Risultati per: Trattamento dell’osteoporosi in post-menopausa

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 ATP66-ATP66, February 1, 2022. Introduction:Annually, 55,000 more females than males are affected by stroke in the United States. Females also tend to experience more severe strokes with worse functional outcomes, which result in poorer health-related quality of life. Despite the marked differences in long-term recovery between males and females with stroke, little is known about the sex differences in motor performance that may contribute to the differences in recovery and what therapies could be used to optimize recovery, especially for female stroke survivors. In this study, we aimed to determine if sex-related differences in neuromuscular fatigability exist post stroke.Methods:Sixteen chronic stroke survivors (at least 6 months post stroke, 9 females, 58 +/- 14 years) and thirteen neurologically intact controls (7 females, 59 +/- 12 years) performed a submaximal isometric fatiguing knee extension contraction with either the paretic (stroke) or the dominant (control) leg. The submaximal fatiguing contraction torque was equivalent to 30% of the maximal voluntary isometric contraction (MVIC) of the knee extensors. The participants were asked to sustain at the target torque until one of the two criteria for fatigue was met: (1) if the participant’s torque cannot maintain within a 10% window of error for more than 5 seconds; or (2) if there are more than 5 deviations from the 10% error window in a consecutive 10-second time period. Time to task failure (TTF) was measured.Results:Overall, both male and female stroke survivors tended to have lower MVIC than their healthy counterparts (male: 151 +/- 60 Nm vs. 206 +/- 39 Nm; female: 58 +/- 17 Nm vs. 121 +/- 27 Nm). On average, males tended to fatigue similarly between stroke and control groups (259 +/- 164 s vs. 249 +/- 96 s, respectively); while female stroke survivors tended to have a briefer TTF compared to female controls (207 +/- 69 s vs. 311 +/- 129 s).Conclusions:During submaximal isometric knee extension exercise, female stroke survivors had a shorter task duration than female controls, while this stroke-related difference was not observed in males. Our results indicate that, although stroke impairs muscle strength in both sexes, fatigability may be exacerbated to a greater extent in females than in males post stroke.

Stroke, Volume 53, Issue Suppl_1, Page A14-A14, February 1, 2022. Introduction:We previously demonstrated that the quantitative volumetric assessment of iodinated contrast extravasation (ICE) present on post-intervention imaging was closely associated with the likelihood of an acute ischemic stroke patient having PH-1 or PH-2, and thus ICE may serve as a useful CT biomarker to assess risk of reperfusion injury (hemorrhagic conversion (HC) and blood brain barrier (BBB) disruption). Here we used receiver operator curve (ROC) analysis to compare the efficacy of ICE, infarct volume, and 24hr NIHSS change as a predictor of discharge mRS and HC post-reperfusion therapy.Method:Data on ischemic stroke patients treated with reperfusion therapy were obtained from our Institutional Review Board approved database from January 2017 to November 2019 that had evaluable images within 24 hours of admission. Ischemic volume (IV) was measured on diffusion-weighted imaging. ICE was measured on CT head. A freehand 3D region of interest tool on the Visage Imaging PACS System was used to measure volumes. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling and ROC analysis.Results:Of the 82 patients, median age was 73 (interquartile range (IQR) 61- 77, 49% were women, admission NIHSS was 12 (IQR 7 – 21), 24hr NIHSS change was 4 (IQR 0 -13), IV was 50.6 +/- 7.1 mL, 48% were treated with thrombectomy, 7% had PH-1 or PH-2 identified on MRI, median systolic blood pressure was 154 (IQR 137-175), 56% were MCA territory strokes, and 37% had a discharge mRS of 0-2. ICE volume was 2.6 +/- 1.0 mL. ICE increased the likelihood of PH-1 or PH-2 HC (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 – 22.94) and decreased the likelihood of discharge with mRS of 0-2, OR of 0.09 (CI 0.008-0.972). IV was a better predictor of 0-2 mRS (ROC area under the curve (AUC) 0.832) than ICE (AUC 0.640) and 24hr NIHSS change (AUC 0.557), but ICE was a better predictor of PH-1 or PH-2 (AUC 0.942) than IV (AUC 0.667) and 24hr NIHSS change (AUC 0.447).Conclusion:ICE may predict reperfusion injury and functional outcome, but it is a better predictor of hemorrhagic conversion in patients treated with reperfusion therapy.

