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  • 1
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    Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data
    Elsevier BV ; 2018
    In:  The Lancet Neurology Vol. 17, No. 10 ( 2018-10), p. 895-904
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 17, No. 10 ( 2018-10), p. 895-904
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(18)30242-4
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2081241-3
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  • 2
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    Use of Thick Maximum‐Intensity Projection Brain Computed Tomography Angiography for Evaluation of Baseline Collateral Status Improves Interrater Agreement
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke: Vascular and Interventional Neurology Vol. 4, No. 1 ( 2024-01)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. 1 ( 2024-01)
    Abstract: In acute ischemic stroke caused by large‐vessel occlusion, tissue viability is dependent on the blood supply from leptomeningeal collaterals until reperfusion is achieved. Rapid and accurate evaluation of baseline collateral status is a key marker of eligibility for endovascular therapy but can be challenging to interpret using source images of the computed tomography angiography (SI‐CTA). Our objective was to assess whether the use of thick maximum‐intensity projection computed tomography angiography (MIP‐CTA) improves interrater agreement for evaluation of baseline collaterals status between stroke trainees and an expert stroke neurologist. Methods An expert stroke neurologist and 2 stroke trainees independently reviewed images from 40 brain CTA scans with anterior circulation large‐vessel occlusion and assessed collateral status using the Tan collateral scoring system using SI‐CTA in the first reading and then using MIP‐CTA in the second reading. We calculated interrater agreement and recorded the total time needed in each reading. Results Interrater agreement was fair between the 2 stroke fellows and stroke expert when using SI‐CTA (κ=0.45 with 52.5% agreement). After using MIP‐CTA, interrater agreement improved to moderate (κ=0.69 with 70% agreement). The median reading time was 1.89 minutes per scan using SI‐CTA and 1.00 minute per scan using MIP‐CTA ( P 〈 0.0001). Conclusions We show that using MIP‐CTA, when compared with SI‐CTA, shortens interpretation time and improves interrater agreement between stroke trainees and a stroke imaging expert for the evaluation of baseline collaterals in patients presenting with anterior circulation large‐vessel occlusion.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.123.001010
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 3144224-9
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  • 3
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    Abstract WMP73: Minimally Invasive Surgery for Intracerebral Hemorrhage: Meta-Analysis of High Quality RCTs
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: Intracerebral hemorrhage (ICH) represents a devastating clinical entity with disproportionately higher rates of mortality and functional disability compared to ischemic stroke. As large trials of craniotomy in ICH failed to prove functional benefits, minimally invasive surgery (MIS) represents a potential frontier of ICH management with evidence of functional and mortality improvements. We aimed to provide level A evidence of MIS role in ICH management. Methods: Independent authors searched four electronic databases (Medline, Embase, Web of Science, and CENTRAL) and assessed the methodological quality of included studies using the Cochrane risk of bias tool (RoB2). Only high-quality (low risk of bias in all RoB2 domains) randomized clinical trial (RCTs) were included. We pooled odd ratios (ORs) with corresponding 95% confidence intervals (CIs) using random-effects model. Results: Six high-quality RCTs met our inclusion criteria. Among 1551 ICH patients, 810 were allocated to the MIS group and 741 to non-MIS. MIS was associated with significantly lower odds of mortality or disability at 90-days (OR, 0.71 [95% CI, 0.52-0.97]; p = 0.03) and lower odds of 90-days mortality (OR, 0.71 [95% CI, 0.49-1.03] ; p = 0.07). Rates of functional independence and favorable functional outcomes was higher in MIS treated individuals (OR, 1.81 [95% CI, 0.78-1.79]; p = 0.43) and (OR, 1.31 [95% CI, 0.96-1.78] ; p = 0.09), respectfully. Conclusions: This meta-analysis provides level A evidence that supports the current notion of mortality and functional improvement in ICH individuals treated with MIS. Further RCTs are warranted to validate the generalizability of these results.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.WMP73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient
    Centers for Disease Control and Prevention (CDC) ; 2017
    In:  Emerging Infectious Diseases Vol. 23, No. 6 ( 2017-06), p. 978-981
    Details
    In: Emerging Infectious Diseases, Centers for Disease Control and Prevention (CDC), Vol. 23, No. 6 ( 2017-06), p. 978-981
    Type of Medium: Online Resource
    ISSN: 1080-6040 , 1080-6059
    URL: Article
    DOI: 10.3201/eid2306.161173
