The Impact of Diabetes Mellitus and Admission Hyperglycemia on Clinical Outcomes after Recanalization Therapies for Acute Ischemic Stroke: STAY ALIVE National Prospective Registry.

It was previously reported that diabetes mellitus (DM) and admission hyperglycemia (aHG) were associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). Our study aimed to assess the prognostic effect of DM and aHG (≥7.8 mmol/L) on clinical outcomes in patients treated with recanalization therapies (IVT and MT). Our multicentric study was based on data from the prospective STAY ALIVE stroke registry between November 2017 and January 2020. We compared the demographic data, clinical parameters and time metrics between recanalized DM and non-DM groups, and we analyzed the impact of DM and aHG on 90-day functional outcome, 90-day mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Statistical analyses were also performed in two subgroups: (1) patients treated with IVT alone and (2) patients treated with MT. Altogether, we included 695 patients from the three participating stroke centers in Hungary. Regarding the overall population, patients with diabetes were older (72 vs. 67 years, p < 0.001) and comorbidities were more frequent. There were significant differences in the 90-day good functional outcome (48.9% vs. 66.7%, p < 0.001), 90-day mortality (21.9% vs. 11.6%, p < 0.001) and the rate of symptomatic intracranial hemorrhaging (sICH) (7.8% vs. 2.2%, p < 0.001) between the groups. Diabetes and aHG were independently associated with a poor clinical outcome (OR 2.02, 95% CI 1.31−3.11, p = 0.001; OR 2.09, 95% CI 1.39−3.14, p < 0.001) and mortality at 3 months (OR 2.45, 95% CI 1.35−4.47, p = 0.003; OR 2.42, 95% CI 1.37−4.28, p = 0.002) and sICH (OR 4.32, 95% CI 1.54−12.09, p = 0.005; OR 4.61, 95% CI 1.58−13.39, p = 0.005) in the overall population. However, the presence of DM and aHG was not correlated with successful reperfusion (OR 0.39, 95% CI 0.09−1.67, p = 0.205; OR 0.42, 95% CI 0.09−1.97, p = 0.274) after MT. Our study revealed that diabetes and hyperglycemia on admission were correlated with poor clinical outcomes at 3 months in patients with acute stroke regardless of the recanalization method. In addition, the variables were also associated with sICH after recanalization therapies. However, successful recanalization was not associated with DM and aHG in patients who underwent MT.

Optimization of Large Vessel Occlusion Detection in Acute Ischemic Stroke Using Machine Learning Methods.

The early detection of large-vessel occlusion (LVO) strokes is increasingly important as these patients are potential candidates for endovascular therapy, the availability of which is limited. Prehospital LVO detection scales mainly contain symptom variables only; however, recent studies revealed that other types of variables could be useful as well. Our aim was to comprehensively assess the predictive ability of several clinical variables for LVO prediction and to develop an optimal combination of them using machine learning tools. We have retrospectively analysed data from a prospectively collected multi-centre stroke registry. Data on 41 variables were collected and divided into four groups (baseline vital parameters/demographic data, medical history, laboratory values, and symptoms). Following the univariate analysis, the LASSO method was used for feature selection to select an optimal combination of variables, and various machine learning methods (random forest (RF), logistic regression (LR), elastic net method (ENM), and simple neural network (SNN)) were applied to optimize the performance of the model. A total of 526 patients were included. Several neurological symptoms were more common and more severe in the group of LVO patients. Atrial fibrillation (AF) was more common, and serum white blood cell (WBC) counts were higher in the LVO group, while systolic blood pressure (SBP) was lower among LVO patients. Using the LASSO method, nine variables were selected for modelling (six symptom variables, AF, chronic heart failure, and WBC count). When applying machine learning methods and 10-fold cross validation using the selected variables, all models proved to have an AUC between 0.736 (RF) and 0.775 (LR), similar to the performance of National Institutes of Health Stroke Scale (AUC: 0.790). Our study highlights that, although certain neurological symptoms have the best ability to predict an LVO, other variables (such as AF and CHF in medical history and white blood cell counts) should also be included in multivariate models to optimize their efficiency.

Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects.

INTRODUCTION: Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15-20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. We sought to assess the efficacy and safety of EVT in tandem lesions, particularly the EICA stenting management. METHODS: We retrospectively analyzed all patients with anterior circulation stroke associated with EICA lesion and receiving EVT in the three participated stroke centers between November 2017 and December 2020. Patients' data were collected from our prospective stroke registry (STAY ALIVE). Patients enrolled in our study were divided into two groups depending on whether acute carotid stenting (ACS) or balloon angioplasty only (BAO) technique was used. Our primary outcome was the 90-day functional outcome assessed by modified Rankin scale (mRS). Mortality at 90 days and symptomatic intracranial hemorrhage (sICH) were considered as secondary outcomes. RESULTS: A total of 101 patients (age: 67 ± 10 years, 38.6% female) were enrolled in our study, including 29 (28.3%) BAO cases, and 72 (71.3%) patients treated with ACS. Patients in the BAO group were slightly older (70 ± 9 years vs. 66 ± 10 years, p = 0.054), and had higher prevalence of comorbidities such as hypertension (100.0% vs. 59.4%, p < 0.001). There was no significant difference in favorable outcomes (51.7% vs. 54.4%, p = 0.808) between the groups. However, we observed a trend towards higher rates of sICH (8.3% vs. 3.4%, p = 0.382) and 90-day mortality (23.5% vs. 13.8%, p = 0.278) with significantly higher frequency of distal embolization (39.1% vs. 17.9%, p = 0.043) in patients with ACS. In the overall population age (p = 0.013), atrial fibrillation (AF) (p = 0.008), National Institutes of Health Stroke Scale (NIHSS) baseline (p = 0.029), and successful recanalization (p = 0.023) were associated with favorable outcome. CONCLUSION: Endovascular approach of EICA in addition to MT was safe and effective in tandem occlusion of anterior circulation. Furthermore, our results suggest that balloon angioplasty technique without acute stenting shows a comparable favorable outcome rate to ACS with moderately less hemorrhagic events and mortality rates.