Interventionelle Therapie von Stenosen der extracraniellen und intracraniellen Abschnitte der Arteria vertebralis mit technischer Erfolgs- und Komplikationsrate und 30 Tage follow-up

Ziele der Studie Ziel dieser Studie war die Erfolgsrate der interventionellen Therapie der Arteria vertebralis vorwiegend des extracraniellen Abschnittes zu belegen mit peri-und postinterventionellen Komplikationsrate und der klinischen Symptomatik innerhalb von 30 Tagen. Patienten und Methoden 116 Patienten mit Stenosen im Bereich des extracraniellen und intracraniellen Abschnittes der Arteria vertebralis wurden interventionell behandelt. Bei 74 Patienten (63.8 %) befanden sich die Stenosen im extracraniellen Abschnitt und bei 42 Patienten (36.2 %) waren die Stenosen intracraniell, haupsächlich im V4-Abschnitt lokalisert. Es wurden die peri-und postinterventionellen Komplikationsrate und das klinische Outcome innerhalb von 30 Tagen beobachtet. Ergebnisse Insgesamt waren 108 der Patienten (93.1 %) von 116 klinisch-neurologisch peri-und postinterventionell unauffällig. Bei 8 Patienten traten Komplikationen auf, wovon bei 6 der Patienten eine interventionelle Therapie im intracraniellen Abschnitt der A. vertebralis erfolgte. Hierunter traten hauptsächlich Dissektionen auf. Als erster Hauptrisikofaktor in unserer Studie war mit 54.3% die arterielle Hypertonie, gefolgt von Diabetes mellitus mit 25% und als drittwichtigster Risikofaktor mit 20.7 % der Nikotinabusus. Schlussfolgerung Die interventionelle Therapie der extracraniellen Arteria vertebralis mittels Stent und/oder Ballondilatation zeigte sich als erfolgsversprechend. Innerhalb von 30 Tagen wurde keinerlei Symptomatik berichtet oder beobachtet.Objective The purpose of the study was to analyze the success rate of the interventional therapy of the extracerebral vertebral arteries and the post interventional complications during a period of 30 days. Patients and methods We performed angiographies on 116 patients with different extra/ and intracerebral stenoses of the A. vertebralis. In 74 patients we found extracerebral stenoses and in 42 patients intracerebral stenoses, predominantly in the V4 Segment. We had a follow-up for 30 days observing the success and the complications rate. Results From the total of 116 patients, 108 patients (93.1%) showed no complications. We observed complication by 8 patients, 6 of whom were treated interventional in the intracerebral segment of the A. vertebralis with the main complication being a dissection. The first risk factor in our study was the arterial hypertension with a percent of 54,3%, followed by Diabetes mellitus with 25 % and smoking with 20,7%. Conclusions The interventional therapy of the extracerebral vertebral artery with Stent and PTA showed successful results. Within a period of 30 days there were no complications

Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination

SARS-CoV-2 infection is associated with an increased rate of thromboembolic events and mortality. Diferent vaccines are globally used to limit the pandemic. In this report, we present the case of two young female patients with newly diagnosed cerebral sinus vein thrombosis occurring after injection of the vector-based ChAdOx1 vaccine. Both patients presented with unusual headache only. The two of them used an estrogen-containing contraception, had had a history of deep venous thrombosis, and both had MTHFR mutations. Both patients developed SARS-CoV-2 specifc humoral and cellular immunity including both CD4 and CD8 T cells. This rare, but serious complication needs to be considered after vaccination of young females, even if there is no evidence of heparin-induced thrombocytopenia

Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes

BackgroundUntil recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns.MethodsIn this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge).ResultsOnly 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38–0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement.ConclusionPerception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public’s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired

Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics.Results: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%).Conclusions: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.</p

Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes

Background: Until recently, public education campaigns aimed at improving helpseeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns. Methods: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72  h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge). Results: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38–0.76]; p  =  0.001), had lower treatment rates, and had less improvement in MRS scores (b  =  0.40, p  =  0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement. Conclusion: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public’s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired

Hybrid‐Mobile Stroke Unit: Opening the Indication Spectrum for Stroke Mimics and Beyond

Background Despite proven benefits, the use of single‐purpose mobile stroke units (MSUs) has raised concerns about their effective and cost‐efficient integration into clinical practice, especially when considered for operation in nonurban areas. The MSU concept may benefit from opening the indication spectrum to include frequent stroke mimics and additional emergencies. Methods The current observational study evaluated benefits for the treatment and triage decision‐making of use of an MSU with extended capabilities (Hybrid‐MSU), also including radiography, ultrasonography, extended point‐of‐care laboratory, ECG, electroencephalography, and advanced medications. Apart from patients with a dispatch code for “stroke”, the ambulance was also dispatched to those with codes for “seizures”, “falls with head trauma”, “headache”, “unconsciousness”, “infection and pandemic”, “chest pain”, and “breathing problems”. Results For 250 patients treated by the Hybrid‐MSU, but not for 250 conventionally treated patients, the prehospital diagnostic workup allowed, apart from treatment with stroke thrombolytics (n=15), prehospital administration of specific anticonvulsants (n=15), antibiotics (n=5), early secondary stroke prophylaxis with aspirin (n=49), and the Sepsis Six bundle (n=2). Prehospital diagnosis avoided 215 (86.0%) admissions to the emergency department, either by management at home (n=116, 46.4%) or by directly transferring patients to the required specialized wards (n=99, 39.6%). Conclusion The current study demonstrates the feasibility of the use of a Hybrid‐MSU and indicates its potential benefits for prehospital treatment and triage decision‐making. Opening the indication spectrum, together with an act‐alone ability, could be a key in the future integration of MSUs into routine health care