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Source: JAMA Neurology
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Total 17 results found since Jan 2013.

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

Error in Table
The Original Investigation titled “Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion: A Secondary Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism—Japan Large I schemic Core Trial (RESCUE-Japan LIMIT),” published online October 10, 2022, was corrected to add 2 missing P values in Table 2.
Source: JAMA Neurology - December 12, 2022 Category: Neurology Source Type: research

Association Between ASPECTS and Efficacy and Safety Outcomes With EVT in Patients With Stroke
This secondary analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism —Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT) evaluates the safety and efficacy of endovascular therapy in patients with acute large ischemic stroke by Alberta Stroke Program Early Computed Tomography Score.
Source: JAMA Neurology - October 10, 2022 Category: Neurology Source Type: research

Disentangling Workflow Paradigms and Treatment Decision-Making in Acute Ischemic Stroke —Reply
In Reply We thank Ospel and Goyal for their interest in the Evaluation of Direct Transfer to Angiography Suite vs Computed Tomography Suite in Endovascular Treatment (ANGIOCAT) study and read with interest their letter in which they express some concerns in relation to the direct-to-angiography suite (DTAS) paradigm. In the ANGIOCAT study, patients adjudicated to the conventional imaging group, despite receiving computed tomography perfusion (CTP) in some cases, achieved one of the shortest workflow times reported ever (door-to-puncture time of 44 minutes). According to guidelines, CTP was never used to exclude patients fr...
Source: JAMA Neurology - February 7, 2022 Category: Neurology Source Type: research

Noncontrast CT vs CT Perfusion or MRI Selection in Late Presentation of Large-Vessel –Occlusion Stroke
This cohort study compares the clinical outcomes of patients with stroke who presented 6 to 24 hours after symptom onset and were selected for mechanical thrombectomy by noncontrast computed tomography vs those selected by computed tomography perfusion or magnetic resonance imaging.
Source: JAMA Neurology - November 8, 2021 Category: Neurology Source Type: research

Direct to Angiography Suite Without Stopping for Computed Tomography Imaging in Acute Stroke
This randomized clinical trial assesses whether direct transfer to the angiography suite improves clinical outcomes compared with usual imaging workflow among patients within 6 hours from onset of symptoms for large vessel occlusion ischemic stroke.
Source: JAMA Neurology - August 2, 2021 Category: Neurology Source Type: research

Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion —Reply
In Reply We thank Ospel and colleagues for their thoughtful comments on our article showing that more proximal occlusion and greater thrombus length predict early neurological deterioration of ischemic origin (ENDi) in patients with acute minor ischemic stroke with large-vessel occlusion treated with intravenous thrombolysis, with implications regarding how to best manage these patients. Although the precise pathophysiological links between more proximal occlusion, a longer thrombus, and ENDi are uncertain, we fully agree that a leading hypothesis is in situ thrombus extension leading to secondary hemodynamic compromise vi...
Source: JAMA Neurology - July 6, 2021 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

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography
To the Editor In a secondary analysis of the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source trial, Healey and colleagues determined that for patients with embolic stroke of undetermined source and left atrial enlargement rivaroxaban treatment was associated with a 74% reduction in recurrent stroke. The authors suggest that left atrial enlargement could become a new determinant in secondary stroke prevention.
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

SELECTing Patients With Large Ischemic Core Who May Benefit From Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the clinical and radiologic outcomes in an observational cohort of 105 patients who had extensive ischemic changes on noncontrast computed tomographic (CT) scans (Alberta Stroke Program Early CT Scores [ASPECTS] of 0-5) or CT perfusion scans with ischemic core volume greater than 50 mL and who were treated within 24 hours of stroke onset with endovascular thrombectomy or medical management. All but 1 of the patients who received endovascular treatment and were included based on low ASPECTS had a score of 4 or 5. The ASPECTS regions are not volumetrically or functional...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Thrombolysis Works in Lacunar Infarct, Complicating Imaging Selection
A new, exploratory analysis of the Efficacy and Safety of MRI-Based Thrombolysis in Wake-up Stroke (WAKE-UP) trial by Barow and colleagues in this issue ofJAMA Neurology provides unique and compelling data suggesting that thrombolysis improves clinical outcomes after acute lacunar infarction. The European Union –commissioned, 500-patient, randomized, double-blind, placebo-controlled WAKE-UP trial of alteplase captured the magnetic resonance imaging (MRI) and magnetic resonance angiography of patients with acute ischemic stroke prior to thrombolysis. This allowed categorization of infarcts as lacunar vs n onlacunar, using...
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Stroke Imaging
In this issue ofJAMA Neurology, Boulouis et al report on the crucial influence of pretreatment collateral blood vessel status in determining the benefit of transfer for endovascular thrombectomy for large vessel acute ischemic stroke. All patients had relatively little evidence of irreversible injury on noncontrast computed tomography (CT) at their referring hospitals. However, when imaging was repeated at the comprehensive stroke center, a substantial proportion of patients had evolved large infarcts that caused them not to proceed to endovascular therapy or foreshadowed a poor outcome. These data contribute to the weight...
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

Managing Patients With Large Ischemic Core
To the Editor We read with interest the article by Rebello and colleagues on endovascular treatment. There is still uncertainty on how best to manage patients who have a large ischemic core and a large artery clot. Using matched controls is an excellent approach when the study is not a randomized clinical trial. The authors modified the approach of Mandava and colleagues, who had proposed matching controls based on the National Institutes of Health Stroke Scales, age, and pretreatment glucose level. The authors had substituted an “ischemic core on computed tomography perfusion” for the National Institutes of Health Str...
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research

Computed Tomography Perfusion and Diffusion-Weighted Imaging in Acute Stroke
To the Editor In JAMA Neurology, Rudilosso and colleagues presented 2 cases using computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI). They suggested that CTP was superior to DWI in the identification of ischemic changes in acute stroke. In most patients, DWI findings appear positive within several minutes to several hours of the onset of acute cerebral infarction. Positive DWI findings depend on cytotoxic edema. The morphology of the brain maintains intact when cerebral blood flow is decreased to 30% of its normal level. If perfusion is returned to normal, no abnormality will be detected by DWI. When ...
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research