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  • 11
    Online Resource
    Online Resource
    Content Analysis of Stroke Teleconsultation Recordings in the Moravian-Silesian Region, Czech Republic
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 12 ( 2021-9-9)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2021-9-9)
    Abstract: Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-based stroke neurologists are mandated in the Czech Republic as triage and prenotification tool in acute stroke patients. The main aim of this study was to analyze the efficacy as well as quality of such teleconsultations in daily clinical practice. Methods: This is a descriptive analysis of teleconsultations between EMS paramedic crews and hospital-based neurologists in a geographically defined region of the Czech Republic (Moravian-Silesian region) between October 2018 to December 2018. All teleconsultations were analyzed for length and content. Content analysis included the following information: date, age, sex, prehospital neurological deficit(s), known/unknown time of symptom onset, anticoagulation status, vital signs, premorbid disability, and patient ID/insurance company number. Results: Within the study period, paramedics conducted 522 calls across 6 stroke centers. Of these, 334 (64%) calls were conducted because patients met pre-established prehospital criteria for suspected acute stroke. Median call duration was 1 min 44 s ± 56 s (minimum 50 s, maximum 5 min 5 s). Amongst the analyzed prehospital teleconsultations, stroke onset time was reported in 95% of cases, neurological deficit in 96%, significant co-morbidities in 53%, premorbid disability in 37%, and anticoagulation status in 53%. Conclusion: Teleconsultations between paramedics and hospital-based neurologists are not time-consuming. Stroke onset time and severity of neurological deficit are consistently communicated, however other important information such as comorbidities, premorbid disability, and anticoagulation status are reported inconsistently.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2021.664918
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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  • 12
    Online Resource
    Online Resource
    Abstract T MP109: Leptomeningeal Collaterals, Ageing and Metabolic Syndrome in Development of White Matter Hyperintensities
    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: Ageing and metabolic syndrome are associated with poor leptomeningeal collateral status. Animal studies suggest that collateral rarefaction and consequent decrease in vascular efficiency may result in increase in white matter hyperintensities. Using mediational analysis, we test if the known effect of ageing and metabolic syndrome on development of white matter hyperintensities is mediated through collateral status. Methods: Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery (MCA) ± intracranial internal carotid artery (ICA) occlusions on baseline CT-angiography (CTA) and brain MRI done within 90 minutes after admission CT/CTA, from May 2004 to July 2009, were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using previously validated regional leptomeningeal score (rLMC). FLAIR volume of white matter hyperintensities (ml) was measured in the unaffected hemisphere using Quantomo® software. The template of Baron and Kenney along with two tests (Sobel’s and Aroian’s) was used to test for the presence of mediation. Results: Baseline characteristics (n=120): mean age 67.4±11.4 years, male (53.3%), median baseline NIHSS 14 (IQR 11-20), and median stroke symptom onset to CTA 166 minutes (IQR 96-262). Poor collateral status at baseline (rLMC score 0-10) was seen in 42/120 (35%). Mean periventricular hyperintensity (PVH) volume was 6.5 ml (SD=6.0) while mean white matter hyperintensity (WMH-total) volume was 8.6 ml (SD=8.0). Higher age was associated with increased PVH and WMH-total (p 〈 0.01) while metabolic syndrome was associated with increased PVH only (p=0.03). We did not find statistical evidence of leptomeningeal collaterals mediating the association between ageing and PVH/WMH-total or between metabolic syndrome and PVH (Sobel’s and Aroian’s test p 〉 0.05). Conclusion: The effect of ageing and metabolic syndrome on development of white matter hyperintensities is independent of an effect mediated through the poor collateral status.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tmp109
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 13
    Online Resource
    Online Resource
