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  • 1
    Online Resource
    Online Resource
    Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke : A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials
    American Medical Association (AMA) ; 2021
    In:  JAMA Neurology Vol. 78, No. 6 ( 2021-06-01), p. 709-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 78, No. 6 ( 2021-06-01), p. 709-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2021.1055
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
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  • 2
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    Validity and Reliability of the Thrombolysis in Brain Infarction (TIBI) Flow Grades
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 324-325
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 324-325
    Abstract: 48 Background: In patients eligible for thrombolytic therapy, the TIBI grading system defines residual transcranial Doppler (TCD) flow signals at the site of clot location. In addition, TIBI flow grades correlate with angiography and predict short-term improvement following TPA therapy. The aim of this study was to develop a valid and reliable instrument to assess how accurately health professionals determine TIBI flow grades. Methods: Two expert sonographers developed a 60 question computerized examination of the 6 TIBI flow grades. Gold standard interpretation was determined by a consensus interpretation by a pool of expert sonographers. All items were equally weighted and written in a standard format. A computerized TIBI grading tutorial and standard interpretation rules were available for all test-takers. To assess content validity and reliability, a blinded panel of 3 experts independently took the examination. Inter-rater agreement was determined among experienced sonographers, stroke neurologists, and other health professionals (N=11). Results: Expert assessment of each test item measured objective congruence at 1.0, overall test validity coefficient of 0.996 (95%CI 0.993–0.997), and an item/TIBI flow grade validity coefficient of 0.992 (95%CI 0.996–0.997). Overall test and individual item reliability had coefficients of 0.98(95%CI 0.97–0.99) and 0.97 (95%CI 0.95–0.98, p 〈 0.0001) respectively. Inter-rater agreement was 0.89 (coefficient of contingency) and 0.86 (kappa) for all participants. Kappa range included 0.98 for an experienced interpreter, 0.81–0.89 for stroke neurologists with beginner experience in TCD and 0.65 for those without previous TCD experience (66% of correct answers after 1 hour tutorial). Conclusions: Our computerized examination is a valid and reliable tool to assess an individuals ability to score TIBI flow grades. In addition, TIBI flow grade evaluation has a high degree of inter-rater reliability, even among those with limited experience in ultrasound.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.324-e
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 3
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    The hyperdense sylvian fissure MCA ”dot“ sign: a marker of acute CT ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 346-346
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 346-346
    Abstract: P40 Background: The hyperdense appearance of the middle cerebral artery is now a familiar early warning of large cerebral infarction, brain oedema and poor prognosis. Less well described, however, is the hyperdensity associated with embolic occlusion of branches of the middle cerebral artery seen in the sylvian fissure (MCA ”dot“ sign). The aim of this study was to define this sign, and to determine the incidence, its diagnostic value, and reliability. Methods: Computed tomographic (CT) scans performed on patients with acute ischemic stroke within 3 hours of symptom onset were analysed for signs of thromboembolic stroke and evidence of early CT ischemia. Two neuroradiologists and two stroke neurologists initially blinded to all clinical information, and then with knowledge of the affected hemisphere evaluated scans for the presence of a hyperdense MCA sign (HMCA), a hyperdense sylvian fissure MCA ”dot“ sign, and for early MCA territory ischemic changes. Results: Of 100 consecutive patients presenting within 3 hours of symptom onset early CT ischemia was seen in 74 % of the baseline CT scans. The HMCA sign was seen in 5% of CT scans whereas the MCA ”dot“ sign was seen in 16% of which 2 were associated with a HMCA sign. The presence of a HMCA sign was associated with a greater probability of dependence or death than when a MCA ”dot“ sign was observed or no hyperdensity was seen (P 〈 0.05). All 5 patients with a HMCA sign, including 2 with an associated MCA ”dot“ sign were either dead or dependent at 3 months. Patients with a dot sign alone had independent outcomes in 64% of cases (P 〈 0.8). Balanced kappa statistics for both signs were in the moderate to good range when the side of stroke was known. Conclusions: The hyperdense sylvian fissure MCA ”dot“ sign is an early marker of thromboembolic occlusion of the distal MCA and of its branches.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.346-b
