GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Effect of Direct Transportation to Thrombectomy-Capable Center vs Local Stroke Center on Neurological Outcomes in Patients With Suspected Large-Vessel Occlusion Stroke in Nonurban Areas : The RACECAT Randomized Clinical Trial
    American Medical Association (AMA) ; 2022
    In:  JAMA Vol. 327, No. 18 ( 2022-05-10), p. 1782-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 327, No. 18 ( 2022-05-10), p. 1782-
    Abstract: In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. Objective To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. Design, Setting, and Participants Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. Interventions Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). Main Outcomes and Measures The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death] ) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. Results Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21] ); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). Conclusions and Relevance In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. Trial Registration ClinicalTrials.gov Identifier: NCT02795962
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2022.4404
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 3 ( 2023-03), p. 770-780
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 3 ( 2023-03), p. 770-780
    Abstract: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. Methods: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am –8:59 pm ) and nighttime (9:00 pm –7:59 am ). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. Results: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR] , 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163] ; P interaction =0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; P interaction 〈 0.01); no heterogeneity was observed for other stroke subtypes ( P interaction 〉 0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. Conclusions: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.041013
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Abstract WP279: Can We Reduce Door-to-Needle Times and Improve Outcome by Giving tPA on the CT Suite?
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Objectives: The time to administration of intravenous (iv) tPA has a relevant impact on patients outcome. Our treatment protocol has been modified in order to improve our latency times by starting iv tPA bolus in the computed tomography room (CT-tPA). We aimed to evaluate the impact of CT-tPA on door-to-needle times and functional outcome in patients with acute ischemic stroke. Material and methods: We consecutively evaluated 70 patients treated in accordance with the CT-tPA protocol from June 2011 to June 2012. Those patients were compared to 130 patients from the previous year who received iv tPA bolus in the Stroke Unit (conventional protocol). Demographic data, baseline stroke severity, and inpatient latency times were evaluated. The primary outcome was the modified Rankin scale (mRS) at 3 months. Functional independency was considered when mRS≤2. Results: Two-hundred patients were evaluated, with mean age of 74.4±11.5 years and median NIHSS of 13 (IQR 11). There was no difference in baseline clinical characteristics at admission between CT-tPA and conventional protocol. The door-to-CT times were similar in both groups. Mean door-to-needle time was 57.1 min in the conventional protocol, and was reduced to 53.4 after CT-tPA protocol implantation. We analyzed the number of patients who received iv tPA bolus bellow 30 and 50 minutes in each group. The CT-tPA group had 9% more patients treated in 〈 30 min (16% vs. 25%) and 11% more treated in 〈 50 min-window (50% vs. 61%) after arrival to the emergency department. Clinically, there was a trend toward a better functional outcome in the CT-tPA protocol, with an increase of 10.7% of patients with mRS≤ 2 at 3 months compared with the conventional protocol (56.9% vs 46.2%). We also observed a reduction of 3-months mortality in patients treated according to the CT-tPA protocol (19% vs. 23%). The application of CT-tPA was not associated with the increase of ICH nor with tPA protocol violations. Conclusions: The CT-tPA protocol reduces door-to-needle times, increasing the number of patients treated bellow the 〈 50 and 〈 30 minutes time-window. We hypothesized that this time-reduction would improve functional outcome in a larger number of patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP279
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Potential Blood Pressure Thresholds and Outcome in Acute Intracerebral Hemorrhage
    S. Karger AG ; 2014
    In:  European Neurology Vol. 72, No. 3-4 ( 2014), p. 203-208
    Details
    In: European Neurology, S. Karger AG, Vol. 72, No. 3-4 ( 2014), p. 203-208
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Little is known about the relationships between different systolic blood pressure (SBP) thresholds and their outcomes in acute intracerebral hemorrhage (ICH). We aimed to determine the associations of potential systolic blood pressure (SBP) thresholds with hematoma growth (HG) and clinical outcome in patients with acute ICH. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 117 patients with acute ( 〈 6 h) spontaneous supratentorial ICH underwent blood pressure monitoring at 15 min interval over the first 24 h. SBP thresholds of 140, 150, 160, 170, 180, 190, and 200 mm Hg were assessed by means of the percentage of 24-hour values exceeding each threshold (SBP load). HG at 24 h, early neurological deterioration (END), 24-hour and 90-day mortality, and poor outcome were recorded. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 SBP 170, 180, 190, and 200 loads were significantly correlated with the amount of both absolute and relative hematoma enlargement at 24 h. In multivariate analyses, SBP 170 load was related to HG and END, while SBP 160 load was associated with mortality at 24 h. No thresholds were independently related to outcomes at 90 days. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 In patients with acute ICH, SBP lowering to at least less than 160 mm Hg threshold may be needed to minimize the deleterious effect of high SBP on 24-hour outcomes.
