Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry.

BACKGROUND: Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry. METHODS: Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2-4, 4-6, and >6 hours. RESULTS: 299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours. CONCLUSIONS: Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the 'two golden hours' from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.

[Knowledge of stroke among the Israeli population].

BACKGROUND: Stroke and its long-term neurological sequelae can be prevented by management of risk factors and seeking medical care as early as possible following the onset of stroke symptoms. AIMS: This study aimed to investigate the scope of knowledge on stroke, and to assess the perceived risk of stroke among the Israeli population. METHODS AND RESULTS: A telephone survey was conducted of a sample study of 300 men and women, 40 years of age or older, that represent the Hebrew speaking population in Israel of this age range. The best known risk factor for stroke was arterial hypertension, but 24% of the study population could not spontaneously recall any risk factor. Nearly half of the study sample (46%) was aware of the fact that a healthy lifestyle may contribute to stroke prevention, but only 24% mentioned that medical follow-up and control of hypertension, dyslipidemia and diabetes mellitus reduce the risk of stroke. Among interviewed subjects who reported the existence of at least one risk factor of stroke, only 14% recognized that they belong to a group at risk of having a stroke. Awareness of neurological disabilities resulting from stroke was relatively high, with only 15% of responders unable to name any disability. CONCLUSION: Our study demonstrates the lack of knowledge on stroke among the Israeli population. Knowledge is particularly poor regarding the possibility of stroke prevention through risk factor management, and with respect to recognition of symptoms of acute stroke. A program directed at raising the awareness and knowledge of stroke by the Israeli public is required for effective stroke prevention and therapy.

Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease.

OBJECTIVES: The purpose of this research was to evaluate the relationship between coronary and carotid atherosclerotic disease using current guidelines for the definition of carotid artery stenosis (CAS). BACKGROUND: The reported prevalence of concomitant coronary and carotid atherosclerotic disease has varied among studies due to differences in study populations and methodologies used. METHODS: We performed a retrospective analysis of prospectively collected data obtained between January 2007 and May 2009 from consecutive patients undergoing same-day coronary angiography and carotid Doppler studies. Spearman correlations and multinomial logistic regression models were used to identify independent correlates of CAS. RESULTS: The study included 1,405 patients (age 65 ± 11 years, 77.2% male), of whom 12.8% had significant CAS (peak systolic velocity [PSV] >125 cm/s) and 4.6% had severe CAS (PSV >230 cm/s). Mild CAS (PSV <125 cm/s and the presence of a sonographic atherosclerotic lesion) was present in 58%. The severity of CAS and the extent of coronary artery disease (CAD) were significantly correlated (r = 0.255, p < 0.001). Independent predictors of severe CAS defined by PSV were the presence of left-main or 3-vessel CAD, increasing age, a history of stroke, smoking status, and diabetes mellitus. CONCLUSIONS: The degree of internal carotid artery (ICA) stenosis is related to the extent of CAD, though the prevalence of clinically significant ICA stenosis is lower in specific CAD subsets than previously reported.