Stroke; a journal of cerebral circulation
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Comparative Study
Comparison of ischemic stroke outcomes and patient and hospital characteristics by race/ethnicity and socioeconomic status.
Current literature provides mixed evidence on disparities by race/ethnicity and socioeconomic status in discharge outcomes after hospitalization for acute ischemic stroke. Using comprehensive data from 8 states, we sought to compare inpatient mortality and length of stay by race/ethnicity and socioeconomic status. ⋯ Risk-adjusted inpatient mortality was similar among patients by race/ethnicity but higher among patients from lower income areas. However, this pattern was not evident in sensitivity analyses, including the use of mechanical ventilation as a partial surrogate for stroke severity.
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Comparative Study
Seasonal variation in 30-day mortality after stroke: teaching versus nonteaching hospitals.
A systematic review found an association between the July start of internships and residencies and higher mortality rates for hospitalized patients, but data related to stroke are limited. We assessed seasonal variations in 30-day risk-adjusted mortality rates (RAMRs) after ischemic stroke by hospital teaching status. ⋯ The 30-day RAMR decreased overall, but seasonal patterns were present, with the highest RAMR in January and a smaller peak in July. Because patterns were similar for teaching and nonteaching hospitals, the July peak cannot be explained by the introduction of new trainees in the beginning of the academic year. The reasons for these seasonal patterns warrant further investigation.
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The high prevalence of atrial fibrillation in aging populations leads to an increasing incidence of vitamin K antagonists-associated intracerebral hemorrhages (VKAs-ICH). It remains unclear whether VKAs are causes or risk factors for ICH. We aimed at identifying the specificities of VKAs-ICH. ⋯ A similar anatomic distribution of ICH in patients with or without VKAs suggests that VKAs should not be considered as a cause of ICH because both locations are usually due to different vasculopathies (deep perforating arteries vasculopathy in deep and cerebral amyloid angiopathy in lobar). The different impact of VKAs on ICH volumes according to location suggests a different susceptibility of these vasculopathies to VKAs. This finding may lead to specific therapeutic strategies.
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Subarachnoid hemorrhage (SAH) may appear on computerized tomography scans after mechanical thrombectomy for acute ischemic stroke. The incidence and prognosis of this observation remain unknown. We investigated the frequency and clinical consequences of SAH after treating acute ischemic stroke with a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent. ⋯ SAH on post-therapeutic computerized tomography scans were not uncommon after primary mechanical thrombectomy with a Solitaire stent, but they seemed to be benign. Rescue angioplasty and unidentified, small vessel ruptures due to mechanical stretch during stent retrieval might give rise to these lesions.
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Additional intraventricular hemorrhage leads to higher mortality and worse functional outcome after intracerebral hemorrhage (ICH). Intraventricular fibrinolysis (IVF) with recombinant tissue plasminogen activator (rtPA) is an emerging treatment strategy for such patients. However, experimental studies suggest that rtPA may exert proedematous effects and lead to increased perihemorrhagic edema (PHE) after ICH. We aimed to compare the course of PHE after ICH between patients who received IVF with rtPA and controls matched for ICH volume. ⋯ IVF with rtPA did not lead to a relevant increase in PHE after ICH. rtPA doses used in the current study seem to be safe regarding PHE.