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  • 1
    Online Resource
    Online Resource
    Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 2 ( 2022-02), p. 143-148
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 2 ( 2022-02), p. 143-148
    Abstract: Stent-assisted coiling of wide-necked intracranial aneurysms (IAs) using the Neuroform Atlas Stent System (Atlas) has shown promising results. Objective To present the primary efficacy and safety results of the ATLAS Investigational Device Exemption (IDE) trial in a cohort of patients with posterior circulation IAs. Methods The ATLAS trial is a prospective, multicenter, single-arm, open-label study of unruptured, wide-necked, IAs treated with the Atlas stent and adjunctive coiling. This study reports the results of patients with posterior circulation IAs. The primary efficacy endpoint was complete aneurysm occlusion (Raymond-Roy (RR) class I) on 12-month angiography, in the absence of re-treatment or parent artery stenosis 〉 50%. The primary safety endpoint was any major ipsilateral stroke or neurological death within 12 months. Adjudication of the primary endpoints was performed by an imaging core laboratory and a Clinical Events Committee. Results The ATLAS trial enrolled and treated 116 patients at 25 medical centers with unruptured, wide-necked, posterior circulation IAs (mean age 60.2±10.5 years, 81.0% (94/116) female). Stents were placed in all patients with 100% technical success rate. A total of 95/116 (81.9%) patients had complete angiographic follow-up at 12 months, of whom 81 (85.3%) had complete aneurysm occlusion (RR class I). The primary effectiveness outcome was achieved in 76.7% (95% CI 67.0% to 86.5%) of patients. Overall, major ipsilateral stroke and secondary persistent neurological deficit occurred in 4.3% (5/116) and 1.7% (2/116) of patients, respectively. Conclusions In the ATLAS IDE posterior circulation cohort, the Neuroform Atlas Stent System with adjunctive coiling demonstrated high rates of technical and safety performance. Trial registration number https://clinicaltrials.gov/ct2/show/NCT02340585 .
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-017115
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
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  • 2
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    Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis
    Elsevier BV ; 2022
    In:  The Lancet Vol. 399, No. 10321 ( 2022-01), p. 249-258
    Details
    In: The Lancet, Elsevier BV, Vol. 399, No. 10321 ( 2022-01), p. 249-258
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(21)01341-6
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    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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  • 3
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    Abstract WMP1: Eligibility for Endovascular Trial Enrollment in the 6-24 Hour Time Window: Analysis of a Single Comprehensive Stroke Center
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background and Purpose: Recent completion of the DAWN trial supports the benefit of endovascular therapy in patients presenting in the 6-24 hour time window with anterior circulation large vessel occlusions. The scope and impact of these results on clinical practice remain unknown. Methods: A retrospective review of ischemic stroke admissions to a single comprehensive stroke center was performed during the enrollment period (November 2015-February 2017) to identify patients meeting criteria for DAWN eligibility. Patients presenting beyond 6 hours were further investigated to clarify reasons for trial exclusion. Results: Of the 2667 acute ischemic stroke patients admitted within the study period, 30% (n=792) presented within the 6-24 hour time window and 33% (890) had an NIHSS of 10 or higher. Of the 11% (n=298) patients meeting both criteria, trial exclusion occurred due to: absence of large vessel occlusion (LVO) (48%,n=143), presence of sub-occlusive, distal or posterior circulation LVO (18%, n=54), large core infarct or ASPECT 〈 7 (25%, n=73) or absence of clinical core mismatch (5%, n=16), mRS 〉 1 (13%, n=38). There were 45 patients who met all DAWN criteria. Conclusions: Of all acute ischemic stroke patients presenting to a single CSC, 1.7% of patients qualified for DAWN clinical trial enrollment. Of patients with proximal anterior circulation occlusion presenting in the 6- 24 hour time window with NIHSS of 10 or higher , 29% were eligible for treatment based on DAWN criteria. These data predict an increase in thrombectomy utilization with important implications for Comprehensive Stroke Center resource utilization and stroke systems of care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WMP1
