NDLI: Should ischemic stroke patients with aphasia or high National Institutes of Health stroke scale score undergo preprocedural intubation and endovascular treatment?

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Should ischemic stroke patients with aphasia or high National Institutes of Health stroke scale score undergo preprocedural intubation and endovascular treatment?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hassan, Ameer E. Adil, Malik M. Zacharatos, Haralabos Rahim, Basit Chaudhry, Saqib A. Tekle, Wondwossen G. Qureshi, Adnan I.
Description	Author Affiliation: Hassan AE ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota); Adil MM ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.); Zacharatos H ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.); Rahim B ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.); Chaudhry SA ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.); Tekle WG ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota); Qureshi AI ( Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.)
Abstract	BACKGROUND: Presence of aphasia or severe neurologic deficits is considered an indication for preprocedural intubation (PPI) for endovascular treatment (ET) in acute ischemic stroke patients. We determined the feasibility, technical success rates, and outcomes of ET without PPI in 2 groups of patients: those with aphasia and those with an admission NIHSS score of 20 or more. METHODS: The rates of intraprocedural intubation (IPI), good functional outcome at discharge (modified Rankin Scale score of 0-2), mortality, and intracerebral hemorrhage (ICH) were compared between those who did or did not undergo PPI in the above-mentioned patient groups. RESULTS: A total of 60 (50%) of 120 patients with aphasia underwent ET without PPI; 6 of 60 patients required IPI. The odds of any ICH (odds ratio [OR] 6.3) and in-hospital mortality (OR 9.3) were significantly higher in those undergoing PPI. In the second analysis, 36 (39%) of 93 patients with an NIHSS score of 20 or more underwent ET without PPI; 6 of 57 patients required IPI. The risk of any ICH (OR 7.6) and in-hospital mortality (OR 5.0) was higher among patients who underwent PPI. The rates of good outcome at discharge were significantly lower among patients with aphasia (OR .1, 95% confidence interval [CI] .04-.2) or those with an NIHSS score of 20 or more (OR .07, 95% CI .005-.9) with PPI compared with those without PPI. CONCLUSIONS: Despite the risk of IPI, patients with aphasia or an admission NIHSS score of 20 or more who underwent ET with PPI had lower rates of good outcomes and higher rates of ICH and death.
File Format	HTM / HTML
ISSN	10523057
Issue Number	5
Volume Number	23
e-ISSN	15328511
Journal	Journal of Stroke and Cerebrovascular Diseases
Language	English
Publisher	Elsevier
Publisher Date	2014-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Chi-square Distribution Research Support, N.i.h., Extramural Therapy Brain Ischemia Humans Middle Aged Patient Admission Male Predictive Value Of Tests Journal Article Feasibility Studies Patient Selection Time Factors Etiology Discipline Cardiology Female Retrospective Studies Diagnosis Odds Ratio Severity Of Illness Index Disability Evaluation Stroke Adverse Effects Cerebral Hemorrhage Hospital Mortality Risk Assessment Complications Mortality Risk Factors Endovascular Procedures Logistic Models Treatment Outcome Aged, 80 And Over Recovery Of Function Aphasia Aged Intubation, Intratracheal
Content Type	Text
Resource Type	Article
Subject	Rehabilitation Neurology (clinical) Surgery Cardiology and Cardiovascular Medicine

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