Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Stroke, Ahead of Print.

Stroke, Volume 53, Issue Suppl_1, Page AWP108-AWP108, February 1, 2022. Background:Current guidelines for recanalization treatment are based on the time window between symptom onset and treatment in addition to ischemic core and perfusion lesion volumes by computed tomography perfusion imaging (CTP). Linear growth of infarction is commonly assumed.The aim was to test, whether measured follow-up infract volume (FIV) could be approximated from the linear growth model (eFIV) based on CTP baseline infarct growth rate.We assumed the infarct growth to stop, when recanalization was achieved or when the eFIV reached the volume of the perfusion lesion (Tmax >6s volume).Methods:All consecutive stroke code patients from 11/2015-9/2019 transferred to Helsinki University Hospital as candidates for endovascular treatment (EVT) were screened; patients with large vessel occlusion (LVO), EVT, CTP and known time of symptom onset were included to study.The infarct growth rate was calculated by dividing the CTPcoreby the time from symptom onset to baseline imaging.eFIV was calculated by infarct growth rate multiplied with the time from baseline imaging to recanalization or follow-up imaging. We assumed a performance of +/- 19% for the accuracy of the CTPcoreassessment. FIV was measured from the 24h non-enhanced computed tomography images. Recanalization was defined as modified Treatment in Cerebral Infarction (mTICI) scale as successful (TICI 2b or 3) or futile (TICI 0,1,2a).Results:Out of 5234 patients, 48 had LVO and EVT, CTP imaging and known time of symptom onset (Figure 1). In 40/48 (83%) patients, infarct growth was not within the 19% margins of linear growth. eFIV exceeded FIV in 25/42 patients with successful recanalization (median absolute difference 25 mL,7-73).Conclusions:eFIV from linearly approximated growth model did not support linear growth of the infarct.

Stroke, Volume 53, Issue Suppl_1, Page AWMP1-AWMP1, February 1, 2022. Approved thrombolytic agents are limited in their use for the treatment of acute ischemic stroke (AIS) due to their benefit-risk profile beyond 4.5 h since last known normal (LKN). TMS-007 is a small molecule, SMTP family member with a novel mode of action: promotion of plasminogen-fibrin binding to enhance physiological thrombolysis while inhibiting inflammation at the site of thrombosis. TMS-007 may extend the treatment time window based on nonclinical pharmacological evidence. We evaluated TMS-007 in a randomized, placebo-controlled, double-blind, dose-escalation phase 2a study. TMS-007 or placebo was administered as a single intravenous infusion at a dose of 1, 3, or 6 mg/kg to AIS patients who were ineligible for t-PA or thrombectomy within 12 h of LKN. The number of patients allocated to placebo and TMS-007 at doses 1, 3, and 6 mg/kg were 38, 6, 18, and 28, respectively. The combined TMS-007 dosing group (Group T; n = 52) was compared with placebo group (Group P; n = 38). The average age was ~72 years old and time since LKN to treatment was ~9 h in both groups (not significantly different). The incidence of symptomatic intracranial hemorrhage (ICH) with worsening NIHSS score of

Stroke, Volume 53, Issue Suppl_1, Page ANS3-ANS3, February 1, 2022. Introduction:The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up.Methods:With this retrospective cohort study, we evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive (CSC) and primary stroke centers (PSC) in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of successful post-hospitalization follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across network hospitals less than 1 mile (CSC) and 25 miles (PSC25) from the specialty stroke clinic.Results:Of the 553 ischemic stroke patients [median age 68 years (IQR 58-79), median NIHSS 4 (IQR 1-8)] discharged home or to a rehab facility during the study period, 241 (43.6%) had follow-up in the Emory Stroke Clinic (CSC=48%, PSC25=23%). Overall, 90-day follow-up increased from 31% before to 48% after telemedicine implementation. Similarly, telemedicine appointments increased from 19% to 72% of the follow-up visits. The increase in follow-up visits was modest among CSC patients, from 41% to 51% (p=0.16), relative to the increase among PSC25 patients (5.3% to 31%, p=0.002).Conclusions:Telemedicine implementation at an academic healthcare network successfully increased post-stroke discharge follow-up in a centralized subspecialty stroke clinic for hospitalized patients up to 25 miles from the clinic site. However, more work is required to facilitate follow up in the majority of patients.

