Outcomes and Characteristics of Large Vessel Occlusion Patients in a Multi-Hospital System with National Institute of Health Stroke Scale (NIHSS) ≤ 5 Treated with Endovascular Thrombectomy vs Medical Management

https://digitalcommons.psjhealth.org/other_pubs/1067/thumbnail.jp

A Propensity-Matched Analysis of Outcomes for Patients With M2 Branch Occlusions at Endovascular Stroke Centers

Introduction: Endovascular therapy (EVT) for Emergent Large Vessel Occlusion (ELVO) is recommended for patients with acute proximal MCA (M1 segment) occlusions (Class I, level A evidence), but the benefits of EVT are uncertain in patients with M2 and more distal occlusions. The purpose of this study was to compare the efficacy and outcomes of EVT-treated M2 ELVOs with EVT-treated M1 ELVOs, and to examine the outcomes of EVT-treated M2 ELVO patients with those whose M2 ELVOs were not treated. Methods: Data were obtained from a multi-hospital system of patients from January 2014 and May 2018. Two propensity score (PS)-based nearest-neighbor matching analyses were used to match similar patients who had 1) EVT-treated M1 vs EVT-treated M2 ELVOs and 2) EVT-treated vs non-EVT-treated M2 ELVOs. Outcomes included length of stay (LOS), rate of successful reperfusion, discharge disposition, symptomatic intracranial hemorrhage (sICH), and discharge mRS. Chi-squared, Fisher’s exact, and Mann-Whitney U tests were used to compare matched patients. Results: Overall, 160 patients with EVT-treated M2 ELVOs, 350 with EVT-treated M1 ELVOs, and 113 with non-EVT-treated M2 ELVOs were included. Propensity score analyses resulted in 118 matched patients with EVT-treated M2 and EVT-treated M1 occlusions and 70 matched patients with EVT-treated and non-EVT-treated M2 ELVOs. M2 ELVOs made up 20% of all LVO patients. Treated M1 and M2 ELVOs were similar with respect to baseline NIHSS and outcomes. When attempted,intra-arterial reperfusion of M2 ELVOs was achieved at comparable rates to M1 ELVOs with equal rates of sICH (1.7%). Higher NIHSS was associated with EVT of M2 ELVOs (15.00[8.50,21.00] vs 7.00[4.00,17.75]; p\u3c0.001). Rates of mortality trended more favorably in treated M2 ELVOs (12.9% vs 20), which was not statistically significant (p=0.362). Conclusions: EVT for M2 ELVOs is as safe and effective as EVT for M1 vessel ELVOs. Rates of successful reperfusion, discharge mRS, LOS, sICH, discharge disposition and mortality are similar among EVT treated M2 and EVT treated M1 ELVOs. Though not statistically significant, EVT for patients with M2 ELVOs resulted in favorable trends toward higher survival rates of potential clinical significance

Implementation of Coordinated Telestroke Program in an Urban Setting Improves Acute Stroke Care

Purpose: Telestroke has been shown to improve acute ischemic stroke (AIS) care in rural settings, but few studies have examined the impact of telestroke in an urban setting. In an urban area, there was a planned transition from an outpatient-based acute stroke provider pool to a centralized telehealth team of neurovascular and neurocritical care providers. This study assessed the impact of this change by comparing patient outcomes during three time periods: pre-initiation (PRE), transition after initiation (TRAN) and post-transition (POST). Methods: Data for AIS patients 18 and older from five urban hospitals were used. Outcomes were hospital length of stay (LOS) and percentage of patients who had a door-to-needle time (DTN) \u3c45 and \u3c60 minutes, IV-alteplase or endovascular treatment, an IV-alteplase-related complication, and a discharge other than to home or rehab. Generalized linear and Cox proportional hazard models were used to compare outcomes for patients discharged during PRE (June 2015 - June 2016), TRAN (July 2016 – December 2016) and POST (January 2017 – March 2018) time periods adjusting for arrival mode, gender, admit NIHSS, age, and arrival time. Results: Of 4,984 patients that met inclusion criteria, there were 2,075 treated in PRE, 1,052 in TRAN and 1,857 in POST. After adjustment, TRAN patients were 1.77 times more likely to be treated with IV-alteplase than PRE patients (p=.013). POST patients were 2.46 times more likely to receive endovascular treatment than PRE patients (p=.009) and 2.07 times as likely as those in the TRAN period (p=.007). Patients in the TRAN period were 1.63 times more likely to be treated with IV alteplase in \u3c60 minutes (p\u3c.001) and 2.22 times more likely in the POST period (p=.002) compared to those in PRE. There were no significant differences in the odds of being treated in \u3c45 minutes, LOS, or discharge disposition. Conclusion: A transition to a specialty stroke care through a telestroke network showed improvements in treatment rates and percentage of patients with DTN less than 60 minutes.https://digitalcommons.psjhealth.org/other_pubs/1072/thumbnail.jp

