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Morimoto T, Yoshimoto N, Kuragaichi T, Taki J, Yamada K. Mechanical thrombectomy for cerebrovascular occlusion in a patient with situs inversus. Radiol Case Rep 2024; 19:3488-3491. [PMID: 38872738 PMCID: PMC11170093 DOI: 10.1016/j.radcr.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Situs inversus is a rare congenital abnormality characterized by mirror-image transposition of the major visceral organs and vessels. Few reports have discussed the use of mechanical thrombectomy in acute ischemic stroke with situs inversus. We present such a case, to raise awareness and deepen the knowledge on these cases. A 44-year-old man was admitted to our hospital with sudden-onset dysarthria and left-sided paresis. Computed tomography (CT) angiography revealed situs inversus and occlusion in the internal carotid artery. First, intravenous tissue plasminogen activator was administered, followed by immediate reperfusion with mechanical thrombectomy. We achieved thrombolysis in cerebral infarction grade 3. After the procedure, the patient fully recovered. Prompt diagnosis is crucial for rapid recanalization in patients with vascular anomalies such as situs inversus.
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Affiliation(s)
- Takaaki Morimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Takashi Kuragaichi
- Department of Cardiology, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Junya Taki
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
| | - Keisuke Yamada
- Department of Neurosurgery, Hyogo Prefecture Amagasaki General Medical Center, Hyogo, Japan
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Qureshi AI, Lodhi A, Maqsood H, Ma X, Hubert GJ, Gomez CR, Kwok CS, Ford DE, Hanley DF, Mehr DR, Shah QA, Suri MFK. Physician Transfer Versus Patient Transfer for Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e031906. [PMID: 38899767 DOI: 10.1161/jaha.123.031906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. METHODS AND RESULTS We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random-effects meta-analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of -62.08 (95% CI, -112.56 to -11.61]; P=0.016; 8 studies involving 1419 patients) with high between-study heterogeneity in the estimates (I2=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00-1.66]; P=0.046; 7 studies with 1222 patients) with physician transfer with low between-study heterogeneity (I2=0%). Physician transfer was not associated with higher odds of near-complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89-1.57; P=0.25; I2=2.8%; 11 studies with 1856 subjects). CONCLUSIONS Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institutes St Cloud MN USA
- Department of Neurology University of Missouri Columbia MO USA
| | | | | | - Xiaoyu Ma
- Zeenat Qureshi Stroke Institutes St Cloud MN USA
| | - Gordian J Hubert
- Department of Neurology, TEMPiS Telestroke Center München Klinik gGmbH Munich Germany
| | - Camilo R Gomez
- Department of Neurology University of Missouri Columbia MO USA
| | - Chun S Kwok
- Department of Cardiology, Queen Elizabeth Hospital Birmingham University Hospitals of Birmingham NHS Trust Stoke-on-Trent UK
| | - Daniel E Ford
- Department of Medicine Johns Hopkins University Baltimore MD USA
| | - Daniel F Hanley
- Department of Neurology Johns Hopkins University Baltimore MD USA
| | - David R Mehr
- Department of Geriatric Medicine University of Missouri Columbia MO USA
| | - Qaisar A Shah
- Department of Neurology Winchester Medical Center Winchester VA USA
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Beaman C, Gautam A, Peterson C, Kaneko N, Ponce L, Saber H, Khatibi K, Morales J, Kimball D, Lipovac JR, Narsinh KH, Baker A, Caton MT, Smith ER, Nour M, Szeder V, Jahan R, Colby GP, Cord BJ, Cooke DL, Tateshima S, Duckwiler G, Waldau B. Robotic Diagnostic Cerebral Angiography: A Multicenter Experience of 113 Patients. J Neurointerv Surg 2024; 16:726-730. [PMID: 37468266 DOI: 10.1136/jnis-2023-020448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Neurointerventional robotic systems have potential to reduce occupational radiation, improve procedural precision, and allow for future remote teleoperation. A limited number of single institution case reports and series have been published outlining the safety and feasibility of robot-assisted diagnostic cerebral angiography. METHODS This is a multicenter, retrospective case series of patients undergoing diagnostic cerebral angiography at three separate institutions - University of California, Davis (UCD); University of California, Los Angeles (UCLA); and University of California, San Francisco (UCSF). The equipment used was the CorPath GRX Robotic System (Corindus, Waltham, MA). RESULTS A total of 113 cases were analyzed who underwent robot-assisted diagnostic cerebral angiography from September 28, 2020 to October 27, 2022. There were no significant complications related to use of the robotic system including stroke, arterial dissection, bleeding, or pseudoaneurysm formation at the access site. Using the robotic system, 88 of 113 (77.9%) cases were completed successfully without unplanned manual conversion. The principal causes for unplanned manual conversion included challenging anatomy, technical difficulty with the bedside robotic cassette, and hubbing out of the robotic system due to limited working length. For robotic operation, average fluoroscopy time was 13.2 min (interquartile range (IQR), 9.3 to 16.8 min) and average cumulative air kerma was 975.8 mGY (IQR, 350.8 to 1073.5 mGy). CONCLUSIONS Robotic cerebral angiography with the CorPath GRX Robotic System is safe and easily learned by novice users without much prior manual experience. However, there are technical limitations such as a short working length and an inability to support 0.035" wires which may limit its widespread adoption in clinical practice.