Stroke, Volume 53, Issue Suppl_1, Page ATP162-ATP162, February 1, 2022. Background and Purpose:Angioplasty and stenting is a therapeutic option for patients with medically refractory intracranial atherosclerotic disease (ICAD). We previously demonstrated the feasibility of using Resolute (R) Onyx Stent, a drug-eluting balloon mounted coronary stent (DES), for ICAD patients. WEAVE (Wingspan Stent System Post Market Surveillance) trial assessed the periprocedural safety of Wingspan Stents in ICAD patients. We present our on-going experience with R-Onyx in ICAD patients integrating WEAVE styled methodology to assess outcomes in our cohort.Methods:A prospectively maintained neuro-endovascular database was queried for intracranial angioplasty and stenting cases from October 2019 to June 2021. Patients with symptomatic ICAD despite maximum medical management with >70% stenosis who were treated with R-Onyx DES were included. Primary outcomes were assessed according to WEAVE trial criteria (ischemic or hemorrhagic stroke or death within 72 h of the procedure). Secondary outcomes were assessed by occurrence of stroke and/or in-stent restenosis evaluated 30 days post-procedure clinically or angiographically.Results:A total of 58 patients were eligible for analysis with a mean age of 63.66 years, and 63.8% (n=37) were males. A total of 42 patients had an indication for treatment consisting of recurrent stroke while 16 had recurrent transient ischemic attacks. A total of 62 R-onyx DES stents were used to treat 58 patients with symptomatic lesions with an average stenosis of 84.7%. All procedures were completed successfully with

Stroke, Volume 53, Issue Suppl_1, Page AWP258-AWP258, February 1, 2022. Introduction:The spatiotemporal pattern of microvascular reperfusion in vivo after large vessel recanalization is poorly understood. Combining chronic cranial window with embedded microprism (CCW-MP) and visible-light optical coherence tomography angiography (Vis-OCTA) enables the study of mouse cortical cerebrovasculature up to 60 days post-stroke. Vis-OCTA/CCW-MP can identify the presence or absence of microvascular flow, without labelling, up to 1 mm in cortical depth of the mouse brain at 1.3 micron resolution. We sought to build on these findings to understand the pattern of microvascular no-reflow in a mouse model of stroke that simulates large vessel occlusion and reperfusion.Hypothesis:Different regions of the cortex have striking variation in flow characteristics after macrovascular reperfusion.Methods:All mice studied were 3-4 mo old, C57/Bl6 background, and subject to IMPROVE guideline. Control mice (n=3) were studied to confirm absence of cortical or vascular changes induced by CCW-MP surgery. Test mice (n =6) underwent CCW-MP as previously published. After 2 weeks to allow for healing post-surgery, mice were subject to transient middle cerebral artery occlusion (tMCAO) to model large vessel occlusion and reperfusion. Vis-OCTA measured cortical flow at baseline, 24 hours post-stroke, and 72 hours post-stroke. Cortical mouse vascular regions were divided into layers 1-3: layer 4 : layer 5-6 from top to bottom.Results:Control mice showed no neuronal death, astrogliosis, microgliosis, or neutrophil recruitment induced by CCW-MP implantation. There was no significant difference between vascular density for prism-adjacent cortex and prism-remote cortex. We also determined that the CCW-MP images cortical vascular territory supplied by the middle cerebral artery. For the test mice, all six mice survived combined surgery. Vis-OCTA showed four of six mice had reduction of microvascular flow > 20% from baseline by 72h post-stroke at layer 5-6.Conclusions:Microvascular reperfusion post large vessel recanalization can be incomplete up to 72 hours post-stroke, especially at deeper cortical levels. Further studies should define associated changes in inflammatory cells as well as oxygenation of vessels.

