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  • 1
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: Antiplatelet administration within 48 hours of acute stroke presentation is standardized as it reduces mortality and recurrent ischemic stroke rate. Gender disparities have been noted in acute stroke care, including IV tPA and thrombectomy. Limited data exists for gender disparities in antiplatelet administration by day 2 of hospitalization. Methods: In an IRB-approved analysis, we retrospectively assessed patients admitted with acute ischemic strokes from the prospectively collected UC San Diego Stroke Registry from 2013 to 2023. We reviewed baseline demographics, whether an antiplatelet agent was initiated by hospital day 2, and choice of antiplatelet agent. We grouped patients based on their gender identification: male versus female. Patients who transitioned to comfort care, had an embolic source, were treated with a therapeutic dose of anticoagulation, had hemorrhagic conversion of infarct, or had a contraindication to antiplatelet use were excluded. Chi-squared, Kruskal-Wallis and Fisher tests were utilized. Results: 471 patients were included in this analysis (179 female, 292 male). We found no significant differences in medical history except diabetes (60 female, 69 male, p = 0.03). We found a significant difference in age (female 69.3 years, male 64.3 years, p 〈 0.01). We found a significant difference in patient race (p = 0.01). There was no significant difference in antiplatelet administration by hospital day 2 (171 female, 287 male, p = 0.14) or choice of antiplatelet (aspirin p = 0.29, clopidogrel p = 0.12, ticagrelor p = 0.67, dual antiplatelet p = 0.22). Conclusions: These findings suggest equality of care in antiplatelet administration for acute ischemic stroke between genders, which is reassuring. This data was collected at an academic comprehensive stroke center. Further studies should be completing including patients who were treated at various levels of stroke centers.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 2
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Recent studies of national door-in-door-out times (DIDO) in the Get with the Guidelines Stroke registry found that 〈 30% of transfers for acute interventions were completed within the recommended 120 minute timeframe. There is a critical need for effective emergent transfer protocols to improve outcomes. The Brain Emergency Management Initiative (BEMI) is a telestroke transfer protocol connecting acute stroke patients at hub sites to a spoke center for embolectomy. BEMI includes early activation of helicopter transport, rapid imaging transmission, standardized documentation, and remote patient admission. BEMI has been shown to significantly reduce DIDO and time-of-treatment-decision-to-groin-puncture (TDGP). The aim of this study was to evaluate the sustainability of the BEMI impact on reduction of key transfer metrics. We retrospectively assessed prospectively collected data for patients transferred for embolectomy in our telestroke system. Patients were assessed in 3 groups: pre-BEMI (2013-mid 2016; before protocol, n=32), early-BEMI (mid 2016-2017; initial year of protocol, n=31) and new-BEMI (2018-2023; n=210). Inclusion criteria were emergency telestroke consultation and transfer for acute embolectomy. Exclusion criteria were inpatient telestroke consultation, incomplete data and aborted transfers. Variables were assessed via Chi-square, T-test or Wilcoxon Rank Sum as appropriate. Median times were used given skewedness of data. We evaluated 273 total transfers. Analyses compared BEMI groups to the pre-BEMI group. Median NIHSS was higher in the BEMI groups (pre-BEMI median=10 points vs. early-BEMI=20, p=0.0063 ; vs. new-BEMI=17, p=0.005 ). There were significantly shorter median DIDO and TDGP times in the BEMI groups (DIDO: pre-BEMI median=143 minutes vs. early-BEMI=118, p=0.015 ; vs. new-BEMI=97, p=1.7e-7 ) (TDGP pre-BEMI median=155 minutes vs. early-BEMI=130, p=0.01 ; vs. new-BEMI=125, p=6.8e-14 ). This finding was sustainable from the early to new BEMI groups. Additional time metrics will be assessed in this dataset. The BEMI protocol significantly improved transfer and treatment times in our telestroke network. BEMI may serve as a model for stroke transfer protocols at other centers to assist in improving time metrics.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 3
    In: Journal of Neuroimaging, Wiley
    Abstract: Cerebral vasomotor reactivity (VMR) is vital for regulating brain blood flow and maintaining neurological function. Impaired cerebral VMR is linked to a higher risk of stroke and poor post‐stroke outcomes. This study explores the relationship between statin treatment intensity and VMR in patients with ischemic stroke. Methods Seventy‐four consecutive patients (mean age 69.3 years, 59.4% male) with recent ischemic stroke were included. VMR levels were assessed 4 weeks after the index stroke using transcranial Doppler, measuring the breath‐holding index (BHI) as an indicator of the percentage increase in middle cerebral artery blood flow (higher BHI signifies higher VMR). Multistep multivariable regression models, adjusted for demographic and cerebrovascular risk factors, were employed to examine the association between statin intensity treatment and BHI levels. Results Forty‐one patients (55%) received high‐intensity statins. Patients receiving high‐intensity statins exhibited a mean BHI of 0.85, whereas those on low‐intensity statins had a mean BHI of 0.67 (mean difference 0.18, 95% confidence interval: 0.13‐0.22, p ‐value 〈 .001). This significant difference persisted in the fully adjusted model (adjusted mean values: 0.84 vs. 0.68, p ‐value: .008). No significant differences were observed in BHI values within patient groups on high‐intensity or low‐intensity statin therapy (all p ‐values 〉 .05). Furthermore, no significant association was found between baseline low‐density lipoprotein (LDL) levels and BHI. Conclusions High‐intensity statin treatment post‐ischemic stroke is linked to elevated VMR independent of demographic and clinical characteristics, including baseline LDL level. Further research is needed to explore statin therapy's impact on preserving brain vascular function beyond lipid‐lowering effects.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2035400-9
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  • 4
    In: BIOS, Beta Beta Biological Society, Vol. 95, No. 1 ( 2024-2-22)
    Type of Medium: Online Resource
    ISSN: 0005-3155
    Language: Unknown
    Publisher: Beta Beta Biological Society
    Publication Date: 2024
    detail.hit.zdb_id: 2175911-X
    SSG: 12
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