Acute ischaemic stroke: recent advances in reperfusion treatment

Widimský, Petr; Snyder, Kenneth V.; Sulženko, Jakub; Hopkins, L. Nelson; ̌Sťetkářová, Ivana

doi:10.1093/eurheartj/ehac684

Cited by 31 publications

(17 citation statements)

References 74 publications

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“…Advances in acute stroke management have led to improved survival. 1,2 Stroke rehabilitation progresses care further by optimizing functional recovery and quality of life. The Canadian Stroke Best Practice Recommendations (CSBPR) recommend higher rehabilitation intensity (RI) to aid recovery.…”

Section: Introductionmentioning

confidence: 99%

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

MacDonald,

Linkewich,

Bayley

et al. 2023

International Journal of Stroke

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Background: Several studies have demonstrated improved outcomes poststroke when higher intensity rehabilitation is provided. Canadian Stroke Best Practice Recommendations advise patients receive 180 min of therapy time per day; however, the exact amount required to reach benefit is unknown. Aims: The primary aim of this study was to determine the association between rehabilitation intensity (RI) and total Functional Independence Measure (FIM) Instrument change. Secondary aims included determining the association between RI and discharge location, 90-day home time, rehabilitation effectiveness, and motor and cognitive FIM change. Methods: A retrospective cohort study was conducted using available administrative databases of acute stroke patients discharged to inpatient rehabilitation facilities in Ontario, Canada, from January 2017 to December 2021. RI was defined as number of minutes per day of direct therapy by all providers divided by rehabilitation length of stay. The association between RI and the outcomes of interest were analyzed using regression models with restricted cubic splines. Results: A total of 12,770 individuals were included. Mean age of the sample was 72.6 years, 46.0% of individuals were female, and 87.6% had an ischemic stroke. Mean RI was 74.7 min (range: 5–162 min) per day. Increased RI was associated with an increase in mean FIM change. However, there was diminishing incremental increase after reaching 95 min/day. Increased RI was positively associated with motor and cognitive FIM change, rehabilitation effectiveness, 90-day home time, and discharge to preadmission setting. Higher RI was associated with a lower likelihood of discharge to long-term care. Conclusions: None of the patients met the recommended RI of 180 min/day based on the Canadian Stroke Best Practice Recommendations. Despite this, higher intensity was associated with better outcomes. Given that most positive associations were observed with a RI ⩾95 min/day, this may be a more feasible target.

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Section: Introductionmentioning

confidence: 99%

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

MacDonald,

Linkewich,

Bayley

et al. 2023

International Journal of Stroke

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“…Prognosis of stroke patients admitted into the intensive care unit (ICU) remains very poor despite stroke unit's care and recent advances in acute reperfusion treatment for ischemic strokes (1). The reported short-term mortality rate for stroke patients requiring ICU management ranged from 40 to 70% (2)(3)(4)(5)(6) and the likelihood of survival without disabilities was very low in a recent study, since only a fifth of patients had a good neurological outcome at 6 months after stroke (2).…”

Section: Introductionmentioning

confidence: 99%

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

Ariès

Bailly²,

Baudic

et al. 2023

Preprint

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Background Little is known on the burden of ICU care for stroke patients. The aim of this study was to provide a description of management strategies, resource use, complications and their association with prognosis of stroke patients admitted to ICU. Methods Using a population-based stroke registry, we analyzed consecutive stroke patients admitted to 3 ICU with at least one organ failure between 2008 and 2017. The study period was divided into two periods corresponding to the arrival of mechanical reperfusion technique. Predictors of ICU mortality were separately assessed in two multivariable logistic regression models, a “clinical model” and an “intervention model”. The same analysis was performed for predictors of functional status at hospital discharge. Results 215 patients were included. Stroke etiology was ischemia in 109 patients (50.7%) and hemorrhage in 106 patients (49.3%). Median NIHSS score was 20.0 (9.0; 40.0). The most common reason for ICU admission was coma (41.2%) followed by acute circulatory failure (41%) and respiratory failure (27.4%). 112 patients (52%) died in the ICU and 20 patients (11.2%) had a good functional outcome (mRS≤3) at hospital discharge. In the "clinical model,” factors independently associated with ICU mortality were: age (OR = 1.03 [95%CI, 1.0 to 1.06]; p=0.04) and intracranial hypertension (OR = 6.89 [95%CI, 3.55 to 13.38]; p<0.0001). In the “intervention model,” the need for invasive mechanical ventilation (OR = 7.39 [95%CI, 1.93 to 28.23]; p=0.004), the need for vasopressor therapy (OR = 3.36 [95%CI, 1.5 to 7.53]; p=0.003) and decision of withholding life support treatments (OR = 19.24 [95%CI, 7.6 to 48.65]; p<0.0001) were associated with bad outcome. Conclusion Our study showed the very poor prognosis of acute stroke patients admitted to ICU. These results also suggest that the clinical evolution of these patients during ICU hospitalization may provide important information for prognostication.

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“…5 IS remains a highly preventable disease, and there have been remarkable advances in acute IS treatments during the past decade. 6 In this issue of Neurology ® , Fan et al 7 publish a detailed analysis of the GBD database from 1990 to 2019, focusing on IS. To estimate the worldwide burden of IS and a prediction about the number of deaths due to attributable risk factors from 2020 to 2030, they developed a Bayesian model stratified by sex, world region, and the number of deaths and disability-adjusted life year (ASDR).…”

mentioning

confidence: 99%

“…5 IS remains a highly preventable disease, and there have been remarkable advances in acute IS treatments during the past decade. 6…”

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confidence: 99%

A Potential Forecast for Ischemic Stroke Burden in 2030

Cantú-Brito

García‐Grimshaw

2023

Neurology

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The first stage for planning effective public health interventions for cerebrovascular diseases is having updated epidemiological surveillance systems to understand the problem clearly.1 The Global Burden of Disease (GBD) study has become a critical resource for quantifying health loss from hundreds of communicable and noncommunicable diseases and their risk factors from 204 countries and territories since 1990, among them stroke.2

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Acute ischaemic stroke: recent advances in reperfusion treatment

Cited by 31 publications

References 74 publications

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

A Potential Forecast for Ischemic Stroke Burden in 2030

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