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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

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

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

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

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

Conscious Sedation vs General Anesthesia for Vertebrobasilar Stroke Thrombectomy
This case-control study compares clinical and angiographic outcomes between monitored anesthesia care and general anesthesia in patients presenting with vertebrobasilar occlusion strokes.
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research

Response to Endovascular Therapy for Acute Ischemic Stroke
To the Editor Recent data from randomized clinical trials provide clear evidence that endovascular treatment for acute ischemic stroke because of large vessel anterior circulation occlusion improves clinical outcomes for patients. These studies reported that most patients had an occlusion of the first segment (M1) of the middle cerebral artery and less than 10% in the M2 segment. The retrospective multicenter study conducted by Sarraj et al reports that endovascular treatment is safe and effective for an occlusion of the M2 segment. However, the literature reports different definitions for the M1 and M2 segments, which may...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research