1
|
Reeves MJ, Fonarow GC, Smith EE, Sheth KN, Messe SR, Schwamm LH. Twenty Years of Get With The Guidelines-Stroke: Celebrating Past Successes, Lessons Learned, and Future Challenges. Stroke 2024; 55:1689-1698. [PMID: 38738376 PMCID: PMC11208062 DOI: 10.1161/strokeaha.124.046527] [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] [Indexed: 05/14/2024]
Abstract
The Get With The Guidelines-Stroke program which, began 20 years ago, is one of the largest and most important nationally representative disease registries in the United States. Its importance to the stroke community can be gauged by its sustained growth and widespread dissemination of findings that demonstrate sustained increases in both the quality of care and patient outcomes over time. The objectives of this narrative review are to provide a brief history of Get With The Guidelines-Stroke, summarize its major successes and impact, and highlight lessons learned. Looking to the next 20 years, we discuss potential challenges and opportunities for the program.
Collapse
Affiliation(s)
- Mathew J. Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine, University of California Los Angeles (G.C.F.)
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (E.E.S.)
| | - Kevin N. Sheth
- Center for Brain & Mind Health, Departments of Neurology & Neurosurgery (K.N.S.), Yale School of Medicine, New Haven, CT
| | - Steven R. Messe
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.R.M.)
| | - Lee H. Schwamm
- Department of Neurology and Bioinformatics and Data Sciences (L.H.S.), Yale School of Medicine, New Haven, CT
| |
Collapse
|
2
|
Patel K, Taneja K, Wolfe J, Oak S, Favilla C, Siegler JE. Factors Associated with Discharge against Medical Advice among Acute Stroke Patients: Analysis of the Nationwide Emergency Department Sample. Cerebrovasc Dis 2023; 53:365-371. [PMID: 37734335 PMCID: PMC11251651 DOI: 10.1159/000531515] [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: 02/25/2023] [Accepted: 06/05/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Patients discharged against medical advice have been shown to have worse outcomes across a host of different conditions. However, risk factors related to increased odds of discharge against medical advice remain understudied in patients who suffer from acute cerebral infarction. METHODS We retrospectively examined the 2019 National Emergency Department Sample Database for stroke patients. Multivariable logistic regression was used to estimate associations between patient- and hospital-level factors and the outcome of discharge against medical advice. RESULTS Of the 603,623 encounters for acute ischemic stroke, 8,858 (1.5%) were discharged against medical advice. Predictors of discharge against medical advice were lower income quartile and having either Medicaid insurance (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.10-1.58) or being uninsured (OR 1.28, 95% CI: 1.03-1.58). Vascular comorbidities associated with discharge against medical advice included prior tobacco use (OR 1.60, 95% CI: 1.45-1.78) and coronary artery disease (OR 1.19, 95% CI: 1.04-1.35). Treatment with thrombectomy (OR 0.33, 95% CI: 0.13-0.78) or systemic thrombolysis (OR 0.39, 95% CI: 0.23-0.66) was inversely associated with discharge against medical advice. A high modified Charlson comorbidity index (3+ vs. 0, OR 0.49, 95% CI: 0.42-0.56) was also associated with a lower odds of discharge against medical advice. Presenting to a Northeastern hospital had the highest rate of discharge against medical advice, when compared to other regions (p < 0.05). CONCLUSIONS Certain patient-level, socioeconomic, and regional factors were associated with discharge against medical advice following acute stroke. These patient- and systems-level factors warrant heightened attention in order to optimize acute care and secondary prevention strategies.
Collapse
Affiliation(s)
- Karan Patel
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Kamil Taneja
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Jared Wolfe
- Cooper Medical School of Rowan University, Camden, New Jersey, USA,
| | - Solomon Oak
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Christopher Favilla
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
| |
Collapse
|
3
|
Xiong Y, Wang S, Li Z, Fisher M, Wang L, Jiang Y, Huang X, Zhao X, Meng X, Wang Y. Thirteen-year trends in risk scores predictive values for subsequent stroke in patients with acute ischemic event. Brain Behav 2023; 13:e2962. [PMID: 36978218 PMCID: PMC10176011 DOI: 10.1002/brb3.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION A high residual risk of subsequent stroke suggested that the predictive ability of Stroke Prognosis Instrument-II (SPI-II) and Essen Stroke Risk Score (ESRS) may have changed over the years. AIM To explore the predictive values of the SPI-II and ESRS for 1-year subsequent stroke risk in a pooled analysis of three consecutive national cohorts in China over 13 years. RESULTS In the China National Stroke Registries (CNSRs), 10.7% (5297/50,374) of the patients had a subsequent stroke within 1 year; area under the curve (AUC) of SPI-II and ESRS was .60 (95% confidence interval [CI]: .59-.61) and .58 (95% CI: .57-.59), respectively. For SPI-II, the AUC was .60 (95% CI: .59-.62) in CNSR-I, .60 (95% CI: .59-.62) in CNSR-II, and .58 (95% CI: .56-.59) in CNSR-III over the past 13 years. The declining trend was also found in ESRS scale (CNSR-I: .60 [95% CI: .59-.61]; CNSR-II: .60 [95% CI: .59-.62]; and CNSR-III: .56 [95% CI: .55-.58]). CONCLUSIONS The predictive power of the traditional risk scores SPI-II and ESRS was limited and gradually decreased over the past 13 years, thus the scales may not be useful for current clinical practice. Further derivation of risk scales with additional imaging features and biomarkers may be warranted.
Collapse
Affiliation(s)
- Yunyun Xiong
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Shang Wang
- Neurocardiology Center, Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Zixiao Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Marc Fisher
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Liyuan Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xinying Huang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xia Meng
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yongjun Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| |
Collapse
|
4
|
Gordon Perue G, Then R, Gayle F, Galav S, Thotamalla Y, Hepburn M, Rowe D, Suazo L, Villamán C, Manosalva H, Ortega-Gutierrez S, Yavagal D, Inoa V. Mission thrombectomy 2020 (MT2020+) surveys of Caribbean stroke services: A call for action in our region. J Neurol Sci 2023; 449:120640. [PMID: 37060622 DOI: 10.1016/j.jns.2023.120640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Stroke is the leading cause of death and adult-onset disability in the Caribbean region. Despite the tremendous advances in acute stroke care in the past 25 years, treatment in the Caribbean lags stroke standards of care. Mission Thrombectomy 2020+ (MT2020+) is a metrics based global campaign focused on increasing access to organized stroke care and mechanical thrombectomy. We conducted two consecutive online surveys across the MT2020+ Caribbean Region assessing access to thrombolytics, mechanical thrombectomy and stroke centers. The first survey - Mechanical Thrombectomy Access-Caribbean sub-study, allowed a comparison between global services and those in the MT2020+ Caribbean region. This survey provided a snapshot of the current state of stroke centers worldwide and confirmed lower available stroke resources in the MT2020+ Caribbean Region which has one certified stroke center, and 9 mechanical thrombectomy capable centers. The second survey - MT2020+ Caribbean Region infrastructure survey - was designed to determine the availability of stroke resources that are key components of stroke care in participating hospitals. Key infrastructural components such as 24/7 computerized tomographic scanners, access to thrombolytic therapy and access to mechanical thrombectomy capable centers were scarce. There were low volumes of mechanical thrombectomy performed in the Caribbean compared to other countries around the world. Limited resources and inadequate stroke infrastructure remains a major challenge in the Caribbean. We advocate for governmental support and investment, public and private partnerships and legislation to increase access and availability to acute stroke treatments to allow for equal access to care for all Caribbean citizens.
Collapse
Affiliation(s)
- Gillian Gordon Perue
- Department of Neurology, University of Miami, Miami, FL, United States of America.
| | - Ryna Then
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | | | | | | | - Madihah Hepburn
- Summa Health Neurosciences & Stroke Center, Akron, OH, United States of America
| | | | - Luis Suazo
- Centro de Medicina Avanzada y Telemedicina, Dominican Republic
| | - Cosme Villamán
- Dept. Neurointervención Clínica Corominas y Corazones del Cibao, Dominican Republic
| | | | | | - Dileep Yavagal
- Department of Neurology and Neurosurgery, University of Miami, United States of America
| | - Violiza Inoa
- Semmes-Murphey Clinic, Memphis, Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States of America
| |
Collapse
|
5
|
Moody KA, Maillie L, Dhamoon MS. National Patterns and Outcomes of Neurologist Care in Acute Ischemic Stroke. Neurohospitalist 2023; 13:13-21. [PMID: 36531857 PMCID: PMC9755618 DOI: 10.1177/19418744221129428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background & Purpose Specialist care of acute ischemic stroke patients has been associated with improved outcomes but is not well-characterized. We sought to elucidate the involvement and influence of neurologists on acute ischemic stroke care. Methods Using 100% Medicare datasets, index acute ischemic stroke admissions from 2016-2018 were identified with International Classification of Diseases, 10th Revision codes. Neurologists were identified by NPI code. Neurologist involvement in care was defined as: "neurologist involved in care"; "hospital with a neurologist"; and "percent of acute ischemic stroke treated by neurologist." Adjusted logistic regression models summarized exposure to neurologists and their association with outcomes (inpatient mortality, good outcome, and 30-day readmission). Results Among 647838 index AIS admissions from 2016-2018, 15.6% included a neurologist involved in care, associated with receiving intravenous thrombolysis (19.1% vs 6.5%), endovascular thrombectomy (13.2% vs 1.4%), treatment at a teaching hospital (87.7% vs 55.5%), and treatment at a hospital in the highest volume quartile (95.3% vs 75.6%). Of 4797 hospitals, 36.1% had a neurologist, among which the mean percent of admissions treated by a neurologist was 14.7% (SD 24.4). Neurologist involvement was associated with increased inpatient mortality (OR 1.81; 95% CI 1.75-1.86), decreased odds of a good outcome (OR .92; 95% CI .90-.93), and increased 30-day readmission (OR 1.04; 95% C: 1.01-1.06). Conclusions The minority of acute ischemic stroke admissions among the elderly in the US are treated by neurologists. Neurologist involvement in care is associated with worse outcomes, possibly from the allocation of severe cases to neurologists.
Collapse
Affiliation(s)
- Kate A. Moody
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luke Maillie
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
6
|
Sheriff F, Xu H, Maud A, Gupta V, Vellipuram A, Fonarow GC, Matsouaka RA, Xian Y, Reeves M, Smith EE, Saver J, Rodriguez G, Cruz-Flores S, Schwamm LH. Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e023212. [PMID: 35229659 PMCID: PMC9075329 DOI: 10.1161/jaha.121.023212] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Endovascular therapy (EVT) use increased following clinical trials publication in 2015, but limited data suggest there may be persistent race and ethnicity differences. Methods and Results We included all patients with acute ischemic stroke arriving within 6 hours of last known well and with National Institute of Health Stroke Scale (NIHSS) score ≥6 between April 2012 and June 2019 in the Get With The Guidelines‐Stroke database and evaluated the association between race and ethnicity and EVT use and outcomes, comparing the era before versus after 2015. Of 302 965 potentially eligible patients; 42 422 (14%) underwent EVT. Although EVT use increased over time in all racial and ethnic groups, Black patients had reduced odds of EVT use compared with non‐Hispanic White (NHW) patients (adjusted odds ratio [aOR] before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In‐hospital mortality/discharge to hospice was less frequent in Black, Hispanic, and Asian patients compared with NHW. Conversely discharge home was more frequent in Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients compared with NHW (24%). However, at 3 months, functional independence (modified Rankin Scale, 0–2) occurred less frequently in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients compared with NHW patients (38.1%). Conclusions In a large cohort of patients treated with EVT, Black versus NHW patient disparities in EVT use have narrowed over time but still exist. Discharge related outcomes were slightly more favorable in racial and ethnic underrepresented groups; 3‐month functional outcomes were worse but improved across all groups with time.
