Improving care for acute in-hospital ischemic strokes—A narrative review

Chen, Shuo; Singh, Ravinder‐Jeet; Hill, Michael D.

doi:10.1177/1747493018790029

Cited by 15 publications

(29 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A delay in the recognition, assessment and contraindication to intravenous thrombolysis are suggested to be other causative factors. 39,40,42 In our analysis, 15 patients had inhospital stroke, constituting 25.4% of the cohort, and were associated with a poorer outcome compared to the out-of-hospital stroke patients (26.7% vs. 52.3%, respectively). Five of these 15 patients (33.3%) had a concomitant malignancy and 10 of them (66.7%) had congestive heart failure.…”

Section: Inhospital Presentationmentioning

confidence: 79%

“…Inhospital stroke constitutes between 6.5% and 15.0% of all strokes. 39 It is well known that it is associated with a poor outcome, [39][40][41][42] because many inhospital stroke patients are admitted to hospital for surgical procedures, concomitant malignancy or cardiac disease. A delay in the recognition, assessment and contraindication to intravenous thrombolysis are suggested to be other causative factors.…”

Section: Inhospital Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

et al. 2019

View full text Add to dashboard Cite

Purpose: Endovascular therapy for emergent large vessel occlusion has been established as the standard approach for acute ischaemic stroke. However, the effectiveness and safety of endovascular therapy in the very elderly population has not been proved. Objective: To determine the safety and effectiveness of endovascular therapy in octogenarians and nonagenarians. Methods: We retrospectively reviewed all patients who underwent endovascular therapy at two stroke centres between April 2012 and July 2018. Functional outcome was assessed using the modified Rankin scale at 90 days after stroke or at discharge. A favourable outcome was defined as a modified Rankin scale score of 0–2 or not worsening of the modified Rankin scale score before stroke. Outcome was compared between younger patients (aged 46–79 years, n = 40) and octogenarians and nonagenarians (aged 80–97 years, n = 19). Results: Octogenarian and nonagenarian patients had pre-stroke functional deficit (modified Rankin scale score >1) more frequently than younger patients (57.9% vs. 20.0%, respectively, P = 0.0059). No difference was observed between very elderly and younger patients in the rate of successful reperfusion (89.5% vs. 67.5%, respectively, P = 0.11), favourable functional outcome (47.4% vs. 45.0%, respectively, P = 1.00) and mortality (21.1% vs. 27.5%, respectively, P = 1.00). On multiple regression analysis, successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were independent predictors of favourable outcome ( P = 0.0003, 0.015 and 0.028, respectively). Conclusions: Successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were clinical predictors of favourable outcome. However, we did not observe an age-dependent effect of clinical outcome after endovascular therapy.

show abstract

Section: Inhospital Presentationmentioning

confidence: 79%

Section: Inhospital Presentationmentioning

confidence: 99%

Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…3 Approximately, 4%-15% of patients experience a stroke while in hospital for another condition (commonly termed "in-hospital" stroke). [4][5][6] Compared with patients presenting from the community, patients with in-hospital ischemic strokes have worse outcomes and receive less evidence-based care, 7 with very few treated in SUs. 8 There may be several justifiable reasons why patients with inhospital stroke are not managed in SUs.…”

Section: Introductionmentioning

confidence: 99%

“…8 There may be several justifiable reasons why patients with inhospital stroke are not managed in SUs. However, once their primary condition has stabilized, management in the SU to support rehabilitation from the effects of stroke is important for reducing disability, 7 as well as ensuring commencement of secondary prevention therapies.…”

Section: Introductionmentioning

confidence: 99%

Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)

Cadilhac

Kilkenny

Lannin

et al. 2019

Journal of Stroke and Cerebrovascular Diseases

View full text Add to dashboard Cite

On behalf of the Australian Stroke Clinical Registry ConsortiumBackground: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. Aims: To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards. Methods: Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke. Results: Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI À0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.

show abstract

“…Injuries, strokes and cerebral infarctions hold a specific place in the range of socially important diseases due to high level of mortality in all countries. [1][2][3] Current situation initiates development to completely new methods of early diagnostics, therapy and rehabilitation in neuro destructive processes management. Small success was achieved on the way of increasing effectiveness of therapy at this stage.…”

Section: Introductionmentioning

confidence: 99%

Somatotopic principle of perineural implantation of stem cells in patients with brain injuries

Yuri¹,

Valeria²,

Alexandra³

et al. 2018

JNSK

View full text Add to dashboard Cite

Background: Neuro destructive processes of any etiology are related to problematic and socially important diseases due to ineffective therapeutic strategy and need to search for new successful ways of treatment and rehabilitation of patient with cerebral infarctions and brain attacks Aims: Authors plant overify hypothesis on viability of additional use of perineural implantation of autologous mesenchymal stem cells (MSC) in order to optimize standard therapy of patients with brain attacks. Such combined technology is aim datextra activation of brain plasticity mechanisms during development of neuro destructive processes. Methods: The technique of MSC perineural migration to injured brain regions was experimentally verified on rats (n=40) paying attention to somatotopic organization of cranial nerves. This technique was clinically tested in pilot project. Phenotyping of autologous MSC from adipose tissue (AT) was performed in 23 patients with brain attacks. These 23 patients received standard treatment as per international guidelines together with three perineural implantations of autologous MSC from AT with 5-9days intervals. The other group of patients (n=7) received only standard therapy as per international guidelines. Results: Additional use of cell therapy resulted in more rapid and effective recovery of disordered neurological functions in all cases compared to those who received standard therapy. The phenomenon of abrupt recovery of neurological functions was established during first 24hours after each injection of autologous MSC. Cumulative recovery of functions progressed after each implantation. Discussion and conclusion: Experimentally developed technique of perineural implantation of autologous MSC was successfully verified in clinical conditions in accordance with certified cell therapy guideline (The Ministry of Health of the Republic of Belarus) in combination with standard treatment of patients with cerebral infarctions. Cell therapy with autologous MSC from AT by means of perineural delivery to injured brain regions is the basis for activation of reparative potential of nerve tissue and progressive recovery of neurological functions in patients with cerebral infarctions.

show abstract

Improving care for acute in-hospital ischemic strokes—A narrative review

Cited by 15 publications

References 35 publications

Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

Outcomes for Patients With In-Hospital Stroke: A Multicenter Study From the Australian Stroke Clinical Registry (AuSCR)

Somatotopic principle of perineural implantation of stem cells in patients with brain injuries

Contact Info

Product

Resources

About