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Title: Selected prognostic factors in patients with acute ischemic stroke treated with intravenous thrombolysis and if indicated with mechanical thrombectomy
Abstract:
In the first study ("Long-term outcome of acute ischemic stroke with unruptured intravenous aneurysm treated by intravenous thrombolysis"), data from 362 patients were analyzed, 330 of whom underwent brain imaging at admission, including computed tomography of the head, computed tomography angiography and computed tomography perfusion. An unruptured intracranial aneurysm was found in 10 patients. Patients with unruptured aneurysms were older than others and more often women. In patients with acute ischemic stroke, the unruptured aneurysm was located in the same vascular areas as the stroke in only 2 cases. During the course of the disease, one patient developed a brain haemorrhage unrelated to the presence of an aneurysm. The mRS scores at day 90. after stroke onset were as follows: 0 (n=3), 1 (n=2), 2 (n=2), 3 (n=1), 6 (n=2). Patients with an unruptured aneurysm were followed for 56 months after onset. Eight people survived the observation period. In 9 cases, the diameter of the aneurysm ranged from 2 to 6 mm, in one case it was 12 mm. In the literature published so far, only 9 cases with unruptured cerebral aneurysm sized > 10 mm treated with intravenous thrombolysis have been presented. The second study ("The prognostic significance of large vessel occlusion in stroke patients treated by intravenous thrombolysis") included 362 patients treated with thrombolysis and, if indi ; cated, additionally treated with mechanical thrombectomy. The patients were selected from a group of 1209 patients treated in the Stroke Unit of the Department Neurology of the University Hospital in Krakow due to ischemic stroke from June 2014 to December 2018. In 197 patients (54.4%), computed angiotomography of the cerebral arteries showed occlusion of a large cerebral vessel. Multivariate regression analysis showed that the presence of an occluded large vessel and a lower delta NIHSS (NIHSS on admission minus NIHSS 24 hours later) were independent factors affecting the risk of hemorrhagic transformation. Multivariate analysis also showed that the presence of an occluded large cerebral vessel, as well as older age, female gender, lower delta NIHSS, hypertension, acute infection, CRP 10 mg/L, and higher WBC count all contributed to the unfavorable outcome in mRS score (>2 points) at discharge. The presence of an occluded large vessel had no effect on in-hospital mortality. The third study (Prognostic significance of stroke-associated infection and other readily available parameters in acute ischemic stroke treated by intravenous thrombolysis) analyzed data from 352 patients with ischemic stroke treated with intravenous thrombolysis and mechanical thrombectomy when indicated. The aim of the study was to study the prognostic significance at day 90. the occurrence of infection i ; n patients with acute ischemic stroke, defined as the presence of infection determined on the basis of medical records based on clinical observation, e.g. fever, laboratory tests, microbiological tests, chest X-rays. The following types of infection were analyzed: communityacquired and nosocomial pneumonia, urinary tract infection, wound infection, gastrointestinal infection, and infection of unknown origin. Thirty-three other parameters, collected within 24 hours of getting ill, were also analyzed. In the Stroke Unit of the University Hospital in Krakow, the first-line treatment for community-acquired pneumonia was ceftriaxone, and for patients with nosocomial pneumonia, cefriaxone with levofloxacin. Urinary tract infection was first treated with cefuroxime. If the above-mentioned antibiotics were ineffective, treatment according to the antibiogram was applied. In the case of wound infection or gastrointestinal infection, treatment in accordance with the antibiogram was also included. Patients with infection of unknown origin were treated with ceftriaxone plus levofloxacin. Infection requiring antibiotic therapy was found in 83 (23.6%) patients. Multivariate logistic regression analysis showed that atrial fibrillation, pre-stroke mRS greater than 0, lower delta NIHSS, CRP >10 mg/L, and elevated WBC count affected the risk of acute infection (including CRP and WBC in the model ; model). In another model (excluding CRP and WBC), atrial fibrillation, pre-stroke mRS above 0, lower NIHSS delta, hypertension and elevated fibrinogen have been shown to influence the risk of infection in the acute phase of the disease. 231 patients (74.1%) had an mRS < 2 at day 90. Multivariate logistic regression analysis showed younger age, no hypertension, pre-stroke mRS=0, higher delta NIHSS, no acute infection, and CRP <10 mg/L were associated with mRS <2 at day 90. 15.3% of patients died within 90 days after onset. Multivariate logistic regression analysis showed that pre-stroke mRS>0, lower NIHSS delta, hypertension, CRP>10 mg/l, and lowered triglycerides influenced the risk of death. The fourth study (,,Neurological prognostic factors in hospitalized patients with COVID 19 ”) analyzed the impact of various demographic, biochemical and clinical parameters, taking into account 20 different neurological symptoms or signs, as well as the MEWS scale, on the risk of death during hospitalization and oxygen demand during the first 14 days of hospitalization in 349 patients diagnosed with COVID-19 (median aged 64, age range (51-77), women (54, 72%) hospitalized at the University Hospital in Krakow from March 2020 to February 2021 in five Clinical Departments (Neurology, Metabolic Diseases and Diabetology, Infectious Diseases, Internal Medicine, Otolaryngology). The presence of ; high-risk neurological symptoms (stroke or transient cerebral ischemia, impaired consciousness, delirium, convulsions) increased the risk of in-hospital mortality in patients with COVID-19 infection by as much as 3.13 times. The presence of high-risk neurological symptoms and the absence of low-risk symptoms (headache, dizziness headache, depressed mood and fatigue) increased the risk of in-hospital mortality in patients with COVID-19 infection as much as 7.67-fold. The presence of low-risk neurological symptoms reduced the risk of death 6-fold. Regardless of neurological symptoms, the risk of death was increased by: older age, cancer and a higher MEWS score at onset. The absence of low-risk neurological symptoms increased the oxygen demand during hospitalization of COVID-19 patients by 1.86-fold. Regardless of neurological symptoms, the risk of oxygen demand during hospitalization was increased by: older age, male sex, cancer and a higher MEWS score at the onset of the disease.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Jan 15, 2025
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Jan 15, 2025
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http://dl.cm-uj.krakow.pl:8080/publication/5183
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| Edition name | Date |
|---|---|
| ZB-141631 | Jan 15, 2025 |
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