Pub Date : 2024-05-17DOI: 10.3389/fstro.2024.1403812
Trine Apostolaki-Hansson, Amir Hillal, Nathanael Göransson, Björn M. Hansen, Bo Norrving, Birgitta Ramgren, J. Wassélius, Teresa Ullberg
Following the favorable outcomes demonstrated by the Early MiNimally-invasive Removal of IntraCerebral Hemorrhage (ENRICH) trial in supratentorial intracerebral hemorrhage (ICH) patients treated with minimally invasive surgery (MIS), and considering the increasing interest in MIS, we aimed to assess the potential eligibility rate for ICH patients in Sweden.All patients with spontaneous ICH in the Swedish Stroke Register (RS) during 2017–2020 in Skane county (1.37 million) were assessed. Baseline imaging was used for radiological characterization. Clinical data were obtained from RS. MIS eligibility in the total ICH population meeting ENRICH criteria were estimated and extrapolated to the Swedish population (10.5 million).Of 1,314 ICH patients, 5.9% met the ENRICH criteria for MIS (ICH volume 30–80 ml). Considering the ENRICH trial results indicating the effectiveness of MIS was mainly attributable to intervention for lobar hemorrhages, we determined that 2.8% of our ICH cohort in Sweden would be eligible for MIS. The estimated rate of neurosurgery for ICH could increase from the current 1.46–1.90 patients/100,000 population/year (in absolute numbers from 154 to 200 interventions out of 2,400 ICHs in Sweden annually).We show that 2.8% of the Skane ICH population would be eligible for MIS if ENRICH criteria are employed for patients with lobar ICH, corresponding to a 29% increase of current surgical rates for ICH in Sweden. As MIS for ICH is not yet standard practice in Sweden, consideration for its implementation within the neurosurgical organization becomes essential to accommodate the anticipated increase in patient demand.
脑室上脑室内出血（ICH）患者接受微创手术（MIS）治疗后，早期微创清除脑室内出血（ENRICH）试验取得了良好的效果，考虑到人们对微创手术的兴趣与日俱增，我们旨在评估瑞典ICH患者的潜在合格率。基线成像用于放射学特征描述。临床数据来自 RS。在 1314 名 ICH 患者中，5.9% 符合 ENRICH 的 MIS 标准（ICH 容量 30-80 毫升）。考虑到 ENRICH 试验结果表明 MIS 的有效性主要归功于对叶状出血的干预，我们认为瑞典有 2.8% 的 ICH 患者符合 MIS 标准。据估计，ICH 神经外科手术率将从目前的 1.46-1.90 例/100,000 人/年（瑞典每年 2,400 例 ICH 中，介入治疗的绝对数量从 154 例增至 200 例）上升。我们的研究表明，如果对叶状 ICH 患者采用 ENRICH 标准，Skane ICH 患者中将有 2.8% 符合 MIS 治疗条件，这相当于将瑞典目前的 ICH 手术率提高了 29%。由于 MIS 治疗 ICH 在瑞典尚未成为标准做法，因此必须考虑在神经外科组织内实施 MIS，以满足预期增加的患者需求。
{"title":"The potential for minimally invasive intracerebral hemorrhage evacuation in routine healthcare: applicability of the ENRICH trial criteria to an unselected cohort","authors":"Trine Apostolaki-Hansson, Amir Hillal, Nathanael Göransson, Björn M. Hansen, Bo Norrving, Birgitta Ramgren, J. Wassélius, Teresa Ullberg","doi":"10.3389/fstro.2024.1403812","DOIUrl":"https://doi.org/10.3389/fstro.2024.1403812","url":null,"abstract":"Following the favorable outcomes demonstrated by the Early MiNimally-invasive Removal of IntraCerebral Hemorrhage (ENRICH) trial in supratentorial intracerebral hemorrhage (ICH) patients treated with minimally invasive surgery (MIS), and considering the increasing interest in MIS, we aimed to assess the potential eligibility rate for ICH patients in Sweden.All patients with spontaneous ICH in the Swedish Stroke Register (RS) during 2017–2020 in Skane county (1.37 million) were assessed. Baseline imaging was used for radiological characterization. Clinical data were obtained from RS. MIS eligibility in the total ICH population meeting ENRICH criteria were estimated and extrapolated to the Swedish population (10.5 million).Of 1,314 ICH patients, 5.9% met the ENRICH criteria for MIS (ICH volume 30–80 ml). Considering the ENRICH trial results indicating the effectiveness of MIS was mainly attributable to intervention for lobar hemorrhages, we determined that 2.8% of our ICH cohort in Sweden would be eligible for MIS. The estimated rate of neurosurgery for ICH could increase from the current 1.46–1.90 patients/100,000 population/year (in absolute numbers from 154 to 200 interventions out of 2,400 ICHs in Sweden annually).We show that 2.8% of the Skane ICH population would be eligible for MIS if ENRICH criteria are employed for patients with lobar ICH, corresponding to a 29% increase of current surgical rates for ICH in Sweden. As MIS for ICH is not yet standard practice in Sweden, consideration for its implementation within the neurosurgical organization becomes essential to accommodate the anticipated increase in patient demand.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"43 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15DOI: 10.3389/fstro.2024.1393197
