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Abstract WP1: Recanalization Therapy For Acute Symptomatic Occlusion Of The Intracranial Cerebral Arteries In Korea

Jang, Min Uk ; Kang, Jihoon ; Kim, Beom-Joon ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2013

In: Stroke Vol. 44, No. suppl_1 ( 2013-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)

Kurzfassung: Background: Despite its clinical importance in the Koreans, the status of recanalization therapy for acute occlusion of the intracranial cerebral arteries has not been reported yet. Methods: Using a nationwide stroke registry, a consecutive series of 642 patients with symptomatic occlusion of intracranial arteries were identified among 3028 who were hospitalized within 12 h of stroke onset at 10 participating centers between 2010 and 2011. Demographics, clinical characteristics, clinical outcomes, and type of recanalization therapy were described. Results: The mean age was 68.6 years (57.2% males, median baseline NIHSS 12). MCA was most commonly affected vessel (65.1%), followed by intracranial ICA (15.3%), PCA (14.2%), basilar artery (11.1%), and ACA (5.1%). Recanalization therapy was applied in 307 patients (47.8%); intravenous thrombolysis only (IVT) in 45.9%, and endovascular treatment (ET) in 54.1%. Intravenous thrombolysis treatment preceded ET in 69.9%. Doses of tPA were 0.6mg/kg in 22.3% and 0.9mg/kg in 77.7%. Recanalization therapy according to occluded vessels and onset-to-arrival time is described in the Table. Recanalization by IAT as seen on angiography was complete (thrombolysis in cerebral infarction [TICI] grade 3) in 29.5% and partial (TICI grade 2A or 2B) in 50.6%. Solitaire were applied to 48.8% of patients with ET and recanalization rate was 86.4%, and Penumbra were applied to 15.1% and recanalization rate (TICI grade 2A~3) was 76.0%. Favorable outcome (modified Rankin Scale, 0-2) was achieved in 39.4% of those with IVT and in 35.4% of those with ET, and symptomatic hemorrhagic transformation occurred in 8.5% and 12.0%, respectively. Conclusion: This study shows that a considerable proportion of patients with symptomatic occlusion of intracranial cerebral arteries are treated by endovascular approach. Efficacy and safety of endovascular approach in this setting should be tested by randomized clinical trials.

Materialart: Online-Ressource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.44.suppl_1.AWP1

RVK:

XA 10000

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2013

ZDB Id: 1467823-8

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Abstract TP194: Internet-based Control Recruitment for a Case-Control Study of Major Risk Factors for Stroke in Korea: A Failure and Lessons Learned from the Experience

Park, Jong-Moo ; Cho, Yong-Jin ; Lee, Kyung Bok ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2013

In: Stroke Vol. 44, No. suppl_1 ( 2013-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)

Kurzfassung: This study aimed to estimate the population attributable risks (PARs) of major risk factors for stroke in Korea through an internet-based case-control study and test the feasibility and validity of this approach. Control subjects were recruited by a web-based questionnaire from April 2008 to September 2009. Cases were consecutive stroke patients hospitalized to during the same period. Each control was matched with 2 cases for age and sex. The presence of hypertension, diabetes, hypercholesterolemia, smoking, atrial fibrillation, coronary heart disease, history of stroke, family history of stroke and obesity were investigated. Age-standardized prevalence, adjusted odd ratios (ORs) and PARs for 9 risk factors for stroke were calculated. One thousand forty one control subjects were matched with 2,082 cases. Adjusted ORs for stroke were 2.80 for hypertension, 3.56 for diabetes, 3.65 for smoking, 3.95 for history of stroke, and 1.25 for obesity. Risk of atrial fibrillation, coronary heart disease, and family history of stroke were not significant, while hypercholesterolemia showed inverse correlation. PARs for stroke were 16.3% for hypertension, 9.4% for diabetes, 23.6% for smoking, 5.84% for stroke history, and 4.18% for obesity. Comparisons of education level and religion between the control group and the national census data for validating its representativeness revealed significant discrepancy. In conclusion, internet-based control recruitment for a case-control study of stroke risk factors may be feasible; however, careful approaches for reducing selection and reporting biases are essential.

Materialart: Online-Ressource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.44.suppl_1.ATP194

RVK:

XA 10000

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2013

ZDB Id: 1467823-8

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Abstract TP64: Optimal Minor Stroke Definition For Thrombolysis Decision-making

Park, Tai Hwan ; Hong, Keun-Sik ; Choi, Jay-Chul ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2013

In: Stroke Vol. 44, No. suppl_1 ( 2013-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)

