Contemporary Management of Acute Ischemic Stroke Across the Continuum

Demaerschalk, Bart M.; Scharf, Eugene; Cloft, Harry J.; Barrett, Kevin M.; Sands, Kara; Miller, David A.; Meschia, James F.

doi:10.1016/j.mayocp.2020.04.002

Cited by 7 publications

(7 citation statements)

References 123 publications

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“…Given that clinical outcomes are strictly time-sensitive, 5 , 6 , 7 the current early management of patients with AIS is aimed at reducing the time interval between presentation and treatment (with intravenous thrombolysis, MT, or both). 8 , 9 The American Heart Association or American Stroke Association updated their “Target: Stroke Phase III” guidelines for reducing door-to-device times (time interval from arrival at the hospital to first pass with a thrombectomy device), with a goal time of less than 90 minutes for patients arriving directly at the hospital and less than 60 minutes for transfer patients. 10…”

mentioning

confidence: 99%

Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Rangel

Palmisciano

Vanderhye

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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confidence: 99%

Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Rangel

Palmisciano

Vanderhye

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Although the "OWH effect" is an accepted phenomenon, the latter does not exclude the pertinence of telestroke management in AIS. As explored by Demaerschalk et al in a recent publication, telestroke, defined in the cited study as a consultation involving audio and video modalities (20), remains one of the best-studied and validated models for telemedicine (21)(22)(23)(24)(25)(26). An approach by telephone consultation and teleradiology by neurovascular experts has also been shown to be safe, similar to the approach adopted in HFR (27).…”

Section: Discussionmentioning

confidence: 93%

Distance Neurological Supervision Using Telestroke Does Not Increase Door-to-Needle Time in Acute Ischemic Stroke Management: The Experience of Two Regional Stroke Units

et al. 2021

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Background and Aims: Timely administration of recombinant tissue plasminogen activator (r-tPA) improves clinical outcomes in acute ischemic stroke patients. This study aims to explore the influence of the systematic presence on site of a neurologist compared with telestroke management on door-to-needle time in acute ischemic stroke outside of working hours (OWH).Methods: This retrospective cohort study included all r-tPA-treated patients in the emergency rooms of two Swiss stroke units, Nyon Hospital [Groupement Hospitalier de l'Ouest Lémanique (GHOL)] and Fribourg Hospital [Hôpital de Fribourg (HFR)], between February 2014 and September 2018. Door-to-needle time was analyzed for patients admitted during working hours (WH' weekdays 08:00–18:00) and OWH (weekdays 18:00–08:00, weekends, and public holidays). The latter was compared between centers; OWH, every patient was evaluated prior to thrombolysis by a neurologist on site in GHOL, while HFR adopted distance neurological supervision with teleradiology, performed by telephone evaluation of relevant clinical information with online real-time access to brain imaging.Results: Data were analyzed for 157 patients in HFR and 101 patients in GHOL. No statistically significant differences in baseline characteristics were found for the 258 r-tPA-treated acute ischemic stroke patients, in terms of age, gender, cardiovascular risk factors (hypertension, diabetes, and atrial fibrillation), and pre-Modified Rankin Scale (pre-mRs) between centers, with the exception of smoking and anticoagulation status. Patients in HFR presented with more severe strokes {median National Institutes of Health Stroke Scale (NIHSS) [6 (SD 6.88) (GHOL), 8 (SD 6.98) (HFR), p = 0.005]}. No significant differences in baseline characteristics were found as per admission time independently of the center. Door-to-needle time was significantly longer in the HFR cohort when compared with GHOL, irrespective of admission time. Both centers demonstrated significantly longer median door-to-needle time OWH. However, analysis of the door-to-needle time differences between WH and OWH showed no significant interaction using robust ANCOVA WRS2 analysis (p = 0.952) and a Bayesian model (BF01 = 3.97).Conclusions: On-site systematic evaluation by a neurologist did not appear to influence door-to-needle time OWH, suggesting distance supervision may be time-efficient in thrombolysis. This supports existing prospective studies in hyperacute telestroke management. The relevance lies in optimizing resource use considering the increasing demand for emergency neurological management.

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“…Studies in the United States found that women experience approximately 55,000 more strokes each year [91], [92], which has been linked to higher life expectancy, hormonal changes, use of contraceptives, and variable risk factors in women [93]- [96]. On the premise of non-modifiable risk factors; age and sex associated with stroke [21], [30], [99], [100], [35], [53], [54], [57], [63], [76], [97], [98], this study found that age group but not sex had direct effect on the stroke type. While the initial analysis found some association between sex and stroke type, the SEM after controlling for several factors, found no significant direct effect.…”

Section: Discussionmentioning

confidence: 99%

Non-Modifiable Risk Factors (Age and Sex), Stroke Types, and Outcomes in Rivers State, Nigeria: A Retrospective Hospital-Based Study

Osuegbu¹,

Adeniji²,

Owhonda³

et al. 2021

Preprint

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This study used structural equation modelling (SEM) to evaluate the direct effect of sex and age on stroke types and outcomes in Tertiary Health Facilities in Rives State, Nigeria. The study was a cross-sectional retrospective hospital-based research that utilized specific stroke patients’ information between 2015-2019. The study obtained the sex and age, stroke type (ischemic/hemorrhagic), and outcomes (No disability/disability/death) from the records. The retrieved data was Microsoft Excel (2016), then analyzed using SPSS (version 21, Amos) and STATGRAPHICS centurion (Stat Point Tech., Inc.). From the result, out of the recorded 1916 stroke patients, 1229 (64.1%) were female, while 687 (35.9%) were males. The older adults (>55 years) had more recorded cases (n=1289) than young adults (ages 18–35 years; n=77) and middle-aged adults (ages 36–55 years, n=550). The SEM results showed that age was significantly associated with stroke type (P<0.001) and outcomes (P=0.038), while sex was significantly associated with stroke outcomes (P<0.001). The likelihood of death was 1.3 times higher in hemorrhagic stroke than ischemic stroke. In conclusion, age and sex had direct effects on stroke type, while age had a direct effect on stroke outcome. Hemorrhagic stroke was more likely to cause death than ischemic stroke in the studied population.

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Contemporary Management of Acute Ischemic Stroke Across the Continuum

Cited by 7 publications

References 123 publications

Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Distance Neurological Supervision Using Telestroke Does Not Increase Door-to-Needle Time in Acute Ischemic Stroke Management: The Experience of Two Regional Stroke Units

Non-Modifiable Risk Factors (Age and Sex), Stroke Types, and Outcomes in Rivers State, Nigeria: A Retrospective Hospital-Based Study

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