Jason Burnett, Jordan Broussard, Bronson Ciavarra, Louisa Smitherman, Mary Li, Emma Thames, Sharon Zachariah, Grace Kim, Rachel Pijnnaken, Hannah Zeller, John M. Halphen, Sean I. Savitz, Namkee Choi, Jennifer E. S. Beauchamp
To examine the feasibility of a social phone call program to address social isolation and loneliness in stroke survivors.We paired 14 lonely community-living stroke survivors with 14 health professional students for 6-weekly unstructured social phone calls. Feasibility data and measures of social isolation, loneliness and other psychosocial metrics were collected pre- and post-intervention. Students journaled following each unstructured call to capture the informal conversation and their sentiments.Sixty-two percent of the targeted sample was interested. Fourteen eligible and interested participants were enrolled. The 13 (93%) participants completing all calls and surveys were an average of 57 years old, 85% female, and 77% non-Hispanic white. At baseline, participants were highly lonely and moderately depressed. Participants disclosed physical and emotional challenges, previous valued employment, and enjoyment from the calls. Students reported enjoying the connections, learning about the struggles of aging-in-place after stroke, and valuing compassionate care for the stroke population.Knowledge gaps remain regarding effective social support interventions to provide continuity of care directed at managing social disconnection after stroke. A health professional student-delivered social phone call intervention with stroke survivors appears to be a feasible, in part, and encouraging approach for addressing social isolation and loneliness. Future trials require re-evaluation of eligibility criteria and strategies to boost enrollment before efficacy testing is conducted in a larger trial.
{"title":"The feasibility of health professional student delivered social visits for stroke survivors with loneliness","authors":"Jason Burnett, Jordan Broussard, Bronson Ciavarra, Louisa Smitherman, Mary Li, Emma Thames, Sharon Zachariah, Grace Kim, Rachel Pijnnaken, Hannah Zeller, John M. Halphen, Sean I. Savitz, Namkee Choi, Jennifer E. S. Beauchamp","doi":"10.3389/fstro.2024.1393197","DOIUrl":"https://doi.org/10.3389/fstro.2024.1393197","url":null,"abstract":"To examine the feasibility of a social phone call program to address social isolation and loneliness in stroke survivors.We paired 14 lonely community-living stroke survivors with 14 health professional students for 6-weekly unstructured social phone calls. Feasibility data and measures of social isolation, loneliness and other psychosocial metrics were collected pre- and post-intervention. Students journaled following each unstructured call to capture the informal conversation and their sentiments.Sixty-two percent of the targeted sample was interested. Fourteen eligible and interested participants were enrolled. The 13 (93%) participants completing all calls and surveys were an average of 57 years old, 85% female, and 77% non-Hispanic white. At baseline, participants were highly lonely and moderately depressed. Participants disclosed physical and emotional challenges, previous valued employment, and enjoyment from the calls. Students reported enjoying the connections, learning about the struggles of aging-in-place after stroke, and valuing compassionate care for the stroke population.Knowledge gaps remain regarding effective social support interventions to provide continuity of care directed at managing social disconnection after stroke. A health professional student-delivered social phone call intervention with stroke survivors appears to be a feasible, in part, and encouraging approach for addressing social isolation and loneliness. Future trials require re-evaluation of eligibility criteria and strategies to boost enrollment before efficacy testing is conducted in a larger trial.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"67 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140976146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.3389/fstro.2024.1379083
