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  • Ovid Technologies (Wolters Kluwer Health)  (16)
  • 2015-2019  (16)
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  • Ovid Technologies (Wolters Kluwer Health)  (16)
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  • 2015-2019  (16)
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  • 1
    Online Resource
    Online Resource
    Predictors of Endovascular Treatment Among Stroke Codes Activated Within 6 Hours From Symptom Onset
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 9 ( 2018-09), p. 2116-2121
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 9 ( 2018-09), p. 2116-2121
    Abstract: Prehospital stroke code activations help reducing workflow times during in-hospital triage. We aim to identify predictors of endovascular treatment (EVT) among stroke codes (SC) activated within 6 hours from symptom onset. Methods— CICAT (Codi Ictus Catalunya) is a prospective official mandatory registry of all SC in Catalunya. We studied all CICAT entries from 6 comprehensive stroke centers for 18 months. We recorded demographic, clinical, and imaging variables on admission. We explored the relationship between these variables and EVT Results— From 3944 SC, 2778 (70.4%) were admitted within 6 hours from symptom onset. Mean age was 72±15.3 years, median Rapid Arterial Occlusion Evaluation scale score 4 (interquartile range [IQR], 2–6), median onset-to-door time 89 minutes (IQR, 54–158), median National Institutes of Health Stroke Scale score 9 (IQR, 4–18), median Alberta Stroke Program Early CT Score 10 (IQR, 8–10). Final diagnosis was ischemic stroke in 1762 patients (63.4%), hemorrhagic stroke in 359 (13.0%), transient ischemic attack in 164 (5.9%), and stroke-mimic in 493 (17.7%). A large vessel occlusion was confirmed in 720 (25.6%) patients. Of all SC, 16% (n=444) received EVT, with a median door-to-groin time of 77 minutes (IQR, 55–102). Baseline variables associated with EVT were premorbid modified Rankin Scale score 〈 2 ( P 〈 0.001), prehospital Rapid Arterial Occlusion Evaluation scale score 〉 4 ( P =0.003), and National Institutes of Health Stroke Scale on admission 〉 8 ( P 〈 0.001). National Institutes of Health Stroke Scale on admission was the only independent predictor of EVT. Although the rate of Alberta Stroke Program Early CT Score 10 progressively decreased over time (0–3 hours, 73.2% versus 3–6 hours, 57.1%; P 〈 0.01), the rate of Alberta Stroke Program Early CT Score 6 remained 〉 90% along time (0–3 hours, 95.1% versus 3–6 hours, 94.0%; P =0.25) and did not decrease over time. The chances to receive EVT and the presence of large vessel occlusion decreased over time. However, the rate of EVT was not different between patients admitted 0 to 3 hours (26.1%) and those admitted 3 to 6 hours (22.9%; P =0.2). Conclusions— Among SC within 6 hours from symptom onset, National Institutes of Health Stroke Scale on admission was the only factor independently associated with EVT. Only 5% of these patients show an Alberta Stroke Program Early CT Score 〈 6 and this rate does not significantly increase over time. These data may be useful to generate direct transfer to angio-suite protocols based mainly on clinical severity.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.021316
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    When to Stop : Detrimental Effect of Device Passes in Acute Ischemic Stroke Secondary to Large Vessel Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 7 ( 2019-07), p. 1781-1788
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 7 ( 2019-07), p. 1781-1788
    Abstract: Substantial proportion of patients who achieve successful recanalization of acute ischemic stroke due to large vessel occlusion do not achieve good functional outcome. We aim to analyze the effect of number of thrombectomy device passes and degree of the recanalization (by modified Thrombolysis in Cerebral Infarction) on the clinical and functional outcome. Methods— Five hundred forty-two consecutive patients underwent mechanical thrombectomy for large vessel occlusion in the anterior circulation at a single tertiary stroke center. Baseline characteristics, number of passes, recanalization degree, clinical outcome at 24 hours (measured by National Institutes of Health Scale score), and functional outcome (measured by modified