Search

Objective: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID‐19 infection negatively modifies acute stroke procedures and, due to its pro‐coagulative effect, may potentially impact on IVT outcome. Thus, short‐term efficacy and safety of IVT were compared in patients with and without evidence of SARS‐CoV‐2. Methods: An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID‐19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. Results: Patients infected with COVID‐19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p <.01) and D‐dimers (870 vs. 570; p =.03) on admission, higher presence of pneumonia (47.8% vs. 12%; p <.01) and lower percentage of 'minor stroke symptoms' (NIHSS 1–5 pts.) (2% vs., 18%; p <.01). Hospitalizations were longer in patients with COVID‐19 than in those without it (17 vs. 9 days, p <.01), but impact of COVID‐19 infection on patients' in‐hospital mortality or functional status on dismission has been confirmed neither in uni‐ or multivariate analysis. Conclusion: SARS‐CoV‐2 infection prolongs length of stay in hospital after IVT, but does not influence in‐hospital outcome. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the relationship between pretreatment IL-6 and hsCRP levels, symptom severity and functional outcome of patients with acute ischemic stroke (AIS) treated with IV-thrombolysis. Patients and Methods: IL-6 and hsCRP samples were obtained from 83 consecutively treated Caucasian patients with AIS prior to initiation of IV-thrombolysis. Severity of stroke symptoms was assessed using the National Institutes of Health Stroke Scale (NIHSS), whereas functional outcome was assessed with modified Rankin Scale (mRS). The commercially available sets of enzymatic immune tests were used to estimate the concentrations of inflammatory markers in serum. Results: Medians of IL-6 serum concentrations prior to IV-thrombolysis were lower in patients with favorable (mRS 0– 2 pts) functional outcome than in those with unfavorable (mRS 3– 6 pts) functional outcome, both at hospital dismission (5.92: 2.30– 7.71 vs 9.46: 3.79– 17.29 pg/mL; p< 0.01) and on the ninetieth day from stroke onset (5.87: 2.30– 10.58 vs 10.9: 5.94– 17.28 pg/mL; p< 0.01). There were no existing differences regarding hsCRP levels between groups (2.49: 0.11– 9.82 vs 4.44: 0.32– 9.87 mg/dL; p=0.30 and 2.57: 0.11– 2.57 vs 2.83: 0.32– 9.32 mg/dL; p=0.75, respectively). Patients with lacunar strokes were characterized by lower median of IL-6 (5.96: 2.87– 13.0% vs 7.29: 2.30– 17.28; p=< 0.02) and hsCRP (2.25: 0.11– 9.82 vs 4.84: 0.35– 9.87; p=0.01) than those with nonlacunar infarctions. Multivariate analysis showed an impact of IL-6 on mRS measured on hospital dismission and after three months, regardless of their initial NIHSS, presence of hemorrhagic transformation and type 2 diabetes. No impact of hsCRP, lacunar etiology and patients' age on functional outcome existed. Conclusion: Regardless of the stroke etiology, pretreatment of IL-6, but not of hsCRP levels, may help to predict functional outcome after IV-thrombolysis independently of symptom severity and stroke complications. [ABSTRACT FROM AUTHOR]

Background: The presence of chronic kidney disease (CKD) is an indicator of a worse long-term prognosis in patients with ischemic stroke (IS). Unfortunately, not much is known about renal function in the population of post-IS subjects. The aim of our study was to assess the prevalence of renal damage and impaired renal function (IRF) in the population of post-IS subjects. Methods: This prospective analysis concerned 352 consecutive post-IS survivors hospitalized in Pomeranian stroke centers (Poland) in 2009. In this group estimated glomerular filtration rate (eGFR) according to MDRD (modification of diet in renal diseases) and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formulas and urine albumin/creatinine ratio (ACR) were determined. Results: Among survivors decreased eGFR (<60 mL/min./1.73m2 according to MDRD or CKD-EPI) or ACR≥30mg/g were detected in 40.38% (23.07% Men, 55.32% Women; P<0.01). The highest prevalence of IRF was noted in post-IS subjects with atheromatic and lacunar IS. In multivariate analysis the ACR≥30mg/g was predicted by older age, diabetes mellitus (DM) and physical disability (modified Rankin scale 3–5 pts.). The association with reduced eGFR was proved for sex (female), DM and physical disability. Conclusions: CKD is a frequently occurring problem in the group of post-IS subjects, especially after lacunar and atheromatic IS. Post-IS patients, mainly the elderly women, with physical disability and diabetes mellitus, should be regularly screened for CKD. This could reduce the risk of further cardiovascular events and delay the progression of IRF. [ABSTRACT FROM AUTHOR]