Jonas Schröder, Laetitia Yperzeele, Elissa Embrechts, R. Loureiro-Chaves, Ann Hallemans, C. Lafosse, S. Truijen, Gert Kwakkel, W. Saeys
Lower limb motor recovery, including abnormal muscle synergies, occurs mainly within the first 5–8 weeks after a stroke. This suggests the importance of delivering impairment-focused therapies, such as therapeutic robots that promote symmetric gait, during this time-sensitive period, following the principle of “the earlier, the better.”First, to compare early robotic training (ERT) with usual care (UC) against UC alone on restoring intralimb muscle synergies and interlimb symmetry during functional tasks; Second, to investigate whether ERT is superior to delayed robotic training (DRT) starting after the proposed time-sensitive period.This observer-blinded, randomized pilot trial with crossover design involved 19 nonambulatory adults included within 14 days poststroke. Those allocated to ERT (N = 10) received immediately 4 weeks of training (16 sessions, 4× /week) with the Ekso GT® above UC and were compared with the DRT group (N = 9) who received UC alone at this point. Thereafter a 3-week UC period followed to investigate sustainability of ERT and the interventional roles were exchanged; at about week 8 poststroke DRT subjects started the same experimental robotic protocol and ERT subjects continued UC as controls. Outcomes included changes in Fugl-Meyer lower extremity scores (FM-LE) reflecting muscle synergies, weight-bearing asymmetry (WBA), and dynamic control asymmetry (DCA) during quiet standing. Functional ambulation category (FAC) was used to classify walking independence (cut-off ≥4).A trend toward earlier reacquisition of walking independence favoring ERT with UC over UC was not accompanied by differences in FM-LE, WBA, or DCA (first objective). Thereafter, DRT with UC did not yield any significant changes relative to UC, such that no between-group differences were found favoring restorative effects of ERT over DRT (second objective).This pilot trial shows the feasibility of investigating a wearable exoskeleton as an adjunct therapy in subacute stroke. Nevertheless, our preliminary findings suggest that motor recovery of lower limb muscle synergies was not enhanced by 4 weeks of robotic training to reduce compensations with the less-affected side, irrespective of the timing of application.ClinicalTrials.gov, identifier: NCT03727919.
{"title":"Exoskeleton-assisted training to enhance lower limb motor recovery in subacute stroke: does timing matter? A pilot randomized trial","authors":"Jonas Schröder, Laetitia Yperzeele, Elissa Embrechts, R. Loureiro-Chaves, Ann Hallemans, C. Lafosse, S. Truijen, Gert Kwakkel, W. Saeys","doi":"10.3389/fstro.2024.1379083","DOIUrl":"https://doi.org/10.3389/fstro.2024.1379083","url":null,"abstract":"Lower limb motor recovery, including abnormal muscle synergies, occurs mainly within the first 5–8 weeks after a stroke. This suggests the importance of delivering impairment-focused therapies, such as therapeutic robots that promote symmetric gait, during this time-sensitive period, following the principle of “the earlier, the better.”First, to compare early robotic training (ERT) with usual care (UC) against UC alone on restoring intralimb muscle synergies and interlimb symmetry during functional tasks; Second, to investigate whether ERT is superior to delayed robotic training (DRT) starting after the proposed time-sensitive period.This observer-blinded, randomized pilot trial with crossover design involved 19 nonambulatory adults included within 14 days poststroke. Those allocated