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1.
Journal of Stroke ; : 269-279, 2024.
Artículo en Inglés | WPRIM | ID: wpr-1044103

RESUMEN

Background@#and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. @*Methods@#In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). @*Results@#A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). @*Conclusion@#A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.

2.
Journal of Stroke ; : 290-299, 2024.
Artículo en Inglés | WPRIM | ID: wpr-1044105

RESUMEN

Background@#and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. @*Methods@#From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. @*Results@#Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95). @*Conclusion@#Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.

3.
Thanh-N. NGUYEN; Muhammad-M. QURESHI; Piers KLEIN; Hiroshi YAMAGAMI; Mohamad ABDALKADER; Robert MIKULIK; Anvitha SATHYA; Ossama-Yassin MANSOUR; Anna CZLONKOWSKA; Hannah LO; Thalia-S. FIELD; Andreas CHARIDIMOU; Soma BANERJEE; Shadi YAGHI; James-E. SIEGLER; Petra SEDOVA; Joseph KWAN; Diana-Aguiar DE-SOUSA; Jelle DEMEESTERE; Violiza INOA; Setareh-Salehi OMRAN; Liqun ZHANG; Patrik MICHEL; Davide STRAMBO; João-Pedro MARTO; Raul-G. NOGUEIRA; Espen-Saxhaug KRISTOFFERSEN; Georgios TSIVGOULIS; Virginia-Pujol LEREIS; Alice MA; Christian ENZINGER; Thomas GATTRINGER; Aminur RAHMAN; Thomas BONNET; Noémie LIGOT; Sylvie DE-RAEDT; Robin LEMMENS; Peter VANACKER; Fenne VANDERVORST; Adriana-Bastos CONFORTO; Raquel-C.T. HIDALGO; Daissy-Liliana MORA-CUERVO; Luciana DE-OLIVEIRA-NEVES; Isabelle LAMEIRINHAS-DA-SILVA; Rodrigo-Targa MARTÍNS; Letícia-C. REBELLO; Igor-Bessa SANTIAGO; Teodora SADELAROVA; Rosen KALPACHKI; Filip ALEXIEV; Elena-Adela CORA; Michael-E. KELLY; Lissa PEELING; Aleksandra PIKULA; Hui-Sheng CHEN; Yimin CHEN; Shuiquan YANG; Marina ROJE-BEDEKOVIC; Martin ČABAL; Dusan TENORA; Petr FIBRICH; Pavel DUŠEK; Helena HLAVÁČOVÁ; Emanuela HRABANOVSKA; Lubomír JURÁK; Jana KADLČÍKOVÁ; Igor KARPOWICZ; Lukáš KLEČKA; Martin KOVÁŘ; Jiří NEUMANN; Hana PALOUŠKOVÁ; Martin REISER; Vladimir ROHAN; Libor ŠIMŮNEK; Ondreij SKODA; Miroslav ŠKORŇA; Martin ŠRÁMEK; Nicolas DRENCK; Khalid SOBH; Emilie LESAINE; Candice SABBEN; Peggy REINER; Francois ROUANET; Daniel STRBIAN; Stefan BOSKAMP; Joshua MBROH; Simon NAGEL; Michael ROSENKRANZ; Sven POLI; Götz THOMALLA; Theodoros KARAPANAYIOTIDES; Ioanna KOUTROULOU; Odysseas KARGIOTIS; Lina PALAIODIMOU; José-Dominguo BARRIENTOS-GUERRA; Vikram HUDED; Shashank NAGENDRA; Chintan PRAJAPATI; P.N. SYLAJA; Achmad-Firdaus SANI; Abdoreza GHOREISHI; Mehdi FARHOUDI; Elyar SADEGHI-HOKMABADI; Mazyar HASHEMILAR; Sergiu-Ionut SABETAY; Fadi RAHAL; Maurizio ACAMPA; Alessandro ADAMI; Marco LONGONI; Raffaele ORNELLO; Leonardo RENIERI; Michele ROMOLI; Simona SACCO; Andrea SALMAGGI; Davide SANGALLI; Andrea ZINI; Kenichiro SAKAI; Hiroki FUKUDA; Kyohei FUJITA; Hirotoshi IMAMURA; Miyake KOSUKE; Manabu SAKAGUCHI; Kazutaka SONODA; Yuji MATSUMARU; Nobuyuki OHARA; Seigo SHINDO; Yohei TAKENOBU; Takeshi