Rankin Scale at 90 days) were registered. Multivariate analysis was performed to determine the association of number of passes and degree of recanalization with dramatical clinical recovery (final National Institutes of Health Scale score ≤2 or decrease in 8 or more National Institutes of Health Scale score points in 24 hours) and good functional outcome (modified Rankin Scale score ≤2 at 90 days). Results— Four hundred fifty-nine patients (84%) achieved successful recanalization (modified Thrombolysis in Cerebral Infarction 2B–3), 213 (39%) of them after first device pass. In the multivariate analysis, first-pass recanalization and modified Thrombolysis in Cerebral Infarction 3 were independent predictors of good functional outcome (odds ratio, 2.5; 95% CI, 1.4–4.5; P =0.002 and odds ratio, 2.6 CI; 1.5–4.7; P =0.001, respectively) and dramatical clinical recovery (odds ratio, 1.8; 95% CI, 1.1–3; P =0.032 and odds ratio, 2.9; 95% CI, 1.7–5.1; P 〈 0.001, respectively). Rate of recanalization declined after each pass 39% (213/542), 35% (113/310), 33% (63/190), and 24% (26/154) for passes 1 to 4, respectively and 28% (45/158) for every attempt above 4 passes ( P 〈 0.001). In patients who achieved recanalization, a linear association between number of passes and good functional outcome was observed: 1 pass (58.6%), 2 passes (50.5%), 3 passes (48.4%), 4 passes (38.5%), or 5 or more passes (25.6%; P 〈 0.001) as compared with patients who did not achieve recanalization (16.9%). Conclusions— High number of device passes and less degree of recanalization are associated with worse outcome in patients with acute ischemic stroke secondary to large vessel occlusion. Future studies should investigate the optimal number of passes that should be attempted in patients without substantial recanalization.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.025088
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Direct Transfer to Angio-Suite to Reduce Workflow Times and Increase Favorable Clinical Outcome : A Case-Control Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 11 ( 2018-11), p. 2723-2727
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 11 ( 2018-11), p. 2723-2727
    Abstract: Time to reperfusion is fundamental in reducing morbidity and mortality in acute stroke. We aimed to demonstrate that direct transfer to angio-suite (DTAS) of patients with suspected large vessel occlusion stroke improves workflow times and outcomes. Methods— A case-control matched study of the first 79 DTAS patients with confirmed large vessel occlusion (cases) and 145 no-DTAS patients (controls). DTAS protocol included a cone beam computed tomography in the angio-suite to rule out intracerebral hemorrhage for those patients with no prior neuroimaging in a referring center. Cases and controls were matched by location of vessel occlusion, age, baseline National Institutes of Health Stroke Scale (NIHSS) score and time from symptoms onset to Comprehensive Stroke Center arrival. Dramatic clinical improvement was defined as a decrease in NIHSS score of 〉 10 points or final NIHSS score of ≤2. Favorable outcome was defined as modified Rankin Scale score of ≤2 at 90 days. Results— During an 18 months period a total of 97 patients were directly transferred to the angio-suite after admission: 11 (11.6%) showed an intracerebral hemorrhage on cone beam computed tomography, 7 (7.2%) did not have a large vessel occlusion on initial angiogram, and 79 (76.3%) had a large vessel occlusion and received endovascular treatment (cases). There were no differences in age, baseline NIHSS score, level of occlusion and time from onset-to-door between cases and controls. The median door-to-groin time (16 [12–20] versus 70 [45–105] minutes; P 〈 0.01) and onset-to-groin times (222 [152–282] versus 259 [190–345] minutes; P 〈 0.01) were shorter in the DTAS group. At 24 hours, DTAS patients presented lower NIHSS score (7 [4–16] versus 14 [4–20] ; P =0.01), higher rate of dramatic improvement (50.6% Vs. 31.7%; P =0.04), and higher rate of favorable clinical outcome at 90 days (41% versus 28%; P =0.05). A logistic regression model adjusting for all matching variables showed that DTAS protocol was independently associated with 3 months favorable outcome (odds ratio, 2.5; 95% CI, 1.2–5.3; P =0.01). Conclusions— DTAS is an effective strategy to reduce workflow time which may significantly increase the odds of achieving a favorable outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.021989