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Affiliation(s)
- Charles Beaman
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ayushi Gautam
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Catherine Peterson
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Naoki Kaneko
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Luciano Ponce
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Hamidreza Saber
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Kasra Khatibi
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Jose Morales
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - David Kimball
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | | | - Kazim H Narsinh
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - M Travis Caton
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Eric R Smith
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - May Nour
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Branden J Cord
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Daniel L Cooke
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Satoshi Tateshima
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Gary Duckwiler
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Ben Waldau
- University of California Stroke Consortium Robotics Workgroup, California, California, USA
- Neurosurgery, University of California Davis, Sacramento, CA, USA
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Chaychi MTM, Muzammil MA, Ahmed MK. Correspondence on 'Predictors for large vessel recanalization before stroke thrombectomy: the HALT score' by Colasurdo et al. J Neurointerv Surg 2024; 16:324-325. [PMID: 37463766 DOI: 10.1136/jnis-2023-020745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
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Rossis C, Michail KA, Middleton N, Karanikola M, Papathanassoglou E, Mpouzika M. Knowledge on Stroke Recognition and Management among Emergency Department Healthcare Professionals in the Republic of Cyprus. Healthcare (Basel) 2023; 12:77. [PMID: 38200983 PMCID: PMC10778653 DOI: 10.3390/healthcare12010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for emergency department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek Cypriot ED healthcare professionals' (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, twenty-eight assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. A total of 255 nurses (response rate (RR): 74.1%) and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among emergency department nurses and physicians in the Republic of Cyprus revealed significant deficits. This study stresses targeted interventions, including education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.
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Affiliation(s)
| | - Koralia A. Michail
- Department of Nursing, Cyprus University of Technology, 3041 Limassol, Cyprus; (K.A.M.); (N.M.); (M.K.)
| | - Nicos Middleton
- Department of Nursing, Cyprus University of Technology, 3041 Limassol, Cyprus; (K.A.M.); (N.M.); (M.K.)
| | - Maria Karanikola
- Department of Nursing, Cyprus University of Technology, 3041 Limassol, Cyprus; (K.A.M.); (N.M.); (M.K.)
| | | | - Meropi Mpouzika
- Department of Nursing, Cyprus University of Technology, 3041 Limassol, Cyprus; (K.A.M.); (N.M.); (M.K.)
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Jesser J, Nguyen T, Dmytriw AA, Yamagami H, Miao Z, Sommer LJ, Stockero A, Pfaff JAR, Ospel J, Goyal M, Patel AB, Pereira VM, Hanning U, Meyer L, van Zwam WH, Bendszus M, Wiesmann M, Möhlenbruch M, Weyland CS. Treatment practice of vasospasm during endovascular thrombectomy: an international survey. Stroke Vasc Neurol 2023:svn-2023-002788. [PMID: 38164618 DOI: 10.1136/svn-2023-002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND AIM The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during EVT. METHODS We conducted an anonymous international online survey (4 April 2023 to 15 May 2023) addressing treatment standards of neurointerventionalists (NIs) practising EVT. Several illustrative cases of patients with vasospasm during EVT were shown. Two study groups were compared according to the NI's opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive analysis. RESULTS In total, 534 NI from 56 countries responded, of whom 51.5% had performed >200 EVT. Vasospasm was considered a complication potentially influencing the patient's outcome by 52.6% (group 1) whereas 47.4% did not (group 2). Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely (43.7% vs 33.9%, p=0.033) and more often treated severe large-vessel vasospasm with vasodilators (75.3% vs 55.9%; p<0.001), as well as extracranial vasospasm (61.4% vs 36.5%, p<0.001) and intracranial medium-vessel vasospasm (27.1% vs 11.2%, p<0.001), compared with group 2. In case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT, the study groups showed different treatment strategies. Group 2 continued the EVT immediately more often, without initiating therapy to treat the vasospasm first (9.6% vs 21.1%, p<0.001). CONCLUSION There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its management. There was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.
