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How Patient Demographics, Imaging, and Beliefs Influence Tissue-Type Plasminogen Activator Use: A Survey of North American Neurologists Clinical Sciences
Conclusions— Diagnostic certainty and likelihood of treatment with tissue-type plasminogen activator increase with additional clinical data, with the history being the most important factor for diagnostic and treatment decisions. Respondents had difficulty in interpreting the results of CT perfusion scans although they had little impact on treatment decisions. We did not identify treatment bias based on patient age, race, or sex.
Source: Stroke - July 24, 2016 Category: Neurology Authors: Shamy, M. C. F., Pugliese, M., Meisel, K., Rodriguez, R., Kim, A. S., Stahnisch, F. W., Smith, E. E. Tags: Computerized Tomography (CT), Ethics and Policy, Quality and Outcomes, Ischemic Stroke Clinical Sciences Source Type: research

Postreperfusion Blood Pressure Variability After Endovascular Thrombectomy Affects Outcomes in Acute Ischemic Stroke Patients With Poor Collateral Circulation
Conclusion: Postreperfusion BP management by decreasing BPV may have influence on improving clinical outcome in cases of poor collateral circulation among patients achieving successful recanalization after ERT. Introduction Endovascular recanalization therapy (ERT) has been adopted as standard stroke care in patients with acute ischemic stroke (1–6). Time to recanalization and degree of recanalization are the most important predictors of clinical outcomes after ERT (7). Before recanalization, an effort to reduce the time from symptom onset to reperfusion is critical for penumbral salvage. After recanalization...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Cardiac Imaging Within Emergency CT Angiography for Acute Stroke Can Detect Atrial Clots
This study was approved by the ethics committee of the medical faculty of the Ruhr University Bochum. FIGURE 1 Figure 1. Flow chart showing the selection of the study population. Results A total of 59 patients underwent emergency CCTA (Figure 2A) for suspected stroke, of which 44 received the final diagnosis ischemic stroke. There were 17 patients who had ischemic stroke or TIA and known or newly diagnosed atrial fibrillation (Table 1; mean age: 77.5 years, standard deviation: 8.4 years; 53% female). As hypothesized, intracardiac thrombi could be visualized: once in an artificially occluded left atrial appe...
Source: Frontiers in Neurology - April 9, 2019 Category: Neurology Source Type: research

E-089 Rural versus metropolitan stroke activation incidence: using Viz.ai to determine disease penetrance
ConclusionCompared to a metropolitan PSC in our network, two rural PSCs had significantly higher per capita incidence of stroke activations. There was a trend toward higher per capita thrombectomy alerts as well. Given the known health disparities in rural regions of the US, these findings provide clear confirmation of the importance of stroke care protocols in rural areas, and the value of rapid identification and triage for rural communities. Our future studies will examine more detailed patient-specific factors based on geographic region.Disclosures J. Fraser: None. J. Frank: None. A. Chen: None. M. Campbell: None. L. W...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Fraser, J., Frank, J., Chen, A., Campbell, M., Wise, L., Krein, B., Silvernail, R., Dornbos, D., Pahwa, S., Lee, J. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

E-152 Cone-beam CT angiogram acquisition in the angiography suite for LVO detection in acute ischemic stroke
ConclusionDTAS triage workflow with cone-beam head CT and CTA image acquisition in the angiography suite may be a next step to further optimize LVO stroke pathways by bypassing conventional CT/MR. This new workflow has the potential to further decrease door-to-needle times and thereby may improve patient outcome.Disclosures A. Kuhn: None. J. Singh: None. M. Garcia: None. S. Sarid: None. M. Gounis: 1; C; National Institutes of Health (NIH), the United States – Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Balt, Cerenovus, Ceretrieve, CereVasc LLC, Cook Medical, Gal. 2; C; fee-per-h...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Kuhn, A., Singh, J., Garcia, M., Sarid, S., Gounis, M., Anagnostakou, V., Puri, A. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

