Kristina Shkirkova

Ultra-Early Deterioration Predicts Poor Outcome in Stroke Interview with:

Kristina Shkirkova

Kristina Shkirkova

Kristina Shkirkova
Doctoral Student in Neuroscience
Zilkha Neurogenetic Institute
University of Southern California
Los Angeles, CA What is the background for this study?

Response: Stroke is the second leading cause of death and a leading cause of adult disability worldwide. Stroke onset is sudden with symptoms progressing rapidly in the first hours after onset. The course of symptom progression after stroke is not well studied in the ultra-early window before hospital arrival and during early postarrival period.

There is an urgent need to characterize the frequency, predictors, and outcomes of neurologic deterioration among stroke patients in the earliest time window. What are the main findings? 

Response: This study found that ultra-early neurological deterioration occurred in 1 in 3 patients with intracranial hemorrhage and in 1 in 16 patients with acute cerebral ischemia and was associated with markedly reduced functional independence and increased mortality. What should readers take away from your report?

Response: Reducing ultra-early neurological deterioration during prehospital and early postarrival is an important target to improve outcomes among patients with acute stroke. What recommendations do you have for future research as a result of this work?

Response: The results of this study can serve as a baseline against which faster delivery methods and novel treatments can be assessed. Furthermore, the findings important for identifying patients at greatest risk of ultra-early neurological deterioration for fastest standard treatment and enriched enrollment in clinical trials of progression-averting research interventions. Is there anything else you would like to add? 

Response: This study is a secondary analysis of Field Administration of Stroke Therapy-Magnesium (FAST-MAG) trial, a phase 3, NIH-NINDS-sponsored, randomized, placebo-controlled, clinical trial, conducted from 2005-2013, at 315 ambulances and 60 stroke-receiving hospitals in Los Angeles and Orange Counties, California. The FAST-MAG trial succeeded in achieving delivery of the study agent to patients with a suspected stroke faster than in any previous pivotal trial and became a unique research platform for study of acute stroke in prehospital setting resulting in 21 original investigations published to date.

No disclosures 


Shkirkova K, Saver JL, Starkman S, et al. Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke Exploratory Analysis of the FAST-MAG Randomized Clinical Trial. JAMA Neurol. Published online July 23, 2018. doi:10.1001/jamaneurol.2018.1893 

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Last Updated on July 24, 2018 by Marie Benz MD FAAD