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  • 1
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    Online Resource
    Abstract TMP116: Predictors of Readmissions Following Percutaneous Patent Foramen Ovale Closure in a Nationally Representative Dataset
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: The optimal management of patients with recurrent stroke and patent foramen ovale (PFO) is debated. While some are managed medically with antiplatelet/anticoagulant agents, others undergo percutaneous closure of PFO (PC PFO). Device-specific trials have demonstrated a risk of atrial fibrillation/flutter (AF) following closure. To date, nationally representative data has not yet been used to assess the rates and causes of readmission following PC PFO. Methods: The 2013 Nationwide Readmissions Database is a national database of readmissions for all payers and the uninsured with data on 〉 14 million U.S. admissions. We used validated International Classification of Disease, Ninth Revision, Clinical Modification codes to identify PC PFO, ischemic stroke, and medical comorbidities and complications. We calculated readmission rate following PC PFO. We performed Kaplan-Meier analysis to determine the cumulative 1-year risk of readmission with AF and Cox regression modelling to calculate hazard ratios (HR) of AF readmission at 1 year. Results: Among 850 patients who underwent PC PFO, there were 151(17.7%) readmissions within 1 year and 52 within the first 30 days. 11.5% of 30-day readmissions were for atrial fibrillation and 3.9% for flutter. Kaplan-Meier cumulative risk for readmission with AF at 1 year was 2.17%. Readmission rate for ischemic stroke was 〈 1% (0.38%, 0.69%, and 0.61% at 30, 60, and 90 days respectively), compared to just over 1% for AF (1.15%, 1.38%, and 1.37% at 30, 60, and 90 days respectively). Predictors of AF readmission included history of congestive heart failure (CHF) (HR 3.53, 95% CI 1.23-10.17, p = 0.02) and increasing age (HR 1.05 per year, 1.02-1.09, p = 0.002). Conclusion: 1 in 5 of those who undergo PC PFO are readmitted in the first year, and 1/3 of these readmissions occur within 30 days. PC PFO is associated with low readmission rates for stroke and a low risk of the independent vascular risk factor of AF. The hazard for AF is over 3-fold greater for those with CHF and increases with each year increase in age.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TMP116
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 2
    Online Resource
    Online Resource
    Aspirin-Use Before ICH : A Potentially Treatable Iatrogenic Coagulopathy?
    Ovid Technologies (Wolters Kluwer Health) ; 2006
    In:  Stroke Vol. 37, No. 1 ( 2006-01), p. 4-5
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 1 ( 2006-01), p. 4-5
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000196944.24973.f7
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2006
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  • 3
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    Revisiting the Appropriateness of Carotid Endarterectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 6 ( 2003-06), p. 1464-1471
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 6 ( 2003-06), p. 1464-1471
    Abstract: Background and Purpose— In the 1980s, carotid endarterectomy was controversial because proof of efficacy was lacking, complication rates were high, and one third of cases were reported to be inappropriate. Since publication of several randomized controlled trials (RCTs), rates of carotid endarterectomy have doubled nationwide. This study assesses the appropriateness and use of carotid endarterectomy since publication of the RCTs. Methods— Using the literature, we developed a list of 1557 mutually exclusive indications for carotid endarterectomy and asked a panel of national experts to rate the appropriateness of each indication using the RAND methodology. We used these ratings to assess appropriateness in a sample of 2124 patients who underwent the procedure in 1997 to 1998 in 6 hospitals. We also analyzed the reasons for the procedure and rates of death, stroke, and myocardial infarction within 30 days of surgery. Results— Overall, 84.9% of operations were done for appropriate reasons, 4.5% for uncertain reasons, and 10.6% for inappropriate reasons. Among procedures considered inappropriate, the most common reasons were high comorbidity (46.6%) and minimal stenosis (27.1%). Overall, 72.5% were asymptomatic, 17.4% had a carotid transient ischemic attack, and 10.1% had a stroke. The 30-day rate of death or stroke was 5.47% for symptomatic patients and 2.26% for asymptomatic patients. Among patients having combined carotid and coronary artery bypass graft surgery, the rate was 10.32%. The complication rate in asymptomatic patients with high comorbidity was 5.56%. Conclusions— Since the RCTs, rates of overuse appear to have fallen considerably, although they are still significant. A major shift has occurred toward operating on asymptomatic patients. Although overall complication rates were low, rates among asymptomatic patients with high comorbidity exceeded recommended thresholds.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000072514.79745.7D
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 4
    Online Resource
    Online Resource
    Response to Letter Regarding Frequency of Unrecognized Fabry Disease Among Young European-American and African-American Men With First Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 1 ( 2011-01)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 1 ( 2011-01)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.593830
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 5
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    Frequency of Unrecognized Fabry Disease Among Young European-American and African-American Men With First Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 1 ( 2010-01), p. 78-81
