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Selecting stroke patients for thrombectomy: is CTA+ASPECTS enough?
Since 2014, a series of randomised controlled trails (RCTs) have demonstrated the benefit of endovascular thrombectomy (EVT) on functional outcome for the participants who had acute ischaemic stroke (AIS) with occlusion of a proximal intracranial artery in the anterior circulation. The characteristics of the people enrolled in these RCTs have been used to define recommended criteria to select patients for thrombectomy in clinical practice. The initial group of RCTs largely enrolled participants early after AIS (mostly under 6 hours) who had National Institutes of Health stroke scale scores ≥6 (range 0–42 with lowe...
Source: Journal of Neurology, Neurosurgery and Psychiatry - September 14, 2023 Category: Neurosurgery Authors: Powers, W. Tags: Editorial commentaries Source Type: research

Prognostic Value of Venous Outflow Profiles on Multiphase CT Angiography for the Patients with Acute Ischemic Stroke After Endovascular Thrombectomy
This study supports that favorable peak venous VO profiles on mCTA might be a promising biomarker in predicting the good outcome in patients with AIS after EVT.
Source: Translational Stroke Research - September 5, 2023 Category: Neurology Source Type: research

When does life end? New organ donation strategy fuels debate
On a chilly holiday Monday in January 2020, a medical milestone passed largely unnoticed. In a New York City operating room, surgeons gently removed the heart from a 43-year-old man who had died and shuttled it steps away to a patient in desperate need of a new one. More than 3500 people in the United States receive a new heart each year. But this case was different—the first of its kind in the country. “It took us 6 months to prepare,” says Nader Moazami, surgical head of heart transplantation at New York University (NYU) Langone Health, where the operation took place. The run-up included oversight from an ethi...
Source: ScienceNOW - May 11, 2023 Category: Science Source Type: news

Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval —Reply
In Reply We thank Powers for his comments regarding our article. He raises the question if the positive result for patients with target perfusion-imaging mismatch in the 12.8- to 24-hour tercile in the Analysis of Pooled Data From Randomized Studies of Thrombectomy More Than 6 Hours After Last Well Known (AURORA) study could solely be due to a benefit from 12.8 to 16 hours since last known well subgroup, with neutral or negative effects in the 16- to 24-hour time period. This was not the case. Data for patients in the 16- to 24-hour group with the target mismatch profile demonstrated an odds ratio of 3.82 (95% CI, 1.07-13....
Source: JAMA Neurology - February 14, 2022 Category: Neurology Source Type: research

Selection of Patients for Thrombectomy in the Extended Time Window
Based on the protocols used in the DAWN (Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trials (RCTs) of thrombectomy in the extended window, current guidelines recommend thrombectomy either in the 6- to 16-hour window in patients with a target perfusion imaging mismatch profile or in the 6- to 24-hour window in patients with a clinical imaging mismatch profile. However, these criteria ...
Source: JAMA Neurology - July 26, 2021 Category: Neurology Source Type: research

Predictors of Good Outcomes in Stroke Thrombolysis Guided by Tissue-Window
This study aimed to evaluate predictors of good outcomes from thrombolysis in these patients. Methods: Acute ischemic stroke patients received thrombolysis guided by computed tomography perfusion (CTP) from October 2018 to August 2019 were reviewed. Baseline characteristics and outcomes were collected. Good outcomes were defined as modified Rankin scale scores of 0 to 2 at 90 days. Logistic regression analysis was performed and the receiver operating characteristics analysis was used to determine cut-off values for the predictors of outcomes. Results: Sixty-three patients were enrolled. The median age was 64 ...
Source: The Neurologist - January 1, 2021 Category: Neurology Tags: Original Articles Source Type: research

Role of Non-Perfusion Factors in Mildly Symptomatic Large Vessel Occlusion Stroke
Recent reperfusion trials after acute large vessel occlusion (LVO) stroke did not include patients with low national institute of health stroke scale (NIHSS) except for MR CLEAN trial in which they enrolled subjects with NIHSS ranging between 3 and 38. Very few subjects had NIHSS ≤5. Other trials like REVASCAT, ESCAPE, SWIFT PRIME, EXTEND-IA, DAWN, and DIFFUSE 3 had their enrolled patients’ NIHSS at ≥6, interquartile range (IQR) 12-20, IQR 13-20, IQR 9-20, IQR 13-21, and IQR 10-21 respectively.1–3 The most likely rationale is that these low-NIHSS stroke patients have well-developed collateral circulations that allo...
Source: Journal of Stroke and Cerebrovascular Diseases - August 11, 2020 Category: Neurology Authors: Omar Hussein, Ahmed Abd Elazim, Khalid Sawalha, Smeer Salam, Kasser Saba, Mohammad Hamed, Juan Peng, Archana Hinduja Source Type: research

Intracranial mechanical thrombectomy without extracranial revascularization for a tandem occlusion with robust Circle of Willis: case report
Publication date: Available online 4 October 2019Source: Interdisciplinary NeurosurgeryAuthor(s): Mateja de Leonni Stanonik, Christopher Sy, Cameron McDougall, Lee Birnbaum, Justin MascitelliAbstractA 59-year-old male presented with a severe left middle cerebral artery (MCA) syndrome, a National Institutes of Health Stroke Scale (NIHSS) of 17, and was last known well 26 hours prior. Computed tomography angiography (CTA) of the head demonstrated a tandem extracranial ICA and intracranial ICA/MCA occlusion. Computed tomography perfusion (CTP) demonstrated a large mismatch. The patient underwent a mechanical thrombectomy usin...
Source: Interdisciplinary Neurosurgery - October 4, 2019 Category: Neurosurgery Source Type: research

