Abstract 18: The Role of Vascular Imaging at Primary Stroke Centers in the Drip and Ship Paradigm

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alan Flores ◽  
Laia Seró ◽  
Xavier Ustrell ◽  
Anna Pellisé ◽  
Manuel Gomez Choco ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Population Based ◽  
Vascular Imaging ◽  
Related Factors ◽  
Factors Associated ◽  
Transferred Patients ◽  
Population Based Registry

Background: In drip-and-ship protocols, vascular imaging at Primary Stroke Centers (PSC), although recommended, is not usually performed in many PSC, and its value is uncertain. Our aim was to evaluate the role of performing vascular imaging at PSC, comparing patients with vascular imaging at PSC (VI+) Vs. those without vascular imaging (VI-) in several outcomes. Methods: Observational, multicenter study from a prospective, government-mandated, population-based registry of ischemic stroke code patients firstly evaluated at a PSC from January-2016 to June-2020. We determined and compared rates of Mechanical Thrombectomy (MT) candidates transferred to CSC from all ischemic stroke codes at PSC, MT treated at CSC patients from all MT candidates transferred, and metrics related to drip-and-ship paradigm between VI + and VI- groups. A multivariate analysis to determine PSC related factors associated with receiving EVT at CSC was performed. Results: From 5792 ischemic stroke code patients at PSC, 3384 (58.4%) received a vascular imaging at PSC (VI+). Among all, 32.6% were transferred to CSC as MT candidates, and finally, 10.6% were treated with MT at CSC. The rate of transferred MT candidates was lower in the VI+ than VI- group (n: 783, 23.1% Vs. n: 1109, 46 %, p< 0.001). Among the transferred MT candidates, MT treatment at CSC was more common in the VI+ than VI- (n: 377, 48.1% Vs: n: 239, 21.5%, p<0.001). In patients transferred with baseline mild strokes (NIHSS <6), the rate of MT treated patients was higher in VI+ than VI- (n: 31, 29% Vs. n: 20, 7% p<0.001). Interval times as DIDO (median minutes 84 Vs. 81) and DTP time (188 Vs. 182) did not show differences between VI+ and VI-. In multivariate analysis adjusted by age, the independent factors associated to receiving MT at CSC were VI+ (OR: 2,128, CI95%:1,549-2,922, p<0.001), baseline NIHSS, and RACE scale. Conclusion: In the present study, performing vascular imaging at PSC diminishes unnecessary transfers to CSC and is associated with a higher probability of receiving MT at CSC in transferred patients. In mild strokes, performing a vascular imaging at PSC increases the probability of receiving MT at CSC. Metrics related to drip-and-ship model were not affected by performing a vascular imaging at PSC.

Cocaine use, abuse and dependence in a population-based sample of female twins

1998 ◽  
Vol 173 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Kenneth S. Kendler ◽  
Carol A. Prescott
Keyword(s):  
Cocaine Abuse ◽  
Genetic Factors ◽  
Model Fitting ◽  
Population Based ◽  
Cocaine Use ◽  
Past Half Century ◽  
History Of ◽  
Population Based Registry ◽  
Twin Resemblance

BackgroundAlthough cocaine use in women has increased substantially over the past half-century, we understand little about the aetiology in women of cocaine use and abuse, and know almost nothing about the role of genetic factors.MethodWe obtained by telephone interview a history of lifetime cocaine use, abuse and dependence from 1934 individual twins from female–female pairs ascertained through a population-based registry, including both members of 485 monozygotic (MZ) and 335 dizygotic (DZ) pairs.ResultsThe prevalence of lifetime cocaine use, abuse and dependence were 14.0%, 3.3% and 2.3%. Probandwise concordance rates, in MZ and DZ twins, respectively, were: cocaine use 54% and 42%; cocaine abuse 47% and 8% and cocaine dependence 35% and 0%. In MZ and DZ twins, odds ratios were: cocaine use 14.2 and 6.7 and cocaine abuse 40.8 and 2.7. Biometrical model-fitting suggested that twin resemblance for liability to cocaine use was due to both genetic and familial–environmental factors while twin resemblance for cocaine abuse and symptoms of dependence was due solely to genetic factors. Estimated heritabilities were: cocaine use 0.39, cocaine abuse 0.79 and symptoms of dependence 0.65.ConclusionsThe vulnerability to cocaine use and particularly cocaine abuse and dependence in women is substantially influenced by genetic factors.