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract TP32: Predictors of Endovascular Treatment Among Stroke Codes Activated Within 6 Hours From Symptom Onset
    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: Introduction: Prehospital stroke code activations help reducing wokflow times during in-hospital triage. We aim to identify predictors of endovascular treatment among activated stroke codes (ASC) within 6 hours from symptom onset. Methods: CICAT is a prospective official mandatory registry of all ASC in Catalunya. We studied all CICAT entries from 5 comprehensive stroke centers during 18 months. We recorded demographic, historic, clinical and imaging variables on admission. We explored the relationship between these variables and endovascular treatment (EVT) Results: From 3944 ASC, 2818 (71.5%) were admitted 〈 6 hours from symptom onset. Mean age was 72±15.3 years, median RACE scale 4 (IQR 2-6), median onset-to-door time (OTDT) was 87 minutes (IQR 54-158), median NIHSS score 9 (IQR 4-18), median ASPECTS 10 (IQR 8-10. Final diagnosis was ischemic stroke in 1767 patients (62.7%), hemorrhagic stroke in 364 (12.9%), TIA in 167 (5.9%), stroke-mimic in 500 (17.7%). After admision a large vessel occlusion (LVO) was confirmed in 916 (23.2%) patients. While the rate of ASPECTS ≥ 9 among ischemic strokes progressively decreased over time (0-3h: 73.2% vs 3-6h: 57.1%: p 〈 0.01), the rate of ASPECTS ≥6 (0-3h: 95.1% vs 3-6h: 91.6%: p=0.13) and presence of LVO (0-3h: 22.4% vs 3-6h: 22.8%: p=0.82) did not decrease over time. Of all ACS, 16% (n=453) received EVT, with a median door to groin time of 77 minutes (IQR 55-102). Baseline variables independently associated with EVT were premorbid mRS 〉 2 (p 〈 0.001), prehospital RACE score 〉 4 (p=0.003) and NIHSSon admission 〉 8 (p 〈 0.001). The chances to receive EVT were similar in patients admitted 0-3 (16.4%) Vs. 3-6 hours (14.6; p=0.3). ASC with a RACE score 〉 4 had 26.0% probability to receive EVT Conclusion: Among ACS within 6 hours from symptom onset, time from onset to arrival is not associated with the probability of receiving EVT. Only 5% of these patients show an ASPECTS 〈 6 and this rate does not significantly increase during the first 6 hours. These data may be useful to generate direct transfer to angio-suite protocols.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TP32
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Abstract WP129: The Yield of Antiplatelet Resistance in Carotid and Vertebral Artery Stenting
    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: Platelet function measured by Aggregometry tests (AT) are commonly used to measure the response to antiplatelets in patients undergoing intracranial and coronary stenting. However, its relevance in carotid and vertebral stents (CVS) is unsettled. We aimed to determine the yield of antiplatelet resistance (AR) in CVS patients, and its relationship with early restenosis and new ischemic lesions on magnetic resonance imaging (MRI). Methods: We studied consecutive patients undergoing CVS. Platelet function was assessed before stenting by means of VerifyNow-assay using Aspirin and P2Y12 cartridges. Antiplatelet reactivity was defined using the cut-off values ARU≥550 as Aspirin resistance (AASR) and PRU≥220 as Clopidogrel resistance (CR). Patients received baseline and 5-day MRI. Periprocedural complications, the new ischemic lesions at 5-day MRI and stent permeability by carotid ultrasound at 24 hours, 5 days and 3 months were analysed. Results: A total of 366 patients were screened. Of those, 246 patients were enrolled and tested for platelet function. A total of 135 patients (54.2%) showed AR, 48 AASR (19.5%) and 112 CR (45.5%). Aspirin dose after the test was increased in 21 patients (45.7%). In 22 patients (20%) with CR the daily dose was increased, in 40 patients (37.7%) an extra-loading dose was administrated and in 9 patients (8.4%) we increased both. At 24 hours, one patient showed restenosis 〉 50% and another an occlusion (0.4 and 0.4% respectively). At 5 days, 8 patients had restenosis 〈 50% (13.1%) and in 43 (17.5%) MRI showed new ischemic lesions. At 3 months 9 patients had stenosis 〉 50% (4.5%) and stenting-related recurrence was observed in 3 (1.4%). A larger size lesions at 5-day MRI (OR 0.143; 95%CI 0.028-0.719) and a multi-territorial ischemic pattern (OR 0.143; 95%CI 0.075-0.893) were associated with lack of response to Clopidogrel therapy. No significant differences in AASR were observed across different groups. Conclusion: The yield of antiplatelet resistance in our series was 54.2%. Clopidogrel resistance was associated with a larger size and a multi-territorial stroke pattern at 5-day MRI. More studies are needed to elucidate the clinical impact of Aggregometry test and management recommendations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP129