Stroke, Volume 53, Issue Suppl_1, Page ATP205-ATP205, February 1, 2022. Introduction:Neutrophil-lymphocyte ratios (NLRs) can be used to assess inflammatory status, with higher NLRs indicating inflammation and physiologic stress. NLRs after ischemic stroke have been shown to predict both short- and long-term outcomes.Methods:This was a retrospective study of adult patients admitted to a high-volume stroke center in 1/1/2018-12/31/2020 for ischemic stroke who underwent endovascular therapy (ET). The primary outcomes were successful reperfusion (TICI score ≥2B), favorable discharge NIH Stroke Scale/Score (NIHSS≤4), and favorable discharge and 3-month modified Rankin Scale (mRS≤2) scores. The primary predictor was neutrophil-lymphocyte ratio (NLR), measured at admission and throughout the hospital stay, as well as change in NLR between admission and post-ET. Logistic regression and generalized estimating equations assessed associations between NLRs and the outcomes.Results:The study included 131 patients, with a median admission NIHSS of 13 and median discharge NIHSS of 1. Almost all patients (94%) achieved successful reperfusion, and only 2 (1.5%) developed symptomatic ICH. The median discharge mRS was 3, and the median 3-month mRS was 2. The median admission NLR was 6.5 (range 0.8-18.0), and the median NLR change (admission to first post-ET) was 0.0 (range -13.8 to 12.0). Each 1-unit increase in admission NLR was associated with a 19% decreased odds of successful perfusion, 16% decreased odds of favorable discharge NIHSS, 15% decreased odds of favorable discharge mRS, and 14% decreased odds of favorable 3-month mRS. Higher post-ET NLRs on various days were also associated with decreased odds of favorable outcomes (Table 1).Conclusions:Admission and select follow-up NLRs were predictive of successful reperfusion and condition at discharge and at 3-months post-discharge in this patient population. These results show that NLRs, a readily available biomarker, can identify individuals at risk for poor outcomes after ET.

Stroke, Volume 53, Issue Suppl_1, Page AWP10-AWP10, February 1, 2022. Introduction:In cases where the risk of intracranial aneurysms (IA) rupture is low or secondary to other patient health concerns, unruptured IA may be monitored through imaging. In this work, we applied different computational methods to detect IA growth and compared the results to clinical findings.Hypothesis:We hypothesize that automated methods of IA growth detection are comparable to clinical assessment.Methods:The study cohort consisted of 20 female patients with saccular IA diagnosed between 2005-2011 in UCLA Medical Center. 6 were located at the PcoA, 10 at the superior hypophyseal artery, and 4 at the ophthalmic artery. 8 IA were determined to be growing. Baseline IA size was 3.85±4.30 mm. For each case, initial and first follow-up CTA image studies (interval 2.50±2.75 yrs) were analyzed. Cohort follow-up continued for an average of 8.5±5.75 yrs. Automated methods to detect IA growth included maximum diameter (HMAX), surface area (SA), volume (V), and a novel 2-stage morphing approach which deforms the baseline IA surface mesh to that of the subsequent scan and yields a set of characteristics that describe the changes: dMPL, dSA, dV, and dICDD. Statistical methods used included the Mann-Whitney U test and Chi-Square Test with significance set at p

