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  • 1
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    Online Resource
    Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p 〈 0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P624
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Predictors of Early Arterial Reocclusion After Tissue Plasminogen Activator-Induced Recanalization in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Stroke Vol. 36, No. 7 ( 2005-07), p. 1452-1456
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 7 ( 2005-07), p. 1452-1456
    Abstract: Background and Purpose— We aimed to determine clinical and hemodynamic predictors of early reocclusion (RO) in stroke patients treated with intravenous tissue plasminogen activator (tPA). Methods— We studied 142 consecutive stroke patients with a documented middle cerebral artery (MCA) occlusion treated with intravenous tPA. All patients underwent carotid ultrasound and transcranial Doppler (TCD) examination before tPA bolus. National Institutes of Health Stroke Scale (NIHSS) scores were performed at baseline and serially for 〈 24 hours. TCD monitoring of MCA recanalization (RE) and RO was performed during the first 2 hours after tPA bolus and repeated when clinical deterioration occurred 〈 24 hours after documented RE in absence of intracranial hemorrhage. Results— After 1 hour of tPA administration, RE occurred in 84 (61%) patients (53 partial, 31 complete). Of these, 21 (25%) patients worsened after an initial improvement and 17 (12%) of them showed RO on TCD. RO was identified at a mean time of 65±55 minutes after documented RE. RO was associated ( P =0.034) with a lower degree of 24-hour NIHSS score improvement than sustained RE, and a higher modified Rankin scale score at 3 months ( P =0.002). Age older than 75 years ( P =0.012), previous antiplatelet treatment ( P =0.048), baseline NIHSS score 〉 16 points ( P =0.009), higher leukocytes count ( P =0.042), beginning of RE 〈 60 minutes after tPA bolus ( P =0.039), and ipsilateral severe carotid stenosis/occlusion ( P =0.001) were significantly associated with RO. In a logistic regression model, NIHSS score 〉 16 at baseline (odds ratio [OR], 7.1; 95% CI, 1.3 to 32) and severe ipsilateral carotid disease (OR, 13.3; 95% CI, 3.2 to 54) remained as independent predictors of RO. Conclusions— Stroke severity and ipsilateral severe carotid artery disease independently predict RO after tPA-induced MCA RE.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000170711.43405.81
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
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  • 3
    Online Resource
    Online Resource
    Differential Pattern of Tissue Plasminogen Activator–Induced Proximal Middle Cerebral Artery Recanalization Among Stroke Subtypes
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 2 ( 2004-02), p. 486-490
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 2 ( 2004-02), p. 486-490
    Abstract: Background and Purpose— We aimed to evaluate the timing, speed, and degree of tissue plasminogen activator (tPA)–induced recanalization in patients with proximal middle cerebral artery (MCA) occlusion of different stroke subtypes. Methods— We evaluated 72 patients with acute stroke caused by proximal MCA occlusion treated with intravenous tPA in 〈 3 hours. Transcranial Doppler monitoring of recanalization was conducted during tPA infusion and at 6 hours. Strokes were categorized as large-vessel disease strokes, cardioembolic strokes, or strokes of undetermined origin according to Trial of Org 10172 in Acute Stroke Treatment criteria. Results— During 1-hour tPA infusion, recanalization occurred in 34 patients (47%); 32% showed a sudden, 50% showed a stepwise, and 18% showed a slow pattern of recanalization. One-hour recanalization was more frequent in patients with cardioembolic stroke (59%) compared with large-vessel disease (8%) and undetermined origin (50%) strokes. A cardiac source of emboli was identified in 81% of patients who showed a sudden clot breakup during tPA infusion. Rate of complete recanalization at 6 hours was higher ( P =0.006) in patients with cardioembolic stroke (50%) compared with other stroke subtypes (27%). Sudden recanalization was associated ( P =0.002) with a higher degree of neurological improvement at 24 hours compared with stepwise, slow, and no recanalization. A graded response in long-term outcome was observed in relation to the speed of clot lysis during tPA administration. Conclusions— We demonstrate that the pattern of tPA-induced MCA recanalization differs among stroke subtypes. Early recanalization was more frequent, faster, and more complete in patients with cardioembolic stroke compared with other stroke subtypes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000110219.67054.BF
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound Monitoring in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator
    Ovid Technologies (Wolters Kluwer Health) ; 2006
    In:  Stroke Vol. 37, No. 2 ( 2006-02), p. 425-429
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 2 ( 2006-02), p. 425-429
