Predicting risk of symptomatic intracerebral hemorrhage and mortality after treatment with recombinant tissue-plasminogen activator using SEDAN score.

BACKGROUND AND PURPOSE: The most feared complication after treatment with recombinant tissue-plasminogen activator (rt-PA) is the occurrence of symptomatic intracerebral hemorrhage (sICH). The aims of the study were to predict the risk of sICH (ECASS II definition) after a therapy with rt-PA and to examine whether associations exist between SEDAN score and the early mortality in patients with acute ischemic stroke in a monocenter study. METHODS: During a 6-year period (2008-2013), 542 consecutive stroke patients (mean age, 73 ± 3 years; 51.1% women; median NIHSS score, 11) treated with IV thrombolysis were included in a monocenter study. SICH was diagnosed in according to the with ECASS II definition. RESULTS: The absolute risk for sICH revealed 9.2% (95% CI, 6.5-11.4) of patients treated with IV thrombolysis and was 0%, 4.6% (95% CI, 1.3-7.9), 6.6% (95% CI, 3.3-10.5), 13.5% (95% CI, 6.7-19.2), 23.6% (95% CI, 12.7-34.5), and 26.7% (95% CI, 12.7-34.5) for 0, 1, 2, 3, 4, and ≥5 SEDAN points. Logistic regression revealed that sICH was associated with increasing SEDAN scores (OR, 1.93 per SEDAN point; 95% CI, 1.51-2.46; P < 0.001). The predictive performance was assessed with area under a receiver operating characteristic curve (0.73; 95% CI, 0.65-0.80; P < 0.001). During hospitalization (median, 9 days), 53 patients (9.8%; 95% CI, 7.4-12.45) died. In-hospital mortality was higher in patients with than those without sICH (30 vs 7.7%; P < 0.001), and it was increased with increasing SEDAN score (OR, 1.45 per point; 95% CI, 1.12-1.89; P = 0.005). CONCLUSIONS: Higher SEDAN score was associated with an increased risk of sICH and early mortality in this monocenter study.

The prognostic impact of the stroke unit care versus conventional care in treatment of patients with transient ischemic attack: a prospective population-based German study.

BACKGROUND AND PURPOSE: The risk of a stroke after a transient ischemic attack (TIA) is high in the short time following a TIA. The German Stroke Society recommends an early hospitalization of patients with TIA preferably in a stroke unit (SU). This study aims to compare the impact of SU care with conventional care (CC) in patients with TIA. METHODS: In a prospective study, during a 36-month phase (starting November 2007), patients with TIA who were admitted to the hospital within 48 h of symptom onset were enrolled. Stroke rate during hospitalization and the 90-day rates of stroke and mortality were studied. Logistic regression analyses were used to estimate the odds ratio (OR). RESULTS: Of 2,200 patients (mean age, 17.6 ± 12 years, 49% female), 1,347 (61%) treated in a SU and 853 (39%) received CC at general departments. Patients treated in SU were significantly younger than those received a CC (69.9 vs. 71.7 years; P = 0.001). TIA patients treated on SU received more ultrasound investigations of the neck arteries (98 vs. 96%; P = 0.003) and of the brain arteries (97 vs. 82%; P < 0.001) than those of CC. The primary outcomes (stroke during hospitalization, stroke after 90 days, and mortality after 90 days) did not show a difference between the SU and CC groups. In patients of male sex, the 90-day stroke rate was significantly lower in the SU group than the CC group (1.8 vs. 4.5%; P = 0.033). Using the adjusted logistic regression analysis, treatment in a SU revealed a reduction of 90-day stroke rate in patients of male sex (OR 0.38; 95% CI 0.15-0.95; P = 0.04). CONCLUSION: The impact of evaluation and treatment of patients with TIA in SU and CC appears to differ only among patients of male sex. Further randomized trials are necessary.

Stroke recurrence in patients with recently symptomatic carotid stenosis and scheduled for carotid revascularization.

BACKGROUND AND PURPOSE: Patients with symptomatic carotid stenosis (sCS) have a higher risk of stroke recurrence following the first ischaemic event. Guidelines recommend that patients undergo carotid revascularization (CR), preferably within 2 weeks of the event. We aimed to determine the rate of stroke recurrence during hospitalization in patients who were admitted to the hospital with an acute ischaemic event and who underwent CR for recently sCS. METHODS: As part of the stroke registry in Schleswig-Holstein, Germany (QugSS2; Qualitätsgemeinschaft Schlaganfallversorgung in Schleswig-Holstein), over a 4.5-year period (starting 2007) all patients (N = 15,797) who were admitted to the hospital with an acute cerebral ischaemic event were included and prospectively evaluated. RESULTS: A total of 597 (3.8%) patients (mean age, 71 ± 10 years; 30% women) underwent a CR. The median time between symptom onset and admission to hospitals was 6 h. During the mean hospitalization of 10 days, 30 patients (5%) suffered a stroke. The rates of stroke recurrence were higher, albeit non-significantly, in men compared with women (6% vs. 2.3%, respectively; P = 0.059), and in patients admitted with ischaemic stroke compared with patients admitted with transient ischaemic attack (6.1% vs. 2%, respectively; P = 0.052). The risk of stroke recurrence did not show any association with the other demographic and clinical parameters. CONCLUSION: The rate of stroke recurrence was 5% in patients with recently sCS who scheduled for CR. This suggests that CR should be performed immediately after presenting event to prevent stroke recurrence.