Stroke, Volume 53, Issue Suppl_1, Page A34-A34, February 1, 2022. Introduction:Stroke is a leading cause of disability in the United States, and one in four occur in people who have already had a stroke. Preventable hospital readmissions contribute to the high medical costs of stroke. Transition of care programs have been successful in reducing hospital readmissions in other diseases, but the data on such programs for stroke is mixed. A transition of care program was implemented at a large urban stroke center, utilizing interventions shown to be effective in the literature, with the goal of reducing recurrent strokes and hospital readmissions.Methods:The transition of care program consisted of: two Stroke Nurse Navigators, personalized stroke education in the hospital, two-day phone call reinforcing education and reviewing medications, early follow-up within 7-10 business days with a Stroke Neurologist, and further education on personalized risk factors in the clinic. Baseline data from the year prior to intervention, and each quarter of the three-year project period were obtained on the following measures: Rate of recurrent stroke admissions within one year, all-cause readmission within one year, all-cause readmission within 30 days, patient scheduled for initial follow-up within 7-10 days, compliance with follow up in the stroke clinic, and percent of patients receiving two-day post discharge phone call. Discharge data were reviewed on 949 patients in 2016 (year 0) and on 2,328 patients in the three-year project period (starting in July 2017).Results:The rate of readmission for stroke was 8.5%, 9.0%, 6.6%, and 4.2% for year 0, 1, 2, and 3, respectively. This represents a reduction of 50% from the year prior to the intervention to year 3 of the grant. All-cause readmission remained stable, at 38.9%, 42.6%, 36.6%, and 37.4% for year 0, 1, 2, and 3 respectively. An improvement was seen in process measures: patients scheduled for early follow up in the stroke clinic, adherence to follow-up, and two-day post-discharge phone calls.Conclusions:In conclusion, the transition of care intervention led to a reduction from baseline in readmissions for stroke within one year, but did not impact all cause readmission at one year or 30 days. This is a meaningful outcome for those who have suffered strokes. This program can serve as a model.

Stroke, Volume 53, Issue Suppl_1, Page ATP62-ATP62, February 1, 2022. Introduction:Although SSRIs are no longer widely prescribed for post-stroke motor recovery, fluoxetine demonstrated beneficial effects on post-stroke depression (PSD). Given potential side effects of SSRIs, targeted initiation among individuals at highest risk for PSD warrants consideration. While previous studies have identified stroke severity and psychiatric history as factors associated with PSD, the predictability of PSD remains unknown. The purpose of this study is to investigate inpatient predictive factors to better identify individuals who might derive the most benefit from targeted initiation of SSRIs.Methods:All adult patients presenting to our tertiary academic stroke center with acute ischemic stroke between 2016-2020 were enrolled in a prospectively-collected stroke registry. Patients were seen 4-6 weeks post-discharge and a subset were administered the PHQ-9 (Patient Health Questionnaire-9) to screen for PSD (PHQ-9 ≥5). Demographics, history of depression, stroke severity, and inpatient PHQ-9 scores were abstracted. Logistic regression was used to determine factors associated with PSD and an ROC analysis determined the predictability of PSD in the inpatient setting.Results:307 individuals were administered the PHQ-9 at follow-up. This group was younger with less severe strokes, but had no difference in history of depression or inpatient PHQ-9 scores than those without follow-up screening. The mean age of the cohort was 65.5 years; 52% were female. Individuals with history of depression (OR=4.22, 95% CI: 2.40-7.42), inpatient depression (OR=2.82, 95% CI: 1.80-4.43), higher stroke severity (OR=1.05, 95% CI: 1.01-1.10), and those living alone (OR=1.86, 95% CI: 1.01-3.40) had increased odds of PSD at follow-up. Marital status, employment, and outpatient therapy were not associated PSD. The ROC curve using a positive inpatient PHQ-9 achieved an area under the curve (AUC) of 0.62 (95% CI:0.57-0.67), while the AUC was 0.69 (0.64-0.74) after adding history of depression.Conclusion:History of depression and a positive inpatient PHQ-9 appear to be most strongly associated with long-term PSD. Initiating SSRIs only in those individuals at higest risk for PSD may help reduce the burden of stroke recovery in this targeted population.

