11 research outputs found
Treatment of Acute Intracranial Vertebrobasilar Dissection with Angioplasty and Stent Placement: Report of Two Cases
Acute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection
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Abstract TP25: Outcomes of Endovascular Thrombectomy in Late-presenting Patients: Findings From the Florida Stroke Registry
Introduction:
It is unclear whether the outcomes of late presenting patients (6-24 hrs from symptom onset) receiving endovascular thrombectomy (EVT) in routine clinical practice parallels the favorable results of recently completed randomized trials. We evaluated characteristics and outcomes of EVT utilization, over the past decade, for late and early presenting (≤ 6 hrs from onset) patients.
Methods:
From Jan 2010 to Jan 2019, 84,346 ischemic stroke patients presenting within 24 hrs of symptoms were enrolled in the Florida Stroke Registry. Differences in clinical characteristics, utilization trends and outcomes at discharge were compared between late vs. early presenting EVT patients using multivariable regression analysis.
Results:
Among 5,702 EVT patients (mean age 71±15, 48% women), 1,580 (28%) were late presenting. Late presenting EVT patients had higher rates of private insurance (39% vs 35%), dyslipidemia (39% vs 35%) and smoking (16% vs.13% ) but lower rates of Hispanic patients (19% vs 24%) and atrial fibrillation (34% vs 37%.). Late presenting patients had lower National Institute of Health Stroke Scores [median 14 (IQR=12) vs 17 (IQR=11)] and rates of thrombolysis (6% vs 58%). Short term discharge outcomes and treatment complications are shown in Table. In multivariable analysis adjusting for age, sex, stroke severity and intravenous thrombolysis, late presenting EVT patients had similar symptomatic intracerebral hemorrhage rates [OR 1.02 (0.72-1.45)] and outcomes but were less likely to ambulate independently at discharge (OR 0.80, 95% CI 0.70-0.92) compared to early presenting EVT patients.
Discussion:
Over the past decade, nearly a third of EVT patients were treated after 6 hours from onset. In clinical practice late EVT carries comparable safety and favorable outcome profiles to early EVT
Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study
Background: Racial‐ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals. Methods and Results: Seventy‐five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010–2014). Logistic regression models examined racial‐ethnic differences in acute stroke performance measures and defect‐free care (intravenous tissue plasminogen activator treatment, in‐hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non‐Hispanic white (NHW), 18% were non‐Hispanic black (NHB), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico. NHW patients were the oldest, followed by Hispanics, and NHBs. Defect‐free care was greatest among NHBs (81%), followed by NHWs (79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (P Conclusions: Racial‐ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial‐ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence‐based acute stroke quality improvement programs is required to improve stroke care and minimize racial‐ethnic disparities, particularly in resource‐strained Puerto Rico
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Abstract TP23: Safety and Outcome of Endovascular Therapy in Patients With Minor Stroke: Florida Puerto Rico Collaboration to Reduce Stroke Disparities Study
Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study
Background: Racial‐ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals. Methods and Results: Seventy‐five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010–2014). Logistic regression models examined racial‐ethnic differences in acute stroke performance measures and defect‐free care (intravenous tissue plasminogen activator treatment, in‐hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non‐Hispanic white (NHW), 18% were non‐Hispanic black (NHB), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico. NHW patients were the oldest, followed by Hispanics, and NHBs. Defect‐free care was greatest among NHBs (81%), followed by NHWs (79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (P Conclusions: Racial‐ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial‐ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence‐based acute stroke quality improvement programs is required to improve stroke care and minimize racial‐ethnic disparities, particularly in resource‐strained Puerto Rico