    Abstract WP31: Mechanical Thrombectomy Performs Similarly in Real-World Clinical Practise as in Randomized Trials: Nationwide Study From the Czech Republic
    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: Background: In randomized clinical trials (RCTs) mechanical thrombectomy (MT) was proved to be a highly effective and safe treatment in acute ischemic stroke. Its efficacy and safety in routine practice needs to be documented. Methods: Available nationwide 2016 data for the Czech Republic (CR) from SITS-TBY registry of patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion were compared with data from HERMES meta-analysis. Categorical variables were compared by Pearson′s Chi-squared test, ordinal/continuous variables by Mann-Whitney test. Results: Fourteen/15 comprehensive stroke centres reported data to SITS-TBY. From 1,053 MTs performed in the CR, 845 (80%) patients were reported to SITS-TBY. From these patients, 605 (72%) patients were involved in analyses (available outcome data in Tab.). CR and HERMES patients were comparable in: age, sex, baseline NIHSS. Occlusion locations were as follows (CR vs. HERMES): ICA 22% vs. 21% (p=0.16), M1 MCA 62% vs. 69% (p=0.004), M2 MCA 16% vs. 8% (p 〈 0.0001). Intravenous thrombolysis was given in 76% vs. 83% patients (p=0.003). Median onset-to-reperfusion times were comparable: 232 vs. 285 min (p=0.66); median groin-to-reperfusion times were 58 vs. 63 min. Modified TICI 2b/3 was achieved in 74% (433/584) vs. 71% (390/549), p=0.24. There was no difference in percentage of PH type 2 (5.7 vs. 5.1%). Modified Rankin scale 0-2 at 3 months achieved 44% (103/235) vs. 46% (291/633) patients, p=0.57. Conclusions: This nationwide experience on mechanical thrombectomy in acute ischemic stroke documents safety, efficacy and logistics comparable with HERMES data. Tab. Comparison on available demographic characteristics, past medical history, clinical and radiological characteristics, treatment details and outcomes in SITS-TBY versus HERMES.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP31
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 14
    Online Resource
    Online Resource
    Abstract 60: Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With versus Without Pre-Morbid Disability in a National Stroke Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: Given the paucity of high-quality data on acute stroke therapies in patients with pre-morbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), workflow, and outcomes among ischemic stroke patients with vs without pre-morbid disability in a national registry. Methods: We used data for the Czech Republic from 1-January-2016 to 31-December-2020. Pre-morbid disability was defined as pre-stroke modified Rankin Scale score (mRS) 〉 2. We compared receipt of EVT, workflow times, ΔmRS (change from pre-stroke to 3-months), intracerebral hemorrhage (ICH), mortality, and discharge NIHSS among patients with vs without pre-morbid disability, adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score-weighting (PSW) for differences in treatment assignment. Results: Among 22,405 patients, 1,712 (7.6%) had pre-stroke mRS 〉 2. Patients with pre-morbid disability were less likely to receive EVT (10.1% vs 20.7%, aOR:0.30, 95%CI:0.24-0.36) and had longer door-to-puncture times (median:75-minutes, IQR:58-100 vs 54, IQR:27-77, adjusted-difference:12.5, 95%CI:2.68-22.3), worse ΔmRS (adjusted rate-ratio, aIRR on PSW:1.57, 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW[mortality]:2.54, 1.92-3.34); ICH rates did not differ. Among those with pre-morbid disability, 32.1% returned to pre-stroke state; this ranged from 19.6% for those 〉 85-years to 66.0% for 〈 65-years. EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW:0.87, 0.83-0.91) and mortality, with no interaction of treatment effect by pre-morbid disability (e.g. mortality p interaction =0.73). EVT recipients with pre-morbid disability did not differ significantly for several key outcomes including ΔmRS (aIRR:0.99, 0.84-1.17), but were more likely to have mRS 5-6 (70.1% vs 39.5%, aOR:1.85, 1.12-3.04). Conclusions: Patients with pre-morbid disability were less likely to receive EVT and had slower treatment and worse outcomes than those without disability. However, patients fared better with EVT versus medical care, and one-third with pre-stroke disability returned to their pre-stroke state.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.60
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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