Collapse
Affiliation(s)
| | - Haolin Xu
- Duke Clinical Res Inst Durham Durham NC
| | - Alberto Maud
- Texas Tech University Health Sciences Center El Paso TX
| | - Vikas Gupta
- Texas Tech University Health Sciences Center El Paso TX
| | | | - Gregg C Fonarow
- UCLA Division of CardiologyRonald Reagan-UCLA Medical Center Los Angeles CA
| | | | - Ying Xian
- University of Texas Southwestern Medical Center Dallas TX
| | - Mathew Reeves
- College of Human Medicine Michigan State University East Lansing MI
| | | | | | | | | | - Lee H Schwamm
- Mass General HospitalHarvard Medical School Boston MA
| |
Collapse
|
7
|
Moody K, Santos D, Stein LK, Dhamoon MS. Decompressive Hemicraniectomy for Acute Ischemic Stroke in the US: Characteristics and Outcomes. J Stroke Cerebrovasc Dis 2021; 30:105703. [PMID: 33706194 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105703] [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: 12/11/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Decompressive hemicraniectomy can be life-saving for malignant middle cerebral artery acute ischemic stroke (AIS). However, utilization and outcomes for hemicraniectomy in the US are not known. We sought to analyze baseline characteristics and outcomes of patients receiving hemicraniectomy for AIS in the US. MATERIALS AND METHODS We identified adults who received hemicraniectomy for AIS, identified with validated International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) code in the Nationwide Readmissions Database 2014. We calculated 30-day readmission rates, reasons for readmission, and procedures performed. RESULTS 2850 of 531,896 AIS patients (0.54%) received hemicraniectomy. Although patients receiving hemicraniectomy were more likely to be younger (57.0, 95% CI 56.0-58.0; vs 70.9, 95% CI 70.6-71.2; p < 0.0001) and male (40% vs 51.2% female; p<0.0001), 46.3% of patients who received hemicraniectomy were age 60 years and older. Patients 60 years or older receiving hemicraniectomy were more likely to die (29.9% vs 21.9%, p = 0.0081). Hemicraniectomy was more frequently performed at large hospitals (75.3% vs 57.7%; p < 0.0001) in urban areas (99.1% vs 90.3%; p < 0.0001) designated as metropolitan teaching hospitals (88.3% vs 63.4%; p < 0.0001). 30-day readmissions were most commonly due to infection (31.5%), non-infectious medical complications (17.7%), and surgical complications (13.8%). These readmissions were critical. CONCLUSIONS Although hemicraniectomy is used more frequently in the treatment of younger, male, ischemic stroke patients, only half of the patients receiving hemicraniectomy in 2014 were <60 years old. Regardless of age, hemicraniectomy is a geographically segregated procedure, only being performed in large metropolitan teaching hospitals.
Collapse
Affiliation(s)
- Kate Moody
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Daniel Santos
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Laura K Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
8
|
Skolarus LE, Feng C, Burke JF. Exploring Factors Contributing to Race Differences in Poststroke Disability. Stroke 2020; 51:1813-1819. [PMID: 32404036 DOI: 10.1161/strokeaha.119.027700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cross sectional analyses have found large race differences in poststroke disability, yet these analyses do not account for prestroke disability, hospitalization factors, postacute care, transitions, or mortality. In this context, we explore mortality, nursing home placement, and disability in a longitudinal analysis of older stroke survivors who survived at least 90 days poststroke. Methods- A prospective cohort of black or white stroke survivors from the National Health and Aging Trends Study (2009-2016) linked to Medicare were used. Disability was assessed during in-person interviews with validated scales (0-7). We used cox proportional hazards models to separately assess mortality and nursing home admission adjusting for age, sex, sociodemographics (marital status, education, income, insurance status, social network size), comorbidities, hospitalization factors, postacute care, and 90-day readmissions. To estimate racial differences in disability, we used a multilevel linear regression model initially adjusting for age and sex and then compared with a model adjusted for sociodemographics, comorbidities, hospitalization factors, postacute care, and 90-day readmissions. Results- There were 282 stroke survivors, of which 76 (12.6%) were black. There were no race differences in long-term mortality (hazard ratio for black, 1.2 [95% CI, 0.7-2.2]; P=0.5) or nursing home placement (hazard ratio for black, 0.7 [95% CI, 0.2-2.4]; P=0.5). The largest race differences in disability were observed immediately prestroke, estimated age- and sex-adjusted activity limitations were (2.6 [2.0-3.2] in blacks versus 1.4 [1.0-1.8] in whites, mean difference, 1.2 [0.5-1.9], P<0.001) and immediately poststroke (2.6 [2.0-3.3] in blacks versus 1.7 [1.2-2.1] in whites, mean difference, 1.0 [0.2-1.7], P<0.01). Full adjustment did not substantially change the associations between race and disability. Conclusions- Race differences in nursing home placement, long-term mortality, sociodemographics, comorbidities, hospitalization factors, postacute care, and readmissions are unlikely to be large contributors to race differences in poststroke disability. Further research is needed to understand the drivers of race differences in poststroke disability.
Collapse
Affiliation(s)
- Lesli E Skolarus
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.)
| | - Chunyang Feng
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.)
| | - James F Burke
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.).,Department of Neurology, Ann Arbor VA, MI (J.F.B.)
| |
Collapse
|
9
|
Hayakawa M, Matsumaru Y, Yamagami H, Satow T, Iihara K, Sakai N. Trends in Endovascular Reperfusion Therapy for Acute Stroke after Introduction of Mechanical Thrombectomy Devices: Japanese Registry of NeuroEndovascular Therapy (JR-NET)3. Neurol Med Chir (Tokyo) 2020; 60:191-201. [PMID: 32009126 PMCID: PMC7174246 DOI: 10.2176/nmc.oa.2019-0267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In Japan, the era of thrombectomy for acute stroke started when the Merci retriever was approved in 2010 and the Penumbra system in 2011. New-generation Penumbra catheters (MAX series) and stent retrievers were introduced in 2013 and 2014, respectively. The aim of this study was to clarify the general status and trends in endovascular reperfusion therapy for stroke in Japan from 2010 to 2014. We extracted a total of 3705 patients (72.1 ± 12.2 years, 1482 women) from a nationwide study of patients receiving any neuroendovascular treatment, the Japanese Registry of NeuroEndovascular Therapy 3. Reperfusion therapy resulted in a successful reperfusion rate of 59%, and 31% of patients achieved a favorable outcome at 30 days of onset. The frequency of Merci-including procedures increased to 52% in the first half of 2011, but conversely decreased to 1% in the second half of 2014. The frequency of Penumbra-including procedures increased from 18% in the second half of 2011 to 67% in the first half of 2014, decreasing to 38% in the second half of 2014. The reperfusion rate and 30-day clinical outcomes remained almost unchanged until June 2013, and started to improve thereafter, coincident with the introduction and spread of newer-generation devices. The rate of successful reperfusion reached 71-76%, and 36-38% of patients achieved a favorable outcome in 2014. After multivariate adjustment for preprocedure variables, the calendar period from 2013 to 2014 was significantly associated with improvement in reperfusion rates and clinical outcomes.
Collapse
Affiliation(s)
- Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences Kyusyu University
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| |
Collapse
|
10
|
Wang Y, Luo Y, Yao Y, Ji Y, Feng L, Du F, Zheng X, Tao T, Zhai X, Li Y, Han P, Xu B, Zhao H. Silencing the lncRNA Maclpil in pro-inflammatory macrophages attenuates acute experimental ischemic stroke via LCP1 in mice. J Cereb Blood Flow Metab 2020; 40:747-759. [PMID: 30895879 PMCID: PMC7168792 DOI: 10.1177/0271678x19836118] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Long noncoding RNAs (lncRNA) expression profiles change in the ischemic brain after stroke, but their roles in specific cell types after stroke have not been studied. We tested the hypothesis that lncRNA modulates brain injury by altering macrophage functions. Using RNA deep sequencing, we identified 73 lncRNAs that were differentially expressed in monocyte-derived macrophages (MoDMs) and microglia-derived macrophages (MiDMs) isolated in the ischemic brain three days after stroke. Among these, the lncRNA, GM15628, is highly expressed in pro-inflammatory MoDMs but not in MiDMs, and are functionally related to its neighbor gene, lymphocyte cytosolic protein 1 (LCP1), which plays a role in maintaining cell shape and cell migration. We termed this lncRNA as Macrophage contained LCP1 related pro-inflammatory lncRNA, Maclpil. Using cultured macrophages polarized by LPS, M(LPS), we found that downregulation of Maclpil in M(LPS) decreased pro-inflammatory gene expression while promoting anti-inflammatory gene expression. Maclpil inhibition also reduced the migration and phagocytosis ability of MoDMs by inhibiting LCP1. Furthermore, adoptive transfer of Maclpil silenced M(LPS), reduced ischemic brain infarction, improved behavioral performance and attenuated penetration of MoDMs in the ischemic hemisphere. We conclude that by blocking macrophage, Maclpil protects against acute ischemic stroke by inhibiting neuroinflammation.
Collapse
Affiliation(s)
- Yan Wang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ying Luo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yang Yao
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuhua Ji
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Liangshu Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Fang Du
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiaoya Zheng
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tao Tao
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Xuan Zhai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yaning Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Pei Han
- Department of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Baohui Xu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Heng Zhao
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
11
|
Conner SC, Pase MP, Carneiro H, Raman MR, McKee AC, Alvarez VE, Walker JM, Satizabal CL, Himali JJ, Stein TD, Beiser A, Seshadri S. Mid-life and late-life vascular risk factor burden and neuropathology in old age. Ann Clin Transl Neurol 2019; 6:2403-2412. [PMID: 31691546 PMCID: PMC6917310 DOI: 10.1002/acn3.50936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine whether vascular risk factor burden in mid- or late-life associates with postmortem vascular and neurodegenerative pathologies in a community-based sample. METHODS We studied participants from the Framingham Heart Study who participated in our voluntary brain bank program. Overall vascular risk factor burden was calculated using the Framingham Stroke Risk Profile (FSRP). Mid-life FSRP was measured at 50 to 60 years of age. Following death, brains were autopsied and semi-quantitatively assessed by board-certified neuropathologists for cerebrovascular outcomes (cortical infarcts, subcortical infarcts, atherosclerosis, arteriosclerosis) and Alzheimer's disease pathology (Braak stage, cerebral amyloid angiopathy, and neuritic plaque score). We estimated adjusted odds ratios between vascular risk burden (at mid-life and before death) and neuropathological outcomes using logistic and proportional-odds logistic models. RESULTS The median time interval between FSRP and death was 33.4 years for mid-life FSRP and 4.4 years for final FSRP measurement before death. Higher mid-life vascular risk burden was associated with increased odds of all cerebrovascular pathology, even with adjustment for vascular risk burden before death. Late-life vascular risk burden was associated with increased odds of cortical infarcts (OR [95% CI]: 1.04 [1.00, 1.08]) and arteriosclerosis stage (OR [95% CI]: 1.03 [1.00, 1.05]). Mid-life vascular risk burden was not associated with Alzheimer's disease pathology, though late-life vascular risk burden was associated with increased odds of higher Braak stage (OR [95% CI]: 1.03 [1.01, 1.05]). INTERPRETATION Mid-life vascular risk burden was predictive of cerebrovascular but not Alzheimer's disease neuropathology, even after adjustment for vascular risk factors before death.