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Why Stroke Patients Don’t Receive T-PA? An Analysis of Patient Eligibility: Implications for Improving Clinical Impact by Increasing Future Treatment Numbers
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 372-372
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 372-372
    Abstract: P183 Background T-PA is an effective treatment of acute ischemic stroke within 3 hours. However, the success of t-PA on reducing disability is dependent on it being accessible to more patients. We identified the reasons why patients with ischemic stroke did not receive intravenous t-PA and assessed the community impact of the therapy in a large North American city. Methods Consecutive patients with acute ischemic stroke were identified in a prospective stroke registry at a teaching hospital between October 1996 and December 1999. Additional patients with ischemic stroke admitted to one of three other hospitals during the study period were identified. The Oxford Community Stroke Program Classification was used to record stroke type. Results Of 2165 stroke patients presenting to the emergency department 1179 (54.5%) were diagnosed with ischemic stroke, 31.7% with intracranial hemorrhage, and 13.8 % with transient ischemic attack. 84/339 (29%) patients were admitted within 3 hours of stroke received intravenous t-PA. The major reasons for exclusion for stroke patients presenting within 3 hours were mild stroke (20%), clinical improvement (18.6%), and specific protocol exclusions (11.5%). Delay in presentation to emergency department excluded 840/1179 (71%). 1817 ischemic stroke patients were admitted to Calgary hospitals during the study period of which 4.6% received intravenous t-PA. Generalization of the Calgary experience to other Canadian communities suggests the benefit from t-PA for ischemic stroke may be substantial with an additional 460 independent survivors per annum. Conclusion The effectiveness of t-PA can be improved by understanding why patients are excluded from its use. The eligibility of patients for t-PA must increase by promoting health education programs and by developing organized acute stroke care infrastructure within the community.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.372-d
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Intra-arterial therapy following intravenous alteplase for severe ischemic stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 374-374
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 374-374
    Abstract: P190 Background Intravenous alteplase may not be efficacious for the majority of patients with proximal large vessel occlusion. Intra-arterial thrombolysis improves outcome in MCA occlusion but delays occur between the decision to proceed to interventional therapy and its application. Initial administration of intravenous alteplase prior to an intra-arterial approach may provide better outcomes due to earlier exposure of thrombus to alteplase and subsequently improved re-canalisation rates. Criteria for patient selection are undefined. Methods Case series with 90d outcomes. Between February 1999 and July 2000, 7 patients ranging in age from 40–84 years were treated with an IV/IA approach. All patients received IV alteplase within 3h of stroke onset. Two patients had basilar occlusions and six had MCA M1 stem or one or both M2 branch occlusions. Patients were selected using one or both of pre-treatment TCD examination (n=5) or large DWI/PWI mismatch with MRA documented occlusion (n=3). One patient with an MCA occlusion had severe vessel tortuosity and did not receive IA alteplase because access to the thrombus was not possible. Results The median NIHSS score was 19 (range 10–24). Intra-arterial therapy was started between 2–3h of symptom onset in all cases. Angiographic recanalisation was successful in all patients who had an intervention (6 of 7 patients). One patient underwent vertebral artery angioplasty instead of thrombolysis. Two patients died or were severely disabled (mRS 5–6), one from contralateral recurrent MCA stroke several days post-procedure and one with a severe basilar artery stroke. The remaining 4 patients with MCA occlusions had excellent neurological outcomes and were independent at 90d. There were no symptomatic hemorrhages. Conclusions Selection of patients for IV/IA therapy is aided by early cerebrovascular imaging. IV/IA therapy can be performed within 3h of stroke onset and can result in excellent outcomes for patients with the most severe of ischemic strokes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.374