Kurzfassung: Background and purpose: Patients with a low National Institutes of Health Stroke Scale (NIHSS) score are frequently excluded from thrombolysis, but 〉 25% of those patients remain disabled. We sought to define a minor stroke definition that helps guide treatment decision-making. Methods: From a stroke outcome database, untreated patients with NIHSS ≤5 presenting within a 4.5-hour window were identified. The validity of the following minor stroke definitions were assessed: 1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials’ definition; 2) the total NIHSS score, varying a threshold from 0 to 4; 3) our proposed definition which included NIHSS=0 or NIHSS=1 in the items of level of consciousness, gaze, facial palsy, sensory, or dysarthria. Results: Of 647 included patients, 172 (26.6%) had a 3-month unfavorable outcome (modified Rankin Scale 2-6). When the NINDS-TPA trials’ definition, our proposed definition, or NIHSS ≤1 definition was applied, 〉 75% of patients with an unfavorable outcome were defined as a non-minor stroke and 〉 85% of those defined as a minor stroke had a favorable outcome. For a hypothetical population of 1000 patients with NIHSS ≤5, as compared to the NINDS-TPA trials’ definition, our definition would treat additional 23 patients and increase 17-18 favorable outcomes at the expense of 1-2 symptomatic hemorrhagic transformations (SHTs), whereas the NIHSS ≤1 definition would further exclude 54 patients from treatment and the benefit of avoiding 1-4 SHTs would be negated by the increase of three unfavorable outcomes among untreated patients. Conclusion: A validated criterion should be applied to thrombolysis decision-making for patients with a mild deficit. Our definition would further increase the treatment rate and favorable outcomes.

Materialart: Online-Ressource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.44.suppl_1.ATP64

RVK:

XA 10000

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2013

ZDB Id: 1467823-8

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Validation of Minor Stroke Definitions for Thrombolysis Decision Making

Park, Tai Hwan ; Hong, Keun-Sik ; Choi, Jay Chol ; [weitere]

Elsevier BV ; 2013

In: Journal of Stroke and Cerebrovascular Diseases Vol. 22, No. 4 ( 2013-5), p. 482-490

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In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 22, No. 4 ( 2013-5), p. 482-490

Materialart: Online-Ressource

ISSN: 1052-3057

URL: Article

DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.006

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2013

ZDB Id: 2052957-0

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Abstract WP400: Greater Stroke Severity Predominates Over All Other Factors For The Worse Outcome Of Cardioembolic Stroke

Hong, Keun-Sik ; Lee, Juneyoung ; Bae, Hee-Joon ; [weitere]

Ovid Technologies (Wolters Kluwer Health) ; 2013

In: Stroke Vol. 44, No. suppl_1 ( 2013-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)

Kurzfassung: Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contribution has not been well explored. Methods: Using a stroke outcome registry, we compared the outcomes of CE and non-CE strokes. The relative contribution of prognostic factors was assessed with multivariable models and model fitness improvement using -2 log-likelihood and Nagelkerke’s R 2 . Results: A total of 1233 patients were included in this analysis. As compared to non-CE strokes, CE strokes had less mRS 0-2 outcomes (47.2% vs 68.5%, p 〈 0.001), less mRS 0-1 outcomes (33.7% vs 53.5%, p 〈 0.001), more mRS 5-6 outcomes (32.1% vs 10.9%, p 〈 0.001), and higher mortality (19.2% vs 5.2%, p 〈 0.001). When adjusting either baseline demographics or poststroke complications, the outcome differences remained significant. However, adjusting initial NIHSS score alone abolished the differences in mRS 0-2 outcome (Figure) and mRS 0-1 and mRS 5-6 outcomes. For mRS 0-2 outcome, the differences in -2 log-likelihood and Nagelkerke’s R 2 between univariable model and multivariable model were greater with adjusting NIHSS alone (-2 log-likelihood difference, 418; Nagelkerke’s R 2 difference, 38.7%) than with adjusting baseline demographics (184; 17.7%) or poststroke complication (279; 27.3%). Further adjustment of baseline demographics and poststroke complication to the initial NIHSS score adjustment resulted in a small shift of odds ratio. The decrement of -2 log-likelihood and the Nagelkerke’s R 2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the model adjusting baseline demographics, poststroke complication, and initial NIHSS score. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke.

Materialart: Online-Ressource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.44.suppl_1.AWP400

RVK:

XA 10000

Sprache: Englisch

Verlag: Ovid Technologies (Wolters Kluwer Health)

Publikationsdatum: 2013

ZDB Id: 1467823-8

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Greater Stroke Severity Predominates over All Other Factors for the Worse Outcome of Cardioembolic Stroke

Hong, Keun-Sik ; Lee, Juneyoung ; Bae, Hee-Joon ; [weitere]

Elsevier BV ; 2013

In: Journal of Stroke and Cerebrovascular Diseases Vol. 22, No. 8 ( 2013-11), p. e373-e380

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In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 22, No. 8 ( 2013-11), p. e373-e380

Materialart: Online-Ressource

ISSN: 1052-3057

URL: Article

DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.008

Sprache: Englisch

Verlag: Elsevier BV

Publikationsdatum: 2013

ZDB Id: 2052957-0

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