| 1. |
- Ahmed, Niaz, et al.
(author)
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Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018.
- 2019
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In: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 4:4, s. 307-317
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Journal article (peer-reviewed)abstract
- The purpose of the European Stroke Organisation-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year's European Stroke Organisation-Karolinska Stroke Update Meeting was held in Stockholm on 11-13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and at www.eso-karolinska.org and http://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.
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| 2. |
- Katsanos, Aristeidis H, et al.
(author)
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Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis.
- 2022
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In: Neurology. - 1526-632X. ; 98:3
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Journal article (peer-reviewed)abstract
- To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).A study was eligible if it enrolled AIS patients older than 18 years, with an LVO treated with either successful or unsuccessful EVT, and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed using a generalized linear mixed-effects model.A total of 5874 patients (mean age: 69±14 years, 50% women, median NIHSS on admission: 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common OR=0.82, 95%CI:0.80-0.85; adjusted common OR=0.88, 95%CI:0.84-0.93) and modified Ranking Scale score≤2 (unadjusted OR=0.82, 95%CI:0.79-0.85; adjusted OR=0.87, 95%CI:0.82-0.93), and a higher odds of all-cause mortality (unadjusted OR=1.18, 95%CI:1.13-1.24; adjusted OR=1.15, 95%CI:1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurological deterioration (unadjusted OR=1.14, 95%CI:1.07-1.21; adjusted OR=1.14, 95%CI:1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR=1.20, 95%CI:1.09-1.29; adjusted OR=1.20, 95%CI:1.03-1.38) after EVT.Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurological deterioration, three-month mortality, and worse three-month functional outcomes.
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| 3. |
- Matusevičius, Marius
(author)
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Subtypes of ischemic stroke : analysis of revascularization therapy, stroke etiology, and the role of blood pressure
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Treatment with intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) improve outcomes for patients with acute ischemic stroke. The efficacy and safety of IVT and EVT may differ based on specific patient subgroups. Where, and in essence how, the blood clot was formed may affect treatment outcomes. Similarly, a patient’s blood pressure (BP) after a treatment may alter the treatment’s effect. This doctoral thesis aims to investigate how stroke etiology and different blood pressure parameters may affect patients with acute ischemic stroke treated with IVT or EVT. Methods: All projects performed retrospective analyses on acute ischemic stroke patients in prospectively collected databases. Project 1-4 used the Safe implementation of treatment in stroke (SITS) international database. Project 5 registered all patients treated with EVT at the Karolinska University hospital during 2018-02-12 – 2020-02-11. Projects 1 and 3 investigated stroke etiologies, with project 1 investigating IVT treatment for patients with a lacunar stroke while project 3 compared EVT treatment for patients with large artery atherosclerosis and cardiac embolism. Projects 2, 4, and 5 investigated the effect of mean systolic BP (SBP), SBP change, and SBP course during the first 24 hours after EVT treatment, respectively. Primary outcomes were functional independence defined as a modified Rankin scale (mRS) score of 0-2 at 3-month follow-up, and successful reperfusion defined as a modified treatment in cerebral infarction score of 2b-3. Secondary outcomes included death by 3-month follow-up and symptomatic intracerebral hemorrhage (SICH). Multivariate regression analyses, including linear, logistic, and Poisson models, were used in the projects where applicable to adjust for potential confounding effects, in addition to propensity score matching in project 1. Projects 1 and 3 included unadjusted aggregate data meta-analyses of current literature. Results: Project 1 found that IVT treatment led to better outcomes for LS patients when compared to non-IVT treated LS patients and non-LS IVT treated patients, respectively, which was also confirmed in an unadjusted meta-analysis of 13 studies. Project 3 found that after adjusting for known confounders, LAA patients had worse outcomes that patients with CE. However, the unadjusted meta-analysis of 25 studies did not find any difference. Project 2 found that higher mean SBP after EVT was associated with lower chances of functional independence for patients with successful reperfusion, and a higher risk of SICH regardless of reperfusion grade. Projects 4 and 5 found that an increase in SBP or a deviation from a linear decreasing SBP course after EVT treatment were associated with worse outcomes, respectively. Conclusions: The projects in this thesis highlight the associations of stroke etiology and BP with outcomes after reperfusion therapy in acute ischemic stroke patients, suggesting that lacunar stroke patients should not be denied IVT treatment if otherwise eligible, that stroke etiology may affect EVT outcomes, and that generally higher SBP values over the first 24 hours after EVT treatment were associated with worse outcomes.
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