Complications from IV Alteplase in Mild Stroke Patients in a Multi-state Health System

https://digitalcommons.psjhealth.org/other_pubs/1071/thumbnail.jp

Cost Analysis of Implementing Standardized Stroke Patient Education Materials in a Large Five State Health System

https://digitalcommons.psjhealth.org/other_pubs/1052/thumbnail.jp

Large Five State Health System Standardizes Stroke Patient Education While Significantly Improving Health Literacy

https://digitalcommons.psjhealth.org/other_pubs/1053/thumbnail.jp

Quality of life among injectable and oral disease-modifying therapy users in the Pacific Northwest Multiple Sclerosis Registry.

BACKGROUND: Nine oral disease-modifying therapies (DMTs) have been approved for the treatment of multiple sclerosis (MS) in the United States. Few studies have examined self-reported quality of life (QoL) and functional status outcomes among patients who switch to oral medications from injectable MS therapies. This study compares self-reported QoL and disability status between participants switching from injectable to oral DMTs, to those who stay on injectable DMTs continuously for the same time period. METHODS: Longitudinal data were assessed from relapsing MS participants in the Pacific Northwest MS Registry completing a minimum of two surveys between 2012 and 2018 with a maximum of 36 months between surveys. Stayers were defined as those who remained on injectable DMTs continuously from Time 1 to Time 2; switchers were those who switched from injectable to either fingolimod, teriflunomide or dimethyl fumarate during the same time interval. Outcomes of interest were physical and psychological QoL, measured by the Multiple Sclerosis Impact Scale (MSIS-29), and disability, measured by the Patient Determined Disease Steps (PDDS). To analyze the effect of switching to oral DMT on outcomes at Time 2, a one-to-two propensity score matching (PSM) was used to match switchers to stayers. Outcomes at Time 2 were analyzed using paired t-test for QoL scores, and Stuart Maxwell test for PDDS as a categorical variable. RESULTS: Among 2385 participants who returned consecutive yearly surveys, 413 met the inclusion criteria for stayers and 66 for switchers. After one-to-two PSM, 124 stayers were matched to 62 switchers. Paired t-test showed no differences between switchers and stayers for physical (mean difference: - 0.41; [95% confidence interval CI: - 3.3-2.4]; p = 0.78) or psychological (mean difference: - 0.23; [95% CI, - 1.6- 1.1]; p = 0.74) QoL. Additionally, no differences were seen between switchers and stayers in self-reported disability status. CONCLUSIONS: MS registry participants who switched to an oral DMT from injectable showed no significant differences in QoL or self-reported disability status compared to those remaining on injectable DMT continuously in the same time period

GABAB receptors in maintenance of neocortical circuit function

Activation of metabotropic GABA(B) receptors (GABA(B)Rs), which enhances tonic GABA current, substantially increases the frequency of spontaneous seizures. Despite these pro-epileptic consequences of GABA(B)R activation, mice lacking functional GABA(B) receptors (GABA(B1)R KO mice) exhibit clonic and rare absence seizures. To examine these mice further, we recorded excitatory and inhibitory synaptic inputs and tonic GABA currents from Layer 2 neocortical pyramidal neurons of GABA(B1)R WT and KO mice (P30-40). Tonic current was increased while the frequency of synaptic inputs was unchanged in KO mice relative to WT littermates. The neocortical laminar distribution of interneuron subtypes derived from the medial ganglionic eminence (MGE) was also not statistically different in KO mice relative to WT while the number of calretinin-positive, caudal GEderived, cells in Layer 1 was reduced. Transplantation of MGE progenitors obtained from KO mice lacking functional GABA(B1)R did not increase tonic inhibition in the host brain above that of media-injected controls. Taken together, these results suggest a complex role for GABA(B) receptors in mediating neocortical circuit function

A novel ACE2 decoy for both neutralization of SARS-CoV-2 variants and killing of infected cells

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to millions of infections and deaths worldwide. As this virus evolves rapidly, there is a high need for treatment options that can win the race against new emerging variants of concern. Here, we describe a novel immunotherapeutic drug based on the SARS-CoV-2 entry receptor ACE2 and provide experimental evidence that it cannot only be used for (i) neutralization of SARS-CoV-2 in vitro and in SARS-CoV-2-infected animal models but also for (ii) clearance of virus-infected cells. For the latter purpose, we equipped the ACE2 decoy with an epitope tag. Thereby, we converted it to an adapter molecule, which we successfully applied in the modular platforms UniMAB and UniCAR for retargeting of either unmodified or universal chimeric antigen receptor-modified immune effector cells. Our results pave the way for a clinical application of this novel ACE2 decoy, which will clearly improve COVID-19 treatment