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Affiliation(s)
- Jessica Jesser
- Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thanh Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- St. Michael's Hospital, Departments of Medical Imaging and Neurosurgery, Neurovascular Center, University of Toronto, Toronto, Ontario, Canada
- Neuroendovascular Program, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | | | | | - Johannes Alex Rolf Pfaff
- University Insitute for Neuroradiology at PMU, Uniklinikum Salzburg-Christian-Doppler-Klinik, Salzburg, Austria
| | - Johanna Ospel
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Uta Hanning
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Wim H van Zwam
- Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin Bendszus
- Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
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Dymm BL, Kwicklis M, Meurer WJ, Shi X, Lisabeth LD. Recurrent stroke arrival time. J Stroke Cerebrovasc Dis 2023; 32:107069. [PMID: 37037176 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical services (EMS). The impact of this education is unclear. We aimed to measure the associations between EMS use and timing of hospital arrival and first-ever and recurrent strokes as a proxy for stroke education. METHODS The study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes, 259 instances of recurrent stroke within 1 year of the first (early recurrence), and 451 recurrent strokes over 1 year from the first (late recurrence). Following imputation, associations of both EMS arrival (available starting late 2011) and early arrival (< 3 hours) with first-ever versus recurrent stroke (early and late) were assessed with logistic models, accounting for the clustering of multiple strokes per participant with generalized estimating equations. Full model covariates included stroke type, initial stroke severity, marital status, race/ethnicity, gender, age, insurance, education, and EMS use (early arrival model only). RESULTS Compared to first-ever stroke, there were significantly higher unadjusted odds of arrival by EMS for the late recurrence group (late recurrence OR = 1.54, 95% CI = 1.18-1.99; early arrival OR = 1.24, 95% CI = 0.87-1.76). The association for late recurrence remained significant after adjustment (aOR = 1.46, 95% CI = 1.09-1.95). The pre-2010 unadjusted odds of early arrival were non-significant for both early and late recurrence groups (late recurrence OR = 1.05, CI = 0.70-1.56; early recurrence OR = 0.85, CI = 0.54-1.33), while late recurrence was associated with early arrival after 2010 (OR = 1.32, 95% CI = 1.03-1.69). After full adjustment, it was no longer significant (aOR = 1.25, 95% CI = 0.96-1.62). Higher initial stroke severity, married status, and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had borderline significant lower odds of EMS use compared to those who were not. CONCLUSIONS Our study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. Recurrence at least one year after the first stroke was associated with higher EMS usage, but there was not enough evidence to establish a relationship with early arrival after accounting for EMS usage and possible confounders. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.
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Affiliation(s)
| | | | | | - Xu Shi
- University of Michigan Department of Biostatistics, US
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8
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Barnaure I, Kulcsár Z, Schubert T. Supra-aortic Vessel Catheterization in Hostile Anatomy. Clin Neuroradiol 2023; 33:247-249. [PMID: 36036256 DOI: 10.1007/s00062-022-01212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Isabelle Barnaure
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland.
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Abstract
ABSTRACT BACKGROUND: Early recognition of inpatient stroke is critical in reducing poor outcomes. A gap in knowledge and recognition of stroke by nursing staff was observed; protocols did not incorporate the Balance, Eyes, Face, Arms, Speech, and Time (BE-FAST) symptom mnemonic, and code stroke documentation was frequently incomplete. PURPOSE: This initiative aimed to improve timely recognition, evidence-based treatment, and nursing documentation of stroke-related symptoms. METHODS: This quality improvement initiative implemented an inpatient nurse-driven code stroke bundle. A pre-post prospective intervention design was implemented over 3 months. Code stroke bundle components included an evidence-based protocol, algorithm, visual aids, and education. Nursing communication and documentation used the BE-FAST mnemonic in a Situation, Background, Assessment, Recommendation format. RESULTS: Nursing stroke knowledge improved 8% (88% vs 96%, P < .001); stroke response times improved 15 minutes (25.9 vs 11 minutes, P = .383), although not significant; the code stroke documentation completion rate was increased 48.1% (0 [0%] vs 13 [48.1%], P < .001); and improved utilization of the BE-FAST tool with Situation, Background, Assessment, Recommendation communication (0 [0%] vs 20 [47.6%], P = < .001) was observed. The code stroke cancelation rate slightly worsened (10 [26.3%] vs 14 [26.9%], P = .949), code stroke notifications for altered mental status improved (15 [39.5%] vs 8 [15.7%], P = .015), and the stroke mimic rate improved (27 [71.1%] vs 35 [67.3%], P = .708). CONCLUSION: Nurses provide hospital patient care continuously and are in a key position to intervene when patients present changes in symptoms. Through education and creating an evidence-based protocol, nurses can impact patient outcomes in early recognition and activation of the code stroke system. Further studies are warranted to refine strategies leading to continued improvement in early stroke identification.
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Beaman C, Holodinsky JK, Goyal M, Tateshima S, Hill MD, Saver JL, Kamal N. Modeling optimal patient transport in a stroke network capable of remote telerobotic endovascular therapy. Interv Neuroradiol 2022:15910199221140177. [PMID: 36398447 DOI: 10.1177/15910199221140177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telerobotic endovascular therapy (EVT) has the potential to decrease time to treatment and expand existing networks of care to more rural populations. It is currently unclear how its implementation would impact existing stroke networks. METHODS Conditional probability models were generated to predict the probability of excellent outcome for patients with suspected large vessel occlusion (LVO). A baseline stroke network was created for California using existing intravenous thrombolysis (IVT) centers and comprehensive stroke centers (CSCs) capable of IVT and EVT. Optimal transport decisions and catchment areas were generated for the baseline model and three hypothetical scenarios through conversion of IVT centers at various distances from a CSC into centers capable of telerobotic EVT [i.e., hospitals ≥15 and <50 miles from a CSC were converted (Scenario 1), ≥50 and <100 miles (Scenario 2), and ≥100 miles (Scenario 3)]. Procedural times and success rates were varied systematically. RESULTS Telerobotic EVT centers decreased median travel time for LVO patients in all three scenarios. The estimated number of robotically treated LVOs per year in Scenarios 1, 2, and 3 were 2,172, 740, and 212, respectively. Scenario 1 (15-50 miles) was the most sensitive to robotic time delay and success rate, but all three scenarios were more sensitive to decreases in procedural success rate compared to time delay. CONCLUSIONS Telerobotic EVT has the potential to improve care for stroke patients outside of major urban centers. Compared to procedural time delays in robotic EVT, a decrease in procedural success rate would not be well tolerated.
