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Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study

Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy i...

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Autores principales: Pilato, Fabio, Silva, Serena, Valente, Iacopo, Distefano, Marisa, Broccolini, Aldobrando, Brunetti, Valerio, Caliandro, Pietro, Marca, Giacomo Della, Di Iorio, Riccardo, Frisullo, Giovanni, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Calandrelli, Rosalinda, Capone, Fioravante, Alexandre, Andrea, Pedicelli, Alessandro, Colosimo, Cesare, Caricato, Anselmo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761293/
https://www.ncbi.nlm.nih.gov/pubmed/33256264
http://dx.doi.org/10.3390/brainsci10120911
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author Pilato, Fabio
Silva, Serena
Valente, Iacopo
Distefano, Marisa
Broccolini, Aldobrando
Brunetti, Valerio
Caliandro, Pietro
Marca, Giacomo Della
Di Iorio, Riccardo
Frisullo, Giovanni
Monforte, Mauro
Morosetti, Roberta
Piano, Carla
Calandrelli, Rosalinda
Capone, Fioravante
Alexandre, Andrea
Pedicelli, Alessandro
Colosimo, Cesare
Caricato, Anselmo
author_facet Pilato, Fabio
Silva, Serena
Valente, Iacopo
Distefano, Marisa
Broccolini, Aldobrando
Brunetti, Valerio
Caliandro, Pietro
Marca, Giacomo Della
Di Iorio, Riccardo
Frisullo, Giovanni
Monforte, Mauro
Morosetti, Roberta
Piano, Carla
Calandrelli, Rosalinda
Capone, Fioravante
Alexandre, Andrea
Pedicelli, Alessandro
Colosimo, Cesare
Caricato, Anselmo
author_sort Pilato, Fabio
collection PubMed
description Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.
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spelling pubmed-77612932020-12-26 Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study Pilato, Fabio Silva, Serena Valente, Iacopo Distefano, Marisa Broccolini, Aldobrando Brunetti, Valerio Caliandro, Pietro Marca, Giacomo Della Di Iorio, Riccardo Frisullo, Giovanni Monforte, Mauro Morosetti, Roberta Piano, Carla Calandrelli, Rosalinda Capone, Fioravante Alexandre, Andrea Pedicelli, Alessandro Colosimo, Cesare Caricato, Anselmo Brain Sci Article Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency. MDPI 2020-11-26 /pmc/articles/PMC7761293/ /pubmed/33256264 http://dx.doi.org/10.3390/brainsci10120911 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pilato, Fabio
Silva, Serena
Valente, Iacopo
Distefano, Marisa
Broccolini, Aldobrando
Brunetti, Valerio
Caliandro, Pietro
Marca, Giacomo Della
Di Iorio, Riccardo
Frisullo, Giovanni
Monforte, Mauro
Morosetti, Roberta
Piano, Carla
Calandrelli, Rosalinda
Capone, Fioravante
Alexandre, Andrea
Pedicelli, Alessandro
Colosimo, Cesare
Caricato, Anselmo
Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title_full Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title_fullStr Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title_full_unstemmed Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title_short Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study
title_sort predicting factors of functional outcome in patients with acute ischemic stroke admitted to neuro-intensive care unit—a prospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761293/
https://www.ncbi.nlm.nih.gov/pubmed/33256264
http://dx.doi.org/10.3390/brainsci10120911
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