    Language: English
    Publisher: Centers for Disease Control and Prevention (CDC)
    Publication Date: 2017
    detail.hit.zdb_id: 2004375-2
    detail.hit.zdb_id: 1380686-5
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  • 5
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    Abstract WP62: Favorable Clot Characteristics Predict Smaller Infarct Volume in Acute Ischemic Stroke Patients Treated With Reperfusion Therapy
    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: Multiple studies have correlated larger final infarct volume (FIV) with worse clinical outcomes. In INTERRSeCT , an international multicenter prospective cohort study, we sought to determine the favorable intracranial clot characteristics predicting smaller infarct volumes. Methods: FIV was measured (24 ±12 hours after baseline imaging) in 605 patients from INTERRSeCT study by blinded readers using Quantomo (Cybertrial Inc, Calgary). Clot Burden Score (CBS) is a 10-point scale with 10 referring to a completely patent ipsilateral anterior circulation from ICA to both M2 arteries, whereas 0 refers to a completely occluded ipsilateral anterior circulation. Residual Flow Grade (RFG) assesses the radiological permeability of the clot to contrast, with grade 0, 1, and 2 defined as no contrast, diffuse ghosting, and hairline lumen, respectively. Both of these scores were assessed by a blinded reader to the FIV. Using ordinal logistic regression, FIV was divided into deciles as the outcome. CBS and RFG were analyzed from 0 to 10, and 0 to 2, respectively. Two models were used, the first has no recanalization status, while the second included it. Results: The median FIVs with and without recanalization were 12.34 ml (IQR: 32.3 ml) and 22.15 ml (IQR: 60.12ml), respectively. CBS and RFG were independently predictive of FIV (p-value= 〈 0.001 and 0.003, respectively). The common ORs for having one decile higher FIV for 1 point increase in CBS and RFG were 0.82 (CI: 0.77, 0.87) and 0.66 (CI: 0.51, 0.86), respectively. After adjusting for recanalization, the common ORs for having one decile higher FIV for 1 point increase in CBS and RFG were 0.83 (CI: 0.78, 0.88) and 0.72 (CI: 0.54, 0.94), respectively. Conclusions: Residual flow grade and clot burden score are fast and practical techniques for practitioners treating acute ischemic stroke patients. Favorable RFG and CBS independently, predict lower infarct volumes regardless of whether recanalization achieved.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP62
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Abstract 82: Thrombus Migration is a Common Phenomenon With IV TPA and May Have Negative Effects on Outcome When TPA Treatment is Given Before Endovascular Thrombectomy in Proximal Occlusions
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Introduction: There is interest in understanding thrombus dynamics from IV TPA prior to endovascular thrombectomy (EVT) given the possible dichotomy amongst sites of occlusion for IV TPA benefit/harm. Kaesmacher et al reported beneficial 5+% rates of early TICI 〉 2a reperfusion in distal M1 or M2 MCA occlusions with IV TPA. However in more proximal occlusions this was rare; and potentially harmful worsening of perfusion seen with change of occlusion site. We aimed to examine IV TPA related thrombus dynamics including migration further across both proximal and distal occlusions in a multicenter prospective cohort study INTERRSeCT. Methods: Acute ischemic stroke patients with intracranial occlusion who had baseline CTA and follow-up CTA or initial run angio in INTERRSeCT and IV TPA were reviewed. We evaluated change of occlusion site (COS) and classified patients into 4 categories: Complete Recanalization (CR) of primary occlusive lesion with no remaining thrombus; definite Thrombus Migration (dTM) with primary occlusion site moved to a distal artery and occlusion site patent on baseline CTA; probable Thrombus Migration (pTM) with COS evident but initial occlusion extent not visualized; or No Change of occlusion site (NC). Results: A total of 462 IV TPA patients were enrolled, 41% received EVT. Median time from TPA to follow-up imaging was 133 minutes. COS was seen in 50% of cases with CR in 15% and TM in 35% (dTM 12%, pTM 23%). Distal artery occlusion and longer interval of TPA to imaging were independent predictors for COS. In 62 proximal occlusion (ICA and proximal-mid M1 MCA) patients with follow-up imaging within 60 mins after TPA (receiving EVT in 94%), any TM showed a lower rate of 90-day mRS≤2 than NC (47% vs 78%, adjusted OR 0.21, 95%CI 0.04-0.87). No CR was seen in this early group. Conclusions: Thrombus migration is common after IV TPA. Thrombus instability from IV TPA may worsen clinical outcome in proximal occlusions despite early EVT initiation, possibly due to migration of thrombus to distal arteries accelerating infarction or more challenging thrombectomy due to thrombus dispersion. The benefit of IV TPA prior to EVT at comprehensive stroke centers for ICA or prox-mid M1 occlusions require more study in randomized clinical trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.82
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 80381-9