scholarly journals Maternal Risk Factors Associated with Poor Postpartum Healthcare Utilization

2020 ◽  
Author(s):  
michael e silverman ◽  
Holly Loudon ◽  
Laudy Burgos
Keyword(s):  
Mount Sinai Hospital ◽  
Population Based ◽  
Postpartum Care ◽  
Related Factors ◽  
Maternal Risk ◽  
Factors Associated ◽  
Ambulatory Practice ◽  
Mount Sinai ◽  
Prenatal Visits

Abstract Objectives: Perceptions regarding the benefits of postpartum care among mothers and clinicians often differ. Clinicians generally perceive postpartum care as preventative, whereas pregnant and postpartum women often lack knowledge about its preventative benefits. As a result many women choose not to return for scheduled postpartum care visits. Methods: To examine if clinically relevant demographic and birth related factors are informative predictors for postpartum healthcare follow-up care, we conducted a population based cohort study of all women who delivered a child in 2012 – 2015 at the New York Mount Sinai Hospital Obstetrics and Gynecology Ambulatory Practice. Data was ascertained from electronic health records.Results: Of the 4,240 unique women who delivered between 2012-2015 at the Mount Sinai Hospital OB/GYN Ambulatory Practice, 1,685 (39.7%) did not return for their postpartum care follow-up appointment. The number of prenatal visits, maternal age, and parity were significantly associated with postpartum care follow-up. Conclusion for Practice: The purpose of this study was to determine identifiable factors associated with reduced postpartum healthcare follow-up utilization. Several clinically relevant variables were associated with the reduced likelihood for attending postpartum care visits. Because pregnant women represent a medically captured population, the results of this study point to the need to increase postpartum healthcare literacy during perinatal appointments especially among younger mothers, women who have had previous deliveries, and those with fewer prenatal visits.

scholarly journals Epidemiology of Substance Use among University Students in Sudan

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Tarig Osman ◽  
Cathrine Victor ◽  
Alaa Abdulmoneim ◽  
Hala Mohammed ◽  
Fatima Abdalla ◽  
...  
Keyword(s):  
Substance Use ◽  
Multivariate Analysis ◽  
Published Data ◽  
Heroin Use ◽  
Factors Associated ◽  
Current Prevalence ◽  
Male Sex ◽  
The University ◽  
Prime Source

Background. Youth populations are vulnerable to substance use particularly in developing countries where circumstances may be favorable for it. There is no published data on substance use among the youth in Sudan other than on tobacco use.Objectives. The aim of this study was to investigate the prevalence, circumstances, and factors associated with substance use.Methods. An institution-based survey was conducted on a sample of 500 students. Data was collected using a questionnaire designed by the WHO for student drug surveys and analyzed using IBM SPSS version 20.Results. The overall prevalence of substance use is 31%. The current prevalence of tobacco, cannabis, alcohol, amphetamines, tranquilizers, inhalants, opiates, cocaine, and heroin use was 13.7%, 4.9%, 2.7%, 2.4%, 3.2%, 1%, 1.2%, 0.7%, and 0.5%, respectively. Curiosity (33.1%) was the main reason for initiation of substance use. The main adverse effects reported were health problems (19.7%) and theft (19.7%). Peers (40.9%) were the prime source of substance use. On multivariate analysis, male sex was the principle predictor for substance use (AOR: 5.55; 95% CI: 3.38, 9.17).Conclusion. Strategies to control substance use should encompass the role of the university and parents in observing and providing education to improve awareness of substances and their consequences.

scholarly journals Role of the Neurosurgeon in Acute Ischemic Stroke Treatment From Triage to Intensive Care Unit