to ERT (N = 10) received immediately 4 weeks of training (16 sessions, 4× /week) with the Ekso GT® above UC and were compared with the DRT group (N = 9) who received UC alone at this point. Thereafter a 3-week UC period followed to investigate sustainability of ERT and the interventional roles were exchanged; at about week 8 poststroke DRT subjects started the same experimental robotic protocol and ERT subjects continued UC as controls. Outcomes included changes in Fugl-Meyer lower extremity scores (FM-LE) reflecting muscle synergies, weight-bearing asymmetry (WBA), and dynamic control asymmetry (DCA) during quiet standing. Functional ambulation category (FAC) was used to classify walking independence (cut-off ≥4).A trend toward earlier reacquisition of walking independence favoring ERT with UC over UC was not accompanied by differences in FM-LE, WBA, or DCA (first objective). Thereafter, DRT with UC did not yield any significant changes relative to UC, such that no between-group differences were found favoring restorative effects of ERT over DRT (second objective).This pilot trial shows the feasibility of investigating a wearable exoskeleton as an adjunct therapy in subacute stroke. Nevertheless, our preliminary findings suggest that motor recovery of lower limb muscle synergies was not enhanced by 4 weeks of robotic training to reduce compensations with the less-affected side, irrespective of the timing of application.ClinicalTrials.gov, identifier: NCT03727919.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"47 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.3389/fstro.2024.1371093
U. Vaher, M. Männamaa, R. Laugesaar, N. Ilves, Nigul Ilves, D. Loorits, P. Kool, P. Ilves
Epilepsy develops in one third of children after perinatal stroke. Both epilepsy and stroke may be risk factors for impaired cognitive abilities. How the development of epilepsy is related to the cognitive profile of children with perinatal stroke is still unclear. The aim of the study was to evaluate general and specific cognitive functions in children with epilepsy and children without epilepsy after perinatal ischemic stroke.The study group consisted of 51 children with perinatal ischemic stroke confirmed by magnetic resonance imaging: 27 (53%) children with arterial ischemic stroke and 24 (47%) with periventricular venous infarction. Magnetic resonance imaging and electroencephalography were performed in all patients after the neonatal period. Epilepsy was diagnosed if the child had at least two unprovoked seizures occurring >24 h apart or one unprovoked seizure with a high recurrence risk. Cognitive assessments were performed using the Kaufman Assessment Battery for Children, Second Edition, at the age of ≥7 years. General ability (Fluid Crystallized Index, Mental Processing Index, Non-verbal Index) and specific cognitive functions (sequential processing, simultaneous processing, learning, planning, knowledge) were evaluated.At the median age of 19.3 years (interquartile range 14.0–22) at the time of follow-up for epilepsy, 14 (27.5%) patients had developed epilepsy, and 37 (72.5%) patients were without epilepsy. All general cognitive ability scores were lower in children with epilepsy compared to children without epilepsy. Among specific cognitive functions, simultaneous processing, planning, and knowledge were lower in children with epilepsy compared to children without epilepsy: simultaneous processing mean [78.5, 95% CI: [69.8, 87.2], vs. 96.9, 95% CI [90, 103.9], p = 0.0018]; planning mean [82.5, 95% CI: [73, 92], vs. 96.2, 95% CI: [88.7, 103.6], p = 0.026]; knowledge median (25th, 75th percentile): 80.5 (75, 87) vs. 92 (84, 108), p = 0.023.Children with epilepsy after perinatal ischemic stroke have lower general cognitive abilities compared to children without epilepsy. The profile of the subscales indicates lower verbal abilities and executive functions in children with epilepsy. Children with post-stroke epilepsy need targeted cognitive monitoring for early aimed rehabilitation and for establishing an adapted learning environment.
