• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval
To the Editor The Diffusion-Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo (DAWN) trial demonstrated benefit of endovascular treatment (EVT) in select patients 6 to 24 hours after last known well (LKW) with clinical imaging mismatch. The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) trial demonstrated benefit of EVT in select patients 6 to 16 hours after LKW with target perfusion-imaging mismatch. In the article by Albers et al, the authors present indepe...
Source: JAMA Neurology - February 14, 2022 Category: Neurology Source Type: research

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

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

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

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

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

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

Lesion Size and Perspective in Acute Ischemic Stroke
The computed tomographic (CT) or magnetic resonance imaging (MRI) findings of early cerebral ischemia are literally, and figuratively, shades of gray in decision making regarding the triage of patients with acute ischemic stroke for revascularization. The subtleties and areas of uncertainty on imaging of this dynamic process, where an arterial occlusion is mitigated by collateral perfusion in the brain, defy concrete rules or thresholds that are equally consequential across individual patients. Imaging criteria, whether more than one-third of the middle cerebral artery territory, Alberta Stroke Program Early CT (ASPECT) sc...
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

Endovascular Treatment for Patients With Stroke and Large Ischemic Cores and Mismatch Imaging Profiles
This case-control study compares the outcomes of patients following stroke with large baseline ischemic cores on computed tomographic perfusion undergoing endovascular therapy with the outcomes of matched controls who had medical care alone.
Source: JAMA Neurology - November 7, 2016 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