Introduction: Patients with ischemic stroke undergoing intravenous (iv)-thrombolysis are routinely controlled with computed tomography on the second day to assess stroke evolution and hemorrhagic transformation (HT). However, the benefits of an additional computed tomography (aCT) performed over the next days after iv-thrombolysis have not been determined.Methods: We retrospectively screened 287 Caucasian patients with ischemic stroke who were consecutively treated with iv-thrombolysis from 2008 to 2012. The results of computed tomography performed on the second (control computed tomography) and seventh (aCT) day after iv-thrombolysis were compared in 274 patients (95.5%); 13 subjects (4.5%), who died before the seventh day from admission were excluded from the analysis.Results: aCTs revealed a higher incidence of HT than control computed tomographies (14.2% vs 6.6%; P=0.003). Patients with HT in aCT showed higher median of National Institutes of Health Stroke Scale score on admission than those without HT (13.0 vs 10.0; P=0.01) and higher presence of ischemic changes >1/3 middle cerebral artery territory (66.7% vs 35.2%; P<0.01). Correlations between presence of HT in aCT and National Institutes of Health Stroke Scale score on admission (rpbi 0.15; P<0.01), and the ischemic changes >1/3 middle cerebral artery (phi=0.03) existed, and the presence of HT in aCT was associated with 3-month mortality (phi=0.03).Conclusion: aCT after iv-thrombolysis enables higher detection of HT, which is related to higher 3-month mortality. Thus, patients with severe middle cerebral artery infarction may benefit from aCT in the decision-making process on the secondary prophylaxis. [ABSTRACT FROM AUTHOR]

Aims Approximately 30% of acute ischemic stroke ( AIS) occurs in people aged over 80 years. Older patients are increasingly receiving intravenous thrombolysis ( IV-thrombolysis) for AIS; however, the majority of treatments are carried out in urban hospitals. The aim of the present study was to assess the safety and effectiveness of IV-thrombolysis in patients aged older than 80 years. Methods We retrospectively evaluated the clinical and epidemiological data of 409 patients with AIS who were consecutively treated with IV-thrombolysis from September 2006 to June 2012 in the three rural hospitals. Results In the analyzed group, there were 22.3% of patients who were aged over 80 years (2.4% patients aged ≥90 years). Among these patients we found: longer onset to door time ( P = 0.04), onset to treatment time ( P = 0.0003) and door to treatment time ( P < 0.0001). The functional independence (modified Rankin Scale 0-2) at 90 days was lower ( P = 0.0004), whereas the risk of hemorrhagic transformation ( HT; P = 0.001), symptomatic intracerebral hemorrhage ( SICH) according to National Institute of Neurological Disorders and Stroke ( NINDS) definition ( P = 0.003) and mortality rate within 3 months were higher ( P < 0.0001) than in younger patients. A multivariate analysis showed no impact of older age on long-term outcome, and the presence of HT and SICH. Age over 80 years was associated with higher mortality rate. Conclusions Older age affected the increased times for pre- and in-hospital procedures in rural patients with AIS. Older patients should not be denied the chance to benefit from IV-thrombolysis, but because of the higher mortality, the application of this therapy should be carefully decided on. Geriatr Gerontol Int 2014; 14: 689-694. [ABSTRACT FROM AUTHOR]