{"title":"General ability and specific cognitive functions are lower in children with epilepsy after perinatal ischemic stroke","authors":"U. Vaher, M. Männamaa, R. Laugesaar, N. Ilves, Nigul Ilves, D. Loorits, P. Kool, P. Ilves","doi":"10.3389/fstro.2024.1371093","DOIUrl":"https://doi.org/10.3389/fstro.2024.1371093","url":null,"abstract":"Epilepsy develops in one third of children after perinatal stroke. Both epilepsy and stroke may be risk factors for impaired cognitive abilities. How the development of epilepsy is related to the cognitive profile of children with perinatal stroke is still unclear. The aim of the study was to evaluate general and specific cognitive functions in children with epilepsy and children without epilepsy after perinatal ischemic stroke.The study group consisted of 51 children with perinatal ischemic stroke confirmed by magnetic resonance imaging: 27 (53%) children with arterial ischemic stroke and 24 (47%) with periventricular venous infarction. Magnetic resonance imaging and electroencephalography were performed in all patients after the neonatal period. Epilepsy was diagnosed if the child had at least two unprovoked seizures occurring >24 h apart or one unprovoked seizure with a high recurrence risk. Cognitive assessments were performed using the Kaufman Assessment Battery for Children, Second Edition, at the age of ≥7 years. General ability (Fluid Crystallized Index, Mental Processing Index, Non-verbal Index) and specific cognitive functions (sequential processing, simultaneous processing, learning, planning, knowledge) were evaluated.At the median age of 19.3 years (interquartile range 14.0–22) at the time of follow-up for epilepsy, 14 (27.5%) patients had developed epilepsy, and 37 (72.5%) patients were without epilepsy. All general cognitive ability scores were lower in children with epilepsy compared to children without epilepsy. Among specific cognitive functions, simultaneous processing, planning, and knowledge were lower in children with epilepsy compared to children without epilepsy: simultaneous processing mean [78.5, 95% CI: [69.8, 87.2], vs. 96.9, 95% CI [90, 103.9], p = 0.0018]; planning mean [82.5, 95% CI: [73, 92], vs. 96.2, 95% CI: [88.7, 103.6], p = 0.026]; knowledge median (25th, 75th percentile): 80.5 (75, 87) vs. 92 (84, 108), p = 0.023.Children with epilepsy after perinatal ischemic stroke have lower general cognitive abilities compared to children without epilepsy. The profile of the subscales indicates lower verbal abilities and executive functions in children with epilepsy. Children with post-stroke epilepsy need targeted cognitive monitoring for early aimed rehabilitation and for establishing an adapted learning environment.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"41 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.3389/fstro.2024.1421083
N. A. Sunmonu, Keith L. Keene, Hyacinth I. Hyacinth
{"title":"Editorial: Diversity in stroke omic(s) and epidemiology research: opportunities and challenges","authors":"N. A. Sunmonu, Keith L. Keene, Hyacinth I. Hyacinth","doi":"10.3389/fstro.2024.1421083","DOIUrl":"https://doi.org/10.3389/fstro.2024.1421083","url":null,"abstract":"","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"4 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.3389/fstro.2024.1386300
Sarah Ibrahim, Troy Francis, Kathleen A. Sheehan, Kristina Kokorelias, Aleksandra Stanimirovic, Syeda Hashmi, Csilla Kalocsai, Sharon Ng, Suze G. Berkhout, Jill I. Cameron, Valeria Rac, Aleksandra Pikula
Stroke incidence among young adults of working age (under 65 years of age) has significantly increased in the past decade, with major individual, social, and economic implications. There is a paucity of research exploring the needs of this patient population. This study assessed: (1) young adult stroke patients' physical, psychological, and occupational functioning and health-related quality of life (HRQoL); and (2) post-stroke care preferences using patient-reported outcome measures (PROMs), with attention to gender differences.A cross-sectional pilot study was conducted. Sociodemographic and clinical characteristics were collected through chart review and data on occupational function, physical, psychological, and social wellbeing >90 days post-stroke through a self-reported survey. Descriptive statistics, gender-based, and regression analyses were conducted.The sample included 85 participants. Participants reported impairments in both, occupational functioning, with 58.7% not returned to work (RTW), and HRQoL, specifically with social activities (37%), anxiety (34%), and cognitive function (34%). Women had significantly (p < 0.05) worse physical symptoms (sleep disturbance and fatigue), emotional health (depression, stigma, emotional dyscontrol) scores, and sense of self-identify post-stroke. Over 70% of participants preferred in-person post-stroke care led by health care providers and felt they would have benefited from receiving information on physical health (71.4%), emotional and psychological health (56.0%), RTW (38.1%), and self-identity (26.2%) post-stroke. Women preferred cognitive behavioral therapy (p = 0.018) and mindfulness-based stress reduction therapy (p = 0.016), while men preferred pharmacotherapy (p = 0.02) for psychological symptoms.This is the first study to report impaired HRQoL, psychological and occupational functioning using PROMs, with significant gender differences and preferences for post-stroke care delivery among young adult stroke patients at >90 days after stroke. The findings highlight the importance of needs, gender, and age-specific post-stroke education and interventions.