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Affiliation(s)
- Charles Beaman
- Department of Neurology & David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Interventional Neuroradiology, Department of Radiological Sciences & David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jessalyn K Holodinsky
- Department of Clinical Neurosciences, The University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, The University of Calgary, Calgary, Alberta, Canada
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences & David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael D Hill
- Department of Clinical Neurosciences, The University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey L Saver
- Department of Neurology & David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Noreen Kamal
- 3688Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Gariscsak PJ, Salaheen Z, Godfrey C, Tampieri D, Appireddy R. Objective performance metrics in human robotic neuroendovascular interventions: a scoping review protocol. JBI Evid Synth 2022; 20:2815-2823. [PMID: 36081373 DOI: 10.11124/jbies-21-00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to review the available information on objective performance metrics used during robotic neuroendovascular intervention procedures on humans. INTRODUCTION Robotic neuroendovascular intervention is defined as any endovascular procedure within the vasculature of the central nervous system with the assistance of a robotic system for diagnostic or therapeutic procedures. Robotic systems are described as a 2-component system consisting of a patient-side mechanical robot, and a separate operator control station. Robotic neuroendovascular intervention is a growing field and there is a need to establish objective performance metrics for furthering evidence-based reporting of the literature. INCLUSION CRITERIA This scoping review will consider all studies involving humans that utilize robotic neuroendovascular intervention. We will consider all types of studies, reports, and reviews as well as gray literature. Studies will be included if they describe the use of an objective performance metric during robotic neuroendovascular intervention. This review is not limited to a particular country or health care system, and will consider all study designs, regardless of their rigor or language. METHODS Utilizing a 3-step framework as a guide, we will perform a systematic search in Embase, Cochrane Library, and MEDLINE. Available literature from inception to the present will be considered. Studies will be independently screened according to the inclusion criteria by 2 reviewers based on title, abstract, and full text. Data will be extracted, sorted, and presented in both a narrative summary as well as table and diagram based on the objective of the scoping review.
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Affiliation(s)
| | - Zaid Salaheen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christina Godfrey
- School of Nursing, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | | | - Ramana Appireddy
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Lee CW, Chang YP, Huang YT, Hsing CH, Pang YL, Chuang MH, Wu SZ, Sun CK, Hung KC. General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis. Front Neurol 2022; 13:1017098. [PMID: 36188372 PMCID: PMC9515609 DOI: 10.3389/fneur.2022.1017098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed at comparing the difference in prognostic outcomes between patients receiving general anesthesia (GA) and conscious sedation (CS) for endovascular thrombectomy after acute ischemic stroke. Methods Databases from Medline, Embase, Google scholar, and Cochrane library were searched for randomized controlled studies (RCTs) comparing patients undergoing GA and CS for endovascular thrombectomy following anterior circulation ischemic stroke. The primary outcome was frequency of 90-day good functional outcome [defined as modified Rankin Scale score of ≤ 2], while secondary outcomes included successful recanalization rate (SRR) [i.e., modified thrombolysis in cerebral infarction = 2b or 3], mortality risk, symptomatic intracranial hemorrhage (ICH), procedure-related complications, hypotension, pneumonia, neurological outcome at post-procedure 24–48 h, and puncture-to-recanalization time. Results Six RCTs including 883 patients published between 2016 and 2022 were included. Merged results revealed a higher SRR [risk ratio (RR) = 1.11, 95% CI: 1.03–1.2, p = 0.007; I2 = 29%] and favorable neurological outcomes at 3-months (RR = 1.2, 95% CI: 1.01–1.41, p = 0.04; I2 = 8%) in the GA group compared to CS group, without difference in the risk of mortality (RR = 0.88), symptomatic ICH (RR = 0.91), procedure-related complications (RR = 1.05), and pneumonia (RR = 1.9) as well as post-procedure neurological outcome (MD = −0.21) and successful recanalization time (MD = 3.33 min). However, GA was associated with a higher risk of hypotension compared with that of CS. Conclusion Patients with acute anterior circulation ischemic stroke receiving GA were associated with a higher successful recanalization rate as well as a better 3-month neurological outcome compared to the use of CS. Further investigations are warranted to verify our findings. Systematic review registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342483, identifier: CRD42022342483.
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Affiliation(s)
- Chia-Wei Lee
- Department of Neurology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yu-Li Pang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Su-Zhen Wu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- *Correspondence: Kuo-Chuan Hung
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Berczeli M, Chinnadurai P, Legeza PT, Britz GW, Lumsden AB. Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study. Neurosurg Focus 2022; 52:E18. [PMID: 34973671 DOI: 10.3171/2021.10.focus21511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the "workable" length with the CorPath GRX robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve "working length" compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.