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    URL: Article
    DOI: 10.1159/000362269
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1482237-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 5
    Online Resource
    Online Resource
    Selecting Endovascular Treatment Strategy according to the Location of Intracranial Occlusion in Acute Stroke
    S. Karger AG ; 2013
    In:  Cerebrovascular Diseases Vol. 35, No. 6 ( 2013), p. 502-506
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 35, No. 6 ( 2013), p. 502-506
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Selection of endovascular approaches for acute stroke patients remains unclear. The efficacy of intra-arterial therapy (IAT) has been demonstrated in the past. However, in the last years, the use of mechanical thrombectomy by retrievers (RET) is increasing at the expense of IAT. We aimed to compare several clinical outcomes between patients treated with IAT or RET. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In a 6-year period, acute stroke patients ( 〈 8 h) with confirmed internal carotid artery (ICA) occlusion or middle cerebral artery (MCA) occlusion undergoing endovascular therapy were prospectively included in our database. Patients who underwent intra-arterial tissue plasminogen activator (tPA) ± microguidewire mechanical clot disruption (IAT group) were compared with those who underwent thrombectomy with the Solitaire® or Trevo® retrievers (RET group). Recanalization (REC) was considered if at the end of the endovascular procedure thrombolysis in cerebral infarction score was 2a-3. Dramatic clinical improvement (DCI) was defined as a decrease of ≥10 NIHSSS points from baseline to discharge or 7 days. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 One hundred and eighty patients were included, 100 (55.6%) patients in the IAT group and 80 patients (44.4%) in the RET group. There were no differences in baseline characteristics (age, gender, risk factors profile, previous treatment with i.v. tPA, baseline NIHSS, extracranial ICA angioplasty and time to REC). Rates of REC, DCI and symptomatic intracranial hemorrhage were also similar between groups. Among patients with ICA occlusions (41 IAT, 34 RET), REC was significantly higher with RET (83.9 vs. 61%; p = 0.04).There was a trend towards a higher DCI rate in the RET group (32.3%) compared with the IAT group (14.6%; p = 0.06). According to MCA occlusions, there were no major differences in the main outcome variables. The number needed to treat to achieve one additional DCI with RET compared with IAT was 12 for MCA occlusions, and only 5 for ICA occlusions. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Among acute stroke patients undergoing endovascular therapies, the benefits of RET over IAT are greater in ICA occlusions. Retrievers may be considered as the first therapeutic option in these patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000350198
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 6
    Online Resource
    Online Resource
    Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis
    BMJ ; 2023
    In:  Journal of NeuroInterventional Surgery
    Details
    In: Journal of NeuroInterventional Surgery, BMJ
    Abstract: The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI− at LSC arrival on variables related to workflows using data from the RACECAT Trial. Objective To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. Methods We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. Results Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69–96) vs VI− 76 (IQR 59–98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26–53) vs VI− 54 (IQR 40–70), P 〈 0.001). Conclusion Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/jnis-2023-020125
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 7
    Online Resource
    Online Resource
    Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome
    BMJ ; 2013
    In:  Journal of NeuroInterventional Surgery Vol. 5, No. suppl 1 ( 2013-05), p. i70-i73
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 5, No. suppl 1 ( 2013-05), p. i70-i73
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2012-010438
    Language: English
    Publisher: BMJ
    Publication Date: 2013
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 8
    Online Resource
    Online Resource
    Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 4 ( 2014-04), p. 1059-1063
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 4 ( 2014-04), p. 1059-1063
    Abstract: The effect of tissue-type plasminogen activator on functional outcome decreases progressively over time. However, given the differential pattern of arterial occlusion, stroke severity, and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aimed to identify the impact of time-to-treatment according to stroke severity on functional outcome in patients with acute ischemic stroke. Methods— We included 581 consecutive patients treated with alteplase according to the European Summary of Product Characteristics criteria. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8), moderate NIHSS (9–15), and severe stroke NIHSS (≥16). We sequentially analyzed time-to-treatment to achieve favorable outcome (modified Rankin Scale ≤2 at 3 months). Results— Overall, 19.8% had mild, 30.3% had moderate, and 49.9% had severe stroke. Favorable outcome occurred in 79.1%, 60.8%, and 26.2%, respectively. In patients with mild stroke, younger age (odds ratio [OR], 0.88; 95% confidence intervals [CI] , 0.8–0.95), no previous history of stroke (OR, 0.16; 95% CI [0.039–0.65]), and no proximal occlusion (OR, 0.183; 95% CI [0.038–0.89] ) independently predicted favorable outcome. In patients with moderate stroke, age (OR, 0.95; 95% CI [0.92–0.98]), no proximal occlusion (OR, 0.362; 95% CI [0.17–0.75] ), and time-to-treatment before 120 minutes (OR, 2.70; 95% CI [1.14–6.38]) emerged as independent predictors of favorable outcome. In patients with severe stroke, younger age (OR, 0.96; 95% CI [0.94–0.99] ), lower previous modified Rankin Scale (OR, 0.42; 95% CI [0.21–0.82]), and absence of proximal occlusion (OR, 0.48; 95% CI [0.25–0.94] ) appeared as independent predictors. Conclusions— The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity. The window for favorable outcome was ≤120 min for moderate strokes. However, time-to-treatment seemed unrelated to functional outcome in mild and severe stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.004307
