Rapid Infarct Progression in Anterior Circulation Large Vessel Occlusion Ischemic Stroke Patients During Inter-Facility Transfer
We aimed to identify factors associated with rapid infarct progression during inter-facility transfer for endovascular thrombectomy evaluation and its impact on clinical outcomes. Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-s...
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| Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2020-12, Vol.29 (12), p.105308-105308, Article 105308 |
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| container_title | Journal of stroke and cerebrovascular diseases |
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| creator | Reddy, Sujan T. Friedman, Elliott Wu, Tzu-Ching Arevalo, Octavio Zhang, Jing Rahbar, Mohammad H. Ankrom, Christy Indupuru, Hari Kishan Reddy Savitz, Sean I. |
| description | We aimed to identify factors associated with rapid infarct progression during inter-facility transfer for endovascular thrombectomy evaluation and its impact on clinical outcomes.
Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-stroke network were retrospectively analyzed. Patients were divided into fast progressors and slow progressors. Fast progressors were defined as CT ASPECTS score of ≥6 at the referring hospital (RH) and |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2020.105308 |
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Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-stroke network were retrospectively analyzed. Patients were divided into fast progressors and slow progressors. Fast progressors were defined as CT ASPECTS score of ≥6 at the referring hospital (RH) and <6 at the hub hospital. Good clinical outcomes were defined as modified Rankin Scale score (mRS) 0–2 at 90 days. Demographic, clinical and radiologic variables associated with fast progressors and good clinical outcomes were identified using multivariable regression models.
Among the 190 patients, 44 (23%) patients underwent rapid infarct progression. Higher stroke severity at presentation [aOR, 1.096, 95% CI,1.023, 1.174; p = 0.009], presence of early ischemic changes (CT ASPECT 6-9) at the RH [aOR, 2.721, 95% CI, 1.22, 6.071; p = 0.014] were positively associated, whereas prior ischemic stroke [aOR, 0.272, 95% CI, 0.078, 0.948; p = 0.04] and higher collateral score (2,3,4) [aOR, 0.138, 95%CI, 0.059, 0.324, p=<0.0001] were negatively associated with rapid infarct progression. Fifty-eight (31%) transferred patients had good outcomes. After adjusting for reperfusion status, age [aOR, 0.96, 95% CI, 0.93, 0.98; p=<0.001], initial stroke severity [aOR, 0.87, 95% CI, 0.81, 0.93; p=<0.001], absolute rate of decrease in CT ASPECTS [aOR, 0.38, 95% CI, 0.19, 0.77; p = 0.007] and internal carotid artery (ICA) occlusion [aOR, 0.34, 95 %CI, 0.12, 0.94; p = 0.038] were negatively associated with good outcome.
Higher stroke severity, presence of early ischemic changes at the referring facility, absence of prior stroke, and poor collateral scores (CS 0-1) are the factors associated with rapid infarct progression in the telemedicine transfer cohort. Increasing age, higher stroke severity, higher absolute decrease in CT ASPECTS and ICA occlusion determine poor clinical outcomes.