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 1 ( 2010-01), p. 78-81
    Abstract: Background and Purpose— The cause of initial ischemic stroke in up to 30% of young patients remains unclear. Fabry disease, due to deficient α-galactosidase A (α-Gal A) activity, is a vascular endothelial glycosphingolipid storage disease typically presenting in childhood. With advancing age, patients develop renal, cardiac, and cerebrovascular disease and die prematurely. A European study suggested an increased prevalence of unrecognized Fabry disease in patients with cryptogenic stroke. We hypothesized that α-Gal A deficiency is a rare cause of initial early-onset ischemic stroke in men. Methods— The Stroke Prevention in Young Men Study enrolled 〉 550 men (15 to 49 years) with first ischemic stroke in the Baltimore–Washington area in 2004 to 2007. Frozen plasma samples were assayed for α-Gal A activity, and DNA from patients with consistently low plasma α-Gal A activities were sequenced. Results— The study sample consisted of 558 men (42% African-American; median age 44 years). Stroke was cryptogenic in 154 men (40% African-American). In 10 patients with low plasma α-Gal A activities, DNA sequencing identified alterations in the α-Gal A gene in 2 patients. The polymorphism, D313Y, which results in low plasma enzyme activity, but near normal levels of cellular activity was seen in one European-American male. The Fabry disease-causing A143T mutation was seen in an African-American male with cryptogenic stroke (0.18% of all strokes: upper 95% CI=0.53%; 0.65% of cryptogenic strokes: upper 95% CI=1.92%). Conclusions— In this biracial population, unrecognized Fabry disease is a rare but treatable cause of initial ischemic stroke in young men.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.109.558320
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 6
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    Online Resource
    Interhospital Transfers for Endovascular Therapy for Acute Ischemic Stroke : Nationally Representative Data
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 7 ( 2019-07), p. 1789-1796
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 7 ( 2019-07), p. 1789-1796
    Abstract: Multiple randomized clinical trials have demonstrated the superiority of endovascular therapy (ET) for large vessel occlusion acute ischemic stroke (AIS). Few centers can provide ET, and significant debate exists about the most efficient and effective ways to provide ET. We sought to assess real-world utilization of ET, the extent to which patients are transferred from one hospital to another for therapy and the implications of transfer status on outcomes. Methods— We used the 2015 to 2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database, which contains nationwide data on nearly half of US admissions. We identified index AIS admissions, vascular risk factors, and treatment with intravenous thrombolysis and ET using International Classification of Disease, Ninth Revision , and International Classification of Disease, Tenth Revision Clinical Modification codes. Main predictors of outcome were treatment with ET and whether there was an interhospital transfer during the index AIS hospitalization. Among patients with AIS readmitted within 30 days, we examined 3 main outcomes: total charges, length of stay, and in-hospital mortality. Results— A total of 23 121 AIS admissions were treated with ET and 874 229 without. Over 5% of patients who received ET were transferred during the index admission compared with 〈 2% of those not treated with ET. Length of stay and total charges were significantly higher in patients transferred (12.3 versus 9.6 days and $233 626 versus $182 881, respectively). More patients treated with ET who were not transferred to the index hospital were discharged home (25.3% versus 44.4%), and ≈25% of patients transferred for ET died during the hospitalization compared with 15.5% not transferred. Conclusions— The minority of all patients with AIS receive ET. The majority of patients who receive ET present directly to the center that performs the procedure, and those transferred for ET have higher length of stay, cost, and mortality that those not transferred.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.024869
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
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    Online Resource
    Emergent Large Vessel Occlusion Stroke During New York City’s COVID-19 Outbreak : Clinical Characteristics and Paraclinical Findings
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 9 ( 2020-09), p. 2656-2663
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 9 ( 2020-09), p. 2656-2663
    Abstract: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. Methods: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients’ demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. Results: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients’ mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81–0.98] ; P =0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.9 9 [1.12–14.17]; P =0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04–0.81); P =0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47–1.08] , P ≤0.0001). Conclusions: More than half of the ELVO stroke patients during the peak time of the New York City’s COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030397
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 8
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    Abstract NS 9: An Educational Intervention to Enhance Acute Stroke Symptom Recognition Skills Among Nursing Home Nursing Assistants
