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Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times
This study attempts to determine whether automated computed tomography angiogram interpretation coupled with secure group messaging can improve in-hospital endovascular stroke therapy workflows.
Source: JAMA Neurology - September 18, 2023 Category: Neurology Source Type: research

Time for a New Perspective on Intracerebral Hemorrhage
More than 3 million people worldwide experience intracerebral hemorrhage (ICH) each year. Although the incidence of ICH is much lower than that of ischemic stroke, ICH imposes a 50% greater worldwide burden of disability. ICH has a 30-day case fatality rate of more than 40%, and most survivors are left with permanent disabilities. Because of the high likelihood of poor outcomes, physicians caring for patients with ICH tend to use clinical severity scores early on to estimate the risk of mortality or future disability to determine the aggressiveness of medical care and to guide conversations with patients ’ surrogates aro...
Source: JAMA Neurology - July 25, 2022 Category: Neurology Source Type: research

Disentangling Workflow Paradigms and Treatment Decision-making in Acute Ischemic Stroke
To the Editor We congratulate Requena and colleagues on their randomized trial, in which they compared a direct-to-angiography suite (DTAS) paradigm with a conventional workflow paradigm, ie, cross-sectional imaging, followed by transport to the angiography suite for endovascular treatment (EVT) when appropriate. The authors found that a DTAS paradigm not only decreased in-hospital workflow times but also increased the odds of patients undergoing EVT, both of which may have contributed to the improved clinical outcomes in the DTAS group.
Source: JAMA Neurology - February 7, 2022 Category: Neurology Source Type: research

Streamlining the Path to Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the associations of repeated imaging on arrival at an endovascular thrombectomy (EVT) –capable hospital with clinical outcomes after EVT. They studied an observational cohort of 2533 patients who had ischemic stroke with large vessel occlusion within 24 hours of stroke onset. It is well understood that a favorable outcome depends on the time from stroke onset to reperfusion, and th ere is no doubt that proceeding directly to the angiography suite (DTA) saves time compared with repeating imaging (median time, 26 minutes shorter in Sarraj et al). Direct transfer to th...
Source: JAMA Neurology - June 14, 2021 Category: Neurology Source Type: research

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity
This study describes differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.
Source: JAMA Neurology - March 1, 2021 Category: Neurology Source Type: research

Remote Ischemic Perconditioning for the Treatment of Acute Ischemic Stroke —Reply
In Reply We thank Zhao et al for the interest in our randomized clinical trial. We agree that it is of interest to evaluate remote ischemic perconditioning specifically in patients with acute ischemic stroke and mismatch. We did not target these patients exclusively, because when the Remote Ischemic Conditioning in Acute Brain Infarction (RESCUE BRAIN) was designed in 2012, there was no proof of the efficacy of this approach; the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) and Endovascular Therapy Following Imaging Evaluati...
Source: JAMA Neurology - September 28, 2020 Category: Neurology Source Type: research

Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era
This cohort study uses a large US national registry to assess temporal trends from 2008 to 2018 in the use of intravenous and endovascular reperfusion therapies, process measures of quality, and association between functional outcomes and key patient characteristics, comorbidities, and treatments of in-hospital vs out-of-hospital stroke onset.
Source: JAMA Neurology - September 21, 2020 Category: Neurology Source Type: research

In-Hospital Acute Strokes —Opportunities to Optimize Care and Improve Outcomes
Stroke is a well-known complication of acute medical or surgical illnesses. Prior work has shown that patients with stroke occurring in the hospital are more likely to encounter delays in diagnosis, have gaps in care, and experience worse outcomes compared with patients with stroke occurring out of the hospital. Delay in the recognition of symptoms of stroke is particularly relevant for extremely short-term revascularization therapies, which was previously limited to a relatively narrow time window for treatment with intravenous thrombolysis. Patients with in-hospital stroke may be more likely than patients with community-...
Source: JAMA Neurology - September 21, 2020 Category: Neurology Source Type: research

Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
This cohort study compares the rate of ischemic stroke among patients with COVID-19 vs patients with influenza in 2 hospitals in New York City, New York.
Source: JAMA Neurology - July 2, 2020 Category: Neurology Source Type: research

Triage Based on Preclinical Scores
Current guidelines state that patients who experienced a stroke should usually be transferred to the nearest stroke-treating hospital. In accordance with these guidelines, most patients with large-vessel occlusion (LVO) are transported to a primary stroke center (PSC) that does not offer thrombectomy. From there, these patients must undergo a secondary interhospital transport to a thrombectomy-capable comprehensive stroke center (CSC). Such secondary transfers cause considerable treatment delays, ranging from 96 to 111 minutes. Even when the distance between the PSC and a CSC is only 15 miles, transfer times of 104 minutes have been reported.
Source: JAMA Neurology - April 6, 2020 Category: Neurology Source Type: research

Effect of Remote Ischemic Perconditioning on Brain Infarct Growth in Patients With Ischemic Stroke
This randomized clinical trial examines whether in-hospital treatment with remote ischemic perconditioning that is administered within 6 hours of symptom onset, with or without reperfusion therapy, can reduce brain infarction volume growth in patients with acute ischemic stroke.
Source: JAMA Neurology - March 30, 2020 Category: Neurology Source Type: research

Prehospital Stroke Management Optimized by the Use of Clinical Scoring vs Mobile Stroke Unit
This randomized clinical trial explores how prehospital management optimized by the use of the Los Angeles Motor Scale compares with prehospital management in a mobile stroke unit that includes vascular imaging in accurately triaging patients with stroke to the appropriate target hospital providing (comprehensive stroke center) or not providing (primary stroke center) neurointerventional treatment.
Source: JAMA Neurology - September 3, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Quality Improvement Intervention for Hospital Adherence to Therapies for Patients With Stroke
This cluster randomized clinical trial assesses the effect of a multifaceted quality improvement intervention compared with routine care on adherence to evidence-based therapy among patients with acute ischemic stroke and transient ischemic attack.
Source: JAMA Neurology - May 6, 2019 Category: Neurology Source Type: research

Clinical Care and In-Hospital Outcomes of Asian American Patients With Acute Ischemic Stroke
This analysis compares the characteristics, care, and outcomes of Asian American and white patients with acute ischemic stroke at hospitals participating in the Get With The Guidelines –Stroke program.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

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