Neurosurgery ◽  
2019 ◽  
Vol 85 (suppl_1) ◽  
pp. S47-S51
Author(s):  
Kimberly P Kicielinski ◽  
Christopher S Ogilvy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Setting ◽  
Stroke Treatment

Abstract As ischemic stroke care advances with more patients eligible for mechanical thrombectomy, so too does the role of the neurosurgeon in these patients. Neurosurgeons are an important member of the team from triage through the intensive care unit. This paper explores current research and insights on the contributions of neurosurgeons in care of acute ischemic stroke patients in the acute setting.

scholarly journals Factors Associated with Unsuccessful Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke

2019 ◽  
Vol 9 (3) ◽  
pp. 107-113 ◽  
Author(s):  
Toshiaki Goda ◽  
Naoki Oyama ◽  
Takaya Kitano ◽  
Takanori Iwamoto ◽  
Shinji Yamashita ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Single Center ◽  
Patient Factors ◽  
Anterior Circulation ◽  
Factors Associated ◽  
Female Sex ◽  
History Of

Introduction: Mechanical thrombectomy (MT) for acute ischemic stroke has become a standard therapy, and the recanalization rate has significantly improved. However, some cases of unsuccessful recanalization still occur. We aimed to clarify patient factors associated with unsuccessful recanalization after MT for acute ischemic stroke. Methods: This was a single-center, retrospective study of 119 consecutive patients with anterior circulation acute ischemic stroke who underwent MT at our hospital between April 2015 and March 2019. Successful recanalization after MT was defined as modified Treatment in Cerebral Ischemia (mTICI) grade 2b or 3, and unsuccessful recanalization was defined as mTICI grades 0–2a. Several factors were analyzed to assess their effect on recanalization rates. Results: Successful recanalization was achieved in 88 patients (73.9%). The univariate analysis showed that female sex (38.6 vs. 67.7%, p = 0.007), a history of hypertension (53.4 vs. 83.9%, p = 0.003), and a longer time from groin puncture to recanalization (median 75 vs. 124 min, p < 0.001) were significantly associated with unsuccessful recanalization. The multivariate analysis confirmed that female sex (OR 3.18; 95% CI 1.12–9.02, p = 0.030), a history of hypertension (OR 4.84; 95% CI 1.32–17.8, p = 0.018), M2–3 occlusion (OR 4.26; 95% CI 1.36–13.3, p = 0.013), and the time from groin puncture to recanalization (per 10-min increase, OR 1.22; 95% CI 1.09–1.37, p < 0.001) were independently associated with unsuccessful recanalization. Conclusion: Female sex and a history of hypertension might be predictors of unsuccessful recanalization after MT for anterior circulation acute ischemic stroke. Further studies are needed to fully evaluate predictors of recanalization.

scholarly journals Factors Associated with Procedural Thromboembolisms after Mechanical Thrombectomy for Acute Ischemic Stroke

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 353
Author(s):  
Taek Min Nam ◽  
Ji Hwan Jang ◽  
Young Zoon Kim ◽  
Kyu Hong Kim ◽  
Seung Hwan Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Area Under The Curve ◽  
Multivariable Logistic Regression Analysis ◽  
Cutoff Value ◽  
Factors Associated ◽  
Procedural Time