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Treatment of stroke requires a coordinated effort by clinicians educated to identify and transfer presumed acute stroke patients to hospital Emergency Departments (EDs) for expedited evaluation. With the aging of the population and the increasing demand for nursing home (NH) services, the community of clinicians educated to identify acute symptoms of stroke needs to be inclusive of Nursing Assistants (CNAs) in NH settings, who provide 70 to 80% of direct-care hours to NH residents. Approximately 25% of NH residents are referred to EDs for emergency care each year. Poorly executed transitions between EDs and NHs have the potential to delay assessment and intervention in a context in which “time is brain.” Purpose: The goal of this educational intervention was to integrate evidence-based messages for acute stroke symptom recognition into NH CNA practice and to assess knowledge change by comparing stroke-related knowledge at baseline to knowledge acquired immediately post-intervention. Methods: An educational module on acute stroke symptom recognition based on the Massachusetts Department of Public Health’s “Stroke Heroes Act FAST Education Guide” was delivered live by an advanced practice nurse to a convenience sample of 39 CNAs from 4 of an urban NH’s skilled nursing units. Pre- and post-test surveys, based on the “Hip Hop Stroke” survey questions, were administered to participants and results were analyzed using descriptive statistics. Results: Mean age of participants was 43.2 years (SD = 8.1), 82.1% were female, and 74.4% were Black. Mean years of clinical experience were 12.6 (SD = 8.2). Most (94.7%) described stroke as involving the brain on the pre-test, but only 22.2% of CNAs could select all 4 signs of stroke from the eight options offered on the pre-test. Post-intervention, 100% indicated that a stroke involves the brain and 33.3% correctly selected all 4 signs of stroke. In addition, 78.6% accurately described the meaning of all 4 “FAST” letters on the post-test. Conclusions: This educational intervention improved NH CNA knowledge of stroke symptoms. While this intervention could be replicated in other NH settings, the effect of early stroke symptom recognition on the quality of the emergency care provided to NH residents, and the impact of that emergency care on stroke-related morbidity and mortality among NH residents, warrant further study. It is notable that most participants were Black, as it is well documented that racial-ethnic minorities are less likely to be aware of acute stroke symptoms and the need for urgent treatment. Further research is needed to determine the optimal design of educational interventions in at-risk populations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.ANS9
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 9
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    Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke : The NYC MIST Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 12 ( 2020-12), p. 3495-3503
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 12 ( 2020-12), p. 3495-3503
    Abstract: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models. Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes ( P 〈 0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively ( P =0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P 〈 0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS ( P =0.10). Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03048292.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030248
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 10
    Online Resource
    Online Resource
    Effect of Peer Education on Stroke Prevention : The Prevent Recurrence of All Inner-City Strokes Through Education Randomized Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 11 ( 2014-11), p. 3330-3336
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 11 ( 2014-11), p. 3330-3336
    Abstract: Efforts to reduce disparities in recurrent stroke among Black and Latino stroke survivors have met with limited success. We aimed to determine the effect of peer education on secondary stroke prevention among predominantly minority stroke survivors. Methods— Between 2009 and 2012, we enrolled 600 stroke or transient ischemic attack survivors from diverse, low-income communities in New York City into a 2-arm randomized clinical trial that compared a 6 week (1 session/week), peer-led, community-based, stroke prevention self-management group workshop (N=301) to a wait-list control group (N=299). The primary outcome was the proportion with a composite of controlled blood pressure ( 〈 140/90 mm Hg), low-density lipoprotein cholesterol 〈 100 mg/dL, and use of antithrombotic medications at 6 months. Secondary outcomes included control of the individual stroke risk factors. All analyses were by intent-to-treat. Results— There was no difference in the proportion of intervention and control group participants achieving the composite outcome (34% versus 34%; P =0.98). The proportion with controlled blood pressure at 6 months was greater in the intervention group than in the control group (76% versus 67%; P =0.02). This corresponded to a greater change in systolic blood pressure in the intervention versus control group (−3.63 SD, 19.81 mm Hg versus +0.34 SD, 23.76 mm Hg; P =0.04). There were no group differences in the control of cholesterol or use of antithrombotics. Conclusions— A low-cost peer education self-management workshop modestly improved blood pressure, but not low-density lipoprotein cholesterol or antithrombotic use, among stroke and transient ischemic attack survivors from vulnerable, predominantly minority urban communities. Clinical Trial Registration— URL: http://www.clinicaltrials.gov/show/NCT0102727 . Unique identifier: NCT01027273.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.006623
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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