A comparison of conscious sedation and local anesthesia for thrombectomy in acute ischemic stroke: a multicenter study.

Introduction: Ischemic cerebrovascular disease (ICVD) is a serious health problem in which brain tissue suffers from hypoxic damage due to obstruction in cerebral vessels. Mechanical thrombectomy is a commonly used method in the treatment of these patients. However, the effects of local anesthesia (LA) and conscious sedation (CS) during thrombectomy are still unclear. We evaluated whether there was a relationship between the two anesthesia regimens in terms of 90-day modified Rankin Scale (mRS) scores. Methods: In this study, a retrospective observational study was conducted to evaluate the effects of LA and CS used during mechanical thrombectomy in four comprehensive stroke centers among ICVD patients. Patients were divided into the LA group and the CS group. Statistical analysis was performed before and after 1:1 matching under propensity score matching (PSM) analysis. The primary outcome measure was an mRS score of 0-2 at 90 days. Secondary outcomes were procedure times, recanalization rates, symptomatic and asymptomatic hemorrhage rates, and procedural complications. Results: A total of 193 patients (118 patients with LA and 75 patients with CS) were included in the final analysis before PSM. After 1:1 PSM, 98 patients-49 patients from each group-were included in the study. There was no difference in clinical outcomes between the LA- and CS-applied groups (p = 0.543). When blood pressure (BP) values at follow-up after endovascular treatment (EVT) were compared, the lowest systolic and lowest diastolic BP were found to be lower in the CS group (p = 0.001 and p = 0.009). There was no significant difference between the two groups in terms of recanalization rates, symptomatic intracranial hemorrhage (sICH) rates, 90-day mRS, and procedure-related complication rates (p = 0.617, p = 0.274, p = 0.543, and p = 1.000). Conclusion: This study did not reveal the superiority of CS applied during EVT on 90-day mRS, sICH, recanalization rates, or procedural complications. However, the risk of developing hypotension during the CS application was found to be high.

Do stroke services still show sex differences? A multicenter study.

BACKGROUND: The issue of sex differences in stroke has gained concern in the past few years. However, multicenter studies are still required in this field. This study explores sex variation in a large number of patients and compares stroke characteristics among women in different age groups and across different countries. METHODS: This multicenter retrospective cross-sectional study aimed to compare sexes regarding risk factors, stroke severity, quality of services, and stroke outcome. Moreover, conventional risk factors in women according to age groups and among different countries were studied. RESULTS: Eighteen thousand six hundred fifty-nine patients from 9 countries spanning 4 continents were studied. The number of women was significantly lower than men, with older age, more prevalence of AF, hypertension, and dyslipidemia. Ischemic stroke was more severe in women, with worse outcomes among women (p: < 0.0001), although the time to treatment was shorter. Bridging that was more frequent in women (p:0.002). Analyzing only women: ischemic stroke was more frequent among the older, while hemorrhage and TIA prevailed in the younger and stroke of undetermined etiology. Comparison between countries showed differences in age, risk factors, type of stroke, and management. CONCLUSION: We observed sex differences in risk factors, stroke severity, and outcome in our population. However, access to revascularization was in favor of women.

Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy.

OBJECTIVE: The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy. INTRODUCTION: Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy. MATERIALS AND METHODS: Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0-2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study. CONCLUSION: Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32-5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52-8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome. DISCUSSION: This study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability.

The role of ASPECTs in patient selection for endovascular therapy - CTA source images versus noncontrast CT.

The Alberta Stroke Program Early Computed Tomography Score (ASPECTs) on noncontrast CT (NCCT) is widely used for the decision of endovascular therapy (ET) in randomized controlled trials. CT angiography source images (CTA-SI) is another method to evaluate ischemic brain damage. We aimed to evaluate the association between pretreatment ASPECTs on CTA-SI and post-treatment clinical and radiological outcomes in acute stroke patients treated with ET. The association between both scores along with final infarct and outcome were analyzed. A total of 90 patients with successful recanalization were included in the study. The mean age was 59 ±â€¯11.8. According to the results, CTA-SI ASPECTs was better correlated with final infarct than NCCT ASPECTs (p < 0.001). In univariate analyzes, factors associated with good outcome were age, baseline NIHSS score, and presence of diabetes mellitus (p = 0.001, p = 0.002, p = 0.034, respectively). On the other hand, when an analysis differentiating patients by age was performed, 40 patients below 60 years of age had significantly better outcomes despite having higher baseline NIHSS scores (p = 0.002). Finally, in multivariate analyzes, only age and baseline NIHSS score were found to be independent predictors of good outcome (p = 0.003 for both). In conclusion, CTA-SI ASPECTs in patient selection for ET seems to be more useful than NCCT ASPECTs. However, both scoring modalities were not found to be independent predictors of good outcome. Outcomes are changeable for the younger population who could continue their lives with mild or no deficits despite having a relatively low initial ASPECTs.

Early hyperbaric oxygen therapy for cerebral air embolism during atrial fibrillation ablation.

Cerebral air embolism is a potentially life-threatening complication of left-sided ablation procedures. We present a 51-year-old woman with cerebral air embolism during atrial fibrillation cryoballoon ablation. Taking a deep breath while removing the dilatator was the most likely mechanism in our case. The patient was successfully treated with hyperbaric oxygen therapy at early stage and was discharged without any neurological sequelae.

Evaluation of cardiac autonomic functions in myasthenia gravis.

OBJECTIVE: We aimed to comprehensively evaluate cardiac autonomic function in patients with MG and to investigate the relationship between this disorder and disease duration, thymoma and acetylcholine receptor antibody positivity in cases of cardiac autonomic disorder. METHODS: The study included 30 patients with MG and 30 age-matched healthy control subjects. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure) and autonomic parameters (low frequency [LF], high-frequency [HF], sympathovagal balance [LF/HF], baroreceptor reflex sensitivity [BRS]) of the patients were automatically measured at rest and in a tilted position with the Task Force Monitor. RESULTS: The mean systolic and diastolic blood pressure measurements obtained at rest and during the tilt test were higher in patients with MG. Sympathovagal balance has been disturbed in favour of sympathetic tone, and parasympathetic insufficiency has become more prominent. When baroreceptor sensitivity was used as the second parameter to evaluate autonomic heart functions, BRS at rest and during the tilt test was lower in the MG group compared with the control group. DISCUSSION: These results suggest that sympathovagal balance has been disturbed in favour of sympathetic tone and that parasympathetic insufficiency has become more prominent. The current findings support the presence of cardiac autonomic involvement in patients with MG. The determination of cardiac autonomic function via noninvasive methods among patients with MG has high predictive value. The identification of autonomic dysfunction at an early stage and the early treatment of cardiovascular diseases can reduce morbidity and mortality.