Risultati per: Stroke

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC15, February 2025.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC18, February 2025.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 178, Issue 2, Page JC16, February 2025.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Circulation, Volume 151, Issue 5, Page 331-333, February 4, 2025.

Introduction
Stroke is a major cause of acquired disability globally, yet the neural mechanisms driving motor recovery post-stroke remain elusive. Recent research has underscored the growing significance of subcortical pathways in neural plasticity and motor control. Among these, the cortico-reticulospinal tract (CRST) has gained attention in rehabilitation due to its unique ascending and descending structural features as well as its cellular properties which position it as an excellent candidate to compensate for inadequate motor control post-stroke. However, the optimal strategies to harness the CRST for motor recovery remain unknown. Non-invasive modulation of the CRST presents a promising though challenging, therapeutic opportunity. Acoustic startle priming (ASP) training and intermittent theta burst stimulation (iTBS) are emerging as potential methods to regulate CRST function. This study aims to investigate the feasibility of segmentally modulating the cortico-reticular and reticulospinal tracts through ASP and iTBS while evaluating the resulting therapeutic effects.

Methods and analysis
This is a randomised, blinded interventional trial with three parallel groups. A total of 36 eligible participants will be randomly assigned to one of three groups: (1) iTBS+ASP group, (2) iTBS+non-ASP group, (3) sham iTBS+ASP group. The trial comprises four phases: baseline assessment, post-first intervention assessment, assessment after 3 weeks of intervention and a 4-week follow-up. The primary outcomes are the changes in the Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale after the 3-week intervention. Secondary outcomes include neurophysiological metrics and neuroimaging results from diffusion tensor imaging and resting-state functional MRI.

Ethics and dissemination
The trial is registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085220) and Medical Ethics Committee of Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology (Registration No.TJ-IRB20231109). It will be conducted in the Departments of Rehabilitation Medicine and Radiology at Tongji Hospital in Wuhan, China. The findings will be disseminated through peer-reviewed journal publications and presentations at scientific conferences.

Trial registration number
ChiCTR2400085220.

Stroke, Volume 56, Issue Suppl_1, Page ATMP35-ATMP35, February 1, 2025. Introduction:Studies have suggested efficacy of glycoprotein IIb/IIIa antagonists such as tirofiban for patients with acute ischemic stroke (AIS). However, neurological deterioration is still common in many of the recommended antiplatelet regimens. We aimed to evaluate the efficacy and safety of tirofiban versus dual antiplatelet therapy (DAPT) or aspirin in patients with AIS.Methods:Following PRISMA guidelines, we searched Pubmed, Embase, Scopus and Cochrane databases for studies comparing effects of tirofiban versus DAPT or aspirin alone in patients with AIS. Main outcomes were increase in NIHSS score, Modified Rankin Scale (mRS) scores at 90 days (0 to 2), intracranial hemorrhage (ICH) and mortality. Statistics analysis was performed using Review Manager 5.4.1 software. Heterogeneity was assessed with I2statistics.Results:We included 5 RCT and 5 non-RCT studies covering 1,857 patients, of whom 926 were treated with Tirofiban. Neurological deterioration, assessed by changes in NIHSS scores from baseline across four studies, was less pronounced in the Tirofiban group (MD -0.32; 9% CI -0.83-0.19; p

Stroke, Volume 56, Issue Suppl_1, Page AWP181-AWP181, February 1, 2025. Background:Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.Methods:In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.Results:For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (p= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (p= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (p= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (p= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (p= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (p= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (p= 0.20).Conclusions:RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.

Stroke, Volume 56, Issue Suppl_1, Page ATMP33-ATMP33, February 1, 2025. Introduction:Acute ischemic stroke (AIS) with large vessel occlusion (LVO) benefits from mechanical thrombectomy (MT), but the majority of Americans require interhospital transfer for MT. Thrombolysis at the spoke hospital with the patient transferred to the hub for MT is a model known as “drip-and-ship.” In contrast, “mothership” patients present directly to MT capable centers and have immediate access to MT. We sought to evaluate the effects of thrombolysis dwell time (time for the drug to work) and drip-and-ship versus mothership status on recanalization rates.Methods:Among 385 patients who received thrombolysis for AIS at our academic comprehensive stroke center from January 1, 2023 to June 30 2024, 76 patients had LVO and repeat vessel imaging available to evaluate for recanalization status. Thrombolysis dwell time was defined as the timefrom administration of thrombolysis to repeat vascular imaging. Recanalization was defined as complete resolution of the occlusion. Partial recanalization was defined as some recanalization (i.e. M1 transformed into M2). Patients without vascular imaging or without repeat vessel imaging were excluded. Data was collected on demographics, last known normal time (LKN), National Institutes of Health Stroke Scale (NIHSS), thrombolysis administration time, and repeat vascular imaging results.Results:Among 76 AIS LVO patients, the mean age was 68.8 years (range, 25.1 to 96.8), and 40 (52.6%) were women. The mean initial NIHSS was 14.7 (range, 0 to 34). Twenty-three (30%) were mothership and 53 (69.7%) were drip-and-ship. The mean time from LKN to thrombolysis was 2.2 hours (range, 0 to 4.9). The site of LVO occlusion was as follows: 56 (76.7%) M1, 8 (10.5%) M2s occlusions, 5 (6.6%) carotid terminus, 5 (6.6%) basilar, and 2 (2.6%) PCA occlusions. In 69 (90.8%), repeat vascular imaging was cerebral angiogram. There were 7 (9.2%) complete recanalization, and 20 (26.2%) partial recanalization. Mothership status was associated with lower rates of partial recanalization (8.7% vs 34%, p 0.016) and shorter mean thrombolysis dwell time (0.9 hours vs 2.7 hours, p < 0.0001) compared to drip-and-ship status.Conclusions:In LVO AIS patients who receive thrombolysis, drip-and ship status is associated with higher partial recanalization rates and longer thrombolysis drug dwell time compared to mothership status. This may impact strategy for recruitment of sites in clinical trials.