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Abstract WP28: Safety and Feasibility of Angioplasty and Stenting in Symptomatic Internal Carotid Artery Occlusive Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Symptomatic internal carotid artery occlusion (ICAO) can lead to subsequent neurologic decline, recurrent stroke, and mortality. We sought to evaluate safety and feasibility of endovascular revascularization for ICAO without tandem intracranial large vessel occlusion (LVO). Methods: This is a retrospective cohort analysis of all patients presenting to a single academic center with ischemic stroke and ipsilateral, cervical ICAO from November 2003 through April 2016. Patients were excluded if pre-procedural angiography demonstrated tandem LVO or if patients were known to have chronic ICAO. Study endpoints included discharge neurologic exam, post-procedural infarct burden, 3-month functional outcomes, and treatment durability. Results: A total of 107 patients with symptomatic, angiographically confirmed cervical ICAO without tandem LVO were identified. Median admission NIHSS was 8 (IQR 11). Baseline radiographic stroke severity was assessed by ASPECT score (median 9; IQR 2), perfusion mismatch (present in 93%), and clinical-diffusion mismatch (42%). Median time from symptom onset to treatment was 25 hours (IQR 61). Successful revascularization was achieved in 92% of patients. At discharge, 83% had stable or improved NIHSS, while at 3-months 65% achieved functional independence (mRS ≤2). The most common complication was distal embolization (22%) of which 16% required intra-arterial treatment. Rate of significant restenosis (≥70%) was 15% at 1-year. Conclusions: Stenting in selected patients at risk of neurological deterioration due to symptomatic ICAO can be performed with high rates of technical success and good clinical outcomes. Because of significant peri-procedural risks and high rates of restenosis, randomized studies are necessary to understand the benefit of this approach.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP28
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Abstract TP11: Treatment Times and Outcomes With Utilization of Telemedicine Prior to Transfer for Stroke Endovascular Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Reducing time to treatment is important for acute stroke therapy including intravenous tPA and endovascular therapy. Remote evaluation of acute stroke patients by telemedicine may help triage patients for endovascular therapy and facilitate earlier treatment. Purpose: We aimed to evaluate efficiency and clinical outcome using telemedicine as a screening tool prior to transfer of stroke patients to comprehensive stroke centers for endovascular therapy. Methods: We retrospective reviewed patients receiving endovascular therapy at the University of Pittsburgh Medical Center from January 2014 through May 2015 who were initially evaluated for acute stroke at an outside facility and transferred to our hospital. We statistically analyzed our data using unpaired T test with equal standard deviation. Results: 116 patients treated with endovascular therapy were identified. 35 (30.1%) had telemedicine (TM) evaluations prior to transfer and 81 (69.8%) were transferred without telemedicine screening (NTM). The average age was 68 years in TM group and 67 years in NTM group. 71% of TM patients received IV TPA compared to 30% of NTM patients. The average NIHSS on arrival was 17 among TM and 16 in NTM. The mean time from door to groin puncture was 54 minutes in TM patients compared to 66 minutes in NTM group (p=0.37). Good outcomes (mRS 〈 2) occurred in 54% of TM cases and 36% of the NTM group (p=0.12). Poor outcomes (mRS 5-6) were 21% in TM patients and 40% in the NTM group (p=0.08). TICI 2b/3 revascularization was achieved in 88.5% and 88.9% in TM and NTM groups respectively (p=0.2). Conclusion: Evaluating acute stroke patients using telemedicine prior to transfer to comprehensive stroke centers may reduce time to intervention and improve selection of patients more likely to benefit from endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp11
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Clinical effectiveness of endovascular stroke treatment in the early and extended time windows
    SAGE Publications ; 2022
    In:  International Journal of Stroke Vol. 17, No. 4 ( 2022-04), p. 389-399
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 17, No. 4 ( 2022-04), p. 389-399
    Abstract: The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. Aim We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry. Methods A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. Results As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all P  〉  0.05). Registry-derived patients had significant less disability than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR), P  〈  0.05 for all). Conclusion Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/17474930211005740
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2211666-7
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  • 7
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    Online Resource
    Transcervical access in acute ischemic stroke
    BMJ ; 2014
    In:  Journal of NeuroInterventional Surgery Vol. 6, No. 9 ( 2014-11), p. 652-657
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 6, No. 9 ( 2014-11), p. 652-657
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2013-010971
    Language: English
    Publisher: BMJ
    Publication Date: 2014
    detail.hit.zdb_id: 2506028-4
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  • 8
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    Streamlining door to recanalization processes in endovascular stroke therapy
