Browsing by Author "Tsivgoulis, Georgios"

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    Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
    (2021) Nogueira, Raúl G.; Qureshi, Muhammad M.; Abdalkader, Mohamad; Martins, Sheila Ouriques; Yamagami, Hiroshi; Mansour, Ossama Yassin; Qiu, Zhongming; Sathya, Anvitha; Czlonkowska, Anna; Tsivgoulis, Georgios; Aguiar de Sousa, Diana; Demeestere, Jelle; Mikulik, Robert; Vanacker, Peter; Siegler, James E.; Kõrv, Janika; Biller, Jose; Liang, Conrad W.; Sangha, Navdeep S.; Zha, Alicia M.; Czap, Alexandra L.; Holmstedt, Christine Anne; Turan, Tanya N.; Ntaios, George; Malhotra, Konark; Tayal, Ashis; Loochtan, Aaron; Ranta, Annamarei; Mistry, Eva A.; Alexandrov, Anne W.; Huang, David Y.; Yaghi, Shadi; Raz, Eytan; Sheth, Sunil A.; Mohammaden, Mahmoud H.; Frankel, Michael; Bila Lamou, Eric Guemekane; Aref, Hany M.; Elbassiouny, Ahmed; Hassan, Farouk; Menecie, Tarek; Mustafa, Wessam; Shokr, Hossam M.; Roushdy, Tamer; Sarfo, Fred S.; Alabi, Tolulope Oyetunde; Arabambi, Babawale; Nwazor, Ernest O.; Sunmonu, Taofiki Ajao; Wahab, Kolawole; Yaria, Joseph; Hussein Mohammed, Haytham; Adebayo, Philip B.; Riahi, Anis D.; Sassi, Samia Ben; Navia, Víctor; Olavarría, Verónica
    Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
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    Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
    (2020) Tsivgoulis, Georgios; Saqqur, Maher; Sharma, Vijay K.; Brunser, Alejandro; Eggers, Jürgen; Mikulik, Robert; Katsanos, Aristeidis H.; Sergentanis, Theodore N.; Vadikolias, Konstantinos; Perren, Fabienne; Rubiera, Marta; Shahripour, Reza Bavarsad; Nguyen, Huy Thang; Martínez-Sánchez, Patricia; Safouris, Apostolos; Heliopoulos, Ioannis; Shuaib, Ashfaq; Derksen, Carol; Voumvourakis, Konstantinos; Psaltopoulou, Theodora; Alexandrov, Anne W.; Alexandrov, Andrei V.; CLOTBUST-PRO investigators
    Background and Purpose Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. Methods We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. Results We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (jos-2019-01648P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). Conclusions Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

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