Stroke, Volume 53, Issue Suppl_1, Page AWP77-AWP77, February 1, 2022. Objective:Early post-acute care for stroke survivors affect their morbidity, mortality, and long term disability and quality of lives. This study aimed to understand the utilization of post-acute services among different racial/ethnicity population.Methods:We examined the discharge destinations amongst patients admitted directly from the emergency department for ischemic stroke and transient ischemic attack (TIA) in 2017-2018 using the National Inpatient Sample, a 20% stratified sample of all discharges from U.S. community hospitals.Results:This study included 1,000,645 live ischemic stroke/TIA discharges with good racial/ethnicity representations (Table). Compared to their White counterpart, Hispanic patients were more likely to be discharged to home without home health care (49.1% vs 42.1%, OR 1.33, 95% CI 1.27-1.38), as well as Native Americans (47.5%, OR 1.24, 95% CI 1.06-1.46). Conversely, Hispanics are less likely to be discharged to inpatient rehabilitation or skilled nursing facilities than White (29.1% vs 36.5%, OR 0.71, 95% CI 0.68-0.74), as well as Native Americans (32.7%, OR 0.85, 95% CI 0.72-0.99). Facility discharge rates were comparable among Black and White (OR 0.99, 95% CI 0.97-1.03).Conclusion:Hispanics and Native Americans are more likely to be discharged to home without home health care and less likely to be discharged to facilities after stroke. Further study are need to understand the attributes of the discharge disparities after stroke hospitalization.

Stroke, Volume 53, Issue Suppl_1, Page AWP117-AWP117, February 1, 2022. Introduction:Hyperfibrinolysis is associated with intracerebral hemorrhage (ICH) after the use of tPA for acute ischemic stroke (AIS). Point-of-care Rotational ThromboElastoMetry (ROTEM) testing may rapidly detect hyperfibrinolysis and identify AIS patients at high risk for hemorrhage.Hypothesis:Evidence of fibrinogen depletion on ROTEM will accurately predict bleeding following revascularization therapy for AIS.Methods:We reviewed medical records of AIS patients who underwent revascularization therapy between 2019-2020. All patients underwent ROTEM testing post-procedure to facilitate targeted blood product transfusion should hemorrhage occur. However, transfusion was not performed prophylactically. Repeat imaging with dual-energy CT was performed within 24 hours. A quality control registry of all AIS patients who undergo revascularization is maintained for purposes of Joint Commission certification. All variables, including ROTEM values and occurrence of intra- and extracranial hemorrhage, were entered prospectively. We examined the predictive value of a FIBTEM-A10

Stroke, Volume 53, Issue Suppl_1, Page AWMP24-AWMP24, February 1, 2022. Introduction:Depression is common after stroke, and is a debilitating factor undermining recovery in approximately one third of stroke survivors. It is essential to understand the underlying mechanisms to develop better treatments. Such insight may come from identifying plasma proteins correlated with post-stroke depression. Previous work investigated inflammatory proteins.Methods:We recruited 85 subjects 5 months to 9 years after ischemic stroke, age >40, and able to perform cognitive testing. Mood was assessed with the Stroke Impact Scale (SIS3), transformed to a 100-point scale. Plasma was analyzed by O-link proteomics for 1011 proteins. Multivariable regression models were constructed to estimate SIS3 using proteomics and clinical data. Models were subject to bootstrapping for robustness, and cross-validation to ensure results were reported on subjects blinded during model training. Pearson correlation analysis identified linear associations between individual proteins and SIS3 scores. We also report differences in key proteins in subjects dichotomized into non-depressed (SIS3 >63) or depressed (SIS3≤63) groups.Results:Proteomics results alone predicted SIS3 in multivariable models, and the best model also used age and time since stroke. A total of 180 proteins correlated significantly with SIS3. Plasma levels of IL-6 (p=0.0325), EGF (p