Stroke, Volume 56, Issue Suppl_1, Page ATP308-ATP308, February 1, 2025. Introduction:The social environment plays an essential role in a patient’s arrival time to the hospital when experiencing medical emergencies. For stroke events an understanding of these socio-ecological factors may provide insight on eligibility for time-based interventions. This study aimed to assess the relationship between the first person made aware during a stroke and the impact on a patient’s hospital arrival timeliness.Methods:Time is Brain is a multi-center observational study assessing the role of social network mechanisms involved in delays to the hospital. As part of this study, we enrolled patients who had an acute stroke syndrome within the past seven days and received hospital care at either Mass General Brigham or Yale New Haven Hospital. We collected data on the social circumstances and the decision-making during the acute stroke in the community. We asked participants: 1. Did you tell anyone about your symptoms? 2. If yes, who did you tell about these symptoms? 3. Did anyone other than yourself notice symptoms? 4. If yes, who noticed your symptoms? We combined the responses for these questions into the first person aware of symptoms. The categories for people first aware were family members, spouse, co-worker/friend/stranger, and no one made aware. Here, we describe the median last known well to hospital arrival time and the median symptom onset to hospital arrival for each of these categories.Results:In 181 patients, we found that 72 (39.6%) individuals identified a spouse, 51 (28.2%) identified a family member, 33 (18.2%) identified a co-worker, friend, or stranger, and 25 (13.8%) did identified no one. Patients who reached out to friends, co-workers, or strangers had a median last known well to hospital arrival time of 180 minutes and a median symptom onset to hospital arrival time of 92 minutes. In contrast, arrival times were longest for those who contacted family with a median last known well to hospital arrival time of 615 minutes and median symptom onset to hospital arrival time of 120 minutes.Conclusion:The decision to seek care during stroke usually includes family or lay others. This preliminary analysis suggests that who is involved may influence the time to arrival to the hospital and ultimately improve individual stroke recovery. When considering how to improve arrival times, this multi-person decision-making process should be a factor in intervention development.

Stroke, Volume 56, Issue Suppl_1, Page ATP314-ATP314, February 1, 2025. Introduction:Blood pressure (BP) control after a stroke is crucial in lowering the risk of stroke recurrence. Our prior work found that over 60% of patients recently discharged from a regional health system with stroke did not achieve BP control according to current guidelines. Less is known about the impact of insurance type and co-morbidities on post-stroke BP control.Objective:To analyze the relationship between insurance type, comorbidities and post-stroke BP control among patients within a regional health system.Methods:This report is an observational cohort study. Patients were admitted between 2013-2021 for ischemic and hemorrhagic stroke and had seen a PCP/PCAPP (primary care physician/primary care advance practice provider) in a regional health system or affiliated outpatient clinics using the EPIC electronic health record. We excluded patients who died during hospitalization, were lost to follow-up, or were on dialysis.Results:The analysis included 2,750 patients. Six months after hospital discharge, the insurance coverage among stroke survivors with uncontrolled BP ( >130/80 mm Hg) was 61.1% for public, 35.8% for private, 1.9% for other/unknown, and 1.3% for self-pay. In comparison, among those with controlled BP (

Stroke, Volume 56, Issue Suppl_1, Page ATP311-ATP311, February 1, 2025. Introduction:Immune Checkpoint Inhibitors (ICIs) used for treatment of malignancies might promote atherosclerosis and increase the risk of ischemic stroke (IS). We aimed to compare IS characteristics of patients with non-small cell lung cancer (NSCLC) who received ICIs compared to those who did not. We hypothesized that IS associated with atherosclerosis will be more common among those treated with ICIs than other treatments.Methods:A retrospective single center study of patients,18 or older, with NSCLC presenting between 2013 and 2023, treated with either ICIs, chemotherapy, or a combination and had an IS any time following treatment. Patients without vessel imaging were excluded. We collected demographics and stroke characteristics. Two sample Mann-Whitney U and chi-square test were used to compare demographics and stroke etiologies among patients who received chemotherapy and those who received ICIs with or without chemotherapy.Results:A total of 58 patients were identified, 22 received chemotherapy only and 36 received ICIs. The mean age was 68.8, with 50% male (29/58). ICI treated groups had significantly more stage IV diagnoses (chemotherapy only 3.6%, ICI 67%, p=0.04). There was no difference in median time from treatment to stroke onset in days between groups; chemotherapy 90.5 (range 27-386) vs. ICI 337.5 (range 95-665), p= 0.39. The stroke etiology in those treated with chemotherapy alone were as follows: Large artery atherosclerosis (3), cardioembolic (8), small vessel disease (5), ESUS (5), other (1). For those treated with either ICI alone or ICI and chemotherapy: Large artery atherosclerosis (5), cardioembolic (6), small vessel disease (2), ESUS (23), other (0). Stroke etiology consistent with embolic stroke with unknown source (ESUS) was more common in the ICI group (chemotherapy only 2.3%, ICI 64%, p=0.02).Conclusions:Contrary to prior research suggesting atherogenesis with ICI, the most common stroke etiology in the ICI group was ESUS.