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Affiliation(s)
- Marton Berczeli
- 1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston.,2Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary; and
| | - Ponraj Chinnadurai
- 1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston.,3Advanced Therapies, Siemens Medical Solutions USA Inc., Malvern, Pennsylvania
| | - Peter T Legeza
- 1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston.,2Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary; and
| | - Gavin W Britz
- 4Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Houston, Texas
| | - Alan B Lumsden
- 1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston
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14
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Thon JM, Jovin TG. Imaging as a Selection Tool for Thrombectomy in Acute Ischemic Stroke: Pathophysiologic Considerations. Neurology 2021; 97:S52-S59. [PMID: 34785604 DOI: 10.1212/wnl.0000000000012793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Large vessel occlusion (LVO) stroke represents a stroke subset associated with the highest morbidity and mortality. Multiple prospective randomized trials have shown that thrombectomy, alone or in conjunction with IV thrombolysis, is highly effective in reestablishing cerebral perfusion and improving clinical outcomes. In unselected patients and especially in patients with poor collaterals, the benefit of reperfusion therapy is exquisitely time sensitive; the earlier thrombectomy is started, the lower the likelihood of disability or death. Understanding both the pathophysiologic underpinnings and the modifying factors of this strong time-to-treatment effect demonstrated in numerous randomized clinical trials is important for implementation of intrahospital workflow measures to maximize time efficiency of thrombectomy. Reducing delays in reperfusion therapy initiation has become a priority in acute stroke care, and therefore a thorough understanding of the main systems-based factors responsible for these delays is critical. Because the time spent evaluating the patient in the emergency department, which typically includes neuroimaging studies performed in scanners remote from the angiography suite, represents the main source of delays in thrombectomy initiation, the direct to angiography (DTA) model has emerged as a means to substantially reduce treatment times and is being instituted at an increasing number of thrombectomy centers across the world. The aim of this report is to introduce DTA as an emerging stroke care paradigm for patients with suspicion of LVO stroke, review results from studies evaluating its feasibility and impact on outcomes, describe current barriers to its more widespread adoption, and propose potential solutions to overcoming these barriers.
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Affiliation(s)
- Jesse M Thon
- From Cooper Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ
| | - Tudor G Jovin
- From Cooper Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ.
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15
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VAN DER Linden MC, VAN DER Linden N, Lam RC, Stap P, VAN DEN Brand CL, Vermeulen T, Jellema K, VAN DEN Wijngaard IR. Impact of ongoing centralization of acute stroke care from "drip and ship" into "direct-to-mothership" model in a Dutch urban area. Health Policy 2021; 125:1040-1046. [PMID: 34162490 DOI: 10.1016/j.healthpol.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 04/25/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
When acute stroke care is organised using a "drip-and-ship" model, patients receive immediate treatment at the nearest primary stroke centre followed by transfer to a comprehensive stroke centre (CSC). When stroke care is further centralised into the "direct-to-mothership" model, patients with stroke symptoms are immediately brought to a CSC to further reduce treatment times and enhance stroke outcomes. We investigated the effects of the ongoing centralization in a Dutch urban setting on treatment times of patients with confirmed ischemic stroke in a 4-year period. Next, in a non-randomized controlled trial, we assessed treatment times of patients with suspected ischemic stroke, and treatment times of patients with neurologic disorders other than suspected ischemic stroke, before and after the intervention in the CSC and the decentralized hospitals, the intervention being the change from "drip and ship" into "direct-to-mothership". Our findings provide support for the ongoing centralization of acute stroke care in urban areas. Treatment times for patients with ischemic stroke decreased significantly, potentially improving functional outcomes. Improvements in treatment times for patients with suspected ischemic stroke were achieved without negative side effects for self-referrals with stroke symptoms and patients with other neurological disorders.
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Affiliation(s)
- M Christien VAN DER Linden
- Clinical Epidemiologist, Haaglanden Medical Centre (HMC), P.O. Box 432, 2501 CK The Hague, the Netherlands.
| | - Naomi VAN DER Linden
- Assistant Professor, Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Rianne C Lam
- Emergency Nurse Practitioner, Emergency Department, HMC, P.O. Box 432, 2501 CK The Hague, the Netherlands.
| | - Peter Stap
- Emergency Nurse Practitioner, Emergency Department, HMC, P.O. Box 432, 2501 CK The Hague, the Netherlands.
| | - Crispijn L VAN DEN Brand
- Emergency Physician, HMC and Scientific Lead at Dutch Institute for Clinical Auditing, P.O. Box 432, 2501 CK The Hague, the Netherlands.
| | - Tamara Vermeulen
- Nurse Practitioner Neurology, Department of Neurology, HMC, P.O.Box 432, 2501 CK The Hague, the Netherlands.
| | - Korné Jellema
- Neurologist, Department of Neurology, HMC, P.O. Box 432, 2501 CK The Hague, the Netherlands.