O-004 A multicenter study evaluating the frequency and burden of mechanical thrombectomy on stroke centers
Conclusion This is the first study to quantify the time requirement of mechanical thrombectomy and the call burden on neurointerventional physicians at stroke centers. Over a three month period at 10 stroke centers across the United States, mechanical thrombectomy procedures occurred once every 5 days on average, although nearly 60% occurred during non-work hours. As ELVO awareness increases, thrombectomy call has important operational implications for hospitals implementing stroke call coverage. Abstract O-004 Figure 1 Disclosures T. Wilson: None. T. Kim: None. C. Frey: None. A. Spiotta: None. R. de Leacy: None. J. M...
Source: Journal of NeuroInterventional Surgery - July 23, 2017 Category: Neurosurgery Authors: Wilson, T., Kim, T., Frey, C., Spiotta, A., Leacy, R. d., Mocco, J., Albuquerque, F., Ducruet, A., Cheema, A., Arthur, A., Srinivasan, V., Kan, P., Mokin, M., Dumont, T., Rai, A., Leslie-Mazwi, T., Hirsch, J., Singh, J., Singh, J., Wolfe, S., Fargen, K. Tags: Oral Abstracts Source Type: research

Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry
Background: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry.Summary: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 1...
Source: Interventional Neurology - October 10, 2017 Category: Neurology Source Type: research

E-040 Factors associated with failed mechanical thrombectomy in acute ischemic stroke
ConclusionFailed MT was encountered in approximately 12% of cases. The most common location of failed MT was intracranial and this was predominantly due to ICAS. Further studies to evaluate better treatment modalities of ICAS related LVO are warranted.Disclosures O. Lajthia: None. H. Ali: None. R. Neyes: None. E. Almallouhi: None. R. Chalhoub: None. K. Kicielinski: None. J. Lena: None. M. Sattur: None. G. Porto: None. A. Spiotta: None. S. Al Kasab: None.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Lajthia, O., Ali, H., Neyes, R., Almallouhi, E., Chalhoub, R., Kicielinski, K., Lena, J., Sattur, M., Porto, G., Spiotta, A., Al Kasab, S. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

Increased Versus Appropriate Neuroimaging Utilization in Stroke: A Complex Matter
We read with great interest the study by Wang et  al [1], in which they reported updated trends, sociodemographic disparities, and the impact of stroke neuroimaging on mortality across the United States from 2012 to 2019. They found a significantly increased utilization for CT angiography (250%), CTP (428%), and MRI (18%) as a well as a decreasin g rate for MR angiography use (−33%) in stroke patients. The way that the authors present consistent and extensive data on disparities across specific demographic groups (ie, rural patients, ≥80 years, female and black patients) has a significant value in designing effective ...
Source: Journal of the American College of Radiology : JACR - July 31, 2022 Category: Radiology Authors: Ángela Guarnizo, Javier Romero, Sonia Bermúdez Tags: Letters to the Editor Source Type: research

Response to “Copyediting to add final Citation Granja et al letter, Increased vs appropriate neuroimaging utilization in stroke: a complex matter.”
We thank the authors for their comments [1] and for raising several important issues about our article on the updated trends, sociodemographic disparities, and impact of stroke neuroimaging on mortality across the United States from 2012 to 2019 [2]. Their letter reminds readers about our findings of significantly increased utilization of CT angiography (250%), CTP (428%), and MRI (18%) as well as decreased use of MR angiography ( −33%) in stroke patients. Furthermore, our consistent and extensive data on disparities across specific demographic groups (ie, rural patients, patients ≥80 years, female patients, and Black ...
Source: Journal of the American College of Radiology : JACR - August 21, 2022 Category: Radiology Authors: Jason J. Wang, Casey E. Pelzl, Artem Boltyenkov, Jeffrey M. Katz, Jennifer Hemingway, Eric W. Christensen, Elizabeth Rula, Pina C. Sanelli Tags: Letters to the Editor Source Type: research