YOSHIMOTO; Kazunori TOYODA; Takeshi UWATOKO; Nobuyuki SAKAI; Nobuaki YAMAMOTO; Ryoo YAMAMOTO; Yukako YAZAWA; Yuri SUGIURA; Jang-Hyun BAEK; Si-Baek LEE; Kwon-Duk SEO; Sung-Il SOHN; Jin-Soo LEE; Anita-Ante ARSOVSKA; Chan-Yong CHIEH; Wan-Asyraf WAN-ZAIDI; Wan-Nur-Nafisah WAN-YAHYA; Fernando GONGORA-RIVERA; Manuel MARTINEZ-MARINO; Adrian INFANTE-VALENZUELA; Diederik DIPPEL; Dianne-H.K. VAN-DAM-NOLEN; Teddy-Y. WU; Martin PUNTER; Tajudeen-Temitayo ADEBAYO; Abiodun-H. BELLO; Taofiki-Ajao SUNMONU; Kolawole-Wasiu WAHAB; Antje SUNDSETH; Amal-M. AL-HASHMI; Saima AHMAD; Umair RASHID; Liliana RODRIGUEZ-KADOTA; Miguel-Ángel VENCES; Patrick-Matic YALUNG; Jon-Stewart-Hao DY; Waldemar BROLA; Aleksander DĘBIEC; Malgorzata DOROBEK; Michal-Adam KARLINSKI; Beata-M. LABUZ-ROSZAK; Anetta LASEK-BAL; Halina SIENKIEWICZ-JAROSZ; Jacek STASZEWSKI; Piotr SOBOLEWSKI; Marcin WIĄCEK; Justyna ZIELINSKA-TUREK; André-Pinho ARAÚJO; Mariana ROCHA; Pedro CASTRO; Patricia FERREIRA; Ana-Paiva NUNES; Luísa FONSECA; Teresa PINHO-E-MELO; Miguel RODRIGUES; M-Luis SILVA; Bogdan CIOPLEIAS; Adela DIMITRIADE; Cristian FALUP-PECURARIU; May-Adel HAMID; Narayanaswamy VENKETASUBRAMANIAN; Georgi KRASTEV; Jozef HARING; Oscar AYO-MARTIN; Francisco HERNANDEZ-FERNANDEZ; Jordi BLASCO; Alejandro RODRÍGUEZ-VÁZQUEZ; Antonio CRUZ-CULEBRAS; Francisco MONICHE; Joan MONTANER; Soledad PEREZ-SANCHEZ; María-Jesús GARCÍA-SÁNCHEZ; Marta GUILLÁN-RODRÍGUEZ; Gianmarco BERNAVA; Manuel BOLOGNESE; Emmanuel CARRERA; Anchalee CHUROJANA; Ozlem AYKAC; Atilla-Özcan ÖZDEMIR; Arsida BAJRAMI; Songul SENADIM; Syed-I. HUSSAIN; Seby JOHN; Kailash KRISHNAN; Robert LENTHALL; Kaiz-S. ASIF; Kristine BELOW; Jose BILLER; Michael CHEN; Alex CHEBL; Marco COLASURDO; Alexandra CZAP; Adam-H. DE-HAVENON; Sushrut DHARMADHIKARI; Clifford-J. ESKEY; Mudassir FAROOQUI; Steven-K. FESKE; Nitin GOYAL; Kasey-B. GRIMMETT; Amy-K. GUZIK; Diogo-C. HAUSSEN; Majesta HOVINGH; Dinesh JILLELA; Peter-T. KAN; Rakesh KHATRI; Naim-N. KHOURY; Nicole-L. KILEY; Murali-K. KOLIKONDA; Stephanie LARA; Grace LI; Italo LINFANTE; Aaron-I. LOOCHTAN; Carlos-D. LOPEZ; Sarah LYCAN; Shailesh-S. MALE; Fadi NAHAB; Laith MAALI; Hesham-E. MASOUD; Jiangyong MIN; Santiago ORGETA-GUTIERREZ; Ghada-A. MOHAMED; Mahmoud MOHAMMADEN; Krishna NALLEBALLE; Yazan RADAIDEH; Pankajavalli RAMAKRISHNAN; Bliss RAYO-TARANTO; Diana-M. ROJAS-SOTO; Sean RULAND; Alexis-N. SIMPKINS; Sunil-A. SHETH; Amy-K. STAROSCIAK; Nicholas-E. TARLOV; Robert-A. TAYLOR; Barbara VOETSCH; Linda ZHANG; Hai-Quang DUONG; Viet-Phuong DAO; Huynh-Vu LE; Thong-Nhu PHAM; Mai-Duy TON; Anh-Duc TRAN; Osama-O. ZAIDAT; Paolo MACHI; Elisabeth DIRREN; Claudio RODRÍGUEZ-FERNÁNDEZ; Jorge ESCARTÍN-LÓPEZ; Jose-Carlos FERNÁNDEZ-FERRO; Niloofar MOHAMMADZADEH; Neil-C. SURYADEVARA,-MD; Beatriz DE-LA-CRUZ-FERNÁNDEZ; Filipe BESSA; Nina JANCAR; Megan BRADY; Dawn SCOZZARI.
Journal of Stroke ; : 256-265, 2022.
Artículo en Inglés | WPRIM | ID: wpr-938173

RESUMEN

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

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