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Early initiation of enteral nutrition (EN) is recommended for acute stroke patients, but it is time-consuming. Reducing EN administration time without increasing the frequency of complications is a worthwhile goal. We aimed to determine whether this goal was feasible.Consecutive acute stroke patients with severe dysphagia within 72 h of hospital admission who received EN were retrospectively enrolled. Patients were classified into two groups (Rapid administration group: 100 mL/5 min on days 1-3 after stroke onset and 200 mL/30 min on days 4-7, Conventional administration group: 100 mL/h on days 1-3 and 200 mL/h on days 4-7).Among 118 consecutive acute stroke patients, 71 patients [median age, 77 (68-82) years; 37 (52%) males] were enrolled. The baseline clinical characteristics of the rapid administration group (45 patients) and the conventional administration group (26 patients) did not differ. The total duration of EN administration in the first week after stroke onset was significantly longer in the conventional vs. rapid administration group [21 (15-21) h vs. 6 (2-8) h, p 0.01]. There were no significant differences in the frequency of diarrhea (42% vs. 42%, p = 1.00), vomiting (0% vs. 7%, p = 0.29), or pneumonia (15% vs. 7%, p = 0.41). There was also no difference in the percentage of patients with one or more complications (54% vs. 49%, p = 0.81).Rapid administration of EN is safe and has the potential to decrease the time required for EN feeding.

National institutes of Health Stroke Scale (NIHSS) score and the presence of successful recanalization are crucial determinants of clinical outcome in patients with major artery occlusion. However, it is unknown whether successful recanalization rate after endovascular therapy (EVT) depends on NIHSS score.From our prospective EVT registry, data on patients with an occlusion at the internal carotid artery or middle cerebral artery were analyzed. Successful recanalization was judged as positive when reperfusion of the thrombolysis in cerebral infarction (TICI) scale ≥2b was observed. Successful recanalization rate was also evaluated based on the NIHSS score subgroups: 0-8, 9-16, 17-24, and24. Multivariate regression analysis was used to evaluate the impact of NIHSS score on successful recanalization.We studied 183 patients (age 76 [68-83], male 110 [60%], NIHSS score 19 [14-24]). One hundred and forty-six (80%) patients had the successful recanalization. Patients achieved the recanalization had lower NIHSS score as 18 (12-23), contrary those failed it had higher NIHSS score as 24 (20-27) (p .001). Successful recanalization rate was correlated to the NIHSS score grade; 100% in the NIHSS 0-8 group, 88% in 9-16, 81% in 17-24, and only 60% in24 (p .001). Multivariate regression analysis showed NIHSS score was an independent parameter of recanalization (odds ratio 0.905 [95%CI 0.837-0.979], p = .013).NIHSS score may serve as a predictor of successful recanalization. Recanalization is relatively easier in mild stroke than in those with severe stroke.

Background and Purpose: We investigated whether the signal change on fluid-attenuated inversion recovery (FLAIR) can serve as a tissue clock that predicts the clinical outcome after endovascular thrombectomy (EVT), independently of the onset-to-admission time. Methods: Consecutive patients with acute stroke treated with EVT between September 2014 and December 2018 were enrolled. Based on the parenchymal signal change on FLAIR, patients were classified into FLAIR-negative and FLAIR-positive groups. The clinical characteristics, imaging findings, EVT parameters, and the intracranial hemorrhage defined as Heidelberg Bleeding Classification ≥1c hemorrhage (parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, and/or subdural hemorrhage) were compared between the 2 groups. A modified Rankin Scale score 0 to 1 at 3 months was considered to represent a good outcome. Results: Of the 227 patients with EVT during the study period, 140 patients (62%) were classified into the FLAIR-negative group and 87 (38%) were classified into the FLAIR-positive group. In the FLAIR-negative group, the patients were older ( P =0.011), the onset-to-image time was shorter ( P P =0.006), and the rate of intravenous thrombolysis was higher ( P P =0.173), the frequency of both any-intracranial hemorrhage and Heidelberg Bleeding Classification ≥1c hemorrhage were higher in the FLAIR-positive group ( P =0.004 and 0.011). At 3 months, the percentage of patients with a good outcome (FLAIR-negative, 41%; FLAIR-positive, 27%) was significantly related to the FLAIR signal change ( P =0.047), while the onset-to-image time was not significant ( P =0.271). A multivariate regression analysis showed that a FLAIR-negative status was independently associated with a good outcome (odds ratio, 2.10 [95% CI, 1.02–4.31], P =0.044). Conclusions: A FLAIR-negative status may predict the clinical outcome more accurately than the onset-to-admission time, which may support the role of FLAIR as a tissue clock.

