Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, May 21, 2021

Early clinical surrogates for outcome prediction after stroke thrombectomy in daily clinical practice

What the fuck good does prediction of non-recovery do? Do you tell your patients you have nothing that will get them 100% recovered? Or will you be like my doctor and know nothing and tell nothing about stroke?

Early clinical surrogates for outcome prediction after stroke thrombectomy in daily clinical practice

  1. Lukas Meyer1,
  2. Gabriel Broocks1,
  3. Matthias Bechstein1,
  4. Fabian Flottmann1,
  5. Hannes Leischner1,
  6. Caspar Brekenfeld1,
  7. Gerhard Schön2,
  8. Milani Deb-Chatterji3,
  9. Anna Alegiani3,
  10. Götz Thomalla3,
  11. Jens Fiehler1,
  12. Helge Kniep1,
  13. Uta Hanning1
  14. For the German Stroke Registry – Endovascular Treatment (GSR – ET)
  1. Correspondence to Dr Lukas Meyer, Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany; lu.meyer@uke.de

Abstract

Background and purpose To investigate early clinical surrogates for long-term independency of patients treated with thrombectomy for large vessel occlusion stroke in daily clinical routine.

Methods All patients with anterior circulation stroke enrolled in the German Stroke Registry-Endovascular Treatment from 07/2015 to 04/2018 were analysed. National Institute of Health Stroke Scale (NIHSS) on admission, NIHSS percentage change, NIHSS delta and NIHSS at 24 hours as well as existing binary definitions of early neurological improvement (ENI; improvement of 8 (major ENI)/10 (dramatic ENI) NIHSS points or reaching 0/1 were compared for predicting functional outcome at 90 days using the modified Rankin Scale (mRS). Excellent and favourable outcome were defined as 0–1 and 0–2, respectively.

Results Among 2262 endovasculary treated patients with acute ischaemic anterior circulation stroke, NIHSS at 24 hours had the highest discriminative ability to predict excellent (receiver operator characteristics (ROC)NIHSS 24 hours area under the curve (AUC) 0.86 (0.84–0.88)) and favourable long-term functional outcome (ROCNIHSS 24 hours AUC 0.86 (0.85–0.88)) in comparison to NIHSS percentage change (ROC% change AUC mRS ≤1: 0.81 (0.78–0.83) mRS ≤2: 0.81 (0.79–0.83)), NIHSS delta change (ROCΔ change AUC mRS ≤1: 0.74 (0.72–0.77), mRS ≤2: 0.77 (0.74–0.79)) and NIHSS admission (ROCAdm AUC mRS ≤1: 0.70 (0.68–0.73), mRS ≤2: 0.67 (0.68–0.71)). Advanced age was the only independent predictor (adjusted OR 1.05, 95% CI 1.03 to 1.07, p<0.001) for turning the outcome prognosis from favourable (mRS ≤2) to poor (mRS ≥4) at 90 days.

Conclusion The NIHSS at 24 hours postintervention with a threshold of ≤8 points serves best as a surrogate for long-term functional outcome after thrombectomy for anterior circulation stroke in daily clinical practice. Only advanced age significantly decreases its predictive value.

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