{"title":"Exploring unmet needs and preferences of young adult stroke patients for post-stroke care through PROMs and gender differences","authors":"Sarah Ibrahim, Troy Francis, Kathleen A. Sheehan, Kristina Kokorelias, Aleksandra Stanimirovic, Syeda Hashmi, Csilla Kalocsai, Sharon Ng, Suze G. Berkhout, Jill I. Cameron, Valeria Rac, Aleksandra Pikula","doi":"10.3389/fstro.2024.1386300","DOIUrl":"https://doi.org/10.3389/fstro.2024.1386300","url":null,"abstract":"Stroke incidence among young adults of working age (under 65 years of age) has significantly increased in the past decade, with major individual, social, and economic implications. There is a paucity of research exploring the needs of this patient population. This study assessed: (1) young adult stroke patients' physical, psychological, and occupational functioning and health-related quality of life (HRQoL); and (2) post-stroke care preferences using patient-reported outcome measures (PROMs), with attention to gender differences.A cross-sectional pilot study was conducted. Sociodemographic and clinical characteristics were collected through chart review and data on occupational function, physical, psychological, and social wellbeing >90 days post-stroke through a self-reported survey. Descriptive statistics, gender-based, and regression analyses were conducted.The sample included 85 participants. Participants reported impairments in both, occupational functioning, with 58.7% not returned to work (RTW), and HRQoL, specifically with social activities (37%), anxiety (34%), and cognitive function (34%). Women had significantly (p < 0.05) worse physical symptoms (sleep disturbance and fatigue), emotional health (depression, stigma, emotional dyscontrol) scores, and sense of self-identify post-stroke. Over 70% of participants preferred in-person post-stroke care led by health care providers and felt they would have benefited from receiving information on physical health (71.4%), emotional and psychological health (56.0%), RTW (38.1%), and self-identity (26.2%) post-stroke. Women preferred cognitive behavioral therapy (p = 0.018) and mindfulness-based stress reduction therapy (p = 0.016), while men preferred pharmacotherapy (p = 0.02) for psychological symptoms.This is the first study to report impaired HRQoL, psychological and occupational functioning using PROMs, with significant gender differences and preferences for post-stroke care delivery among young adult stroke patients at >90 days after stroke. The findings highlight the importance of needs, gender, and age-specific post-stroke education and interventions.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.3389/fstro.2024.1375473
Manali Desai, Ameen Fahad, Kristi Anderson, Michael Erdman, Scott Silliman
Intravenous thrombolysis can be administered to appropriate patients with suspected acute ischemic strokes who are on intravenous heparin infusions after its rapid reversal with protamine sulfate. Several case reports suggest the safety of tissue-type plasminogen activator, or alteplase, in these scenarios. Noting the increasing preferential use of tenecteplase over alteplase for intravenous thrombolysis of acute ischemic stroke, the safe and efficacious use of tenecteplase following heparin reversal has not been demonstrated in the literature. Our case demonstrates successful use of intravenous tenecteplase in a patient who was anticoagulated with therapeutic heparin. The patient had no hemorrhagic complications and had an excellent neurological outcome.