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 9
    Online Resource
    Online Resource
    Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 12 ( 2011-12), p. 3465-3469
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 12 ( 2011-12), p. 3465-3469
    Abstract: Good collateral pial circulation (CPC) predicts a favorable outcome in patients undergoing intra-arterial procedures. We aimed to determine if CPC status may be used to decide about pursuing recanalization efforts. Methods— Pial collateral score (0–5) was determined on initial angiogram. We considered good CPC when pial collateral score 〈 3, defined total time of ischemia (TTI) as onset-to-recanalization time, and clinical improvement 〉 4-point decline in admission–discharge National Institutes of Health Stroke Scale. Results— We studied CPC in 61 patients (31 middle cerebral artery, 30 internal carotid artery). Good CPC patients (n=21 [34%]) had lower discharge National Institutes of Health Stroke Scale score (7 versus 21; P =0.02) and smaller infarcts (56 mL versus 238 mL; P 〈 0.001). In poor CPC patients, a receiver operating characteristic curve defined a TTI cutoff point 〈 300 minutes (sensitivity 67%, specificity 75%) that better predicted clinical improvement (TTI 〈 300: 66.7% versus TTI 〉 300: 25%; P =0.05). For good CPC patients, no temporal cutoff point could be defined. Although clinical improvement was similar for patients recanalizing within 300 minutes (poor CPC: 60% versus good CPC: 85.7%; P =0.35), the likelihood of clinical improvement was 3-fold higher after 300 minutes only in good CPC patients (23.1% versus 90.1%; P =0.01). Similarly, infarct volume was reduced 7-fold in good as compared with poor CPC patients only when TTI 〉 300 minutes (TTI 〈 300: poor CPC: 145 mL versus good CPC: 93 mL; P =0.56 and TTI 〉 300: poor CPC: 217 mL versus good CPC: 33 mL; P 〈 0.01). After adjusting for age and baseline National Institutes of Health Stroke Scale score, TTI 〈 300 emerged as an independent predictor of clinical improvement in poor CPC patients (OR, 6.6; 95% CI, 1.01–44.3; P =0.05) but not in good CPC patients. In a logistic regression, good CPC independently predicted clinical improvement after adjusting for TTI, admission National Institutes of Health Stroke Scale score, and age (OR, 12.5; 95% CI, 1.6–74.8; P =0.016). Conclusions— Good CPC predicts better clinical response to intra-arterial treatment beyond 5 hours from onset. In patients with stroke receiving endovascular treatment, identification of good CPC may help physicians when considering pursuing recanalization efforts in late time windows.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.623827
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 10
    Online Resource
    Online Resource
    Abstract T P34: Poor Collateral Circulation Assessed By Multiphase Cta Predicts Malignant Mca Evolution After Reperfusion Therapies
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Background: Collateral circulation (CC) has been associated with recanalization, infarct volume, risk of haemorrhagic transformation and clinical outcome in patients undergoing acute reperfusion therapies. However, its relationship with the development to malignant MCA infarction (mMCAi) has not been evaluated. Our aim was determine the impact of collateral circulation using multiphase CTA (mCTA) on acute phase in the prediction of mMCAi. Methods: Consecutive acute stroke 〈 4.5h patients that were evaluated for reperfusion therapies and with a M1-MCA or TICA occlusion by CTA were included. CC was evaluated on mCTA, CC evaluation was performed according to the University Calgary CC Scale; CC was also classified as poor (grades 0-3) or good (grades 4-5). The mMCAi was defined according to previously published clinical and radiological criteria. Recanalization was assessed with TCD at 24-hours and TICI score≥2a in endovascular treatment (ET) patients. Good outcome was defined as mRS 0-2 at 3months. Results: 82 patients were included. Mean age: 65.1 ±13.83 years, median baseline NIHSS 18(IQR 5.7), 67.9% M1 and 32.1% TICA occlusions, 53 patients received ET and 57 iv tPA, 15 patients develop a mMCAi. In the univariate analysis, patients with mMCAi had lower CC scores (2.29 Vs. 3.71 p=0.001), higher baseline NIHSS (19.86 Vs. 15.70 p=0.016), lower TIMI reperfusion scores (0 Vs. 2.79 p=00.5) and presence of TICA occlusion was more often compared with M1 occlusion (71% Vs. 11.9%, p=0.033) ET was associated with lower rate of mMCAi development as compared with only i.v. reperfusion treatment (9.4%Vs.29.6%, p=0.028). Furthermore, all patients with poor CC who did not recanalize developed mMCAi (6 Vs. 0, p=0.68) On the multivariate analysis adjusted to age, vessel occlusion, baseline NIHSS and recanalization, the presence of poor CC by mCTA was the only independent predictor of mMCAi (p=0.048 OR: 9.72, 95%IC: 1.387-92.53) Conclusion: CC assessment by mCTA independently predicts malignant MCA progression. In patients with persistent occlusion after reperfusion therapies, the presence of poor CC may help in the early malignant MCA detection and management.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tp34
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...