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  • 7
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    Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment : The INTERRSeCT Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 1 ( 2021-01), p. 203-212
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 1 ( 2021-01), p. 203-212
    Abstract: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51] ). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.029292
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Time Course of Early Hematoma Expansion in Acute Spot-Sign Positive Intracerebral Hemorrhage: Prespecified Analysis of the SPOTLIGHT Randomized Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 3 ( 2023-03), p. 715-721
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 3 ( 2023-03), p. 715-721
    Abstract: In the SPOTLIGHT trial (Spot Sign Selection of Intracerebral Hemorrhage to Guide Hemostatic Therapy), patients with a computed tomography (CT) angiography spot-sign positive acute intracerebral hemorrhage were randomized to rFVIIa (recombinant activated factor VIIa; 80 μg/kg) or placebo within 6 hours of onset, aiming to limit hematoma expansion. Administration of rFVIIa did not significantly reduce hematoma expansion. In this prespecified analysis, we aimed to investigate the impact of delays from baseline imaging to study drug administration on hematoma expansion. Methods: Hematoma volumes were measured on the baseline CT, early post-dose CT, and 24 hours CT scans. Total hematoma volume (intracerebral hemorrhage+intraventricular hemorrhage) change between the 3 scans was calculated as an estimate of how much hematoma expansion occurred before and after studying drug administration. Results: Of the 50 patients included in the trial, 44 had an early post-dose CT scan. Median time (interquartile range) from onset to baseline CT was 1.4 hours (1.2–2.6). Median time from baseline CT to study drug was 62.5 (55–80) minutes, and from study drug to early post-dose CT was 19 (14.5–30) minutes. Median (interquartile range) total hematoma volume increased from baseline CT to early post-dose CT by 10.0 mL (−0.7 to 18.5) in the rFVIIa arm and 5.4 mL (1.8–8.3) in the placebo arm ( P =0.96). Median volume change between the early post-dose CT and follow-up scan was 0.6 mL (−2.6 to 8.3) in the rFVIIa arm and 0.7 mL (−1.6 to 2.1) in the placebo arm ( P =0.98). Total hematoma volume decreased between the early post-dose CT and 24-hour scan in 44.2% of cases (rFVIIa 38.9% and placebo 48%). The adjusted hematoma growth in volume immediately post dose for FVIIa was 0.998 times that of placebo ([95% CI, 0.71–1.43]; P =0.99). The hourly growth in FFVIIa was 0.998 times that for placebo ([95% CI, 0.994–1.003]; P =0.50; Table 3). Conclusions: In the SPOTLIGHT trial, the adjusted hematoma volume growth was not associated with Factor VIIa treatment. Most hematoma expansion occurred between the baseline CT and the early post-dose CT, limiting any potential treatment effect of hemostatic therapy. Future hemostatic trials must treat intracerebral hemorrhage patients earlier from onset, with minimal delay between baseline CT and drug administration. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01359202.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.121.038475
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial
    SAGE Publications ; 2021
    In:  International Journal of Stroke Vol. 16, No. 5 ( 2021-07), p. 593-601
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 16, No. 5 ( 2021-07), p. 593-601
    Abstract: Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. Aims We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. Methods We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24–48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24–48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. Results Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement ( p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age ( p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS ( p = 0.007) and post-stroke complications ( p = 0.026). Absence of vascular risk-factors ( p = 0.004), CT-based lentiform nucleus sparing ( p = 0.002), lower 24-hour NIHSS ( p = 0.001), and absence of complications ( p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. Conclusions Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01778335 .
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493020929943
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2303728-3
    detail.hit.zdb_id: 2211666-7
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  • 10
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    Autoimmune encephalopathy and drug refractory seizures with the presence of two autoantibodies specific for the neuronal cell surface
    Elsevier BV ; 2014
    In:  Epilepsy & Behavior Case Reports Vol. 2 ( 2014), p. 199-202
    Details
    In: Epilepsy & Behavior Case Reports, Elsevier BV, Vol. 2 ( 2014), p. 199-202
    Type of Medium: Online Resource
    ISSN: 2213-3232
    URL: Article
    DOI: 10.1016/j.ebcr.2014.06.002
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2708718-9
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