</description><identifier>ISSN: 1052-3057</identifier><identifier>ISSN: 1532-8511</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2020.105308</identifier><identifier>PMID: 32992188</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aspects decay ; Brain Ischemia - diagnosis ; Brain Ischemia - physiopathology ; Brain Ischemia - therapy ; Collateral score ; Disease Progression ; Endovascular Procedures ; Endovascular thrombectomy ; Female ; Humans ; Infarct progression ; Ischemic stroke ; Male ; Mechanical thrombectomy ; Middle Aged ; Patient Transfer ; Predictive Value of Tests ; Recovery of Function ; Registries ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Stroke - diagnosis ; Stroke - physiopathology ; Stroke - therapy ; Telemedicine ; Thrombectomy ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2020-12, Vol.29 (12), p.105308-105308, Article 105308</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-fd18ecd8ab636775c66af9c10889a33edbfa43d4a275946ff66c38ecef5dc3523</citedby><cites>FETCH-LOGICAL-c519t-fd18ecd8ab636775c66af9c10889a33edbfa43d4a275946ff66c38ecef5dc3523</cites><orcidid>0000-0001-7454-114X ; 0000-0002-2112-4294 ; 0000-0001-8580-2392 ; 0000-0001-5307-5012</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305720307266$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32992188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reddy, Sujan T.</creatorcontrib><creatorcontrib>Friedman, Elliott</creatorcontrib><creatorcontrib>Wu, Tzu-Ching</creatorcontrib><creatorcontrib>Arevalo, Octavio</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Rahbar, Mohammad H.</creatorcontrib><creatorcontrib>Ankrom, Christy</creatorcontrib><creatorcontrib>Indupuru, Hari Kishan Reddy</creatorcontrib><creatorcontrib>Savitz, Sean I.</creatorcontrib><title>Rapid Infarct Progression in Anterior Circulation Large Vessel Occlusion Ischemic Stroke Patients During Inter-Facility Transfer</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>We aimed to identify factors associated with rapid infarct progression during inter-facility transfer for endovascular thrombectomy evaluation and its impact on clinical outcomes.
Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-stroke network were retrospectively analyzed. Patients were divided into fast progressors and slow progressors. Fast progressors were defined as CT ASPECTS score of ≥6 at the referring hospital (RH) and <6 at the hub hospital. Good clinical outcomes were defined as modified Rankin Scale score (mRS) 0–2 at 90 days. Demographic, clinical and radiologic variables associated with fast progressors and good clinical outcomes were identified using multivariable regression models.
Among the 190 patients, 44 (23%) patients underwent rapid infarct progression. Higher stroke severity at presentation [aOR, 1.096, 95% CI,1.023, 1.174; p = 0.009], presence of early ischemic changes (CT ASPECT 6-9) at the RH [aOR, 2.721, 95% CI, 1.22, 6.071; p = 0.014] were positively associated, whereas prior ischemic stroke [aOR, 0.272, 95% CI, 0.078, 0.948; p = 0.04] and higher collateral score (2,3,4) [aOR, 0.138, 95%CI, 0.059, 0.324, p=<0.0001] were negatively associated with rapid infarct progression. Fifty-eight (31%) transferred patients had good outcomes. After adjusting for reperfusion status, age [aOR, 0.96, 95% CI, 0.93, 0.98; p=<0.001], initial stroke severity [aOR, 0.87, 95% CI, 0.81, 0.93; p=<0.001], absolute rate of decrease in CT ASPECTS [aOR, 0.38, 95% CI, 0.19, 0.77; p = 0.007] and internal carotid artery (ICA) occlusion [aOR, 0.34, 95 %CI, 0.12, 0.94; p = 0.038] were negatively associated with good outcome.