    BMJ ; 2017
    In:  Journal of NeuroInterventional Surgery Vol. 9, No. 4 ( 2017-04), p. 340-345
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 9, No. 4 ( 2017-04), p. 340-345
    Abstract: In acute stroke due to large vessel occlusion, faster reperfusion leads to better outcomes. We analyzed the effect of optimization steps aimed to reduce treatment delays at our center. Methods Consecutive patients with ischemic stroke treated with endovascular therapy were prospectively analyzed. We divided the patients into pre-optimization (20 April 2012 to 8 October 2013) and post-optimization (9 October 2013 to 29 July 2014) periods. The main interventions included: (1) continuous feedback; (2) standardized immediate emergency department attending to stroke attending communication with interventional team activation for all potential interventions; (3) pre-notification by the emergency medical service; (4) minimizing additional diagnostic testing; (5) direct transport to the CT scanner; (6) transport directly from the CT scanner to the angiography suite. The main metric used to measure improvement was door to groin puncture time (D2P). Results We included a total of 286 patients (178 pre-optimization, 108 post-optimization). There were no significant differences between major baseline characteristics between the groups with the exception of higher median CT Alberta Stroke Program Early CT Score in the pre-optimization group (p=0.01). Median D2P improved from 105 min pre-optimization to 67 min post-optimization (p=0.0002). Rates of good clinical outcomes (modified Rankin Scale 0–2 at 3 months) were similar in both groups, with a trend toward a better outcome in the post-optimization group in a subgroup analysis of patients with anterior circulation occlusion who received intravenous tissue plasminogen activator. Conclusions This pilot study demonstrates that D2P times can be significantly reduced with a standardized multidisciplinary approach. There was no significant difference in the rate of 3-month good outcome, which is most likely due to the small sample size and confounding baseline patient characteristics.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2016-012324
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2506028-4
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  • 9
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    Fast and slow progressors of infarct growth in basilar artery occlusion strokes
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 1 ( 2022-01), p. neurintsurg-2021-017394-
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 1 ( 2022-01), p. neurintsurg-2021-017394-
    Abstract: Heterogeneity in the infarct growth rate among anterior circulation large vessel occlusion (LVO) strokes has triage and treatment implications. Such data are lacking for basilar artery occlusion (BAO) strokes. We aim to describe the variability in brainstem infarct volume at presentation and compute the distribution of the infarct growth rate (IGR) and rate of loss of neurons during BAO strokes. Methods A retrospective review of consecutive patients with BAO stroke with pretreatment MRI was performed. Ischemic core volume was manually calculated (product of slice thickness and sum of area of region of interests) for the brainstem lesion. The distribution of various brainstem infarct volume groups was analyzed and the IGR (including rate of loss of neurons) was computed. Results Fifty-nine patients were included. Mean age was 64±13 and 34% were men. Mean National Institutes of Health Stroke Scale score was 20±11 and time to MRI was 9±5 hours. Mean brainstem ischemic core volume was 4.5±4.6 mL. According to predefined thresholds, 13% and 6% of patients with BAO stroke in the 0–6 hour time window were fast (5–10 mL) and ultra-fast progressors ( 〉 10 mL), respectively, and 14% of patients in the 6–24 hour time window were slow progressors ( 〈 1 mL). Median and mean rate of loss of neurons was 146 300 neurons/min and 261 300 (±400 000) neurons/min, respectively, and ranged from 〈 19 400 to 〉 2.12 million. Conclusion Approximately 14% of BAO strokes are slow progressors and 19% are fast/ultra-fast progressors, with the rate of loss of neurons ranging from 〈 19 000 to 〉 2.1 million/min. Large heterogeneity exists in brainstem infarct volume at presentation and IGR among patients with BAO stroke.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2021-017394
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
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  • 10
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    Femoral arteriotomy closure using the Mynx vascular closure device: a profile of device efficacy and complications
    OMICS Publishing Group ; 2014
    In:  Interventional Cardiology Vol. 6, No. 3 ( 2014-06), p. 271-277
    Details
    In: Interventional Cardiology, OMICS Publishing Group, Vol. 6, No. 3 ( 2014-06), p. 271-277
    Type of Medium: Online Resource
    ISSN: 1755-5302 , 1755-5310
    URL: Article
    DOI: 10.2217/ica.14.11
    Language: English
    Publisher: OMICS Publishing Group
    Publication Date: 2014
    detail.hit.zdb_id: 2537202-6
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