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    The Role of Repeat CT for Predicting Fatal Outcome Following Massive Middle Cerebral Artery Territory Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 381-382
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 381-382
    Abstract: P233 Background Large MCA ischemic stroke when associated with extensive mass effect can result in brain herniation and death. As yet there are no guidelines to aid the selection of patients for decompressive therapies, such as hemicraniectomy. Methods This was a multicentre retrospective study of large MCA infarction requiring neurocritical care. The repeat CT scans performed within 120 hours of stroke onset were assessed for horizontal displacement of septum pellucidum and pineal gland, the size of MCA infarction, involvement of other vascular territories and hydrocephalus. The primary outcome measure was death within 30 days. Results A total of 251 patients fulfilled entry criteria into the study of which 201 received conventional medical therapy alone. Univariate analysis identified the following predictors of early death: NIHSS 〉 16 (P 〈 0.03, OR 2.17 95% CI 1.12–4.2), anteroseptal shift 〉 7 mm (P 〈 0.001, OR 9.2 95% CI 4.1–20.63), pineal shift 〉 3 mm (P 〈 0.001, OR 12.1 95% CI 4.74–30.8), ischemia involving additional vascular territories (P 〈 0.001, OR 7.02 95% CI 3.35–14.7), hydrocephalus (P 〈 0.02, OR 2.13 95% CI 1.15–3.94), and temporal lobe involvement (P 〈 0.001, OR 5.66 95% CI 2.58–12.4). Multivariate analysis was performed but no independent variables were identified because the CT variables were highly correlated. Anteroseptal shift dichotomised into 〈 7 and 〉 7 mm had sensitivity 53%, specificity 93%, positive predictive value (PPV) 88%, negative predictive value (NPV) 69% for neurological death. Pineal shift dichotomised 〈 3 and = 3 mm had sensitivity 45%, specificity 94%, PPV 87% and NPV 66%. Conclusions We identified the role of follow-up CT in predicting early death following massive MCA infarction. Anteroseptal shift 〉 7 mm and pineal shift 〉 3 mm if present were strongly predictive of fatal outcome. These follow-up CT parameters require validation before they impact the decision to perform surgical intervention.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.381-d
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Baseline ASPECT Scores predict extent of stroke: Interim CT Analysis of CASES
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 319-320
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 319-320
    Abstract: 21 Background CT scanning remains the fastest and easiest method of neuro-imaging in acute ischemic stroke. The ASPECT score has been shown to be useful in assessing acute CT scans and has demonstrated validity and reliability. Previous studies have not prospectively evaluated early CT ischemia using ASPECTS. Methods 115 CT scans from the CASES study have been reviewed to date. All baseline and 24–48h follow-up scans were examined by a panel of 3 reviewers. Rating was done by 1 neuroradiologist and 2 of 3 neurologists per session. Consensus was achieved by majority opinion (2 of 3) on each data point. Reviewers were aware of the symptom side but blind to other patient characteristics. Results 79% of CT scans showed some degree of early ischemic change (ASPECTS 〈 10). 4.3% of follow up scans were normal (ASPECTS=10) when the baseline ASPECT score was 〈 9. The baseline ASPECT score was highly associated with the follow-up score (p 〈 0.001) (Figure) Discussion Early ischemic change is common on baseline CT scans. A minority of CT scans may be over-interpreted using ASPECTS. Baseline ASPECT score predicts the regions of infarction in follow-up.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.319-d
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Diffusion-weighted imaging lesion growth occurs despite recanalization in acute ischemic stroke: Implications for future treatment trials
    SAGE Publications ; 2019
    In:  International Journal of Stroke Vol. 14, No. 3 ( 2019-04), p. 257-264
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 14, No. 3 ( 2019-04), p. 257-264