| | - Ido R VAN DEN Wijngaard
- Neurologist, Department of Neurology, HMC, P.O. Box 432, 2501 CK The Hague, the Netherlands, and Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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16
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MacKenzie IER, Arusoo T, Sigounas D. Impact of Direct Admission Versus Interfacility Transfer on Endovascular Treatment Outcomes for Acute Ischemic Stroke: Systematic Review and Meta-Analysis. World Neurosurg 2021; 152:e387-e397. [PMID: 34087463 DOI: 10.1016/j.wneu.2021.05.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mechanical thrombectomy is a proven treatment for large-vessel ischemic stroke with improved functional outcomes compared with intravenous thrombolytics. Access to thrombectomy-capable sites varies greatly by geography, often necessitating interhospital transfer of patients who first present to hospitals unable to provide thrombectomy. The purpose of this meta-analysis was to examine the impact of interhospital transportation on patient outcomes to better inform recommendations for prehospital protocols. METHODS A meta-analysis was performed following systematic literature searches. Outcomes of interest included successful reperfusion, symptomatic intracranial hemorrhage, 90-day modified Rankin Scale score 0-2, 90-day mortality, onset-to-puncture times, and door-to-puncture times. RESULTS Pooled analysis comprised >27,000 patients. Door-to-puncture time was 35.6 minutes shorter among transferred patients; however, symptom onset-to-puncture time was 91.6 minutes longer. Rate of reperfusion or symptomatic intracranial hemorrhage as well as 90-day mortality did not differ significantly between transferred and directly admitted patients. While the proportion of patients achieving good functional outcome at 90 days with modified Rankin Scale score 0-2 did not differ by admission type, when modified Rankin Scale score was narrowed to 0-1, direct transport showed 20% greater probability of achieving excellent functional outcome (P < 0.001). CONCLUSIONS This meta-analysis represents the largest pooled population examined to date to assess how interfacility transportation to thrombectomy-capable sites affects patient outcomes. Our results indicate that direct admission is a significant predictor of excellent functional outcome. The findings presented here can be used to better inform quality improvement projects to streamline access to facilities providing endovascular mechanical thrombectomy capabilities.
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Affiliation(s)
- Isobel E R MacKenzie
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Toomas Arusoo
- Department of Radiology, George Washington University, Washington, DC, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University, Washington, DC, USA.
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17
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Mohamed A, Fatima N, Shuaib A, Saqqur M. Comparison of mothership versus drip-and-ship models in treating patients with acute ischemic stroke: A systematic review and meta-analysis. Int J Stroke 2021; 17:141-154. [PMID: 33877018 DOI: 10.1177/17474930211013285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There is controversy if direct to comprehensive center "mothership" or stopping at primary center for thrombolysis before transfer to comprehensive center "drip-and-ship" are best models of treatment of acute stroke. In this study, we compare mothership and drip-and-ship models to evaluate the best option of functional outcome. METHODS Studies between 1990 and 2020 were extracted from online electronic databases. Clinical outcomes, critical time measurements, functional independence, and mortality were then compared. RESULTS A total of 7824 patients' data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). In addition, 4639 (59.3%) patients were treated under mothership model, and 3185 (40.7%) followed the drip-and-ship model with mean age of 70.01 ± 3.58 versus 69.03 ± 3.36; p < 0.001, respectively. The National Institute Health Stroke Scale was 15.57 ± 3.83 for the mothership and 15.72 ± 2.99 for the drip-and-ship model (p ≤ 0.001). The mean symptoms onset-to-puncture time was significantly shorter in the mothership group compared to the drip-and-ship (159.69 min vs. 223.89 min; p ≤ 0.001, respectively). Moreover, the collected data indicated no significant difference between symptom's onset to intravenous thrombolysis time and stroke onset-to-successful recanalization time (p = 0.205 and p ≤ 0.001, respectively). Patients had significantly worse functional outcome (modified Rankin score) (3-6) at 90 days in the drip-and-ship model (odds ratio (OR): 1.47, 95% confidence interval (CI): 1.13-1.92, p < 0.004) and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95% CI: 1.22-1.81, p < 0.0001) compared to mothership. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95% CI: 0.87-1.55, p = 0.32) and successful recanalization (OR: 1.12, 95% CI: 0.76-1.65, p = 0.56) between the two models of care. CONCLUSION Patients in the mothership model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies are not of sufficient quality to make definite recommendations.
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Affiliation(s)
- Ahmed Mohamed
- Department of Biology (Physiology), 3710McMaster University, Hamilton, ON, Canada
| | - Nida Fatima
- Department of Neurosurgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashfaq Shuaib
- Department of Neurology, 3158University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neuroscience, MSK Trillium Hospital, Institute for Better Health, University of Toronto at Mississauga, Mississauga, ON, Canada
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18
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Beaman CB, Kaneko N, Meyers PM, Tateshima S. A Review of Robotic Interventional Neuroradiology. AJNR Am J Neuroradiol 2021; 42:808-814. [PMID: 33541906 DOI: 10.3174/ajnr.a6976] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022]
Abstract
Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.
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Affiliation(s)
- C B Beaman
- Department of Neurology (C.B.B.), Columbia University Irving Medical Center, New York, New York
| | - N Kaneko
- Department of Radiological Sciences (N.K., S.T.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - P M Meyers
- Department of Radiology and Neurological Surgery (P.M.M.), Columbia University Irving Medical Center, New York, New York
| | - S Tateshima
- Department of Radiological Sciences (N.K., S.T.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Kircher C, Humphries A, Kleindorfer D, Alwell K, Sucharew H, Moomaw CJ, Mackey J, De Los Rios La Rosa F, Kissela B, Adeoye O. Can non-contrast head CT and stroke severity be used for stroke triage? A population-based study. Am J Emerg Med 2020; 38:2650-2652. [PMID: 33041149 DOI: 10.1016/j.ajem.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/19/2020] [Accepted: 08/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke (AIS) patients may benefit from endovascular thrombectomy (EVT) up to 24 h since last known normal (LKN). Advanced imaging is required for patient selection. Small or rural hospitals may not have sufficient CT technician and radiology support to rapidly acquire and interpret images. We estimated transfer rates using non-contrast head CT and stroke severity to select patients to be transferred to larger centers for evaluation. METHODS We identified all AIS among residents of the study region in 2010. Only cases age ≥ 18 with baseline mRS 0-2 that presented to an ED were included. Among cases that presented between 6 and 24 h from LKN, those without evidence of acute infarct on head CT and with initial NIHSS ≥6 or ≥ 10 were identified. RESULTS Of 1359 AIS cases, 448 (33.0%) presented between 6 and 24 h, of which 383 (85.5%) showed no evidence of acute infarct on CT. Of cases with no acute infarct on CT, 89/383 (23.2%) had NIHSS ≥6, of which 66 (74.2%) initially presented to a hospital without thrombectomy capabilities; and 51/383 (13.3%) had NIHSS ≥10, of which 40 (78.4%) presented to a non-thrombectomy hospital. CONCLUSIONS In our population, 40-66 AIS patients annually (0.8-1.3/week, or 3-5 patients/100,000 persons/year) may present to non-thrombectomy hospitals and need to be transferred using non-contrast CT and stroke severity as screening tools. Such an approach may sufficiently mitigate the impact of delays in treatment on outcomes, without overburdening the referring nor accepting hospitals.