    Abstract: Background and Purpose— We sought to evaluate the effects of administration of microbubbles (MBs) on the beginning, speed, and degree of middle cerebral artery (MCA) recanalization during systemic thrombolysis and continuous 2-MHz pulsed-wave transcranial Doppler (TCD) monitoring. Methods— We evaluated 111 patients with acute stroke attributable to MCA occlusion treated with intravenous tissue plasminogen activator (tPA). Thirty-eight patients were treated with tPA plus continuous 2-hour TCD monitoring plus 3 doses of 2.5 g (400 mg/mL) of galactose-based MBs given at 2, 20, and 40 minutes after tPA bolus (MB group). These patients were compared with 73 patients who were allocated to receive tPA plus continuous 2-hour TCD ultrasound (US) monitoring (tPA/US group) or tPA plus placebo monitoring (tPA group), most of whom were enrolled in a previous study of US-enhanced thrombolysis. The beginning, degree, and time to maximum completeness of recanalization during the first 2 hours of tPA bolus were recorded. Results— Median prebolus National Institutes of Health Stroke Scale (NIHSS) score was 18. Eighty patients (72%) had a proximal and 31 (28%) a distal MCA occlusion on TCD. Thirty-seven patients (33%) received tPA/US, 38 (34%) received tPA/US/MB, and 36 (32%) were treated with tPA alone. Stroke severity, time to treatment, location of MCA occlusion, and presence of carotid artery disease were similar among groups. Two-hour recanalization was seen in 14 (39%), 25 (68%), and 27 patients (71%) in the tPA, tPA/US, and tPA/US/MB groups, respectively ( P =0.004). Two-hour complete recanalization rate was significantly ( P =0.038) higher in the tPA/US/MB group (54.5%) compared with tPA/US (40.8%) and tPA (23.9%) groups. The time to beginning of recanalization after tPA bolus was 26±18 minutes in the tPA/US group and 19±12 minutes in the tPA/US/MB group ( P =0.12). Four patients (3.6%) experienced symptomatic intracranial hemorrhage: 2 (5.5%), 1 (2.7%), and 1 patient (2.6%) who received tPA only, tPA/US, and tPA/US/MB, respectively, experienced symptomatic intracranial hemorrhage. At 24 hours, 31%, 41%, and 55% of tPA, tPA/US, and tPA/US/MB improved 〉 4 points in the NIHSS score. Conclusions— Administration of MBs induces further acceleration of US-enhanced thrombolysis in acute stroke, leading to a more complete recanalization and to a trend toward better short- and long-term outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000199064.94588.39
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2006
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  • 5
    Online Resource
    Online Resource
    Acute Hyperglycemia State Is Associated With Lower tPA-Induced Recanalization Rates in Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Stroke Vol. 36, No. 8 ( 2005-08), p. 1705-1709
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 8 ( 2005-08), p. 1705-1709
    Abstract: Background and Purpose— Hyperglycemia (HG) has a deleterious effect in stroke patients by accelerating ischemic brain damage; moreover, its antifibrinolytic effect may also influence reperfusion. We aimed to study the effect of acute/chronic HG on tissue-type plasminogen activator (tPA)–induced recanalization. Methods— We studied 139 consecutive stroke patients with documented intracranial artery occlusion treated with intravenous tissue-type plasminogen activator (tPA). Admission glucose levels were recorded (in mg/dL). The existence of previous chronic HG was determined by plasma levels of glycosylated hemoglobin (HbA1c, %) and fructosamine (in μmol/L). Transcranial Doppler monitoring assessed complete recanalization 2 hours after tPA bolus. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 48 hours. Results— On admission, the median NIHSS score was 18 and mean glucose value was140±63 mg/dL. At 2 hours, 32% of patients(n=44) achieved complete recanalization. Patients who recanalized showed lower admission glucose levels (127 vs 146 mg/dL; P =0.039) but no differences in HbA1c (6.3% vs 6.3%; P =0.896) or fructosamine (292 vs 293 μmol/L; P =0.957) were observed. Other variables associated with recanalization were initial distal middle cerebral artery occlusion ( P =0.011) and platelet count ( P =0.015). Patients with an admission glucose level 〉 158 mg/dL had lower recanalization rates (16% vs 36.1%; P =0.035) and a higher NIHSS score at 48 hours (7 vs 14.5; P =0.04). After adjustment for stroke etiology, age, and risk factors, the only independent predictors on admission of no recanalization were glucose value 〉 158 mg/dL (odds ratio [OR], 7.3; 95% confidence interval [CI] , 1.3 to 42.3; P =0.027), proximal middle cerebral artery occlusion (OR, 2.6; 95% CI, 1.1 to 6.5; P =0.034), and platelet count 〈 219 000/mL (OR, 2.6; 95% CI, 1.1 to 6.1; P =0.029). Conclusions— In tPA-treated patients, the acute but not chronic HG state may hamper the fibrinolytic process, delaying reperfusion of the ischemic penumbra. Early measures to reduce HG may favor early recanalization.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000173161.05453.90.9f
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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