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Abstract TP307: Clinical and Neuroimaging Criteria to Improve Transfers to Comprehensive Stroke Centers for Endovascular Reperfusion Treatment Evaluation
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Transfer protocols from primary (PSC) to comprehensive stroke centers (CSC) are crucial for the success of endovascular treatment (EVT). We aimed to identify clinical and neuroimaging predictors of EVT outcome in patients first assessed at non-capable EVT centers. Methods: Retrospective analysis of consecutive patients included in a prospective, population-based, mandatory registry of acute ischemic strokes (AIS). Inclusion criteria: AIS firstly evaluated at a PSC with suspected large vessel occlusion (LVO) transferred to a CSC for EVT assessment. PSC and CSC-ASPECTS, time-metrics and clinical data were analyzed. Results: Between February 2016 and May 2018, 1185 EVT candidates were transferred from PSC to CSC in our stroke code network (see Graph). Median baseline NIHSS was 13(7-19). 53.4% received iv tPA in the PSC. Upon CSC arrival, LVO was confirmed in 63.1% patients, and 42.8% received EVT. After a median of 130(107-169)min between both CT-acquisitions, the median inter-facilities ASPECTS decay was 1(0-2) and only 11.9% showed a CSC-ASPECTS 〈 6. A ROC curve identified baseline NIHSS 〉 16 as the best cut-off point that predicted CSC-ASPECTS 〈 6(Sensitivity 67%, specificity 75%, AUC 0.7). A logistic regression analysis adjusted by age, time from symptoms to PSC-CT and time from PSC-CT to CSC-CT showed that only a baseline NIHSS 〉 16 independently predicted a CSC-ASPECTS 〈 6(OR 3.8, CI 2.1-6.9, p 〈 0.001). The rate of CSC-ASPECTS 〈 6 increased to 21% among AIS with NIHSS 〉 16, and to 38.1% in patients with NIHSS 〉 16 and PSC-ASPECS≤7. Conclusion: ASPECTS 〈 6 scores are uncommon in CSC even after long transfer times. Except for selected cases (NIHSS 〉 16 or PSC-ASPECTS≤7), confirming ASPECTS upon CSC arrival may not be necessary among AIS transferred from PSC.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP307
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Mucinous Metaplasia of the Vulva in Zoon Vulvitis and Lichen Sclerosus et Atrophicus. Description of 3 Additional Cases of a Rarely Reported Histopathologic Finding
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  The American Journal of Dermatopathology Vol. 41, No. 4 ( 2019-04), p. e39-e42
    Details
    In: The American Journal of Dermatopathology, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 4 ( 2019-04), p. e39-e42
    Abstract: Mucinous metaplasia of the vulva (MMV) is a histopathologic finding that has been reported previously in only 3 patients and needs to be distinguished from vulvar extramammary Paget disease. We report 3 additional instances of MMV associated to Zoon vulvitis and vulvar lichen sclerosus et atrophicus. Histochemical and immunohistochemical studies were performed on biopsies from erythematous and erosive vulvar lesions of 3 women aged 64, 80 and 84 years, with features of Zoon vulvitis (2 cases) and lichen sclerosus et atrophicus (1 case). Mucin-containing epithelial cells were present on the uppermost layers of the squamous epithelium. On immunohistochemical study the metaplastic cells were positive for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen, thus mimicking the phenotype of Paget disease. MMV is most likely related to chronic inflammation. Cytological and architectural features allow for distinction from Paget disease because the mucin-containing cells of mucinous metaplasia of the vulva lack atypia and are predominantly located on the most superficial layers of the surface epithelium.