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Affiliation(s)
- Charles Kircher
- University of Cincinnati (UC) Gardner Neuroscience Institute, Division of Neurocritical Care, Cincinnati OH, United States of America; UC Department of Emergency Medicine, 231 Albert Sabin Way, MSB 1654, Cincinnati, OH 45229, United States of America.
| | - Amanda Humphries
- University of New Mexico School of Medicine, Department of Emergency Medicine, Albuquerque, NM, United States of America
| | - Dawn Kleindorfer
- University of Michigan Department of Neurology, Ann Arbor, MI, United States of America
| | - Kathleen Alwell
- UC Gardner Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, United States of America
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 5041, Cincinnati, OH 45229-3039, United States of America; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Charles J Moomaw
- UC Gardner Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, United States of America
| | - Jason Mackey
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Felipe De Los Rios La Rosa
- UC Gardner Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, United States of America; Baptist Health Neuroscience Center, Miami, FL, United States of America
| | - Brett Kissela
- UC Gardner Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, United States of America
| | - Opeolu Adeoye
- University of Cincinnati (UC) Gardner Neuroscience Institute, Division of Neurocritical Care, Cincinnati OH, United States of America; UC Department of Emergency Medicine, 231 Albert Sabin Way, MSB 1654, Cincinnati, OH 45229, United States of America
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Snyder T, Agarwal S, Huang J, Ishida K, Flusty B, Frontera J, Lord A, Torres J, Zhang C, Rostanski S, Favate A, Lillemoe K, Sanger M, Kim S, Humbert K, Scher E, Dehkharghani S, Raz E, Shapiro M, K Nelson P, Gordon D, Tanweer O, Nossek E, Farkas J, Liff J, Turkel‐Parrella D, Tiwari A, Riina H, Yaghi S. Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS. J Neuroimaging 2020; 30:625-630. [DOI: 10.1111/jon.12729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Thomas Snyder
- Department of Neurology New York Langone Medical Center New York NY
| | - Shashank Agarwal
- Department of Neurology New York Langone Medical Center New York NY
| | - Jeffrey Huang
- Department of Radiology New York Langone Medical Center New York NY
| | - Koto Ishida
- Department of Neurology New York Langone Medical Center New York NY
| | - Brent Flusty
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Aaron Lord
- Department of Neurology New York Langone Medical Center New York NY
| | - Jose Torres
- Department of Neurology New York Langone Medical Center New York NY
| | - Cen Zhang
- Department of Neurology New York Langone Medical Center New York NY
| | - Sara Rostanski
- Department of Neurology New York Langone Medical Center New York NY
| | - Albert Favate
- Department of Neurology New York Langone Medical Center New York NY
| | - Kaitlyn Lillemoe
- Department of Neurology New York Langone Medical Center New York NY
| | - Matthew Sanger
- Department of Neurology New York Langone Medical Center New York NY
| | - Sun Kim
- Department of Neurology New York Langone Medical Center New York NY
| | - Kelley Humbert
- Department of Neurology New York Langone Medical Center New York NY
| | - Erica Scher
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Eytan Raz
- Department of Radiology New York Langone Medical Center New York NY
| | - Maksim Shapiro
- Department of Radiology New York Langone Medical Center New York NY
| | - Peter K Nelson
- Department of Radiology New York Langone Medical Center New York NY
| | - David Gordon
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Omar Tanweer
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Erez Nossek
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Jeffrey Farkas
- Department of Neurology New York Langone Medical Center New York NY
- Department of Radiology New York Langone Medical Center New York NY
| | - Jeremy Liff
- Department of Neurology New York Langone Medical Center New York NY
| | | | - Ambooj Tiwari
- Department of Neurology New York Langone Medical Center New York NY
| | - Howard Riina
- Department of Neurosurgery New York Langone Medical Center New York NY
| | - Shadi Yaghi
- Department of Neurology New York Langone Medical Center New York NY
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Chen WH, Yi TY, Wu YM, Zhang MF, Lin DL, Lin XH. Parenchymal hyperdensity on C-arm CT images after endovascular therapy for acute ischaemic stroke predicts a poor prognosis. Clin Radiol 2019; 74:399-404. [PMID: 30773226 DOI: 10.1016/j.crad.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
AIM To investigate whether hyperdense areas (HDAs) observed after endovascular treatment on multisection computed tomography (CT) are related to outcome. MATERIALS AND METHODS Data on 82 patients with acute anterior circulation ischaemic stroke resulting from intracranial large artery occlusion were analysed retrospectively All patients underwent mechanical thrombectomy and/or emergency angioplasty, and partial or complete recanalisation was successfully achieved. C-arm CT was performed immediately after endovascular treatment for all patients. Clinical and radiological data were compared between patients with and those without HDA and between patients with good and those with poor outcomes. RESULTS Compared with non-HDA patients, HDA patients were more likely to present with severe neurological deficits (admission National Institutes of Health Stroke Scale [NIHSS] score: 18 versus 16, p=0.037) and had a higher number of stent retriever passes performed (2.9±1.3 versus 1.4±1, p<0.001), longer onset-to-presentation times (229±78 versus 171±90 minutes; p=0.002), longer onset-to-recanalisation times (418±94 versus 331±105 minutes; p<0.001), and longer puncture-to-recanalisation times (103±47 versus 69±42 minutes; p=0.001). Fewer HDA patients had a good prognosis (35.7% versus 70%, p<0.001). Multivariate analysis showed the presence of HDAs was an independent negative prognostic factor (OR=0.208; p=0.002). CONCLUSION HDAs on C-arm CT appear to be common in patients with acute ischaemic stroke who underwent successful endovascular treatment. HDA presence suggests a poor prognosis despite successful reperfusion.