Background and purpose: Recent study reported the impact of complete recanalization beyond significant recanalization. The main of present study is to investigate the impact of complete recanalization in stroke patients with distal (M2) middle cerebral artery (MCA) occlusion. Methods: From our prospective endovascular thrombectomy (EVT) registry and multicenter tPA trial (YAMATO study) data bank, data on M2 occlusion and treated with EVT and/or tPA were retrospectively reviewed. In the YAMATO study, all tPA patients were examined using MRA before and at 1 hour after tPA. Thus, we defined the complete recanalization as a modified TICI of 3 at the end of EVT or similar appearances of both MCA on MRA at 1 hour after tPA. Significant recanalization was TICI ≥2b or >50% recanalization of MRA. At 3 months, favorable outcome was defined as mRS ≤ 2. Result: Data on 122 patients with M2 occlusion (median age 79 [72-85] years; male, 69 [57%], NIHSS score 13 [8-19]) received tPA and/or EVT were analyzed. Onset-to-admission was calculated as 95 (52-189) minutes. Complete recanalization was achieved in 27 (22%) patients, and significant recanalization was in 75 (61%) patients. Neither EVT administration it self, tPA, combined EVT and tPA were related to the complete recanalization (p=0.383, 0,237 and 0.612). At 3 months onset, patients with complete recanalization at the end of EVT/tPA frequently had favorable outcome than those without it (75% vs. 43%, p=0.013), while significant recanalization did not statistically increase the rate of favorable outcome (52% vs. 46%, p=0.673). Age, NIHSS score, DWI-ASPECTS, and plasma levels of d-dimer and brain benign peptide were also related to the favorable outcome (0.031, Conclusion: Complete recanalization but not significant recanalization was a parameter associated with favorable outcome in M2 occlusion patients. The goal of recanalization therapy may be immediate and complete recanalization even in patients with distal MCA occlusion.

Hypothesis: Some of hyperacute stroke patients had unfavorable outcome even when the occlusive artery was successfully opened. We hypothesized that moderate-to-sever mitral regurgitation (significant MR) might inhibit cerebral reperfusion, and thus decrease the rate of good clinical outcome after endovascular thrombectomy (EVT) in patients with atrial fibrillation (AF). Method: From our prospective EVT registry, patients received transthoracic echocardiography (TTE), were retrospectively analyzed. Only patients with AF were included. Based on the presence of the moderate-to-sever MR, all patient were divided into group with and without significant MR (MR group, and non-MR group). Clinical background, laboratory findings, and TTE parameters were compared between the 2 groups. Favorable outcome was defined as mRS 0-1 at 3 months. Result: From 2014 September to 2018 December, 316 patients treated with EVT, and 246 received TTE. Among them, data on 127 patients with AF were analyzed. TTE found 25 (20%) patients had significant MR. Patients in MR group were older (p=0.05) and had higher plasma level of brain natriuretic peptide (p=0.05). NIHSS, DWI-APSECTS, TICI ≥2b reperfusion, onset-to-reperfusion time, ICA occlusion (p=0.96, 0.26, 0.52, 0.33, and 0.80) were similar between the 2 groups. Regarding TTE parameters, although ejection fraction was similar (p=0.28), left atrial area (p=0.02), right atrial area (p Conclusion: The presence significant MR was related to the unfavorable outcome independent of the neurological symptom and reperfusion status on cerebral angiography.MR might prevent the clinical recovery in patients with atrial fibrillation.

Purpose and Objective: There have been limited reports that focused on cognitive impairment in acute ischemic stroke after endovascular treatment. The aim of this study, therefore, was to investigate cognitive function in patient after endovascular treatment in acute phase and at 6 months follow-up. Method: In this prospective study, from December 2016 to November 2018, the patients who were diagnosed as ischemic stroke with occlusion of the internal carotid artery and of the middle cerebral artery and treated with endovascular treatment were enrolled. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA-J) test within 5 days of onset and at 6 months follow-up. We defined cognitive impairment as a score of Results: 150 patients were enrolled. MoCA-J was feasible in 69 patients (median 76 years; 49 female) (46%), in acute phase (Figure A). 63 patients (91%) had cognitive impairment and no significant differences were found in the naming and the abstraction domains between MoCA-J Conclusion: In acute phase of ischemic stroke after endovascular treatment, MoCA-J was feasible in about 45%, in which 91% had cognitive impairment. However, at 6 months follow-up, the median MoCA-J score was significantly higher and less number of patients had cognitive impairment. The present results suggest that cognition recovers with time after endovascular treatment in ischemic stroke.