Detection of Crossed Cerebellar Diaschisis by Intravoxel Incoherent Motion MR Imaging in Subacute Ischemic Stroke.
Abstract Intravoxel incoherent motion has received extensive attention in brain studies for its potential as a non-invasive magnetic resonance perfusion method. However, studies on intravoxel incoherent motion imaging and crossed cerebellar diaschisis detection are relatively scarce. The aim of our study was to evaluate the feasibility of using intravoxel incoherent motion imaging in crossed cerebellar diaschisis diagnosis in subacute ischemic stroke patients by comparing results from intravoxel incoherent motion imaging, single-photon emission computed tomography, and arterial spin-labeling perfusion methods. In ...
Source: Cell Transplantation - June 13, 2019 Category: Cytology Authors: Wang J, Suo S, Zu J, Zhu W, Pan L, Song S, Li Y, Li L, Chen Z, Xu J Tags: Cell Transplant Source Type: research

Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data
This study is registered with PROSPERO, number CRD42019128036.FindingsWe identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome a...
Source: The Lancet - May 24, 2019 Category: General Medicine Source Type: research

Thrombectomy in stroke of unknown onset, wake up stroke and late presentations: Australian experience from 2 comprehensive stroke centres
This study shows good ‘real world’ outcomes, comparable to published RCTs, in patients with unknown-onset, or late presentation, stroke treated with EVT more than 6 h from stroke onset.
Source: Journal of Clinical Neuroscience - November 8, 2018 Category: Neuroscience Source Type: research

Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow
ObjectiveThe present study was undertaken to determine the efficacy of coadministration of fingolimod with alteplase in acute ischemic stroke patients in a delayed time window.MethodsThis was a prospective, randomized, open ‐label, blinded endpoint clinical trial, enrolling patients with internal carotid artery or middle cerebral artery proximal occlusion within 4.5 to 6 hours from symptom onset. Patients were randomly assigned to receive alteplase alone or alteplase with fingolimod. All patients underwent pretreatme nt and 24‐hour noncontrast computed tomography (CT)/perfusion CT/CT angiography. The coprimary endpoint...
Source: Annals of Neurology - November 2, 2018 Category: Neurology Authors: De ‐Cai Tian, Kaibin Shi, Zilong Zhu, Jia Yao, Xiaoxia Yang, Lei Su, Sheng Zhang, Meixia Zhang, Rayna J. Gonzales, Qiang Liu, DeRen Huang, Michael F. Waters, Kevin N. Sheth, Andrew F. Ducruet, Ying Fu, Min Lou, Fu‐Dong Shi Tags: Research Article Source Type: research

Successful intravenous thrombolysis of a wake-up stroke with underlying valvular atrial fibrillation.
Authors: Shahedah KK, Khoo CS, Wan Nur Nafisah WY, Ng CF, Noor Ashikin I, Mohd Naim MY, Syazarina Sharis O, Rozman Z, Wan Asyraf WZ Abstract A 42-year-old female admitted with new-onset atrial fibrillation had a wake-up stroke on the high-dependency unit and the time last seen well (TLSW) was 6.5 h. She suffered left-sided body weakness and her National Institutes of Health Stroke Scale (NIHSS) score was 17. An emergency CT perfusion showed right M1 segment occlusion with more than 50% penumbra. She was given recombinant tissue plasminogen activator (r-tPA) at 9 h from TLSW. An immediate diagnostic angiogram with...
Source: Journal of the Royal College of Physicians of Edinburgh - September 8, 2018 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Ischemic Volume and Neurological Deficit: Correlation of Computed Tomography Perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke
The National Institutes of Health Stroke Scale (NIHSS) is the most adopted stroke patients' evaluation tool in emergency settings to assess the severity of stroke and to determine the patients' eligibility for specific treatments. Computed tomography perfusion (CTP) is crucial to identify salvageable tissue that can benefit from the reperfusion treatment. The aim of this study is to identify the relation between the NIHSS scores and the hypoperfused volumes evaluated by CTP in patients with hyperacute ischemic stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - April 30, 2018 Category: Neurology Authors: Giovanni Furlanis, Milo š Ajčević, Lara Stragapede, Carlo Lugnan, Mariana Ridolfi, Paola Caruso, Marcello Naccarato, Maja Ukmar, Paolo Manganotti Source Type: research

Susceptibility-weighted imaging predicts infarct size and early-stage clinical prognosis in acute ischemic stroke
AbstractSusceptibility-weighted imaging (SWI) is a non-invasive technique that can reveal venous structures and iron in the brain. This retrospective study evaluated SWI, relative to other imaging techniques, for determining cerebral infarct size and early-stage clinical prognosis in patients with acute ischemic stroke. Within 3  days after onset, 22 patients with acute ischemic stroke underwent SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), and magnetic resonance angiography (MRA). At least 7 days after onset, the patients also underwent cranial FLAI...
Source: Neurological Sciences - March 20, 2018 Category: Neurology Source Type: research

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