    Abstract: A proportion of patients presenting with acute small ischemic strokes have poor functional outcomes, even following rapid recanalization treatment. Aims Infarct growth may occur even after successful recanalization and could represent an appropriate endpoint for future stroke therapy trials. Methods Magnetic resonance diffusion-weighted imaging lesion volumes were obtained at 5 h (initial posttreatment) and 24 h (follow-up) after acute stroke treatment for n = 33 in ischemic stroke patients. Sample sizes per arm (90% power, 30% effect size) for diffusion-weighted imaging lesion growth between initial and 24 h, early change in the National Institutes of Health Stroke Scale between pre- and 24 h, National Institutes of Health Stroke Scale at 24 h, and diffusion-weighted imaging lesion volume at 24 h were estimated to power a placebo-controlled stroke therapy trial. Results For patients with poor recanalization (modified thrombolysis in cerebral infarction 〈 2 a; modified arterial occlusion lesion = 0–2) (n = 11), the median diffusion-weighted imaging lesion growth was 8.1 (interquartile range: 4.5, 22.4) ml and with good recanalization (modified thrombolysis in cerebral infarction =2 b or 3; modified arterial occlusion lesion = 3) (n = 22), the median diffusion-weighted imaging lesion growth was 10.0 (interquartile range: 6.0, 28.2) ml ( P = 0.749). When considering a 30% effect size, the sample size required per arm to achieve significance in an acute stroke study would be: (1) N = 49 for the diffusion-weighted imaging lesion growth between initial posttreatment and follow-up time points, (2) N = 65 for the change in the National Institutes of Health Stroke Scale between admission and 24 h, (3) N = 259 for the National Institutes of Health Stroke Scale at 24 h, and (4) N = 256 for diffusion-weighted imaging volume at 24 h. Conclusion Despite best efforts to recanalize the ischemic brain, early diffusion-weighted imaging lesion growth still occurs. Treatment trials in stroke should consider early diffusion-weighted imaging lesion growth as a surrogate outcome measure to significantly reduce sample sizes.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493018798550
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2211666-7
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  • 9
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    Temporal evolution and spatial distribution of quantitative T2 MRI following acute ischemia reperfusion injury
    SAGE Publications ; 2020
    In:  International Journal of Stroke Vol. 15, No. 5 ( 2020-07), p. 495-506
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 15, No. 5 ( 2020-07), p. 495-506
    Abstract: Determining mechanisms of secondary stroke injury related to cerebral blood flow and the severity of microvascular injury contributing to edema and blood-brain barrier breakdown will be critical for the development of adjuvant therapies for revascularization treatment. Aim To characterize the heterogeneity of the ischemic lesion using quantitative T2 imaging along with diffusion-weighted magnetic resonance imaging (DWI) within five hours of treatment. Methods Quantitative T2 magnetic resonance imaging was acquired within 5 h (baseline) and at 24 h (follow-up) of stroke treatment in 29 patients. Dynamic contrast enhanced permeability imaging was performed at baseline in a subgroup of patients. Absolute volume change and lesion percent change was determined for the quantitative T2, DWI, and absolute volume change sequences. A Gaussian process with RRELIEFF feature selection algorithm was used for prediction of relative quantitative T2 and DWI lesion growth, baseline and follow-up quantitative T2/DWI lesion ratios, and also NIHSS at 24 h and change in NIHSS from admission to 24 h. Results In n = 27 patients, median (interquartile range) lesion percent change was 114.8% (48.9%, 259.1%) for quantitative T2, 48.2% (−12.6%, 179.6%) for absolute volume change, and 62.7% (26.3%, 230.9%) for DWI, respectively. Our model, consisting of baseline NIHSS, CT ASPECTS, and systolic blood pressure, showed a strong correlation with quantitative T2 percent change (cross correlation R 2  = 0.80). There was a strong predictive ability for quantitative T2/DWI lesion ratio at 24 h using baseline NIHSS and last seen normal to 24 h magnetic resonance imaging time (cross correlation R 2  = 0.93). Baseline dynamic contrast enhanced permeability was moderately correlated to the baseline quantitative T2 values (rho = 0.38). Conclusion Quantitative T2 imaging provides critical information for development of therapeutic approaches that could ameliorate microvascular damage during ischemia reperfusion.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493019895673
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2211666-7
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  • 10
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    Intra-arterial thrombolysis for hyperacute stroke
    Elsevier BV ; 2000
    In:  The Lancet Vol. 356, No. 9235 ( 2000-09), p. 1112-
    Details
    In: The Lancet, Elsevier BV, Vol. 356, No. 9235 ( 2000-09), p. 1112-
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(05)74554-2
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2000
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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