Background and objective: Procedural thromboembolisms after mechanical thrombectomy (MT) for acute ischemic stroke has rarely been studied. We retrospectively evaluated factors associated with procedural thromboembolisms after MT using diffusion-weight imaging (DWI) within 2 days of MT. Materials and Methods: From January 2018 to March 2020, 78 patients with acute ischemic stroke who underwent MT were evaluated using DWI. Procedural thromboembolisms were defined as new cerebral infarctions in other territories from the occluded artery on DWI after MT. Results: Procedural thromboembolisms were observed on DWI in 16 patients (20.5%). Procedural thromboembolisms were associated with old age (73.8 ± 8.18 vs. 66.8 ± 11.2 years, p = 0.021), intravenous (IV) thrombolysis (12 out of 16 (75.0%) vs. 25 out of 62 (40.3%), p = 0.023), heparinization (4 out of 16 (25.0%) vs. 37 out of 62 (59.7%), p = 0.023), and longer procedural time (90.9 ± 35.6 vs. 64.4 ± 33.0 min, p = 0.006). Multivariable logistic regression analysis revealed that procedural thromboembolisms were independently associated with procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis (adjusted OR; 4.697, 95% CI; 1.223–18.042, p = 0.024). The cutoff value of procedural time for predicting procedural thromboembolisms was ≥71 min (area under the curve; 0.711, 95% CI; 0.570–0.851, p = 0.010). Conclusions: Procedural thromboembolisms after MT for acute ischemic stroke are significantly associated with longer procedural time and IV thrombolysis. This study suggests that patients with IV thrombolysis and longer procedural time (≥71 min) are at a higher risk of procedural thromboembolisms after MT for acute ischemic stroke.

scholarly journals Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Johann Philipp Zöllner ◽  
Björn Misselwitz ◽  
Thomas Mauroschat ◽  
Christian Roth ◽  
Helmuth Steinmetz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Large Population ◽  
Intravenous Thrombolysis ◽  
Population Based ◽  
Control Group ◽  
Stroke Registry ◽  
Increased Risk ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

AbstractRecent data have suggested that performing recanalizing therapies in ischemic stroke might lead to an increased risk of acute symptomatic seizures. This applies to both intravenous thrombolysis and mechanical thrombectomy. We therefore determined the frequency of acute symptomatic seizures attributable to these two recanalization therapies using a large, population-based stroke registry in Central Europe. We performed two matched 1:1 case–control analyses. In both analyses, patients were matched for age, stroke severity on admission and pre-stroke functional status. The first analysis compared patients treated with intravenous thrombolysis to a non-recanalization control group. To isolate the effect of mechanical thrombectomy, we compared patients with both mechanical thrombectomy and intravenous thrombolysis to those with only intravenous thrombolysis treatment in a second analysis. From 135,117 patients in the database, 13,356 patients treated with only intravenous thrombolysis, and 1013 patients treated with both intravenous thrombolysis and mechanical thrombectomy were each matched to an equivalent number of controls. Patients with intravenous thrombolysis did not suffer from clinically apparent acute symptomatic seizures significantly more often than non-recanalized patients (treatment = 199; 1.5% vs. control = 237; 1.8%, p = 0.07). Mechanical thrombectomy in addition to intravenous thrombolysis also was not associated with an increased risk of acute symptomatic seizures, as the same number of patients suffered from seizures in the treatment and control group (both n = 17; 1.7%, p = 1). In a large population-based stroke registry, the frequency of clinically apparent acute symptomatic seizures was not increased in patients who received either intravenous thrombolysis alone or in conjunction with mechanical thrombectomy.

scholarly journals Treatment Strategies for Tandem Occlusions in Acute Ischemic Stroke

2020 ◽  
Vol 37 (02) ◽  
pp. 207-213
Author(s):  
Joseph J. Gemmete ◽  
Zachary Wilseck ◽  
Aditya S. Pandey ◽  
Neeraj Chaudhary
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Carotid Revascularization ◽  
Tandem Occlusion ◽  
Coil Occlusion ◽  
Optimal Treatment Strategy

AbstractThere is no consensus for the treatment of a tandem occlusion (TO) in a patient presenting with an acute ischemic stroke. In this review article, we will focus on the controversial treatment strategies for TOs. First, we will discuss treatment options including retrograde, antegrade, and delayed approaches. Second, the role of carotid stent placement versus balloon angioplasty for the extracranial occlusion will be presented. Third, anticoagulation and antiplatelet regimens for the treatment TOs published in the literature will be reviewed. Finally, we will discuss whether there is a role for coil occlusion of the cervical carotid artery or whether staged carotid revascularization days after mechanical thrombectomy of the intracranial occlusion maybe appropriate. The optimal treatment strategy of TO has not been established and further larger trials need to be performed to answer the question.

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