the acute and post-acute phases, comprehensive evaluations of long-term outcomes, including home and workforce reintegration, remain limited. This study aimed to assess home and workforce reintegration 1 year post-EVT in a cohort of acute stroke patients and explore their association with health-related quality of life (HRQoL).

Patients and methods: We conducted a prospective observational study of 404 patients undergoing EVT at a tertiary university medical center between October 2019 and December 2021. Patients' functional outcomes were evaluated using the modified Rankin Scale (mRS), and HRQoL was assessed via the European Quality of Life Five Dimension Scale (EQ-5D). Data on occupational and living status were collected through standardized telephone interviews at 3- and 12-months post-treatment.

Results: Of 357 patients with 12-month follow-up data, 33.6% had a favorable outcome (mRS 0-2). Among stroke survivors, the rate of home reintegration without nursing care was 42.1%, and workforce reintegration among previously employed patients was 43.3% at 12 months. Both outcomes were significantly associated with improved HRQoL. Lower neurological deficits and younger age were predictive of successful home and workforce reintegration.

Discussion and conclusion: One year post-EVT, approximately 40%-50% of acute stroke patients successfully reintegrate into home and work settings. These findings underscore the need for ongoing support tailored to improving long-term reintegration and quality of life for stroke survivors.

Data access statement: The data supporting the findings of the study are available from the corresponding author upon reasonable request and in accordance to European data privacy obligations.

简介血管内血栓切除术(EVT)联合静脉溶栓是目前治疗急性大血管闭塞性卒中的标准方法。除了急性期和急性期后的明显临床疗效外,对长期疗效(包括重返家庭和工作岗位)的全面评估仍然有限。本研究旨在评估一组急性中风患者在 EVT 术后 1 年重返家庭和工作岗位的情况,并探讨其与健康相关生活质量(HRQoL)的关系:我们对2019年10月至2021年12月期间在一所三级大学医疗中心接受EVT治疗的404名患者进行了前瞻性观察研究。患者的功能结果采用改良Rankin量表(mRS)进行评估,HRQoL采用欧洲生活质量五维量表(EQ-5D)进行评估。在治疗后3个月和12个月,通过标准化电话访谈收集有关职业和生活状况的数据:结果:在 357 名有 12 个月随访数据的患者中,33.6% 的患者预后良好(mRS 0-2)。在脑卒中幸存者中,12 个月后无需护理即可重返家庭的比例为 42.1%,之前有工作的患者重返工作岗位的比例为 43.3%。这两项结果都与 HRQoL 的改善密切相关。较低的神经功能缺损和较年轻的年龄是成功重返家庭和劳动力市场的预兆:EVT术后一年,约有40%-50%的急性卒中患者成功重返家庭和工作环境。这些发现强调了为改善中风幸存者的长期重返社会和生活质量而提供持续支持的必要性:支持该研究结果的数据可在合理要求下从通讯作者处获得,并符合欧洲数据隐私义务。
{"title":"Home and workforce reintegration one year after thrombectomy in acute stroke patients.","authors":"Felix J Bode, Nina A Zadon, Hannah Asperger, Niklas M Beckonert, Taraneh Ebrahimi, Louisa Nitsch, Julia Nordsiek, Julius N Meissner, Omid Shirvani, Sebastian Stösser, Christian Thielscher, Franziska Dorn, Nils C Lehnen, Gabor C Petzold, Johannes M Weller","doi":"10.1177/23969873241282875","DOIUrl":"https://doi.org/10.1177/23969873241282875","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) combined with intravenous thrombolysis is the current standard treatment for acute large-vessel occlusion stroke. Beyond clear clinical benefits in the acute and post-acute phases, comprehensive evaluations of long-term outcomes, including home and workforce reintegration, remain limited. This study aimed to assess home and workforce reintegration 1 year post-EVT in a cohort of acute stroke patients and explore their association with health-related quality of life (HRQoL).</p><p><strong>Patients and methods: </strong>We conducted a prospective observational study of 404 patients undergoing EVT at a tertiary university medical center between October 2019 and December 2021. Patients' functional outcomes were evaluated using the modified Rankin Scale (mRS), and HRQoL was assessed via the European Quality of Life Five Dimension Scale (EQ-5D). Data on occupational and living status were collected through standardized telephone interviews at 3- and 12-months post-treatment.</p><p><strong>Results: </strong>Of 357 patients with 12-month follow-up data, 33.6% had a favorable outcome (mRS 0-2). Among stroke survivors, the rate of home reintegration without nursing care was 42.1%, and workforce reintegration among previously employed patients was 43.3% at 12 months. Both outcomes were significantly associated with improved HRQoL. Lower neurological deficits and younger age were predictive of successful home and workforce reintegration.</p><p><strong>Discussion and conclusion: </strong>One year post-EVT, approximately 40%-50% of acute stroke patients successfully reintegrate into home and work settings. These findings underscore the need for ongoing support tailored to improving long-term reintegration and quality of life for stroke survivors.</p><p><strong>Data access statement: </strong>The data supporting the findings of the study are available from the corresponding author upon reasonable request and in accordance to European data privacy obligations.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adjunctive intra-arterial tenecteplase after successful endovascular thrombectomy in patients with large vessel occlusion stroke (POST-TNK): Study rationale and design. 大血管闭塞性卒中患者血管内血栓切除术成功后辅助动脉内替尼采普酶(POST-TNK):研究原理与设计。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-30 DOI: 10.1177/23969873241286983
Jiacheng Huang, Changwei Guo, Jie Yang, Xiaolei Shi, Chang Liu, Jiaxing Song, Fengli Li, Weilin Kong, Shitao Fan, Zhouzhou Peng, Shihai Yang, Jinfu Ma, Xu Xu, Linyu Li, Zhixi Wang, Nizhen Yu, Wenzhe Sun, Chengsong Yue, Xiang Liu, Dahong Yang, Cheng Huang, Duolao Wang, Raul G Nogueira, Thanh N Nguyen, Jeffrey L Saver, Yangmei Chen, Wenjie Zi