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Affiliation(s)
- W-H Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - T-Y Yi
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
| | - Y-M Wu
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - M-F Zhang
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - D-L Lin
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - X-H Lin
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
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Quality and safety in endovascular therapy for acute ischemic stroke. ACTA ACUST UNITED AC 2018; 65:329-334. [PMID: 29571729 DOI: 10.1016/j.redar.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/20/2022]
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23
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Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, Dewey HM, Emsley HCA, Davies DP, Day E, Ford GA, Price CI, May CR, McLoughlin ASR, Gibson JME, Lightbody CE. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017; 17:751. [PMID: 29157233 PMCID: PMC5697163 DOI: 10.1186/s12913-017-2694-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Methods Specialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Results Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Conclusion Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.
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Affiliation(s)
- Kathleen L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia. .,University of Central Lancashire, Preston, UK. .,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Dominique A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Christopher F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Caroline L Watkins
- University of Central Lancashire, Preston, UK.,Australian Catholic University, Sydney, Australia
| | - Michelle Vu
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - D Paul Davies
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Elaine Day
- Lancashire and South Cumbria Strategic Clinical Network, Greater Manchester, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust and Division of Medical Sciences, University of Oxford, Oxford, UK
| | - Christopher I Price
- Northumbria Healthcare NHS Foundation Trust, Newcastle, UK.,Newcastle University, Newcastle, UK
| | - Carl R May
- University of Southampton, Southampton, UK
| | | | | | - Catherine E Lightbody
- University of Central Lancashire, Preston, UK.,Australian Catholic University, Sydney, Australia
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Streamlining Workflow for Endovascular Mechanical Thrombectomy: Lessons Learned from a Comprehensive Stroke Center. J Stroke Cerebrovasc Dis 2017; 26:1655-1662. [PMID: 28579511 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Recently, 5 randomized controlled trials confirmed the superiority of endovascular mechanical thrombectomy (EMT) to intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. The implication is that our health systems would witness an increasing number of patients treated with EMT. However, in-hospital delays, leading to increased time to reperfusion, are associated with poor clinical outcomes. This review outlines the in-hospital workflow of the treatment of acute ischemic stroke at a comprehensive stroke center and the lessons learned in reduction of in-hospital delays. METHODS The in-hospital workflow for acute ischemic stroke was described from prehospital notification to femoral arterial puncture in preparation for EMT. Systematic review of literature was also performed with PubMed. RESULTS The implementation of workflow streamlining could result in reduction of in-hospital time delays for patients who were eligible for EMT. In particular, time-critical measures, including prehospital notification, the transfer of patients from door to computed tomography (CT) room, initiation of intravenous thrombolysis in the CT room, and the mobilization of neurointervention team in parallel with thrombolysis, all contributed to reduction in time delays. CONCLUSIONS We have identified issues resulting in in-hospital time delays and have reported possible solutions to improve workflow efficiencies. We believe that these measures may help stroke centers initiate an EMT service for eligible patients.
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25
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Næsheim T, Filseth OM, Busund R, Åvall A, Klingenberg C, Hesselberg N, Gilbert M. Økonomi trumfer helse for befolkningen i nord. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:90-91. [DOI: 10.4045/tidsskr.16.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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26
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Mitha AP, Wong JH, Hill MD, Goyal M. Introducing a new era of ischemic stroke care. J Neurosurg 2016; 125:508-11. [PMID: 27203148 DOI: 10.3171/2016.1.jns151239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alim P Mitha
- Departments of Radiology and Clinical Neurosciences, and
| | - John H Wong
- Departments of Radiology and Clinical Neurosciences, and
| | - Michael D Hill
- Departments of Radiology and Clinical Neurosciences, and.,Community Health Sciences and Medicine, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, and
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