Collapse
Affiliation(s)
- Sarah C. Conner
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
| | - Matthew P. Pase
- Framingham Heart StudyFraminghamMassachusetts
- Melbourne Dementia Research CentreThe Florey Institute for Neuroscience and Mental HealthMelbourneAustralia
- Centre for Human PsychopharmacologySwinburne University of TechnologyMelbourneAustralia
- Faculty of MedicineDentistry and Health SciencesThe University of MelbourneMelbourneAustralia
| | - Herman Carneiro
- Framingham Heart StudyFraminghamMassachusetts
- Department of MedicineBoston University School of MedicineBostonMassachusetts
| | - Mekala R. Raman
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
| | - Ann C. McKee
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Victor E. Alvarez
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Jamie M. Walker
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Claudia L. Satizabal
- Framingham Heart StudyFraminghamMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Jayandra J. Himali
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Thor D. Stein
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Alexa Beiser
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
| | - Sudha Seshadri
- Framingham Heart StudyFraminghamMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| |
Collapse
|
12
|
Elgendy IY, Omer MA, Kennedy KF, Mansoor H, Mahmoud AN, Mojadidi MK, Abraham MG, Enriquez JR, Jneid H, Spertus JA, Bhatt DL. 30-Day Readmissions After Endovascular Thrombectomy for Acute Ischemic Stroke. JACC Cardiovasc Interv 2019; 11:2414-2424. [PMID: 30522672 DOI: 10.1016/j.jcin.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The authors sought to investigate the incidence, predictors, and causes of 30-day nonelective readmissions after endovascular thrombectomy (EVT). BACKGROUND Randomized trials have demonstrated that EVT improves outcomes in patients with acute ischemic stroke. METHODS The Nationwide Readmissions Database, years 2013 and 2014, was used to identify hospitalizations for a primary diagnosis of acute ischemic stroke during which patients underwent EVT, with or without intravenous thrombolysis. The incidence and reasons of 30-day readmissions were investigated. A hierarchical Cox regression model was used to identify independent predictors of 30-day nonelective readmissions. A propensity score-matched analysis was performed to compare the risk of 30-day nonelective readmissions in those who underwent EVT versus thrombolysis alone. RESULTS Among 2,055,365 weighted hospitalizations with acute ischemic stroke and survival to discharge, 10,795 (0.5%) underwent EVT. The 30-day readmission rate was 12.4% within a median of 9 days (interquartile range: 4 to 18 days). Diabetes mellitus, coagulopathy, Medicare or Medicaid insurance, and gastrostomy during the index hospitalization were independent predictors of 30-day readmission, but coadministration of thrombolytics with EVT was not an independent predictor. The most common reasons for readmission were infections (17.2%), cardiac causes (17.0%), and recurrent stroke or transient ischemic attack (14.8%). Compared with thrombolysis alone, the hazard of 30-day readmissions was similar (hazard ratio: 0.98; 95% confidence interval: 0.91 to 1.05; p = 0.55). CONCLUSIONS In patients hospitalized with acute ischemic stroke who underwent EVT, 30-day nonelective readmissions were common, occurring in approximately 1 in 8 patients, but were similar to those of patients treated with thrombolysis alone. Risk of readmission was associated with certain patient demographics, comorbidities, and complications, but not thrombolysis coadministration. Infections, cardiac causes, and recurrent stroke or transient ischemic attack are the most common reasons for readmission after EVT, emphasizing the need for comprehensive multidisciplinary treatment in the transition to outpatient care.
Collapse
Affiliation(s)
- Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mohamed A Omer
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Hend Mansoor
- Department of Health Services Research, Outcomes, and Policy, University of Florida, Gainesville, Florida
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Michael G Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jonathan R Enriquez
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
13
|
Takagi T, Yoshimura S, Sakai N, Iihara K, Oishi H, Hirohata M, Matsumaru Y, Matsumoto Y, Yamagami H, Menon BK, Almekhlafi M, Holodinsky JK, Kamal N, Hill MD, Goyal M. Distribution and current problems of acute endovascular therapy for large artery occlusion from a two-year national survey in Japan. Int J Stroke 2019; 15:289-298. [PMID: 31409212 DOI: 10.1177/1747493019869706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular treatment is recommended in clinical practice in Japan. However, its utilization and comprehensiveness are less well described. AIMS To report endovascular treatment utilization and overall geographical coverage in Japan and to analyze regional differences in the number of endovascular treatments, specialists, and endovascular treatment-capable hospitals. METHODS A national survey of members of the Japanese Society for NeuroEndovascular Therapy (JSNET) was conducted in 2017 and 2018. The total number of endovascular treatment cases per year was estimated, and the number of endovascular treatment cases per 100,000 people was calculated using the 2015 census. The distribution of treatment hospitals and JSNET specialists was mapped and the population coverage rate was determined. RESULTS The total number of endovascular treatment cases in Japan increased by 34.5% from 2016 (7702) to 2017 (10,360). The number of endovascular treatment-capable hospitals in Japan increased from 597 in 2016 to 693 in 2017, with an average annual caseload of 14.9 in 2017. The number of JSNET specialists per hospital decreased from 1.81 in 2016 to 1.76 in 2017 because of the increase in endovascular treatment-capable hospitals. Only 50 (7.2%) hospitals had > 40 endovascular treatment cases annually. The majority (97.7%) of the Japanese population lives within a 60-min drive of any endovascular treatment-capable hospital. However, only 70.4% live within a 60-min drive of a high-volume center (>40 cases annually). CONCLUSIONS Utilization of endovascular treatment in Japan is increasing; however, the number of cases per hospital remains low, as is the number of specialists per endovascular treatment-capable hospital. Increased number of specialists and centralization of endovascular treatment services may improve patient outcomes.
Collapse
Affiliation(s)
- Toshinori Takagi
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan
| | - Hiroshi Yamagami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Bijoy K Menon
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | | | - Jessalyn K Holodinsky
- Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Noreen Kamal
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Mayank Goyal
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| |
Collapse
|
14
|
Asdaghi N, Yavagal DR, Wang K, Mueller-Kronast N, Bhatt N, Gardener HE, Gutierrez CM, Marulanda-Londoño E, Koch S, Dong C, Oluwole SA, Hanel R, Mehta B, Robichaux M, Nobo U, Zevallos JC, Rundek T, Sacco RL, Romano JG. Patterns and Outcomes of Endovascular Therapy in Mild Stroke. Stroke 2019; 50:2101-2107. [PMID: 31303151 DOI: 10.1161/strokeaha.118.023893] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods- From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Stroke Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (National Institutes of Health Stroke Scale [NIHSS] ≤5) or moderate/severe (NIHSS>5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression. Results- Among 4110 EVT patients (median age, 73 [interquartile range=20] years; 50% women), 446 (11%) had NIHSS ≤5. Compared with NIHSS >5, those with NIHSS ≤5 arrived later to the hospital (median, 138 versus 101 minutes), were less likely to receive intravenous alteplase (30% versus 43%), had a longer door-to-puncture time (median, 167 versus 115 minutes) and more likely treated in South Florida (64% versus 53%). In multivariable analysis younger age, private insurance (versus Medicare), history of hypertension, prior independent ambulation and hospital size were independent characteristics associated with NIHSS ≤5. Among EVT patients with NIHSS ≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared with 53% and 32% of patients with NIHSS >5. Symptomatic intracerebral hemorrhage occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS >5. Conclusions- Despite lack of evidence-based recommendations, 11% of patients receiving EVT in clinical practice have mild neurological presentations. Individual, hospital and geographic disparities are observed among endovascularly treated patients based on the severity of clinical symptoms. Our data suggest safety and overall favorable outcomes for EVT patients with mild stroke.
Collapse
Affiliation(s)
- Negar Asdaghi
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Dileep R Yavagal
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Kefeng Wang
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | | | - Nirav Bhatt
- Department of Neurology, Emory University/Grady Memorial Hospital, GA (N.B.)
| | - Hannah E Gardener
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Carolina M Gutierrez
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Erika Marulanda-Londoño
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Sebastian Koch
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Chuanhui Dong
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Sophia A Oluwole
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Ricardo Hanel
- Department of Neurosurgery, Baptist Neurological Institute, Jacksonville, FL (R.H.)
| | - Brijesh Mehta
- Department of Neurosurgery, Memorial Regional Hospital, Hollywood, FL (B.M.)
| | | | - Ulises Nobo
- Department of Neurology, HIMA San Pablo Hospital, Caguas, Puerto Rico (U.N.)
| | - Juan C Zevallos
- Department of Neurology, Florida International University, Miami (J.C.Z.)
| | - Tatjana Rundek
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Ralph L Sacco
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| | - Jose G Romano
- From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.)
| |
Collapse
|
15
|
Chen H, Shi L, Wang N, Han Y, Lin Y, Dai M, Liu H, Dong X, Xue M, Xu H. Analysis on geographic variations in hospital deaths and endovascular therapy in ischaemic stroke patients: an observational cross-sectional study in China. BMJ Open 2019; 9:e029079. [PMID: 31239305 PMCID: PMC6597735 DOI: 10.1136/bmjopen-2019-029079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Stroke is the leading cause of death and adult disability in China, following a rise in incidence over the last few decades. We aimed to explore the geographic variations in hospital mortality and endovascular therapy (EVT) use among ischaemic stroke (IS) patients in China, and investigate the associated potential risk factors. DESIGN Observational cross-sectional study of patients hospitalised for stroke. SETTING Hospital discharge data for 1267 tertiary hospitals between 1 January 2015 and 31 December 2015 were derived from the Nationwide Hospital Discharge Database operated by the National Health Commission of China. PARTICIPANTS 1 826 332 patients aged ≥18 years, hospitalised following stroke. OUTCOME MEASURES In-hospital mortality and EVT use. RESULTS The nationwide hospital mortality rate of IS patients was 0.88% (95% CI 0.86% to 0.90%); there was a significantly greater risk of mortality in the Northeast (OR 2.37; 95% CI 2.23 to 2.52), West (1.65; 1.54 to 1.78), South (1.25; 1.17 to 1.33) and North (1.29; 1.20 to 1.39) than in the East. Tertiary B hospitals (OR 1.05; 95% CI 1.00 to 1.09), patients admitted from emergency departments and older patients were associated with higher hospital mortality. The national EVT use rate was 0.45% (95% CI 0.44% to 0.46%). Compared with in East China, EVT use was significantly lower in the Northeast (OR 0.22; 95% CI 0.20 to 0.24) and West (0.64; 0.58 to 0.71), though not the North (1.23; 1.14 to 1.33). Tertiary A hospitals (OR 2.62; 95% CI 2.43 to 2.83), male patients and patients admitted from emergency departments were also associated with higher EVT use rates. CONCLUSIONS There were substantial disparities in mortality and EVT use for hospitalised patients with IS among China's tertiary hospitals, linked with both geographic and hospital characteristics. More targeted intervention at regional and hospital levels is needed for providing effective health technologies and eventually improving post-stroke outcomes.
