Risultati per: Linee Guida per le cure post-parto

Stroke, Ahead of Print. Background:The added value of intravenous alteplase in reperfusing ischemic brain tissue in patients undergoing endovascular treatment and directly presented to an endovascular treatment-capable hospital is uncertain. We conducted this post hoc analysis of a randomized trial (DIRECT-MT [Direct Intraarterial Thrombectomy in Order to Revascularize Acute Ischemic Stroke Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: A Multicenter Randomized Clinical Trial]) to explore the association of intravenous alteplase, early (preendovascular treatment) reperfusion, and clinical outcome and to determine factors which may modify alteplase treatment effect on early reperfusion.Methods:In this post hoc analysis of the DIRECT-MT randomized trial comparing intravenous alteplase before endovascular treatment versus endovascular treatment only, 623 of 656 randomized patients, with adequate angiographic evaluation for early reperfusion assessment, were included. The association of intravenous alteplase and early reperfusion (defined as expanded Thrombolysis in Cerebral Infarction score ≥2a on angiogram) was assessed using unadjusted comparisons and multivariable logistic regression.Results:Among 623 patients included (317 received intravenous alteplase and 306 did not), early reperfusion occurred in 91 (15%) patients and was associated with better functional outcome (modified Rankin Scale score, 0–2 of 49/91 [54%] versus 178/531 [34%]; adjusted odds ratio, 1.92 [95% CI, 1.15–3.21];P33 minutes; adjusted odds ratio, 4.07 [95% CI, 1.86–8.86];Pinteraction=0.012).ConclusionS:For patients with large vessel occlusion directly presenting to an endovascular treatment–capable hospital, intravenous alteplase increases early reperfusion when endovascular treatment gets delayed more than approximately half an hour. Thus, intravenous alteplase should be considered if endovascular treatment delays are anticipated by the treating medical team.Registration:URL:https://www.clinicaltrials.gov; Unique identifier: NCT03469206.

Il 2022 per l’epilessia potrebbe essere l’anno della svolta: a maggio l’Organizzazione Mondiale della Sanità dovrà ratificare il primo documento ufficiale sulla gestione dell’epilessia e di altri disturbi neurologici

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 ATMP111-ATMP111, February 1, 2022. Introduction:Social Isolation (SI) is a risk factor for a wide array of psychological disorders. SI significantly enhances the incidence of developing neurological diseases, including stroke within the elderly population. Recent studies have shown microRNA (miRNA) signatures in the brain and the circulation are altered in social defeat models and under stressful environmental conditions. Although SI has shown to influence post-stroke recovery, potential targetable interventions to mitigate these inflammatory events are limited.Hypothesis:Post-stroke SI influences temporally distinct miRNA networks in the brain that regulate acute microglial activation and contribute to chronic depressive phenotypes.Methods:Aged (18-20 month) C57BL/6 male mice were subjected to 60-minute middle cerebral artery occlusion (MCAO) followed by reperfusion. Mice were randomly assigned to either continued pair housing (PH), or SI three days after a 60-minute MCAO. Mice were euthanized at post-stroke SI Day 1, 4, and 27 and ipsilateral hemispheres were collected for miRNA sequencing and downstream analysis. Behavioral tests and brain cell analysis using flow cytometry were performed using independent experimental cohorts.Results:The top 10 differentially expressed miRNAs were identified in SI vs. PH mice across three time points (FC ≥ 1.5, FDR adjustedP

Stroke, Volume 53, Issue Suppl_1, Page AWMP47-AWMP47, February 1, 2022. Introduction:Mexican Americans (MAs) are less likely to receive post-stroke intensive rehabilitation, more likely to suffer from depression, and have worse functional, neurologic and cognitive outcomes compared with non-Hispanic whites (NHWs). The aim of this study was to determine if there is a difference between readmission rates post-stroke among NHWs and MAs.Methods:This was a population-based study of all validated strokes among MAs and NHWs in Nueces County, Texas, October 2019 – March 2021. Baseline demographic and clinical information was recorded from the chart including comorbidity index, age, sex, and NIHSS. Follow up calls were made to the patient or their proxy at 2 week intervals post-discharge up to 12 weeks. Readmission was assessed by asking the patient or proxy if the patient had been readmitted for any reason. P-values were obtained using Fisher exact tests of equivalence between NHWs vs MAs. Additionally, Poisson regression with robust standard errors was used to investigate the association between readmission and race-ethnicity adjusting for age, sex, log of NIHSS, and comorbidity index, with an offset to account for differences in length of observation.Results:403 patients (256 MAs and 147 NHWs) were followed. Of these, there were 65 total (16.1%) including 42 MAs (16.4%) and 23 NHWs (15.6%) who reported readmission within a 12 week follow up period. Table 1 provides the regression results. There was no ethnic difference in readmission rate. Median comorbidity index was higher for MAs when compared to NHWs (3 vs 2, p=.00345) but was not associated with readmission. Only stroke severity was associated with readmission.Conclusion:In our study of patients followed up after discharge post-stroke, a similar proportion of MAs reported readmission compared to NHWs. Overall, the readmission rate was high, with approximately 1 in 6 patients requiring readmission within 90 days. Renewed efforts to promote health post-stroke are needed.

Stroke, Volume 53, Issue Suppl_1, Page ATP169-ATP169, February 1, 2022. Background:Critical congenital heart defects (CCHD) are a subset of mostly cyanotic lesions that require intervention within the first days to weeks of life for survival. For children born with CCHD, the neonatal period is considered the time of highest risk for brain injury as abnormalities in fetal circulation can lead to vulnerabilities in cerebral perfusion prior to corrective cardiac procedures. The prevalence and timing of cerebrovascular events associated with CCHD after the neonatal period is less clear.Methods:We performed a cross-sectional analysis using the National Inpatient Sample database from 2012-2018. We included all children aged 1-18 years hospitalized with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We created multivariable linear and logistic regression models to assess differences in age at stroke onset and mortality after stroke.Results:We identified 4,647 pediatric strokes, 162 (3.5%) of which were associated with CCHD. Adjusting for demographic and clinical covariates, the median age at time of stroke was lower in CCHD patients across all stroke subtypes (Figure). Children with CCHD experienced a higher proportion of IS compared to children without CCHD (75.3% vs 49.5%, P

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.