ABSTRACT
60 Table 1Basic characteristics and vascular risk factors in two groupsCharacteristics Closure group (n=38) MM group (n=40) P value Median age 45 54 0.001 Age range 21-65 23-79 Highest age group 30-39 (n=12) & 50-59 (n=12) 50-59 (n=14) Males 23 (61%) 25 (62%) 0.43 Females 15 (39%) 15 (38%) Diabetes 2 (5%) 8 (20%) 0.02 Hypertension 6 (15%) 18 (45%) 0.002 Current smokers 6 (15%) 5 (12.5%) 0.41 Ex-smokers 4 (11%) 4 (10%) 0.46 Hyperlipidaemia 13 (34%) 23 (57%) 0.018 60 Figure 1PFO MDTs outcome closure group 48% (n=38), Medical Management group 51% (n=40) and one patients is waiting to be reviewed to decide about the closure[Figure omitted. See PDF] 60 Figure 2RoPE score is used to identify the patients whose PFOs are likely to be pathogenic rather than incidental. The score involves multiple variables based on vascular risk factors such as diabetes, hypertension, prior history of stroke or TIA and smoking history as well as patientsage and stroke features (cortical and non cortical infarcts)[Figure omitted. See PDF]ConclusionPFO closures at NUH were deemed to be safe day case procedures with no pressure placed on either the TOE or GA services by performing cases under LA and using ICE during the COVID-19 pandemic. A robust and evidence-based practice was followed to choose the suitable patients for the procedure in structured MDT meetings ensuring equitable access for all surrounding hospitals.Conflict of InterestNone
ABSTRACT
BACKGROUND: Recent reports have suggested that atrial fibrillation (AF) is more prevalent in the large vessel occlusion (LVO) subgroup of acute ischaemic stroke patients. Given the association between left atrial enlargement (LAE) and AF, we sought to evaluate the feasibility of assessing LAE on non-gated CT and its association with LVO in the hyperacute stroke setting. METHODS: We analysed our prospectively collected database that included all stroke patients referred for consideration of endovascular treatment between April 14, 2020, and May 21, 2020. During this period, a CT chest was included in our regional stroke protocol to aid triage of patients suspected for COVID-19 from which cardiac measurements were obtained. Patients were dichotomized into LVO and no-LVO groups, and LA measurements were trichotomized into normal, borderline, and enlarged. Univariate analyses were performed between groups. RESULTS: Of the included 38 patients, 21 were categorized as LVO and 17 as no LVO. There was a statistically significant association between LAE and LVO (p = 0.028). No significant difference was demonstrated between groups for the baseline AF and other clinical characteristics, except for baseline NIHSS (p = 0.0005). There was excellent inter- and intra-rater reliability (ICC = 0.969) for LA measurements. CONCLUSION: Our study provides preliminary data to suggest LAE is more prevalent in the LVO stroke subgroup at presentation and can be reliably assessed on non-gated CT in the hyperacute setting. These findings have potential implications for stratifying secondary management and may prompt a more rigorous pursuit of occult AF or other cardiac causes of stroke.