Collapse
Affiliation(s)
- Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University, New Orleans, Louisiana, USA
| | - Ni Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yangtong Han
- Department of Neurology, Ji Shui Tan Hospital and Fourth Medical College of Peking University, Beijing, China
| | - Yilu Lin
- Department of Global Health Management and Policy, Tulane University, New Orleans, Louisiana, USA
| | - Mingfeng Dai
- Center for Health Statistics and Information, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Honglei Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Xiao Dong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ming Xue
- Center for Health Statistics and Information, National Health and Family Planning Commission of the Peoples Republic of China, Beijing, China
| | - Hua Xu
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
16
|
Patel MD, Honvoh G, Fernandez AR, Cadena R, Kelly ER, McDaniel P, Brice JH. Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina. South Med J 2019; 112:331-337. [PMID: 31158888 DOI: 10.14423/smj.0000000000000986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit [neuro-ICU] bed capacity) for North Carolina overall and by region and population density. We also assessed daily trends in hospital bed availability. METHODS This statewide descriptive study was conducted with data from the State Medical Asset Resource Tracking Tool (SMARTT), a Web-based system used by North Carolina to track available medical resources within the state. The SMARTT system was queried for stroke-specific physician and bed resources at each North Carolina hospital during a 1-year period (June 2015-May 2016), including daily availability of neuro-ICU beds. We compared hospital resources by geographic region and population density (metropolitan, urban, and rural). RESULTS Data from 108 acute care hospitals located in 75 of 100 counties in North Carolina were included in the analysis. Fifty-seven percent of hospitals had no neurology specialty physicians. Western and eastern North Carolina had the lowest prevalence of these physicians. Most hospitals (88%) had general ICUs, whereas only 17 hospitals (16%) had neuro-ICUs. Neuro-ICUs were concentrated in metropolitan areas and in central North Carolina. On average, there were 276 general ICU and 27 neuro-ICU beds available statewide each day. Daily neuro-ICU bed availability was lowest in eastern and southeastern regions and during the week compared with weekends. CONCLUSIONS In North Carolina, stroke-specific hospital subspecialists and resources are not distributed evenly across the state. Daily bed availability, particularly in neuro-ICUs, is lacking in rural areas and noncentral regions and appears to decrease on weekdays. Regionalization of stroke care needs to consider the geographic distribution and daily variability of hospital resources.
Collapse
Affiliation(s)
- Mehul D Patel
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Gilson Honvoh
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Antonio R Fernandez
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Rhonda Cadena
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Emma R Kelly
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Philip McDaniel
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| | - Jane H Brice
- From the Department of Emergency Medicine, the Department of Biostatistics, EMS Performance Improvement Center, Department of Neurology, and the Davis Library, University of North Carolina at Chapel Hill
| |
Collapse
|
17
|
Temporal Trends in the Use of Acute Recanalization Therapies for Ischemic Stroke in Patients with Cancer. J Stroke Cerebrovasc Dis 2019; 28:2255-2261. [PMID: 31153762 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/19/2019] [Accepted: 05/08/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We sought to characterize the US nationwide temporal trends in recanalization therapy utilization for ischemic stroke among patients with and without cancer. METHODS We identified all acute ischemic stroke (AIS) hospitalizations in the National Inpatient Sample from January 1, 1998 to September 30, 2015. The primary exposure was solid or hematologic cancer. The primary outcome was use of intravenous thrombolysis. The secondary outcome was use of endovascular therapy (EVT). RESULTS Among 9,508,804 AIS hospitalizations, 503,510 (5.3%) involved cancer patients. Intravenous thrombolysis use among ischemic stroke patients with cancer increased from .01% (95% confidence interval [CI], .00%-.02%) in 1998 to 4.91% (95% CI, 4.33%-5.48%) in 2015, whereas intravenous thrombolysis use among ischemic stroke patients without cancer increased from .02% (95% CI, .01%-.02%) in 1998 to 7.22% (95% CI, 6.98%-7.45%) in 2015. The demographic- and comorbidity-adjusted odds ratio/year of receiving intravenous thrombolysis was similar in patients with cancer (1.21; 95% CI, 1.20-1.23) versus those without (1.20; 95% CI, 1.19-1.21). EVT use among ischemic stroke patients with cancer increased from .05% (95% CI, .02%-.07%) in 2006 to 1.90% (95% CI, 1.49%-2.31%) in 2015, whereas EVT use among ischemic stroke patients without cancer increased from .09% (95% CI, .00%-.18%) in 2006 to 1.88% (95% CI, 1.68%-2.09%) in 2015. CONCLUSIONS Among 9.5 million AIS hospitalizations, patients with cancer received intravenous thrombolysis about two thirds as often as patients without cancer. This difference persisted over time despite increased utilization in both groups. EVT utilization was similar between cancer and non-cancer AIS patients.
Collapse
|
18
|
Menon BK, Xu H, Cox M, Saver JL, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt DL, Fonarow GC, Schwamm LH, Smith EE. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019; 139:169-179. [DOI: 10.1161/circulationaha.118.036701] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bijoy K. Menon
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
| | - Haolin Xu
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Margueritte Cox
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Jeffrey L. Saver
- Department of Neurology (J.L.S.), University of California, Los Angeles
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
| | - Eric Peterson
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Ying Xian
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Roland Matsuoka
- Departments of Biostatistics and Bioinformatics (R.M.), Duke University, Durham, NC
| | - Reza Jehan
- Departments of Neurosurgery and Radiology (R.J.), University of California, Los Angeles
| | - Dileep Yavagal
- Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.Y.)
| | - Rishi Gupta
- Wellstar Neuroscience Institute, Georgia Institute of Technology, Marietta (R.G.)
| | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C. Fonarow
- Ahmanson-University of California, Los Angeles, Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles, Medical Center (G.C.F.), University of California, Los Angeles
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)
| | - Eric E. Smith
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
| |
Collapse
|
19
|
Vaughan Sarrazin M, Limaye K, Samaniego EA, Al Kasab S, Sheharyar A, Dandapat S, Guerrero WR, Hasan DM, Ortega-Gutierrez S, Derdeyn CP, Torner JC, Chamorro A, Leira EC. Disparities in Inter-hospital Helicopter Transportation for Hispanics by Geographic Region: A Threat to Fairness in the Era of Thrombectomy. J Stroke Cerebrovasc Dis 2018; 28:550-556. [PMID: 30552028 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/06/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients. METHODS Acute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders. RESULTS A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019). DISCUSSION Our findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.
Collapse
Affiliation(s)
| | - Kaustubh Limaye
- Department of Neurology, University of Iowa, Iowa City, Iowa.
| | | | - Sami Al Kasab
- Department of Neurology, University of Iowa, Iowa City, Iowa.
| | - Ali Sheharyar
- Department of Neurology, University of Iowa, Iowa City, Iowa.
| | | | | | - David M Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa.
| | | | - Colin P Derdeyn
- Department of Radiology, University of Iowa, Iowa City, Iowa.
| | - James C Torner
- Department of Epidemiology, University of Iowa, Iowa City, Iowa.
| | - Angel Chamorro
- Department of Neurology, University of Iowa, Iowa City, Iowa; Department of Neurology, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Enrique C Leira
- Department of Neurology, University of Iowa, Iowa City, Iowa; Department of Neurosurgery, University of Iowa, Iowa City, Iowa; Department of Epidemiology, University of Iowa, Iowa City, Iowa.
| |
Collapse
|
20
|
Fréchou M, Margaill I, Marchand-Leroux C, Beray-Berthat V. Behavioral tests that reveal long-term deficits after permanent focal cerebral ischemia in mouse. Behav Brain Res 2018; 360:69-80. [PMID: 30500429 DOI: 10.1016/j.bbr.2018.11.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
Efforts are still needed regarding the research of therapeutics for ischemic stroke. While in experimental studies the protective effect of pharmacological agents is often highlighted by a reduction of the lesion size evaluated in the short term (days), in clinical studies a functional recovery of patients suffering from stroke is expected on the long-term (months and years). Long-term functional preclinical studies are highly recommended to evaluate potential neuroprotective agents for stroke, rather than an assessment of the infarction size at a short time point. The present study thus aimed to select among various behavioral tests those able to highlight long-term deficits (3 months) after cerebral ischemia in mice. Permanent focal cerebral ischemia was carried out in male Swiss mice by intraluminal occlusion of the left middle cerebral artery (MCA). Fourteen behavioral tests were assessed from 7 days to 90 days after ischemia (locomotor activity, neurological score, exit circle test, grip and string tests, chimney test, adhesive removal test, pole test, beam-walking tests, elevated plus maze, marble burying test, forced swimming test, novel object recognition test). The present study clearly identified a battery of behavioral tests able to highlight deficits up to 3 months in our mouse model of permanent MCA occlusion (locomotor activity, neurological score, adhesive removal test, pole test, beam-walking tests, elevated plus maze, marble burying test, forced swimming test and novel object recognition test). This battery of behavioral tests highlighting long-term deficits is useful to study future neuroprotective strategies for stroke treatment.
Collapse
Affiliation(s)
- Magalie Fréchou
- Equipe de recherche "Pharmacologie de la Circulation Cérébrale" EA 4475, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie de Paris, 75006 Paris, France.
| | - Isabelle Margaill
- Equipe de recherche "Pharmacologie de la Circulation Cérébrale" EA 4475, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie de Paris, 75006 Paris, France.
| | - Catherine Marchand-Leroux
- Equipe de recherche "Pharmacologie de la Circulation Cérébrale" EA 4475, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie de Paris, 75006 Paris, France.
| | - Virginie Beray-Berthat
- Equipe de recherche "Pharmacologie de la Circulation Cérébrale" EA 4475, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie de Paris, 75006 Paris, France.
| |
Collapse
|
21
|
Lindekleiv H, Berge E, Bruins Slot KMH, Wardlaw JM. Percutaneous vascular interventions versus intravenous thrombolytic treatment for acute ischaemic stroke. Cochrane Database Syst Rev 2018; 10:CD009292. [PMID: 30365156 PMCID: PMC6516947 DOI: 10.1002/14651858.cd009292.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Most ischaemic strokes are caused by blockage of a cerebral artery by a thrombus. Intravenous administration of recombinant tissue plasminogen activator given within 4.5 hours is now standard treatment for this condition. Percutaneous vascular interventions use an intra-arterial, mechanical approach for thrombus disruption or removal (thrombectomy). Recent randomised trials indicate that percutaneous vascular interventions are superior to usual care (usual care usually included intravenous thrombolysis). However, intravenous thrombolysis was usually given in both arms of the trial and there was a lack of direct comparison of percutaneous vascular interventions with intravenous thrombolysis. OBJECTIVES To assess the effectiveness and safety of percutaneous vascular interventions compared with intravenous thrombolytic treatment for acute ischaemic stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last search: August 2018). In addition, in September 2017, we searched the following electronic databases: CENTRAL, MEDLINE, Embase, and Science Citation Index; and Stroke Trials Registry, and US National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) that directly compared a percutaneous vascular intervention with intravenous thrombolytic treatment in people with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors applied the inclusion criteria, extracted data, and assessed risk of bias. We obtained both published and unpublished data. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included four trials with 450 participants. Data on functional outcome and death at end of follow-up were available for 443 participants from three trials. Compared with intravenous thrombolytic therapy, percutaneous vascular intervention did not improve the proportion of participants with good functional outcome (modified Rankin Scale score 0 to 2, risk ratio (RR) 1.01, 95% confidence interval (CI) 0.82 to 1.25, P = 0.92). The quality of evidence was low (outcome assessment was blinded, but not the treating physician or participants). At the end of follow-up, there was a non-significant increase in the proportion of participants who died in the percutaneous vascular intervention group (RR 1.34, 95% CI 0.84 to 2.14, P = 0.21). The quality of evidence was low (wide confidence interval). There was no difference in the proportion of participants with symptomatic intracranial haemorrhages between the intervention and control groups (RR 0.99, 95% CI 0.50 to 1.95, P = 0.97). The quality of evidence was low (wide confidence interval). Data on vascular status (recanalisation rate) were only available for seven participants from one trial; we considered this inadequate for statistical analyses. AUTHORS' CONCLUSIONS The present review directly compared intravenous thrombolytic treatment with percutaneous vascular interventions for ischaemic stroke. We found no evidence from RCTs that percutaneous vascular interventions are superior to intravenous thrombolytic treatment with respect to functional outcome. Quality of evidence was low (outcome assessment was blinded, but not the treating physician or participants). New trials with adequate sample sizes are warranted because of the rapid development of new techniques and devices for such interventions.