Stroke, Volume 53, Issue Suppl_1, Page ATMP104-ATMP104, February 1, 2022. Background:Our prior study showed that Atrial Fibrillation (AFib) and not Left Atrial Dilatation (LAD) was associated with ischemic stroke (IS) in a cross-sectional analysis. We sought to validate these findings in a prospective 5-year follow up study.Methods:Patients with transthoracic ECHO (TTE) completed from March-September 2016 were selected. We obtained new diagnoses of Afib and IS over the interval period of 5 years (2016-21). Regression models were used to analyze LAD, Afib and other covariates as they relate to IS, as well as the association of baseline LAD to subsequent AFib.Results:There were 7988 subjects analyzed. Of those we excluded; 578 had IS before 2016 and an additional 249 patients had no follow-up data. Of the remaining 7161, mean age was 65, 54% females, 52% Caucasian, 43% African American, 9% developed new AFib and 3% had a new IS during follow-up. The median follow-up was 47 months. Also, 54% patients had a normal LA, 13% were mildly, 13% were moderately and 20% were severely dilated, of which 6, 11, 13 and 15% were found to have new AFib, respectively (p

Stroke, Volume 53, Issue Suppl_1, Page A56-A56, February 1, 2022. Objective:We aimed to evaluate which factors contributed to acute ischemic stroke (AIS) following up in stroke clinic post hospitalization.Methods:Single center retrospective analysis of AIS patients from January 2016 to April 2021. Patients were excluded if: died during index hospitalization, discharged to hospice or had incomplete data. We evaluated our primary outcome: factors contributing to patients attending post-discharge appointments and secondary outcome: factors contributing to patients scheduling post-discharge appointments utilizing binomial stepwise logistic regression models. Subgroup analysis compared latency to be seen in follow-up clinic between patients who had an appointment scheduled at discharge compared to those who did not using a Mann-Whitney test.Results:Out of 7960 AIS patients, 2734 were included in this study, 2130 (77.9%) of those patients scheduled an appointment post-discharge, whereas 1649 (60.3%) attended an appointment post-discharge. Patients were more likely to attend a follow-up appointment if scheduled while hospitalized, OR=3.48 [95%CI, 2.94-4.14], p

Stroke, Volume 53, Issue Suppl_1, Page A48-A48, February 1, 2022. Introduction:The Neuroscience Institute is comprised of a Comprehensive Stroke Center and three Primary Centers. The healthcare team manages 1,800 hospital admissions yearly with expertise in acute treatment. However, door to rapid follow-up was not well defined. Literature review indicates expeditious post-stroke visits, a structured path to clinic, standardized ambulatory management and clear communication across the continuum ensures best practice.Hypothesis:A defined post-acute stroke management model could be implemented with Nurse Practitioners (NPs). A principal objective was to facilitate a rapid ambulatory visit less than two weeks post-hospitalization.Methodology:NPs were hired in 2019, then trained in acute and outpatient clinical rotations with Vascular Neurologists and inpatient Neurology NPs. Ambulatory NPs created a comprehensive guideline for sub acute visits. Content included: review of hospitalization, appropriate referrals, secondary prevention, functional assessments, medication adherence and stroke health literacy. Formal visit templates were imbedded in the electronic medical record, affording a consistent approach by NPs. Education templates were developed, with content personalized and provided to patients. Interval summary are completed by inpatient NPs; this includes a synopsis of stroke mechanism and acute intervention, neurological deficits, comorbid diagnosis and management plan at discharge. The summary incorporates a thorough review of core measures. A consistent process for scheduling rapid appointments was defined.Results:Data January to June 2021 demonstrated > 50% of patients completed rapid clinic appointments. Communication across the continuum was improved by electronic documentation and enhanced collaboration. There is a standardized approach to ambulatory management with individuation to patients. Expeditious outpatient visits are consistently occurring with an optimized process.Conclusion:NPs are essential stroke providers, closing gaps in the system of care in the acute and post-acute settings. A future goal is to increase the percentage of patients managed expeditiously, reducing incidence of cerebrovascular events thru a comprehensive ambulatory care model.

Stroke, Volume 53, Issue 2, Page 338-344, February 1, 2022. Background and Purpose:Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study.Methods:Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited.Results:HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively (P