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Roeder HJ, Leira EC. The Role of the Vascular Neurologist in Optimizing Stroke Care. Neurol Clin 2024; 42:739-752. [PMID: 38937039 DOI: 10.1016/j.ncl.2024.03.007] [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: 06/29/2024]
Abstract
The article summarizes the training pathways and vocational opportunities within the field of vascular neurology. It highlights the groundbreaking clinical trials that transformed acute stroke care and the resultant increased demand for readily available vascular neurology expertise. The article emphasizes the need to train a larger number of diverse physicians in the subspecialty and the role of vascular neurologists in improving outcomes across demographic and geographic lines.
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Affiliation(s)
- Hannah J Roeder
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA
| | - Enrique C Leira
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA; Department of Epidemiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA.
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McClelland G, Burrow E, Alton A, Shaw L, Finch T, Price C. What factors contribute towards ambulance on-scene times for suspected stroke patients? An observational study. Eur Stroke J 2023; 8:492-500. [PMID: 37231700 PMCID: PMC10334177 DOI: 10.1177/23969873231163290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/24/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Pre-hospital stroke care focusses on rapid access to specialist stroke units, but UK ambulance data shows increasing pre-hospital times. This study aimed to describe factors contributing towards ambulance on-scene times (OST) for suspected stroke patients and identify targets for a future intervention. PATIENTS AND METHODS Ambulance clinicians in North East Ambulance Service were asked to complete a survey after transporting any suspected stroke patients to describe the patient encounter, interventions and timings. Completed surveys were linked with electronic patient care records. Potentially modifiable factors were identified by the study team. Poisson regression analysis quantified the association of selected potentially modifiable factors with OST. RESULTS About 2037 suspected stroke patients were conveyed between July and December 2021, resulting in 581 fully completed surveys by 359 different clinicians. The median age of patients was 75 years (interquartile range (IQR) 66-83) and 52% of patients were male. Median OST was 33 min (IQR 26-41). Three potentially modifiable factors were identified as contributors to extended OST. Performing additional advanced neurological assessments added 10% to OST (34 vs 31 min, p = 0.008); intravenous cannulation added 13% (35 vs 31 min, p = <0.001) and ECGs added 22% (35 vs 28 min, p = <0.001). CONCLUSIONS This study identified three potentially modifiable factors that increased pre-hospital OST with suspected stroke patients. This type of data can be used to target interventions at behaviours that extend pre-hospital OST but which have questionable patient benefit. This approach will be evaluated in a follow up study in the North East of England.
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Affiliation(s)
- Graham McClelland
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abi Alton
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Chris Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Richter D, Weber R, Eyding J, Bartig D, Misselwitz B, Grau A, Hacke W, Krogias C. Acute ischemic stroke care in Germany - further progress from 2016 to 2019. Neurol Res Pract 2021; 3:14. [PMID: 33789773 PMCID: PMC8012074 DOI: 10.1186/s42466-021-00115-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022] Open
Abstract
Background Stroke Unit Care (SUC), intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatment options for acute ischemic stroke (AIS). Using nationwide comprehensive administrative data from Germany, we recently reported nationwide development of AIS admissions, SUC rates, IVT rates and MT rates in Germany between 2010 and 2016. In this update paper, we analyze data on the further development of these data to 2019 after publication of time window extensions for recanalization therapies. Methods We considered all hospitalized cases with the main diagnosis of the ICD-10-GM code I63 (AIS) for the year 2019. We identified stroke therapies by using the corresponding Operating and Procedure Keys for IVT, MT and SUC out of the DRG statistics. Regional analyses are based on data from the 412 German administrative districts and cities. We compared the results with those from 2016. Results Number of hospitalized AIS patients showed a mild decrease in 2019 (n = 225,531) compared with 2016 (n = 227,687), with significant more AIS patients treated on a stroke unit in 2019 (n = 167,799; 74.4% vs. n = 164,270; 72.1%, p < 0.001). The rate of IVT further increased from 14.9% (n = 33,916) in 2016 to 16.3% (n = 36,745) in 2019 (p < 0.001). Similarly, the MT rate increased from 4.3% (n = 9795) in 2016 to 7.2% (n = 16,135) in 2019 (p < 0.001). There was still a high regional variability for MT (1.4 to 15.2%) according to the place of residence of the AIS patients. Conclusions In Germany, the rates of recanalization therapies in patients with AIS continued to increase from 2016 to 2019. Compared to IVT-rates and numbers, the respective data for MT procedures showed an even more pronounced increase.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralph Weber
- Medical Faculty, Ruhr University of Bochum, Bochum, Germany.,Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Jens Eyding
- Medical Faculty, Ruhr University of Bochum, Bochum, Germany.,Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Dirk Bartig
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | | | - Armin Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany. .,Medical Faculty, Ruhr University of Bochum, Bochum, Germany.