Collapse
Affiliation(s)
| | - Eivind Berge
- Oslo University HospitalDepartment of Internal MedicineOsloNorwayNO‐0407
| | | | - Joanna M Wardlaw
- University of EdinburghCentre for Clinical Brain SciencesThe Chancellor's Building49 Little France CrescentEdinburghUKEH16 4SB
| | | |
Collapse
|
22
|
Ganesh A, Goyal M. Thrombectomy for Acute Ischemic Stroke: Recent Insights and Future Directions. Curr Neurol Neurosci Rep 2018; 18:59. [PMID: 30033493 DOI: 10.1007/s11910-018-0869-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Mechanical thrombectomy has become the standard of care for acute ischemic stroke with proximal large vessel occlusions (LVO). This article reviews recent research relating to thrombectomy. RECENT FINDINGS Thrombectomy for anterior circulation stroke with proximal LVO was first shown to be highly efficacious within 6 h of stroke onset, but "late-window" trials have further demonstrated efficacy until 24-h postonset in select patients with salvageable tissue. However, the concept of "time is brain" remains critical. Thrombectomy trials have further stimulated worldwide efforts to develop systems of care for rapid treatment of eligible patients. Thrombectomy is cost-effective and likely to have long-term efficacy for both disability and mortality outcomes. Thrombectomy is a highly efficacious acute stroke therapy. Enduring uncertainties include efficacy in patients with premorbid disability, posterior circulation, or more distal occlusions; use of bridging thrombolysis; and optimal techniques to achieve consistent revascularization and address tandem occlusions or stenoses.
Collapse
Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. .,Department of Radiology, University of Calgary, Calgary, Canada. .,Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada.
| |
Collapse
|
23
|
Peng JW, Liu Y, Meng G, Zhang JY, Yu LF. Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial. Exp Ther Med 2018; 16:2600-2614. [PMID: 30186492 DOI: 10.3892/etm.2018.6444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/02/2018] [Indexed: 01/01/2023] Open
Abstract
Hypoperfusion following acute stroke is common in the infarct core and periphery tissues. The present study evaluated the efficacy of salvianolic acid (SA) on the cerebral perfusion of patients who had suffered from acute stroke using perfusion-weighted magnetic resonance imaging (PWI) to examine the blood perfusion of the affected brain tissue prior to and following treatment. Patients who were admitted to PLA 153 Central Hospital within 72 h of acute stroke symptom onset and had a Glasgow coma scale ≥5 were randomized into two groups: SA and control groups. Patients in the SA group were administered SA 0.13 g/day for 14 days. PWI was performed for all patients at admission and post-treatment. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to assess neurological function at admission and 3 months post treatment. A total of 159 patients were enrolled (85 patients in the SA group and 74 patients in the control group). A total of 62 patients in the SA group and 51 patients in the control group exhibited hypoperfusion in the ipsihemisphere of the diffusion-weighted magnetic resonance imaging (DWI) lesion. In addition, relative cerebral blood volume (rCBV), a ratio of the signal value of the region of interest in the same hemisphere of the DWI lesion to that of its mirror in the PWI CBV map, decreased significantly following treatment with SA compared with the control group in patients with hypoperfusion (P=0.02), which were indicated by PWI images at admission, in the DWI lesions or the surrounding areas. Additionally, there was no significant difference in patients with normal perfusion at admission in rCBV in DWI lesions or its surrounding area between the two groups at day 15. However, a significant improvement in NIHSS (P=0.001) and mRS (P=0.005) was indicated in the SA group compared with the control at day 90. The present study indicated that SA may improve the neurological dysfunction of patients with acute stroke, which may be explained by the increased perfusion of hypoperfused brain tissues.
Collapse
Affiliation(s)
- Jian-Wei Peng
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Yuan Liu
- Postgraduate Department, Xinxiang Medical College, Xinxiang, Henan 453003, P.R. China
| | - Gai Meng
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Jin-Yan Zhang
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Lian-Fang Yu
- Department of Radiology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| |
Collapse
|
24
|
Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, Eesa M, Fischer U, Hausegger K, Hirsch JA, Hussain MS, Jansen O, Jayaraman MV, Khalessi AA, Kluck BW, Lavine S, Meyers PM, Ramee S, Rüfenacht DA, Schirmer CM, Vorwerk D. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 39:E61-E76. [PMID: 29773566 PMCID: PMC7410632 DOI: 10.3174/ajnr.a5638] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- D Sacks
- From the Department of Interventional Radiology (D.S.), The Reading Hospital and Medical Center, West Reading, Pennsylvania
| | - B Baxter
- Department of Radiology (B.B.), Erlanger Medical Center, Chattanooga, Tennessee
| | - B C V Campbell
- Departments of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - J S Carpenter
- Department of Radiology (J.S.C.), West Virginia University, Morgantown, West Virginia
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.C.), Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Toulouse, France
| | - D Dippel
- Department of Neurology (D.D.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Eesa
- Department of Radiology (M.E.), University of Calgary, Calgary, Alberta, Canada
| | - U Fischer
- Department of Neurology (U.F.), Inselspital-Universitätsspital Bern, Bern, Switzerland
| | - K Hausegger
- Department of Radiology (K.H.), Klagenfurt State Hospital, Klagenfurt am Wörthersee, Austria
| | - J A Hirsch
- Neuroendovascular Program, Department of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - M S Hussain
- Cerebrovascular Center, Neurological Institute (M.S.H.), Cleveland Clinic, Cleveland, Ohio
| | - O Jansen
- Department of Radiology and Neuroradiology (O.J.), Klinik für Radiologie und Neuroradiologie, Kiel, Germany
| | - M V Jayaraman
- Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.V.J.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - A A Khalessi
- Department of Surgery (A.A.K.), University of California San Diego Health, San Diego, California
| | - B W Kluck
- Interventional Cardiology (B.W.K.), Heart Care Group, Allentown, Pennsylvania
| | - S Lavine
- Departments of Neurological Surgery and Radiology (S.L.), Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - P M Meyers
- Departments of Radiology and Neurological Surgery (P.M.M.), Columbia University College of Physicians and Surgeons, New York, New York
| | - S Ramee
- Interventional Cardiology, Heart and Vascular Institute (S.R.), Ochsner Medical Center, New Orleans, Louisiana
| | - D A Rüfenacht
- Neuroradiology Division (D.A.R.), Swiss Neuro Institute-Clinic Hirslanden, Zürich, Switzerland
| | - C M Schirmer
- Department of Neurosurgery and Neuroscience Center (C.M.S.), Geisinger Health System, Wilkes-Barre, Pennsylvania
| | - D Vorwerk
- Diagnostic and Interventional Radiology Institutes (D.V.), Klinikum Ingolstadt, Ingolstadt, Germany
| |
Collapse
|
25
|
Schwamm LH, Wu O, Song SS, Latour LL, Ford AL, Hsia AW, Muzikansky A, Betensky RA, Yoo AJ, Lev MH, Boulouis G, Lauer A, Cougo P, Copen WA, Harris GJ, Warach S. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Ann Neurol 2018; 83:980-993. [PMID: 29689135 DOI: 10.1002/ana.25235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/08/2018] [Accepted: 04/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Most acute ischemic stroke (AIS) patients with unwitnessed symptom onset are ineligible for intravenous thrombolysis due to timing alone. Lesion evolution on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) correlates with stroke duration, and quantitative mismatch of diffusion-weighted MRI with FLAIR (qDFM) might indicate stroke duration within guideline-recommended thrombolysis. We tested whether intravenous thrombolysis ≤4.5 hours from the time of symptom discovery is safe in patients with qDFM in an open-label, phase 2a, prospective study (NCT01282242). METHODS Patients aged 18 to 85 years with AIS of unwitnessed onset at 4.5 to 24 hours since they were last known to be well, treatable within 4.5 hours of symptom discovery with intravenous alteplase (0.9mg/kg), and presenting with qDFM were screened across 14 hospitals. The primary outcome was the risk of symptomatic intracranial hemorrhage (sICH) with preplanned stopping rules. Secondary outcomes included symptomatic brain edema risk, and functional outcomes of 90-day modified Rankin Scale (mRS). RESULTS Eighty subjects were enrolled between January 31, 2011 and October 4, 2015 and treated with alteplase at median 11.2 hours (IQR = 9.5-13.3) from when they were last known to be well. There was 1 sICH (1.3%) and 3 cases of symptomatic edema (3.8%). At 90 days, 39% of subjects achieved mRS = 0-1, as did 48% of subjects who had vessel imaging and were without large vessel occlusions. INTERPRETATION Intravenous thrombolysis within 4.5 hours of symptom discovery in patients with unwitnessed stroke selected by qDFM, who are beyond the recommended time windows, is safe. A randomized trial testing efficacy using qDFM appears feasible and is warranted in patients without large vessel occlusions. Ann Neurol 2018;83:980-993.
Collapse
Affiliation(s)
- Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lawrence L Latour
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Amie W Hsia
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.,Comprehensive Stroke Center, MedStar Washington Hospital Center, Washington, DC
| | | | - Rebecca A Betensky
- Massachusetts General Hospital Biostatistics Center, Boston, MA.,Harvard T. H. Chan School of Public Health, Boston, MA
| | - Albert J Yoo
- Neuroendovascular Service, Texas Stroke Institute, Plano, TX.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Gregoire Boulouis
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Department of Neuroradiology, Paris Descartes University, Saint Anne Hospital Center, Paris, France
| | - Arne Lauer
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Pedro Cougo
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Gordon J Harris
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Steven Warach
- Dell Medical School, University of Texas at Austin, Austin, TX
| | | |
Collapse
|
26
|
Raychev RI, Stradling D, Patel N, Gee JR, Lombardi DA, Moon JL, Brown DM, Pathak M, Yu W, Stratton SJ, Cramer SC. Evolution of a US County System for Acute Comprehensive Stroke Care. Stroke 2018; 49:1217-1222. [PMID: 29626136 DOI: 10.1161/strokeaha.118.020620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/25/2018] [Accepted: 03/01/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE In Orange County, California, patients with suspected acute stroke are taken to stroke neurology receiving centers that are designated by County Emergency Medical Services authorities as either hubs or spokes based on endovascular treatment capability. We examined relationships between stroke details, reperfusion therapies, hospital transfers, and their change over time. METHODS All patients from January 1, 2013, to December 31, 2015, for whom 911 was called within 7 hours of onset in whom Emergency Medical Services personnel suspected acute stroke were evaluated. RESULTS Among 6132 patients, 3924 (64%) had confirmed diagnosis of stroke (74% ischemic/26% hemorrhagic), yielding diagnostic precision of 64% in the field. Of the 2892 patients with acute ischemic stroke, acute reperfusion therapy was given to 29.2% (21.7% intravenous tPA [tissue-type plasminogen activator] only and 7.5% endovascular treatment). Rates of endovascular treatment of patients with ischemic stroke increased over time, more than doubling from 5.6% in 2013 to 12.5% (odds ratio per 3-month quarter=1.09; 95% confidence interval, 1.04-1.14; P<0.0001). Only 3.4% of patients with acute ischemic stroke were transferred from a spoke to a hub hospital; transfer rates were inversely related to age (P<0.0001), and reperfusion therapy rates did not vary according to transfer status. CONCLUSIONS Favorable features of this acute stroke care system include reperfusion therapy in 29.2% of patients with ischemic stroke and substantial increases in endovascular treatment rates over time. Continued efforts to optimize acute stroke systems of care can be directed toward improving access to best acute stroke therapies.
Collapse
Affiliation(s)
- Radoslav I Raychev
- From the Saddleback Memorial Medical Center, Laguna Hills, CA (R.I.R.).,Department of Neurology, University of California, Los Angeles (R.I.R.)
| | - Dana Stradling
- Department of Neurology, University of California, Irvine (D.S., W.Y., S.C.C.)
| | | | - Joey R Gee
- Mission Hospital, Mission Viejo, CA (J.R.G.)
| | | | | | - David M Brown
- Hoag Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, CA (D.M.B.)
| | | | - Wengui Yu
- Department of Neurology, University of California, Irvine (D.S., W.Y., S.C.C.)
| | - Samuel J Stratton
- Orange County Emergency Medical Services, Santa Ana, CA (S.J.S.).,Department of Community Health Sciences (S.J.S.)
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine (D.S., W.Y., S.C.C.)
| |
Collapse
|
27
|
Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke: From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO). J Vasc Interv Radiol 2018; 29:441-453. [PMID: 29478797 DOI: 10.1016/j.jvir.2017.11.026] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 01/19/2023] Open
|
28
|
Zhou G, Li MH, Lu HT, Deng JS, Zhao YW, Wang YXJ, Zhu YQ. No inferiority of Tonbridge thrombectomy device for acute thrombus retrial compared with Solitaire device: an experimental evaluation with a canine distal external carotid-maxillary artery occlusion model. J Neurointerv Surg 2018; 10:1085-1091. [PMID: 29444961 DOI: 10.1136/neurintsurg-2017-013673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/22/2018] [Accepted: 02/02/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Mechanical thrombectomy (MT) has been widely accepted as a safe and effective treatment for acute ischemic stroke (AIS). Development of stent retriever devices has been intensively developed over the past two decades. In this study, we compared the effectiveness and safety of a new thrombectomy device with Solitaire FR for the treatment of AIS models. METHODS Mechanical performance of stent retrievers was tested in vitro. Thrombin-induced thrombus was pre-injected into the right distal external carotid-maxillary artery in 18 dogs to create an acute thrombus occlusion model, and these animals were divided into a Tonbridge group (n=9, with Tonbridge stent Tonbridge Medical Technology) and a Solitaire group as control (n=9, with Solitaire stent, ev3 Neurovascular). Final flow restoration, side branches, recanalization time, distal vessel embolism, and device-related complications were recorded and compared. A post-procedure angiogram was obtained at 30 and 90 days after thrombectomy. Device manipulation-related damage to the arterial walls was evaluated histologically. RESULTS In vitro test showed that the maximum friction within the microcatheter was 0.763 for the Tonbridge device and 0.784 n for the Solitaire (P>0.05). Slight increase in radial force was noticed for the Tonbridge (0.035 N/mm vs 0.031 N/mm of Solitaire, P>0.05). Eighteen and 16 retriever attempts were done in the Tonbridge (mean 2.0 attempts) and the Solitaire (mean 1.8 attempts) groups (P=0.74). The Tonbridge device led to good flow restoration in all nine (100%) models compared with eight (88.9%) in the Solitaire group (P=0.30). Side branches' influence (P=0.39), distal thromboembolism (P=0.60), and device-related complications (P=1.00) found no difference between the two groups. The rates of disruption of the internal elastic lamina (IEL) were 8.3% (2/24) and 4.2% (1/24) of the specimens, respectively (P=0.683). TICI 2b/3 flow of the right CCA were similar between the two groups at 1 (6/6 vs 6/6) and 3 months (6/6 vs 6/6) follow-up (P>0.05). CONCLUSION Our preliminary study indicated this new device was technically feasible and effective to be used in thrombectomy for the treatment of acute thrombus occlusion in canine models.
Collapse
Affiliation(s)
- Geng Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ming-Hua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai-Tao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiang-Shan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu-Wu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Yue-Qi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
29
|
Parikh NS, Chatterjee A, Díaz I, Pandya A, Merkler AE, Gialdini G, Kummer BR, Mir SA, Lerario MP, Fink ME, Navi BB, Kamel H. Modeling the Impact of Interhospital Transfer Network Design on Stroke Outcomes in a Large City. Stroke 2018; 49:370-376. [PMID: 29343588 DOI: 10.1161/strokeaha.117.018166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We sought to model the effects of interhospital transfer network design on endovascular therapy eligibility and clinical outcomes of stroke because of large-vessel occlusion for the residents of a large city. METHODS We modeled 3 transfer network designs for New York City. In model A, patients were transferred from spoke hospitals to the closest hub hospitals with endovascular capabilities irrespective of hospital affiliation. In model B, which was considered the base case, patients were transferred to the closest affiliated hub hospitals. In model C, patients were transferred to the closest affiliated hospitals, and transfer times were adjusted to reflect full implementation of streamlined transfer protocols. Using Monte Carlo methods, we simulated the distributions of endovascular therapy eligibility and good functional outcomes (modified Rankin Scale score, 0-2) in these models. RESULTS In our models, 200 patients (interquartile range [IQR], 168-227) with a stroke amenable to endovascular therapy present to New York City spoke hospitals each year. Transferring patients to the closest hub hospital irrespective of affiliation (model A) resulted in 4 (IQR, 1-9) additional patients being eligible for endovascular therapy and an additional 1 (IQR, 0-2) patient achieving functional independence. Transferring patients only to affiliated hospitals while simulating full implementation of streamlined transfer protocols (model C) resulted in 17 (IQR, 3-41) additional patients being eligible for endovascular therapy and 3 (IQR, 1-8) additional patients achieving functional independence. CONCLUSIONS Optimizing acute stroke transfer networks resulted in clinically small changes in population-level stroke outcomes in a dense, urban area.
Collapse
Affiliation(s)
- Neal S Parikh
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.).
| | - Abhinaba Chatterjee
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Iván Díaz
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Ankur Pandya
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Gino Gialdini
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Benjamin R Kummer
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Saad A Mir
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Michael P Lerario
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Matthew E Fink
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Babak B Navi
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (N.S.P., A.C., A.E.M., G.G., B.R.K., S.A.M., M.P.L., M.E.F., B.B.N., H.K.); Department of Neurology (N.S.P., A.E.M., S.A.M., M.E.F., B.B.N., H.K.) and Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); Department of Biomedical Informatics, Columbia University, New York, NY (B.R.K.); and Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.)
| |
Collapse
|
30
|
Smith EE, Saver JL, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt DL, Fonarow GC, Schwamm LH. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017; 136:2303-2310. [PMID: 28982689 DOI: 10.1161/circulationaha.117.031097] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beginning in December 2014, a series of pivotal trials showed that endovascular thrombectomy (EVT) was highly effective, prompting calls to reorganize stroke systems of care. However, there are few data on how these trials influenced the frequency of EVT in clinical practice. We used data from the Get With The Guidelines-Stroke program to determine how the frequency of EVT changed in US practice. METHODS We analyzed prospectively collected data from a cohort of 2 437 975 patients with ischemic stroke admitted to 2222 participating hospitals between April 2003 and the third quarter of 2016. Weighted linear regression with 2 linear splines and a knot at January 2015 was used to compare the slope of the change in EVT use before and after the pivotal trials were published. Potentially eligible patients were defined as last known well to arrival time ≤4.5 hours and National Institutes of Health Stroke Scale score ≥6. RESULTS The frequency of EVT use was slowly increasing before January 2015 but then sharply accelerated thereafter. In the third quarter 2016, EVT was provided to 3.3% of all patients with ischemic stroke at all hospitals, representing 15.1% of all patients who were potentially eligible for EVT based on stroke duration and severity. At EVT-capable hospitals, 7.5% of all patients with ischemic stroke were treated in the third quarter of 2016, including 27.3% of the potentially eligible patients. From 2013 to 2016, case volumes nearly doubled at EVT-capable hospitals. Mean case volume per EVT-capable hospital was 37.6 per year in the last 4 quarters. EVT case volumes increased in nearly all US states from 2014 to the last 4 quarters, but with persistent geographic variation unexplained by differences in potential patient eligibility. CONCLUSIONS EVT use is increasing rapidly; however, there are still opportunities to treat more patients. Reorganizing stroke systems to route patients to adequately resourced EVT-capable hospitals might increase treatment of eligible patients, improve outcomes, and reduce disparities.
Collapse
Affiliation(s)
- Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada (E.E.S.).
| | - Jeffrey L Saver
- Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.)
| | - Margueritte Cox
- University of California, Los Angeles. Duke Clinical Research Institute (M.C., L.L., Y.X.)
| | - Li Liang
- University of California, Los Angeles. Duke Clinical Research Institute (M.C., L.L., Y.X.)
| | | | - Ying Xian
- University of California, Los Angeles. Duke Clinical Research Institute (M.C., L.L., Y.X.)
| | - Deepak L Bhatt
- Duke University, Durham, NC. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.)
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)
| |
Collapse
|
31
|
Mueller-Kronast NH, Zaidat OO, Froehler MT, Jahan R, Aziz-Sultan MA, Klucznik RP, Saver JL, Hellinger FR, Yavagal DR, Yao TL, Liebeskind DS, Jadhav AP, Gupta R, Hassan AE, Martin CO, Bozorgchami H, Kaushal R, Nogueira RG, Gandhi RH, Peterson EC, Dashti SR, Given CA, Mehta BP, Deshmukh V, Starkman S, Linfante I, McPherson SH, Kvamme P, Grobelny TJ, Hussain MS, Thacker I, Vora N, Chen PR, Monteith SJ, Ecker RD, Schirmer CM, Sauvageau E, Abou-Chebl A, Derdeyn CP, Maidan L, Badruddin A, Siddiqui AH, Dumont TM, Alhajeri A, Taqi MA, Asi K, Carpenter J, Boulos A, Jindal G, Puri AS, Chitale R, Deshaies EM, Robinson DH, Kallmes DF, Baxter BW, Jumaa MA, Sunenshine P, Majjhoo A, English JD, Suzuki S, Fessler RD, Delgado Almandoz JE, Martin JC, Haussen DC. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke. Stroke 2017; 48:2760-2768. [DOI: 10.1161/strokeaha.117.016456] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nils H. Mueller-Kronast
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Osama O. Zaidat
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Michael T. Froehler
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Reza Jahan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Mohammad Ali Aziz-Sultan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Richard P. Klucznik
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jeffrey L. Saver
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Frank R. Hellinger
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Dileep R. Yavagal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Tom L. Yao
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David S. Liebeskind
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ashutosh P. Jadhav
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Rishi Gupta
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ameer E. Hassan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Coleman O. Martin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Hormozd Bozorgchami
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ritesh Kaushal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Raul G. Nogueira
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ravi H. Gandhi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric C. Peterson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Shervin R. Dashti
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Curtis A. Given
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Brijesh P. Mehta
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Vivek Deshmukh
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Sidney Starkman
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Italo Linfante
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Scott H. McPherson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peter Kvamme
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Thomas J. Grobelny
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Muhammad S. Hussain
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ike Thacker
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Nirav Vora
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peng Roc Chen
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Stephen J. Monteith
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Robert D. Ecker
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Clemens M. Schirmer
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric Sauvageau
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Alex Abou-Chebl
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Colin P. Derdeyn
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Lucian Maidan
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Aamir Badruddin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Adnan H. Siddiqui
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Travis M. Dumont
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Abdulnasser Alhajeri
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - M. Asif Taqi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Khaled Asi
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jeffrey Carpenter
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Alan Boulos
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Gaurav Jindal
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Ajit S. Puri
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Rohan Chitale
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Eric M. Deshaies
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David H. Robinson
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - David F. Kallmes
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Blaise W. Baxter
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Mouhammad A. Jumaa
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Peter Sunenshine
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Aniel Majjhoo
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Joey D. English
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Shuichi Suzuki
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Richard D. Fessler
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Josser E. Delgado Almandoz
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Jerry C. Martin
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| | - Diogo C. Haussen
- From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women’s Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial
| |
Collapse
|
32
|
Latorre JGS, Flanagan S, Phipps MS, Shenoy AM, Bennett A, Seidenwurm D. Quality improvement in neurology. Neurology 2017; 89:1619-1626. [DOI: 10.1212/wnl.0000000000004486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022] Open
|
33
|
Challenges in the Anesthetic and Intensive Care Management of Acute Ischemic Stroke. J Neurosurg Anesthesiol 2017; 28:214-32. [PMID: 26368664 DOI: 10.1097/ana.0000000000000225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Acute ischemic stroke (AIS) is a devastating condition with high morbidity and mortality. In the past 2 decades, the treatment of AIS has been revolutionized by the introduction of several interventions supported by class I evidence-care on a stroke unit, intravenous tissue plasminogen activator within 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. There is new class I evidence also demonstrating benefits of endovascular therapy on functional outcomes in those with anterior circulation stroke. In addition, the importance of the careful management of key systemic physiological variables, including oxygenation, blood pressure, temperature, and serum glucose, has been appreciated. In line with this, the role of anesthesiologists and intensivists in managing AIS has increased. This review highlights the main challenges in the endovascular and intensive care management of AIS that, in part, result from the paucity of research focused on these areas. It also provides guidelines for the management of AIS based upon current evidence, and identifies areas for further research.