{"title":"Case report: Tenecteplase for acute ischemic stroke after heparin reversal","authors":"Manali Desai, Ameen Fahad, Kristi Anderson, Michael Erdman, Scott Silliman","doi":"10.3389/fstro.2024.1375473","DOIUrl":"https://doi.org/10.3389/fstro.2024.1375473","url":null,"abstract":"Intravenous thrombolysis can be administered to appropriate patients with suspected acute ischemic strokes who are on intravenous heparin infusions after its rapid reversal with protamine sulfate. Several case reports suggest the safety of tissue-type plasminogen activator, or alteplase, in these scenarios. Noting the increasing preferential use of tenecteplase over alteplase for intravenous thrombolysis of acute ischemic stroke, the safe and efficacious use of tenecteplase following heparin reversal has not been demonstrated in the literature. Our case demonstrates successful use of intravenous tenecteplase in a patient who was anticoagulated with therapeutic heparin. The patient had no hemorrhagic complications and had an excellent neurological outcome.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"58 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.3389/fstro.2024.1389830
David S. Liebeskind, Scott Brown, Albert J. Yoo
The recent results of large core trials in acute ischemic stroke prompt the most influential paradigm shift in over a decade since endovascular therapy (EVT) was proven as the mainstay of acute stroke treatment. Six randomized, controlled trials (RCTs) of EVT in patients with more extensive ischemia on imaging than prior approved treatment indications revealed a consistent benefit of EVT, despite different imaging criteria and ischemic core definitions across the individual trials. These findings unfolded sequentially, akin to the acts of a drama, with the story evolving until perhaps the most conclusive results on extensive ischemia treatment about to be published. At this juncture, it is important to summarize the collective findings of these 6 RCTs, consider the potential expansion in the use of EVT, outline the penultimate or next steps during the encore of this drama and ponder the broad implications of these recent findings on the entire stroke field for many years to come. This logical rationale and perspective form the basis of Establishing Neuroimaging Criteria of Revascularization Efficacy (ENCORE), the proposed pooled, subject-level, meta-analysis of the recent large core trials, leveraging imaging re-adjudication by a collaborative, imaging core lab with documented expertise. Expansion of the treatment indications for EVT will likely ensue, yet numerous questions persist regarding other confounding variables that we normally use in routine clinical practice. Precision medicine for large core ischemic stroke mandates a more detailed investigation of the numerous clinical, imaging and angiographic variables that each trial dataset collected. In a simple pooled meta-analysis, these varying definitions, methodology and analytic approaches preclude anything beyond current summary results showing that EVT is favored, in general, over medical treatment. The epilog of the large core trials can be written by ENCORE, using the imaging and statistical methods and relevant expertise of the prior Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration.
{"title":"ENCORE! Getting to the core of the ischemic core at the core lab","authors":"David S. Liebeskind, Scott Brown, Albert J. Yoo","doi":"10.3389/fstro.2024.1389830","DOIUrl":"https://doi.org/10.3389/fstro.2024.1389830","url":null,"abstract":"The recent results of large core trials in acute ischemic stroke prompt the most influential paradigm shift in over a decade since endovascular therapy (EVT) was proven as the mainstay of acute stroke treatment. Six randomized, controlled trials (RCTs) of EVT in patients with more extensive ischemia on imaging than prior approved treatment indications revealed a consistent benefit of EVT, despite different imaging criteria and ischemic core definitions across the individual trials. These findings unfolded sequentially, akin to the acts of a drama, with the story evolving until perhaps the most conclusive results on extensive ischemia treatment about to be published. At this juncture, it is important to summarize the collective findings of these 6 RCTs, consider the potential expansion in the use of EVT, outline the penultimate or next steps during the encore of this drama and ponder the broad implications of these recent findings on the entire stroke field for many years to come. This logical rationale and perspective form the basis of Establishing Neuroimaging Criteria of Revascularization Efficacy (ENCORE), the proposed pooled, subject-level, meta-analysis of the recent large core trials, leveraging imaging re-adjudication by a collaborative, imaging core lab with documented expertise. Expansion of the treatment indications for EVT will likely ensue, yet numerous questions persist regarding other confounding variables that we normally use in routine clinical practice. Precision medicine for large core ischemic stroke mandates a more detailed investigation of the numerous clinical, imaging and angiographic variables that each trial dataset collected. In a simple pooled meta-analysis, these varying definitions, methodology and analytic approaches preclude anything beyond current summary results showing that EVT is favored, in general, over medical treatment. The epilog of the large core trials can be written by ENCORE, using the imaging and statistical methods and relevant expertise of the prior Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"51 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140739563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While tyrosine kinase inhibitors (TKI)-associated cerebral vascular stenosis (CVS) exhibit distinct mechanisms compared to conventional stroke in basic research, the clinical strategy remains nearly the same other than TKI-switching. We present the case of a 22-year-old female with chronic myeloid leukemia without stroke risk factors, who developed ponatinib-associated CVS. Three potential characteristics of TKI-associated CVS were identified: a heightened threshold for infarction, an atypical infarct area, and vascular recoverability. Specifically, brain computed tomography remained normal despite 20 h of severe hemiplegia. The ischemic distribution was confined in gray matter and the anterior cerebral artery territory on magnetic resonance imaging, despite severe stenosis of the internal carotid artery. Ischemic changes resolved within 10 days and arterial stenosis improved after ponatinib withdrawal. These unique features, distinct from typical stroke, could lead to misdiagnosis as non-organic neurological disorders or other conditions in ponatinib-treated patients.