    Type of Medium: Online Resource
    ISSN: 0193-1091
    URL: Article
    DOI: 10.1097/DAD.0000000000001277
    RVK:
    XA 18760
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2041296-4
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  • 8
    Online Resource
    Online Resource
    Farmalarm : Application for Mobile Devices Improves Risk Factor Control After Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 7 ( 2019-07), p. 1819-1824
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 7 ( 2019-07), p. 1819-1824
    Abstract: Risk factor control and treatment compliance in the following months after stroke are poor. We aim to validate a digital platform for smartphones to raise awareness among patients about the need to adopt healthy lifestyle, improve communication with medical staff, and treatment compliance. Methods— Farmalarm is an application (app) for smartphones designed to increase stroke awareness by medication alerts and compliance control, chat communication with medical staff, didactic video files, exercise monitoring. Patients with stroke discharged home were screened for participation and divided into groups: to follow the FARMALARM program for 3 to 4 weeks or standard of care follow-up. We determined achievement of risk factor control goals at 90 days. Results— From August 2015 to December 2016, from the 457 patients discharged home, 159 (34.8%) were included: Farmalarm (n=107); age 57±12, Control (n=52), age 59±10; without significant differences in baseline characteristics between groups. At 90 days, knowledge of vascular risk factors was higher in FARMALARM group (86.0% versus 69.2%, P 〈 0.01). The rate of patients with diabetes mellitus (83.2% versus 63.5%, P 〈 0.01) and hypercholesterolemia (80.3% versus 63.5%, P =0.03) under control and the rate of patients with 4 out of 4 risk factors under control was higher in FARMALARM group (50.4% versus 30.7%, P =0.02). A regression model showed that the use of Farmalarm was independently associated with all risk factors under control at 90 days (odds ratio, 2.3; 95% CI, 1.14–4.6; P =0.02). Conclusions— In patients with stroke discharged home, the use of mobile apps to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.024355
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Abstract TP194: Farmalarm: A Mobile Application to Improve Stroke Awareness
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance Methods: Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients. Results: During 16 months, from all patients discharged home, 159 were included in the study: FARMALARM n=107; age 58±12, Control n=52, age 59±11. There were no significant differences in baseline characteristics between groups. At 90 days, mean of total cholesterol (156±37 vs. 169±50, p=0.01) and low-density-lipoprotein cholesterol (87±31 vs. 101±43, p 〈 0.01) were lower in the FARMALARM group. Achievement of risk factor control was higher in the FARMALARM group (p=0.03) and the rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (42.2% Vs 14.7%; p=0.01). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 2.87; 95% CI:1.2-6.9;p=0.01). Conclusion: FARMALARM is a reliable mobile application to monitor medication compliance and increase stroke awareness in stroke patients discharged home and it could improve the control of vascular risk factors.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP194
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Online Resource
    Abstract 111: Endovascular Therapy for Mild Strokes: How Low Should We Go?
    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: Endovascular therapy (EVT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) with NIHSS ≥ 6. LVO patients may present with mild (NIHSS 〈 6) but disabling deficits and were not well represented in RCTs resulting in a NIHSS cutoff of ≥ 6 on AHA guidelines. Milder deficits may not justify EVT risk-benefit ratio. To generate practice level data, we evaluated EVT treatment effect in mild stroke. Methods: A retrospective cohort from 8 USA and Spain centers of AIS with LVO in the anterior circulation with NIHSS ≤ 6 presenting within 24 hrs (1/12 to 3/17) was pooled. EVT patients were compared with those only treated with medical management (MM). 90 day mRS (0-1 excellent) was chosen as the primary outcome as an appropriate goal for mild stroke. Multivariable analyses compared the treatment effects and their interactions with NIHSS, both as an ordinal and dichotomized (0-3 vs 4-5) variable. Adjustment was made for age, time LSN to EVT center arrival, IV-tPA, occlusion site and ASPECTS. Within center correlation was accounted for. Results: 223 patients were included (EVT 105, MM 118). The two groups had similar baseline age (65.7 and 66.3 yrs, p=0.73), ASPECTS (9.4 and 9.3 p=0.53), %IV t-PA (39% and 36% p=0.65) and median (IQR) time mins to EVT center 156(66.5-301) and 212(90-387) p=0.09, EVT and MM respectively. There was no difference in outcomes (54.6% EVT vs 53.4% MM) when all patients (NIHSS 0-6) were assessed (aOR 0.94, 95% CI 0.62-1.40, p=0.94); same for NIHSS 0-5 (55.1% EVT vs 55.6% MM), (aOR 0.95, 95% CI 0.71-1.26, p=0.95). For NIHSS 0-3, MM had better outcomes (51.9% EVT vs 74.6% MM), (aOR 0.39, 95% CI 0.25-0.61, p 〈 0.01). For NIHSS 4-5, results favored EVT (57.1% EVT vs 22.2% MM), (aOR 4.04, 95% CI 2.56-6.38, p 〈 0.01). Fig 1, 2 show CIs of EVT and MM as related to NIHSS. Conclusion: Though limited by a non-randomized comparison, the data suggest a possible benefit for EVT in mild strokes with NIHSS 4-5. In NIHSS ≤3, the intervention had no additive benefit.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.111
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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