Collapse
|
34
|
Abstract
Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evolution of catheter-based treatment from first-generation thrombectomy devices to the game-changing stent retrievers, results from recent trials, and the evolving stroke systems of care to provide timely access to acute stroke intervention to patients in the United States.
Collapse
|
35
|
Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association's Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke Vasc Neurol 2017; 2:94-105. [PMID: 28959497 PMCID: PMC5600018 DOI: 10.1136/svn-2017-000092] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 01/06/2023] Open
Abstract
The American Heart Association’s Get With the Guidelines (GWTG)-Stroke programme has changed stroke care delivery in the USA since its establishment in 2003. GWTG is a voluntary registry and continuous quality improvement initiative that collects data on patient characteristics, hospital adherence to guidelines and inpatient outcomes. Implementation of the programme saw increased provision of evidence-based care and improved patient outcomes. This review will describe the development of the programme and discuss the impact on stroke outcomes and transformation of stroke care delivery that followed its implementation.
Collapse
Affiliation(s)
- Cora H Ormseth
- Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kevin N Sheth
- Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey L Saver
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Gregg C Fonarow
- Department of Cardiology, UCLA Medical Center, Los Angeles, California, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Chompoopong P, Rostambeigi N, Kassar D, Maud A, Qureshi IA, Cruz-Flores S, Rodriguez GJ. Are We Overlooking Stroke Chameleons? A Retrospective Study on the Delayed Recognition of Stroke Patients. Cerebrovasc Dis 2017; 44:83-87. [PMID: 28511184 DOI: 10.1159/000471929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE New effective recanalization therapies are currently available for acute ischemic stroke; yet a vast majority of stroke patients are left untreated. The lack of early recognition may be because often times, stroke patients present with atypical manifestations that resemble other conditions (which are referred to as "stroke chameleons"). We set to study the proportion of patients with delayed stroke recognition in a single center. METHODS We performed a retrospective analysis of a prospectively collected data over a 9-year period. All adult patients discharged with the diagnosis of ischemic stroke or transient ischemic attack (TIA) were identified and traced for their diagnosis on admission. Those cases with a diagnosis other than ischemic stroke or TIA on admission were identified as possible stroke chameleons and categorized into different groups according to the occurrence of neurological or non-neurological manifestations at presentation. RESULTS Of 2,303 cases with discharge diagnosis of ischemic stroke or TIA, 919 (39.9%) were found to be possible stroke chameleons. More than half of these patients (58.4%) presented with neurological manifestations including disorders of the somatic sensation (33%), alteration of consciousness (30%), and disorders of speech/language (11%). The remaining possible stroke chameleons had manifestations pertaining to other organ systems such as cardiopulmonary, gastrointestinal, systemic infection, trauma, and thromboembolic events elsewhere. CONCLUSIONS In our cohort, a surprisingly large percentage of possible stroke chameleons was observed. It is important to confirm our findings, study the impact on clinical outcome, and develop strategies for early stroke patient recognition.
Collapse
|
37
|
Rinaldo L, Brinjikji W, Rabinstein AA. Transfer to High-Volume Centers Associated With Reduced Mortality After Endovascular Treatment of Acute Stroke. Stroke 2017; 48:1316-1321. [PMID: 28336679 DOI: 10.1161/strokeaha.116.016360] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/29/2017] [Accepted: 02/06/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Some have argued that it may be beneficial to expand the availability of endovascular revascularization services to lower-volume hospitals to minimize the morbidity associated with transfer to larger endovascular centers. We compared the outcomes after revascularization of patients directly admitted to a low-volume center and those transferred to a high-volume center. METHODS We searched a national database of hospital-reported outcomes for patients who underwent endovascular revascularization for acute ischemic stroke. Hospitals were categorized as low, medium, or high procedural volume hospitals. Outcomes of inpatient admissions were collected and compared on the basis of admission source and hospital procedural volume. RESULTS A total of 118 institutions with 8533 patients were included. Mortality rate (14.9% versus 18.6%; P=0.049) and mortality index (1.1 versus 1.6; P=0.048) were significantly lower among directly admitted relative to transferred patients. For all patients, there were significant differences in institutional mortality rate (low: 19.7%, medium: 14.9%, high: 9.8%; P=0.003) and mortality index (low: 1.5, medium: 1.1, high: 0.8; P=0.004) between low-, medium-, and high-volume hospitals. For transferred patients to high-volume centers, both mortality rate (high: 10.0% versus low: 20.4%; P=0.005) and mortality index (high: 0.8 versus low: 1.5; P=0.034) were significantly lower than that observed for directly admitted patients to low-volume hospitals. CONCLUSIONS We report a beneficial effect of treatment at high-volume hospitals in spite of the detrimental effects of transfer. These findings argue for the centralization of care.
Collapse
Affiliation(s)
- Lorenzo Rinaldo
- From the Department of Neurosurgery (L.R.), Department of Radiology (W.B.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN
| | - Waleed Brinjikji
- From the Department of Neurosurgery (L.R.), Department of Radiology (W.B.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- From the Department of Neurosurgery (L.R.), Department of Radiology (W.B.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN.
| |
Collapse
|
38
|
Dufouil C, Beiser A, McLure LA, Wolf PA, Tzourio C, Howard VJ, Westwood AJ, Himali JJ, Sullivan L, Aparicio HJ, Kelly-Hayes M, Ritchie K, Kase CS, Pikula A, Romero JR, D'Agostino RB, Samieri C, Vasan RS, Chêne G, Howard G, Seshadri S. Revised Framingham Stroke Risk Profile to Reflect Temporal Trends. Circulation 2017; 135:1145-1159. [PMID: 28159800 PMCID: PMC5504355 DOI: 10.1161/circulationaha.115.021275] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Age-adjusted stroke incidence has decreased over the past 50 years, likely as a result of changes in the prevalence and impact of various stroke risk factors. An updated version of the Framingham Stroke Risk Profile (FSRP) might better predict current risks in the FHS (Framingham Heart Study) and other cohorts. We compared the accuracy of the standard (old) and of a revised (new) version of the FSRP in predicting the risk of all-stroke and ischemic stroke and validated this new FSRP in 2 external cohorts, the 3C (3 Cities) and REGARDS (Reasons for Geographic and Racial Differences in Stroke) studies. METHODS We computed the old FSRP as originally described and a new model that used the most recent epoch-specific risk factor prevalence and hazard ratios for individuals ≥55 years of age and for the subsample ≥65 years of age (to match the age range in REGARDS and 3C studies, respectively) and compared the efficacy of these models in predicting 5- and 10-year stroke risks. RESULTS The new FSRP was a better predictor of current stroke risks in all 3 samples than the old FSRP (calibration χ2 of new/old FSRP: in men: 64.0/12.1, 59.4/30.6, and 20.7/12.5; in women: 42.5/4.1, 115.4/90.3, and 9.8/6.5 in FHS, REGARDS, and 3C, respectively). In the REGARDS, the new FSRP was a better predictor among whites compared with blacks. CONCLUSIONS A more contemporaneous, new FSRP better predicts current risks in 3 large community samples and could serve as the basis for examining geographic and racial differences in stroke risk and the incremental diagnostic utility of novel stroke risk factors.
Collapse
Affiliation(s)
- Carole Dufouil
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Alexa Beiser
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Leslie A McLure
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Philip A Wolf
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Christophe Tzourio
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Virginia J Howard
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Andrew J Westwood
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Jayandra J Himali
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Lisa Sullivan
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Hugo J Aparicio
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Margaret Kelly-Hayes
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Karen Ritchie
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Carlos S Kase
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Aleksandra Pikula
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Jose R Romero
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Ralph B D'Agostino
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Cécilia Samieri
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Ramachandran S Vasan
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Genevieve Chêne
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - George Howard
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Sudha Seshadri
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.).
| |
Collapse
|
39
|
Evolution of acute ischemic stroke therapy from lysis to thrombectomy: Similar or different to acute myocardial infarction? Int J Cardiol 2016; 222:441-447. [PMID: 27505331 DOI: 10.1016/j.ijcard.2016.07.251] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/19/2016] [Accepted: 07/30/2016] [Indexed: 11/20/2022]
|
40
|
Jovin TG, Albers GW, Liebeskind DS. Stroke Treatment Academic Industry Roundtable: The Next Generation of Endovascular Trials. Stroke 2016; 47:2656-65. [PMID: 27586682 DOI: 10.1161/strokeaha.116.013578] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The STAIR (Stroke Treatment Academic Industry Roundtable) meeting aims to advance acute stroke therapy development through collaboration between academia, industry, and regulatory institutions. In pursuit of this goal and building on recently available level I evidence of benefit from endovascular therapy (ET) in large vessel occlusion stroke, STAIR IX consensus recommendations were developed that outline priorities for future research in ET. METHODS Three key directions for advancing the field were identified: (1) development of systems of care for ET in large vessel occlusion stroke, (2) development of therapeutic approaches adjunctive to ET, and (3) exploring clinical benefit of ET in patient population insufficiently studied in recent trials. Methodological issues such as optimal trial design and outcome measures have also been addressed. RESULTS Development of systems of care strategies should be geared both toward ensuring broad access to ET for eligible patients and toward shortening time to reperfusion to the minimum possible. Adjunctive therapy development includes neuroprotective approaches, adjuvant microcirculatory/collateral enhancing strategies, and periprocedural management. Future research priorities seeking to expand the eligible patient population are to determine benefit of ET in patients presenting beyond conventional time windows, in patients with large baseline ischemic core lesions, and in other important subgroups. CONCLUSIONS Research priorities in ET for large vessel occlusion stroke are to improve systems of care, investigate effective adjuvant therapies, and explore whether patient eligibility could be expanded.