{"title":"Case report: Three characteristics of tyrosine kinase inhibitor-associated cerebrovascular stenosis. High threshold for infarction, atypical infarct area, and vascular recoverability under the use of ponatinib","authors":"A. Hanazono, Masamichi Abe, Shuntaro Togashi, Teruko Takahashi, Naoto Takahashi, Masashiro Sugawara","doi":"10.3389/fstro.2024.1367869","DOIUrl":"https://doi.org/10.3389/fstro.2024.1367869","url":null,"abstract":"While tyrosine kinase inhibitors (TKI)-associated cerebral vascular stenosis (CVS) exhibit distinct mechanisms compared to conventional stroke in basic research, the clinical strategy remains nearly the same other than TKI-switching. We present the case of a 22-year-old female with chronic myeloid leukemia without stroke risk factors, who developed ponatinib-associated CVS. Three potential characteristics of TKI-associated CVS were identified: a heightened threshold for infarction, an atypical infarct area, and vascular recoverability. Specifically, brain computed tomography remained normal despite 20 h of severe hemiplegia. The ischemic distribution was confined in gray matter and the anterior cerebral artery territory on magnetic resonance imaging, despite severe stenosis of the internal carotid artery. Ischemic changes resolved within 10 days and arterial stenosis improved after ponatinib withdrawal. These unique features, distinct from typical stroke, could lead to misdiagnosis as non-organic neurological disorders or other conditions in ponatinib-treated patients.","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":"112 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.3389/fstro.2024.1350825
D. Jayaraman, Stephanie Kjelstrom, Georgia Montone, Divya Rajasekaran
Stroke is one of the leading causes of death and disability worldwide. Every year, about 795,000 strokes are reported in the United States, of which around 23% are recurrent. We analyzed the national inpatient sample to assess the outcomes in patient with pulmonary hypertension and ischemic stroke. Our study included 7 million inpatient discharge encounters among which 553,085 patients had ischemic stroke. Among this, 16,830 had PH and 536,255 did not have PH.female (63.8% vs. 48.8%; p < 0.0001). A higher proportion of stroke patients with PH died in the hospital (5.7% vs. 3.7%; p < 0.0001) as well as had a longer average length of stay (LOS) [6.3 days (SD 6.2) vs. 5.0 days (SD 6.8); p < 0.0001]. Our study noted that black patients with PH were younger [70.5 years (SD 13.8)]. Black patients had the longest length of stay compared to Caucasians (7.8 days SD 8.3) (p < 0.0001).
{"title":"Pulmonary hypertension leads to poor inpatient outcome in non-white patients admitted with stroke: an analysis of national inpatient sample","authors":"D. Jayaraman, Stephanie Kjelstrom, Georgia Montone, Divya Rajasekaran","doi":"10.3389/fstro.2024.1350825","DOIUrl":"https://doi.org/10.3389/fstro.2024.1350825","url":null,"abstract":"Stroke is one of the leading causes of death and disability worldwide. Every year, about 795,000 strokes are reported in the United States, of which around 23% are recurrent. We analyzed the national inpatient sample to assess the outcomes in patient with pulmonary hypertension and ischemic stroke. Our study included 7 million inpatient discharge encounters among which 553,085 patients had ischemic stroke. Among this, 16,830 had PH and 536,255 did not have PH.female (63.8% vs. 48.8%; p < 0.0001). A higher proportion of stroke patients with PH died in the hospital (5.7% vs. 3.7%; p < 0.0001) as well as had a longer average length of stay (LOS) [6.3 days (SD 6.2) vs. 5.0 days (SD 6.8); p < 0.0001]. Our study noted that black patients with PH were younger [70.5 years (SD 13.8)]. Black patients had the longest length of stay compared to Caucasians (7.8 days SD 8.3) (p < 0.0001).","PeriodicalId":504975,"journal":{"name":"Frontiers in Stroke","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139791135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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