Stroke, Volume 53, Issue Suppl_1, Page AWP81-AWP81, February 1, 2022. Introduction:Beliefs regarding ones’ control over their health can lie internally, influenced by their own actions, or externally, controlled by others or due to chance.Objective:To examine the association between health-related locus of control (HRLC) type and post-stroke disability, quality of life, and depression.Methods:This study utilized data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial (n=552). Participants were categorized into three groups based on their highest Multidimensional Health Locus of Control (MHLC) score. The Stroke Impact Scale (SIS) was used to assess post-stroke disability and quality of life. Linear regression was used to identify differences in each SIS domain score between the three groups while adjusting for the intervention. Depression was defined as a Center for Epidemiological Studies Depression (CESD) score ≥16. Logistic regression was used to examine differences in depression between the three groups while adjusting for the intervention.Results:Of the 529 participants who completed the MHLC questionnaire at baseline, 179 (33.3%) were categorized into theinternalgroup,163 (30.8%) into thepowerful othersgroup, and 190 (35.9%) into thechancegroup. Of the 297 participants who completed the CESD questionnaires at 12 months, 163 (54.8%) scored ≥ 16. Participant’s mean scores for each SIS domain are reported in Table 1. For the SIS communication domain, thechancegroup’s mean score was 3.03 points lower than thepowerful othersgroup’s score (SE=1.39, p=.029). There were no statistically significant differences in scores for the other seven SIS domains or for depression between groups (Table 1).Discussion:External HRLC based on chance may be a predictor of communication difficulties in patients post-stroke. However, mean communication scores are skewed. Control beliefs are important in post-stroke recovery. More research is needed to validate these findings.

Stroke, Ahead of Print. Background:The objective of this study was to evaluate factors associated with intraventricular hemorrhage (IVH) expansion and its association with long-term outcomes.Methods:We performed a post hoc analysis of the international, multi-center CLEAR III trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage) which enrolled IVH patients between September 1, 2009, and January 31, 2015. The exposure was IVH expansion, defined as >1 mL increase in volume between baseline and stability computed tomography scans, before treatment randomization. We assessed factors associated with IVH expansion and secondarily assessed the relationship of IVH expansion with clinical outcomes: composite of death or major disability (modified Rankin Scale score, >3), and mortality alone at 6 months. The relationship of IVH expansion on ventriculoperitoneal shunt placement was additionally explored. Multivariable logistic regression was used for all analyses.Results:Of 500 IVH patients analyzed, the mean age was 59 (±11) years old, 44% were female and 135 (27%) had IVH expansion. In multivariable regression models, factors associated with IVH expansion were baseline parenchymal intracerebral hemorrhage (ICH) volume (adjusted odds ratio [OR], 1.04 per 1 mL increase [95% CI, 1.01–1.08]), presence of parenchymal hematoma expansion: >33% (adjusted OR, 6.63 [95% CI, 3.92–11.24]), time to stability head CT (adjusted OR, 0.71 per 1 hour increase [95% CI, 0.54–0.94]), and thalamic hematoma location (adjusted OR, 1.68 [95% CI, 1.01–2.79]) while additionally adjusting for age, sex, and race. In secondary analyses, IVH expansion was associated with higher odds of poor 6-month outcomes (adjusted OR, 1.84 [95% CI, 1.12–3.02]) but not mortality (OR, 1.40 [95% CI, 0.78–2.50]) after adjusting for baseline ICH volume, thalamic ICH location, age, anticoagulant use, Glasgow Coma Scale score, any withdrawal of care order, and treatment randomization arm. However, there were no relationships of IVH expansion on subsequent ventriculoperitoneal shunt placement (adjusted OR, 1.02 [95% CI, 0.58–1.80]) after adjusting for similar covariates.Conclusions:In a clinical trial cohort of patients with large IVH, acute hematoma characteristics, specifically larger parenchymal volume, hematoma expansion, and thalamic ICH location were associated with IVH expansion. Given that IVH expansion resulted in poor functional outcomes, exploration of treatment approaches to optimize hemostasis and prevent IVH expansion, particularly in patients with thalamic ICH, require further study.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT00784134.