Higher stroke severity, presence of early ischemic changes at the referring facility, absence of prior stroke, and poor collateral scores (CS 0-1) are the factors associated with rapid infarct progression in the telemedicine transfer cohort. Increasing age, higher stroke severity, higher absolute decrease in CT ASPECTS and ICA occlusion determine poor clinical outcomes.</description><subject>Aged</subject><subject>Aspects decay</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - physiopathology</subject><subject>Brain Ischemia - therapy</subject><subject>Collateral score</subject><subject>Disease Progression</subject><subject>Endovascular Procedures</subject><subject>Endovascular thrombectomy</subject><subject>Female</subject><subject>Humans</subject><subject>Infarct progression</subject><subject>Ischemic stroke</subject><subject>Male</subject><subject>Mechanical thrombectomy</subject><subject>Middle Aged</subject><subject>Patient Transfer</subject><subject>Predictive Value of Tests</subject><subject>Recovery of Function</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stroke - diagnosis</subject><subject>Stroke - physiopathology</subject><subject>Stroke - therapy</subject><subject>Telemedicine</subject><subject>Thrombectomy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1052-3057</issn><issn>1532-8511</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkc1uEzEUhUcIREvhFZCXCGmCf8YezwapBAqRIrWCwtZy7OvUYTIO1zORuuPRcZpSgcSGlS3fz-cc3VNVrxmdMcrUm81sk0dM38EBwgrT3mYf84xTfgCkoPpRdcqk4LWWjD0udyp5LahsT6pnOW8oZUxq-bQ6EbzrONP6tPr52e6iJ4shWHQjucK0Rsg5poHEgZwPI2BMSOYR3dTb8fC-tLgG8q1Q0JNL5_rpDl9kdwPb6MiXu4zkqtAwjJm8nzAO62JRtOoL62Ifx1tyjXbIAfB59STYPsOL-_Os-nrx4Xr-qV5eflzMz5e1k6wb6-CZBue1XSmh2lY6pWzoHKNad1YI8KtgG-Eby1vZNSoEpZwoPyBI74Tk4qx6e9TdTasteFeioe3NDuPW4q1JNpq_J0O8Meu0N63SiktWBF7dC2D6MUEezTZmB31vB0hTNrxpWtkw3XUFfXdEHaacEcKDDaPmUKXZmH9VaQ5VmmOVReTln4EfJH53V4DlEYCytn0ENNmVjTvwEcGNxqf4P36_AHKdwvY</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Reddy, Sujan T.</creator><creator>Friedman, Elliott</creator><creator>Wu, Tzu-Ching</creator><creator>Arevalo, Octavio</creator><creator>Zhang, Jing</creator><creator>Rahbar, Mohammad H.</creator><creator>Ankrom, Christy</creator><creator>Indupuru, Hari Kishan Reddy</creator><creator>Savitz, Sean I.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7454-114X</orcidid><orcidid>https://orcid.org/0000-0002-2112-4294</orcidid><orcidid>https://orcid.org/0000-0001-8580-2392</orcidid><orcidid>https://orcid.org/0000-0001-5307-5012</orcidid></search><sort><creationdate>20201201</creationdate><title>Rapid Infarct Progression in Anterior Circulation Large Vessel Occlusion Ischemic Stroke Patients During Inter-Facility Transfer</title><author>Reddy, Sujan T. ; Friedman, Elliott ; Wu, Tzu-Ching ; Arevalo, Octavio ; Zhang, Jing ; Rahbar, Mohammad H. ; Ankrom, Christy ; Indupuru, Hari Kishan Reddy ; Savitz, Sean I.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-fd18ecd8ab636775c66af9c10889a33edbfa43d4a275946ff66c38ecef5dc3523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aspects decay</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - physiopathology</topic><topic>Brain Ischemia - therapy</topic><topic>Collateral score</topic><topic>Disease Progression</topic><topic>Endovascular Procedures</topic><topic>Endovascular thrombectomy</topic><topic>Female</topic><topic>Humans</topic><topic>Infarct progression</topic><topic>Ischemic stroke</topic><topic>Male</topic><topic>Mechanical thrombectomy</topic><topic>Middle Aged</topic><topic>Patient Transfer</topic><topic>Predictive Value of Tests</topic><topic>Recovery of Function</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Stroke - diagnosis</topic><topic>Stroke - physiopathology</topic><topic>Stroke - therapy</topic><topic>Telemedicine</topic><topic>Thrombectomy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reddy, Sujan T.</creatorcontrib><creatorcontrib>Friedman, Elliott</creatorcontrib><creatorcontrib>Wu, Tzu-Ching</creatorcontrib><creatorcontrib>Arevalo, Octavio</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Rahbar, Mohammad H.</creatorcontrib><creatorcontrib>Ankrom, Christy</creatorcontrib><creatorcontrib>Indupuru, Hari Kishan Reddy</creatorcontrib><creatorcontrib>Savitz, Sean I.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reddy, Sujan T.</au><au>Friedman, Elliott</au><au>Wu, Tzu-Ching</au><au>Arevalo, Octavio</au><au>Zhang, Jing</au><au>Rahbar, Mohammad H.</au><au>Ankrom, Christy</au><au>Indupuru, Hari Kishan Reddy</au><au>Savitz, Sean I.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rapid Infarct Progression in Anterior Circulation Large Vessel Occlusion Ischemic Stroke Patients During Inter-Facility Transfer</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>29</volume><issue>12</issue><spage>105308</spage><epage>105308</epage><pages>105308-105308</pages><artnum>105308</artnum><issn>1052-3057</issn><issn>1532-8511</issn><eissn>1532-8511</eissn><abstract>We aimed to identify factors associated with rapid infarct progression during inter-facility transfer for endovascular thrombectomy evaluation and its impact on clinical outcomes.
Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-stroke network were retrospectively analyzed. Patients were divided into fast progressors and slow progressors. Fast progressors were defined as CT ASPECTS score of ≥6 at the referring hospital (RH) and <6 at the hub hospital. Good clinical outcomes were defined as modified Rankin Scale score (mRS) 0–2 at 90 days. Demographic, clinical and radiologic variables associated with fast progressors and good clinical outcomes were identified using multivariable regression models.
Among the 190 patients, 44 (23%) patients underwent rapid infarct progression. Higher stroke severity at presentation [aOR, 1.096, 95% CI,1.023, 1.174; p = 0.009], presence of early ischemic changes (CT ASPECT 6-9) at the RH [aOR, 2.721, 95% CI, 1.22, 6.071; p = 0.014] were positively associated, whereas prior ischemic stroke [aOR, 0.272, 95% CI, 0.078, 0.948; p = 0.04] and higher collateral score (2,3,4) [aOR, 0.138, 95%CI, 0.059, 0.324, p=<0.0001] were negatively associated with rapid infarct progression. Fifty-eight (31%) transferred patients had good outcomes. After adjusting for reperfusion status, age [aOR, 0.96, 95% CI, 0.93, 0.98; p=<0.001], initial stroke severity [aOR, 0.87, 95% CI, 0.81, 0.93; p=<0.001], absolute rate of decrease in CT ASPECTS [aOR, 0.38, 95% CI, 0.19, 0.77; p = 0.007] and internal carotid artery (ICA) occlusion [aOR, 0.34, 95 %CI, 0.12, 0.94; p = 0.038] were negatively associated with good outcome.
Higher stroke severity, presence of early ischemic changes at the referring facility, absence of prior stroke, and poor collateral scores (CS 0-1) are the factors associated with rapid infarct progression in the telemedicine transfer cohort. Increasing age, higher stroke severity, higher absolute decrease in CT ASPECTS and ICA occlusion determine poor clinical outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32992188</pmid><doi>10.1016/j.jstrokecerebrovasdis.2020.105308</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-7454-114X</orcidid><orcidid>https://orcid.org/0000-0002-2112-4294</orcidid><orcidid>https://orcid.org/0000-0001-8580-2392</orcidid><orcidid>https://orcid.org/0000-0001-5307-5012</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aspects decay Brain Ischemia - diagnosis Brain Ischemia - physiopathology Brain Ischemia - therapy Collateral score Disease Progression Endovascular Procedures Endovascular thrombectomy Female Humans Infarct progression Ischemic stroke Male Mechanical thrombectomy Middle Aged Patient Transfer Predictive Value of Tests Recovery of Function Registries Retrospective Studies Risk Factors Severity of Illness Index Stroke - diagnosis Stroke - physiopathology Stroke - therapy Telemedicine Thrombectomy Time Factors Treatment Outcome |
| title | Rapid Infarct Progression in Anterior Circulation Large Vessel Occlusion Ischemic Stroke Patients During Inter-Facility Transfer |
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