Collapse
Affiliation(s)
- Tudor G Jovin
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.).
| | - Gregory W Albers
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.)
| | - David S Liebeskind
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.)
| | | |
Collapse
|
41
|
Menon BK, Sajobi TT, Zhang Y, Rempel JL, Shuaib A, Thornton J, Williams D, Roy D, Poppe AY, Jovin TG, Sapkota B, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Lum C, Dowlatshahi D, Eesa M, Lowerison MW, Kamal NR, Demchuk AM, Hill MD, Goyal M. Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial. Circulation 2016; 133:2279-86. [PMID: 27076599 DOI: 10.1161/circulationaha.115.019983] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/08/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Bijoy K. Menon
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Tolulope T. Sajobi
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Yukun Zhang
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Jeremy L. Rempel
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Ashfaq Shuaib
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - John Thornton
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - David Williams
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Daniel Roy
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Alexandre Y. Poppe
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Tudor G. Jovin
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Biggya Sapkota
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Blaise W. Baxter
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Timo Krings
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Frank L. Silver
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Donald F. Frei
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Christopher Fanale
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Donatella Tampieri
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Jeanne Teitelbaum
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Cheemun Lum
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Dar Dowlatshahi
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Muneer Eesa
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Mark W. Lowerison
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Noreen R. Kamal
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Andrew M. Demchuk
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Michael D. Hill
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| | - Mayank Goyal
- From Department of Clinical Neurosciences and Radiology (B.K.M., T.T.S., M.E., N.R.K., A.M.D, M.D.H., M.G.) andDepartment of Community Health Sciences (B.K.M., Y.Z., A.M.D.,M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Canada; Departments of Radiology (J.L.R.) and Medicine (A.S.), University of Alberta, Edmonton, Canada; Departments of Neuroradiology (J.T.) andGeriatric and Stroke Medicine(D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin; Departments
| |
Collapse
|
42
|
Mokin M, Snyder KV, Siddiqui AH, Levy EI, Hopkins LN. Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care. J Am Coll Cardiol 2016; 67:2645-55. [DOI: 10.1016/j.jacc.2015.12.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
|
43
|
Denorme F, De Meyer SF. The VWF-GPIb axis in ischaemic stroke: lessons from animal models. Thromb Haemost 2016; 116:597-604. [PMID: 27029413 DOI: 10.1160/th16-01-0036] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 11/05/2022]
Abstract
Stroke is a leading cause of death and long-term disability worldwide. Ischaemic stroke is caused by a blood clot that obstructs cerebral blood flow. Current treatment mainly consists of achieving fast reperfusion, either via pharmacological thrombolysis using tissue plasminogen activator or via endovascular thrombectomy. Unfortunately, reperfusion therapy is only available to a limited group of patients and reperfusion injury can further aggravate brain damage. Hence, there is an urgent need for better understanding of ischaemic stroke pathophysiology in order to develop novel therapeutic strategies. In recent years, the pathophysiological importance of von Willebrand factor (VWF) in ischaemic stroke has become clear from both clinical and experimental studies. In particular, binding of VWF to platelet glycoprotein Ib (GPIb) has become an interesting target for ischaemic stroke therapy. Recent insights show that inhibting the VWF-GPIb interaction could result in a pro-thrombolytic activity improving cerebral reperfusion rates and concurrently reducing cerebral ischaemia/reperfusion damage. This review gives an overview of the experimental evidence that illustrates the crucial role of the VWF-GPIb axis in ischaemic stroke.
Collapse
Affiliation(s)
| | - Simon F De Meyer
- Simon De Meyer, Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, E. Sabbelaan 53, 8500 Kortrijk, Belgium, Tel.: +32 56 246232, Fax: +32 56 246997, E-mail:
| |
Collapse
|
44
|
Klourfeld E, Zerna C, Al-Ajlan FS, Kamal N, Randhawa P, Yu AY, Dowlatshahi D, Thornton J, Williams D, Holmstedt C, Kelly M, Frei D, Baxter B, Linares G, Bang OY, Poppe AY, Montanera W, Rempel J, Eesa M, Menon BK, Demchuk AM, Goyal M, Hill MD. The future of endovascular treatment: Insights from the ESCAPE investigators. Int J Stroke 2016; 11:156-63. [PMID: 26783306 DOI: 10.1177/1747493015622962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ESCAPE trial demonstrated strong morbidity benefit and mortality reduction for endovascular stroke treatment. Following the release of the main results, the ESCAPE trial investigators convened at a 2-day close-out meeting in March 2015 in Banff, Alberta, Canada. Meeting discussions focused on system implications, procedural characteristics, and future directions. We report the proceedings of the meeting, which provide insights from the trialists into the issues of generalizability, treatment limitations, as well as future directions and opportunities in stroke care optimization.
Collapse
Affiliation(s)
- Evgenia Klourfeld
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Charlotte Zerna
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Fahad S Al-Ajlan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Noreen Kamal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Privia Randhawa
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Amy Y Yu
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), the Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | | | - Michael Kelly
- Royal Saskatchewan Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Donald Frei
- Swedish Medical Center, Colorado Neurological Institute, Denver, CO, USA
| | - Blaise Baxter
- Department of Neurology, Erlanger Hospital, Chattanooga, TN, USA
| | - Guillermo Linares
- Departments of Neurology, Neurosurgery and Radiology, Temple University, Philadelphia, PA, USA
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Seoul, Korea
| | - Alexandre Y Poppe
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Walter Montanera
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Jeremy Rempel
- Department of Radiology, University of Alberta, Edmonton, AB, Canada
| | - Muneer Eesa
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
45
|
Cai L, Stevenson J, Peng C, Xin R, Rastogi R, Liu K, Geng X, Gao Z, Ji X, Rafols JA, Ji Z, Ding Y. Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia. Neuroscience 2016; 318:45-57. [PMID: 26794589 DOI: 10.1016/j.neuroscience.2016.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Normobaric oxygen (NBO), ethanol (EtOH), and therapeutic hypothermia (TH) delivered alone or in combination have neuroprotective properties after acute stroke. We used an autologous thromboembolic rat stroke model to assess the additive effects of these treatments for reducing the deleterious effects of hyperglycolysis post-stroke in which reperfusion is induced with recombinant tissue plasminogen activator (rt-PA). METHODS Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion with an autologous embolus. One hour after occlusion, rt-PA was administered alone or with NBO (60%), EtOH (1.0 g/kg), TH (33 °C), either singly or in combination. Infarct volume and neurological deficit were assessed at 24h after rt-PA-induced reperfusion with or without other treatments. The extent of hyperglycolysis, as determined by cerebral glucose and lactate levels was evaluated at 3 and 24h after rt-PA administration. At the same time points, expressions of glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), phosphofructokinase1 (PFK-1), and lactate dehydrogenase were (LDH) measured by Western blotting. RESULTS Following rt-PA in rats with thromboembolic stroke, NBO combined with TH or EtOH most effectively decreased infarct volume and neurological deficit. As compared to rt-PA alone, EtOH or TH but not NBO monotherapies significantly reduced post-stroke hyperglycolysis. The increased utilization of glucose and production of lactate post-stroke was prevented most effectively when NBO was combined with either EtOH or TH after reperfusion with rt-PA, as shown by the significantly decreased Glut1, Glut3, PFK-1, and LDH levels. CONCLUSIONS In a rat thromboembolic stroke model, both EtOH and TH used individually offer neuroprotection after the administration of rt-PA. While NBO monotherapy does not appear to be effective, it significantly potentiates the efficacy of EtOH and TH. The similar neuroprotection and underlying mechanisms pertaining to the attenuation of hyperglycolysis provided by EtOH or TH in combination with NBO suggest a possibility of substituting EtOH for TH. Thus a combination of NBO and EtOH, which are widely available and easily used, could become a novel and effective neuroprotective strategy in the clinical setting.
Collapse
Affiliation(s)
- L Cai
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - J Stevenson
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - C Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - R Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - R Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - X Geng
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - X Ji
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - J A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Ji
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
| | - Y Ding
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| |
Collapse
|
46
|
Hong KS, Ko SB, Yu KH, Jung C, Park SQ, Kim BM, Chang CH, Bae HJ, Heo JH, Oh CW, Lee BC, Kim BT, Kim BS, Chung CS, Yoon BW, Rha JH. Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke. J Stroke 2016; 18:102-13. [PMID: 26846761 PMCID: PMC4747068 DOI: 10.5853/jos.2015.01655] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 01/19/2023] Open
Abstract
Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of endovascular recanalization therapy (ERT) when added to IV-TPA. Accordingly, to update the recommendations, we assembled members of the writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. Reviewing the evidences that have been accumulated, the writing members revised recommendations, for which formal consensus was achieved by convening a panel composed of 34 experts from the participating academic societies. The current guideline provides the evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.
Collapse
Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sukh Que Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Hoon Chang
- gDepartment of Neurosurgery, Yeungnam University School of Medicine, Daegu, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Bum-soo Kim
- Department of Radiology, Seoul St.Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
47
|
Menon BK, Goyal M. Imaging Paradigms in Acute Ischemic Stroke: A Pragmatic Evidence-based Approach. Radiology 2015; 277:7-12. [PMID: 26402490 DOI: 10.1148/radiol.2015151030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Bijoy K Menon
- From the Calgary Stroke Program and Department of Clinical Neurosciences (B.K.M., M.G.), Department of Radiology (B.K.M., M.G.), and Department of Community Health Sciences (B.K.M.), University of Calgary, Calgary, Alberta, Canada; and Hotchkiss Brain Institute, Calgary, Alberta, Canada (B.K.M., M.G.)
| | - Mayank Goyal
- From the Calgary Stroke Program and Department of Clinical Neurosciences (B.K.M., M.G.), Department of Radiology (B.K.M., M.G.), and Department of Community Health Sciences (B.K.M.), University of Calgary, Calgary, Alberta, Canada; and Hotchkiss Brain Institute, Calgary, Alberta, Canada (B.K.M., M.G.)
| |
Collapse
|
48
|
Zerna C, Assis Z, d'Esterre CD, Menon BK, Goyal M. Imaging, Intervention, and Workflow in Acute Ischemic Stroke: The Calgary Approach. AJNR Am J Neuroradiol 2015; 37:978-84. [PMID: 26659339 DOI: 10.3174/ajnr.a4610] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention.
Collapse
Affiliation(s)
- C Zerna
- From the Calgary Stroke Program, Clinical Neurosciences, and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Z Assis
- From the Calgary Stroke Program, Clinical Neurosciences, and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - C D d'Esterre
- From the Calgary Stroke Program, Clinical Neurosciences, and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - B K Menon
- From the Calgary Stroke Program, Clinical Neurosciences, and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- From the Calgary Stroke Program, Clinical Neurosciences, and Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
49
|
Elgendy IY, Kumbhani DJ, Mahmoud A, Bhatt DL, Bavry AA. Mechanical Thrombectomy for Acute Ischemic Stroke. J Am Coll Cardiol 2015; 66:2498-505. [PMID: 26653623 DOI: 10.1016/j.jacc.2015.09.070] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
|
50
|
d’Esterre CD, Boesen ME, Ahn SH, Pordeli P, Najm M, Minhas P, Davari P, Fainardi E, Rubiera M, Khaw AV, Zini A, Frayne R, Hill MD, Demchuk AM, Sajobi TT, Forkert ND, Goyal M, Lee TY, Menon BK. Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic Stroke. Stroke 2015; 46:3390-7. [DOI: 10.1161/strokeaha.115.009250] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher D. d’Esterre
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mari E. Boesen
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Seong Hwan Ahn
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Pooneh Pordeli
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mohamed Najm
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Priyanka Minhas
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Paniz Davari
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Enrico Fainardi
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Marta Rubiera
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Alexander V. Khaw
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Andrea Zini
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Richard Frayne
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Michael D. Hill
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Andrew M. Demchuk
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Tolulope T. Sajobi
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Nils D. Forkert
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Mayank Goyal
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Ting Y. Lee
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| | - Bijoy K. Menon
- From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d’E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d’E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F.,
| |
Collapse
|