Background: It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy. Method: We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO. Result: IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P Conclusion: Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.

Background and Purpose: Eendovascular thrombectomy(EVT) had a clinical benefit when it was performed within 6 hours after onset symptom in the emergent large vessel occlusion(ELVO) patients. Recently, it is proved that EVT 6 to 24 hours after stroke onset with mismatch between deficit and infarct is benefit. However, it is not unclear whether EVT is effective more than 24 hours after stroke onset. Method: We enrolled ELVO patients treated with EVT more than 24 hours after stroke onset from our prospective registry. We investigated clinical background including onset to puncture time, clinical stroke type, and recanalization rate. We evaluated patient outcome at 3 months after onset and classified patients into two group; good outcome group as modified Rankin Scale (mRS) 0-2 and poor outcome group as mRS 3-6, respectively. We compared clinical background between two groups. Result: In our stroke registry, 443 patients were treated with EVT from January 2011 to July 2019. Among them, 21 patients(5.4%, age was 69(55-72) years old, and male was 16(76%)) were treated with EVT more than 24 hours after stroke onset. All patients had ELVO and clinical and DWI mismatch, which might be thought to be benefit from EVT. Onset to puncture time was median 2632 (1605-6116) minutes and NIHSS scale was 6(2.5-15), and DWI-ASPECTS were 9(7-10). ICA, M1 and BA occlusion were 8(38%), 4 (19%), and 1(4%) patients, respectively. Symptomatic hemorrhage was none. Regarding to patient outcome at 3 months, good and poor outcome were 14(66.7%) and 7(33.3%) patients, respectively. Among the 19 patients with premorbid mRS 0-2, 14(73%) patients achieved good outcome at 3 months. Age, gender, onset to puncture time, DWI-ASPECTS, and ICA occlusion were not different between good and poor outcome groups. However, good outcome patients less frequently had NIHSS score (3.5(2-7) vs. 15(12-23), P=0.006), and cardioembolic stroke (0% vs. 14%, P=0.333). Conclusion: More than a half of ELVO patients with clinical DWI mismatch more than 24 hours after stroke onset had good outcome from EVT. There is possibility that time window of EVT for ELVO patients is extended beyond 24 hours after stroke onset.

Background: Two randomized controlled trials published in 2018 showed the effect of thrombectomy for acute ischemic stroke more than 6 hours after onset. It is reported that hyperintense lesions on fluid-attenuated inversion recovery (FLAIR positive) and susceptibility vessel sign (SVS) on T2*WI are associated with poor outcome (PO) in patients treated with rt-PA thrombolysis within 4.5 hours in acute ischemic stroke. However, it is not clear that FLAIR positive and SVS on T2*WI are associated with PO in patients treated with mechanical thrombectomy at 6 to 24 hours after the onset. Method: We enrolled 72 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke at 6 to 24 hours after the onset from April 2011 to June 2018. We retrospectively compared PO (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=38) with good outcome (GO, a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=34) and examined what was the predictor of PO. Result: FLAIR positive (41.2% vs 25.8%, P= 0.408) and SVS on T2*WI (32.4 vs 29.0%,P=0.852) were found similarly between both groups. Moreover, there was no significant difference between PO and GO groups in age (75.7 years old vs 69.4 years old, P= 0.062), stroke subtypes (P= 0.129), occlusion site (P= 0.682), DWI-ASPECTS (9 vs 8, P= 0.086), other risk factors. National Institutes of Health Stroke Scale (NIHSS) at admission was higher in PO group than GO group (17 vs 12, P = 0.047). The duration from onset to recanalization (O2R) was significantly longer in PO group than in GO group (765 min vs 631 min, P=0.043), and the median Thrombolysis In Cerebral Infarction (TICI) grade was significantly lower in PO group (P Conclusion: FLAIR positive and SVS on T2*WI did not associate with poor outcome in patients treated with thrombectomy at 6 to 24 hours.