Response to Granja et  al Letter, “Increased Versus Appropriate Neuroimaging Utilization in Stroke: A Complex Matter.”
We thank the authors for their comments [1] and for raising several important issues about our article on the updated trends, sociodemographic disparities, and impact of stroke neuroimaging on mortality across the United States from 2012 to 2019 [2]. Their letter reminds readers about our findings of significantly increased utilization of CT angiography (250%), CT perfusion (428%), and MRI (18%) as well as decreased use of MR angiography ( −33%) in stroke patients. Furthermore, our consistent and extensive data on disparities across specific demographic groups (ie, rural patients, patients ≥80 years, female patients, a...
Source: Journal of the American College of Radiology : JACR - August 21, 2022 Category: Radiology Authors: Jason J. Wang, Casey E. Pelzl, Artem Boltyenkov, Jeffrey M. Katz, Jennifer Hemingway, Eric W. Christensen, Elizabeth Rula, Pina C. Sanelli Tags: Letter to the Editor Source Type: research

E-185 Study design and rationale of THUNDER: an acute ischemic stroke study with the penumbra system including thunderbolt aspiration tubing
ConclusionWe report the design of THUNDER—a multicenter prospective study that examines the use of a novel modulated aspiration thrombectomy system in patients with AIS secondary to LVO.Disclosures D. Fiorella: 1; C; Cerenovus, Medtronic, Siemens, Stryker, Microvention, Penumbra. 2; C; Balt, Marblehead, Medtronic, Stryker, Microvention, Penumbra, Cerenovus. K. Woodward: 2; C; Coviden. E. Levy: None. C. Matouk: 2; C; Silk Road Medical, Penumbra, MicroVention-TERUMO, Medtronic, Stryker. 3; C; Silk Road Medical, Penumbra. I. Kaminsky: 3; C; Penumbra. K. Reuland: None. M. Stiefel: None. A. Kansagra: 1; C; Penumbra. 2; C;...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Fiorella, D., Woodward, K., Levy, E., Matouk, C., Kaminsky, I., Reuland, K., Stiefel, M., Kansagra, A., Frei, D. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Plaque Contact Surface Area and Flow Lumen Volume Predict Stroke Risk in Extracranial Carotid Artery Stenosis
The ability to predict culprit lesions in the extracranial carotid circulation remains limited. The standard indication for intervention in asymptomatic disease is currently percent stenosis in the internal carotid artery as measured by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Computed tomography angiography (CTA) offers the opportunity to analyze carotid artery plaques from a morphologic perspective. Here, we aim to improve stroke risk stratification of patients with carotid artery stenosis using plaque 3D modeling and analysis.
Source: Journal of Vascular Surgery - August 24, 2021 Category: Surgery Authors: Ryan Gedney, Veena Mehta, Matthew Bridges, Adam Brown, Ravi Veeraswamy Tags: S2: Plenary Session 2 Source Type: research

Using a CT Angiography Artificial Intelligence Carotid Plaque Morphology Model to Predict Stroke
The gold standard for determining carotid artery stenosis is to calculate stenosis using the North American Symptomatic Carotid Endarterectomy Trial criteria and ultimately plan for medical vs surgical management based on percent stenosis and symptomatic status. Few studies have assessed plaque morphology as an additive tool for stroke prediction. Our study uses an artificial intelligence software in conjunction with a patient's computed tomography (CT) scan of the neck to create a three-dimensional (3D) model of the carotid artery and assess plaque morphology including calcification, intraplaque hemorrhage, matrix, and pe...
Source: Journal of Vascular Surgery - May 23, 2023 Category: Surgery Authors: Rohini J. Patel, Daniel Willie-Permor, Sina Zarrintan, Austin Fan, Mahmoud Malas Tags: Poster Competition Source Type: research

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