Rationale: Adjunct intra-arterial alteplase has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy. Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, could potentially enhance outcomes in stroke patients after successful reperfusion when used as an adjunct intra-arterial therapy.

Aim: To explore the safety and efficacy of intra-arterial tenecteplase after successful endovascular thrombectomy in patients with LVO stroke.

Sample size: To randomize 498 participants 1:1 to receive intra-arterial tenecteplase or no intra-arterial adjunctive thrombolysis therapy.

Methods and design: An investigator-initiated, prospective, randomized, open-label, blind-endpoint multicenter clinical trial. Eligible patients with anterior circulation LVO stroke presenting within 24 h from symptom onset (time last known well) and excellent to complete reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) scale 2c-3) at endovascular thrombectomy are planned to be randomized.

Outcomes: The primary outcome is freedom from disability (modified Rankin Scale, mRS, of 0-1) at 90 days. The primary safety outcomes are mortality through 90 days and symptomatic intracranial hemorrhage within 48 h.

Discussion: The POST-TNK trial will evaluate the efficacy and safety of intra-arterial tenecteplase in patients with LVO stroke and excellent to complete reperfusion.

理由:辅助动脉内阿替普酶已被证明可改善成功接受血管内血栓切除术的大血管闭塞(LVO)卒中患者的临床预后。特奈替普酶以其增强的纤维蛋白特异性和延长的活性持续时间而著称,如果作为动脉内辅助疗法使用,有可能改善再灌注成功后中风患者的预后。目的:探讨在 LVO 中风患者血管内血栓切除术成功后使用动脉内特奈替普酶的安全性和有效性:方法与设计:由研究者发起的一项前瞻性研究:一项由研究者发起的前瞻性、随机、开放标签、盲端点多中心临床试验。符合条件的前循环低密度脂蛋白血栓性脑卒中患者在症状发生后24小时内(最后一次已知良好的时间)出现症状,且血管内溶栓治疗的再灌注效果极佳(扩大的脑梗死溶栓治疗(eTICI)评分2c-3),计划对其进行随机分组:主要结果是90天后无残疾(改良Rankin量表,mRS为0-1)。主要安全性结果为90天内的死亡率和48小时内的无症状颅内出血:POST-TNK试验将评估动脉内替尼采普酶对低密度脂蛋白血症卒中患者的疗效和安全性,以及完全再灌注的效果。
{"title":"Adjunctive intra-arterial tenecteplase after successful endovascular thrombectomy in patients with large vessel occlusion stroke (POST-TNK): Study rationale and design.","authors":"Jiacheng Huang, Changwei Guo, Jie Yang, Xiaolei Shi, Chang Liu, Jiaxing Song, Fengli Li, Weilin Kong, Shitao Fan, Zhouzhou Peng, Shihai Yang, Jinfu Ma, Xu Xu, Linyu Li, Zhixi Wang, Nizhen Yu, Wenzhe Sun, Chengsong Yue, Xiang Liu, Dahong Yang, Cheng Huang, Duolao Wang, Raul G Nogueira, Thanh N Nguyen, Jeffrey L Saver, Yangmei Chen, Wenjie Zi","doi":"10.1177/23969873241286983","DOIUrl":"https://doi.org/10.1177/23969873241286983","url":null,"abstract":"<p><strong>Rationale: </strong>Adjunct intra-arterial alteplase has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy. Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, could potentially enhance outcomes in stroke patients after successful reperfusion when used as an adjunct intra-arterial therapy.</p><p><strong>Aim: </strong>To explore the safety and efficacy of intra-arterial tenecteplase after successful endovascular thrombectomy in patients with LVO stroke.</p><p><strong>Sample size: </strong>To randomize 498 participants 1:1 to receive intra-arterial tenecteplase or no intra-arterial adjunctive thrombolysis therapy.</p><p><strong>Methods and design: </strong>An investigator-initiated, prospective, randomized, open-label, blind-endpoint multicenter clinical trial. Eligible patients with anterior circulation LVO stroke presenting within 24 h from symptom onset (time last known well) and excellent to complete reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) scale 2c-3) at endovascular thrombectomy are planned to be randomized.</p><p><strong>Outcomes: </strong>The primary outcome is freedom from disability (modified Rankin Scale, mRS, of 0-1) at 90 days. The primary safety outcomes are mortality through 90 days and symptomatic intracranial hemorrhage within 48 h.</p><p><strong>Discussion: </strong>The POST-TNK trial will evaluate the efficacy and safety of intra-arterial tenecteplase in patients with LVO stroke and excellent to complete reperfusion.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
European Stroke Journal
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1