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  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • Sarraj, Amrou  (4)
  • 1
    Online Resource
    Online Resource
    Optimizing Prediction Scores for Poor Outcome After Intra-Arterial Therapy in Anterior Circulation Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 12 ( 2013-12), p. 3324-3330
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 12 ( 2013-12), p. 3324-3330
    Abstract: Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions. Methods— Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4–6) were studied. External validation was performed on IAT-treated patients at Emory University. Results— A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome ( P ≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60–79=2, ≥80 years=4), glucose ( 〈 150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11–20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8–10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75–15.02; P 〈 0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score ≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96–17.64; P =0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score ≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores. Conclusions— The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001050
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Abstract T MP3: Collaterals Predicts Imaging Evolution and Patient Outcomes in Acute Ischemic Stroke Patients
    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 flow and early ischemic changes on CT are pivotal determinants of outcome in patients with large artery occlusion (LAO). Evolution of stroke occurs during inter-facility transfer. We sought to evaluate the association between collaterals and stroke evolution measured by ASPECTS decay and the relationship of these imaging findings with patient outcomes. Methods: In a cross-sectional multicenter study, we evaluated 313 transferred patients with AIS and LAO (MCA or ICA) from 01/08-04/14. The collateral score (CS) (Figure 1) and ASPECTS were measured. Good collaterals were defined as scores 2-3 (poor; scores 0-1). ASPECTS decay was defined as dichotomized deterioration in ASPECTS from good (8-10) to bad (0-7) during transfer. ASPECTS was also analyzed as an ordinal variable. Logistic regression and mediation analyses were performed to evaluate the association between the collaterals, ASPECTS and patients good and poor (mRS 0-2 and 4-6, respectively) outcomes. Results: Table 1 depicts baseline characteristics. Patients with poor CS had greater odds of ASPECTS decay during transfer (OR 13.4, 95%CI 7.5-24, p 〈 0.0001), which was associated with higher odds of mRS 4-6 (OR 7.1, 95%CI 3.7-13.8, p 〈 0.0001). The association between poor CS and poor outcome was maintained after adjustment for ASPECTS decay, stroke severity and IV tPA treatment (OR 10.9, 95%CI 4-34, p 〈 0.0001). For every 30 minutes in transfer time, the odds of ASPECTS decay increased by 13% (OR 1.13, 95%CI 1.05-1.2, P 0.0004). With each 1 point drop in ASPECTS, the odds of good outcome were reduced by 42% (OR 0.58, 95%CI 0.54-0.66, P 〈 0.0001). On mediation analysis, ASPECTS decay explained 75% of the relationship between poor CS and poor outcome (Sobel 2.11, p 0.03) after adjusting for IV tPA treatment and stroke severity. Conclusion: Our cohort shows that stroke evolution is determined by transfer time and collateral flow, which are pivotal determinants of clinical outcome in patients with AIS and LAO.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tmp3
    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
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Abstract 127: Intra-Arterial Therapy in Stroke Patients Transferred from Referral Centers
    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: The effectiveness of intra-arterial therapy (IAT) for patients presenting to endovascular capable centers with acute ischemic stroke (AIS) and large artery occlusion (LAO) has not been proven. Most AIS patients present to hospitals which do not have IAT capability and many are transferred to tertiary centers for IAT. We addressed if IAT improves outcome of patients transferred from outside facilities. Methods: In a multicenter retrospective study, we identified 615 AIS patients with LAO transferred to centers that offered IAT within 12 hours from ictus during 01/05-03/14. Patients were divided into two groups (IAT vs No IAT) (Figure 1). Logistic regression was performed for good and poor (discharge mRS 0-2 and 4-6, respectively) outcome. Univariate and multivariate analyses evaluated independent predictors of good and poor outcome after IAT. Results: Patients in the IAT group had more severe strokes, arrived faster to tertiary centers, had less ischemic changes on CT and better collateral flow compared to the non-IAT group (Table 1). Fewer IAT patients had ASPECTS deterioration during transfer. IAT patients had 4 times the odds for good outcome (OR 3.7, 95%CI 2.2-6.3, p 〈 0.0001) compared to those without IAT, even after adjusting for stroke severity, ASPECTS, ASPECTS decay, collateral flow, time, and tPA (OR 2.51 95%CI 1.2-5.8, p=0.02). mRS distribution demonstrated a shift towards better outcomes in IAT treated patients (Fig 2). Patients with better outcome had better ASPECTS/collaterals, were younger and had lower NIHSS. Time to IAT was not an independent predictor of outcome. Conclusion: IAT may improve outcome in selected transfer patients with LAO, a group that was under-represented in prior trials. In late-treated patients, collateral flow, the extent of infarct, and age may be more important than time in determining outcome from IAT. Identifying patients at referral hospitals who may benefit from IAT and expediting their transfer should be tested in RCTs.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.127
    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
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract W P11: Factors Affecting Vascular Neurologists' Decisions to Pursue Endovascular Intervention of Acute Ischemic Stroke Patients
    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: Intra-arterial therapy (IAT) is an approach to promote recanalization in acute ischemic stroke (AIS) patients. While IAT continues to go through further evaluation in multiple phase III trials using new devices and focusing on time improvement, patients with LAO continue to be treated with IAT. Multiple clinical, radiographic and time factors go into vascular neurologists’ decisions whether to pursue IAT or not. We aimed to evaluate factors affecting determination of IAT for stroke amongst patients transferred to tertiary centers. Methods: A US multicenter retrospective cohort analysis was conducted on 313 consecutive transferred patients who met vessel criteria from 01/08-4/14. Collateral were measured by the collateral score (CS). ASPECTS decay was defined as a change from good (8-10) to poor (0-7) scores between center CT scans. IAT patients were compared with no IAT patients with regard to factors predictive of IAT. Results: Table 1 shows baseline characteristics of the two groups. Age was not a predictor of IAT. NIHSS was associated with IAT, but was not a predictor of IAT. For each escalating point on CS, the odds of IAT increased more than 4 times (OR 4.27, 95% CI 2.86-7.87, p 〈 0.0001). For each declining point on ASPECTS, the odds of IAT decreased by 22% (OR 0.78, 95% CI 0.72-0.85, p 〈 0.0001). ASPECTS decay was associated with an 83% reduction in the odds of IAT (OR 0.17, 95% CI 0.05-0.52, p 〈 0.0001). For every 30 minutes of time between centers, the odds of ASPECTS decay increased by 13% (OR 1.13, 95% CI 1.11-1.17 p=0.0004) and IAT chances reduced by 9% (OR 0.91, 95% CI 0.84-1.00, p=0.05). Conclusions: Infarction evolution measured by ASPECTS decay, collaterals status and time from stroke ictus are all major determinants of the vascular neurologist decision whether to proceed with IAT. Our findings further support the time-sensitivity of the process for transferring candidates for IAT.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp11
    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
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