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Shi K, Zou M, Jia DM, Shi S, Yang X, Liu Q, Dong JF, Sheth KN, Wang X, Shi FD. tPA Mobilizes Immune Cells That Exacerbate Hemorrhagic Transformation in Stroke. Circ Res 2021; 128:62-75. [PMID: 33070717 DOI: 10.1161/circresaha.120.317596] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Hemorrhagic complications represent a major limitation of intravenous thrombolysis using tPA (tissue-type plasminogen activator) in patients with ischemic stroke. The expression of tPA receptors on immune cells raises the question of what effects tPA exerts on these cells and whether these effects contribute to thrombolysis-related hemorrhagic transformation. OBJECTIVE We aim to determine the impact of tPA on immune cells and investigate the association between observed immune alteration with hemorrhagic transformation in ischemic stroke patients and in a rat model of embolic stroke. METHODS AND RESULTS Paired blood samples were collected before and 1 hour after tPA infusion from 71 patients with ischemic stroke. Control blood samples were collected from 27 ischemic stroke patients without tPA treatment. A rat embolic middle cerebral artery occlusion model was adopted to investigate the underlying mechanisms of hemorrhagic transformation. We report that tPA induces a swift surge of circulating neutrophils and T cells with profoundly altered molecular features in ischemic stroke patients and a rat model of focal embolic stroke. tPA exacerbates endothelial injury, increases adhesion and migration of neutrophils and T cells, which are associated with brain hemorrhage in rats subjected to embolic stroke. Genetic ablation of annexin A2 in neutrophils and T cells diminishes the effect of tPA on these cells. Decoupling the interaction between mobilized neutrophils/T cells and the neurovascular unit, achieved via a S1PR (sphingosine-1-phosphate receptor) 1 modulator RP101075 and a CCL2 (C-C motif chemokine ligand 2) synthesis inhibitor bindarit, which block lymphocyte egress and myeloid cell recruitment, respectively, attenuates hemorrhagic transformation and improves neurological function after tPA thrombolysis. CONCLUSIONS Our findings suggest that immune invasion of the neurovascular unit represents a previously unrecognized mechanism underlying tPA-mediated brain hemorrhage, which can be overcome by precise immune modulation during thrombolytic therapy.
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Affiliation(s)
- Kaibin Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
- China National Clinical Research Center for Neurological Diseases, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, China (K.S., F.-D.S.)
| | - Ming Zou
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Dong-Mei Jia
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Samuel Shi
- Neuroscience Graduate Program, Arizona State University, Tempe (S.S.)
| | - Xiaoxia Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Qiang Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Jing-Fei Dong
- Division of Hematology, Department of Medicine, BloodWorks Northwest Research Institute, School of Medicine, University of Washington, Seattle (J.-f.D.)
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.)
| | - Xiaoying Wang
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA (X.W.)
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
- China National Clinical Research Center for Neurological Diseases, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, China (K.S., F.-D.S.)
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[Nationwide treatment reality of patients with acute ischemic stroke in Germany : Update of the regionalized analysis on use of recanalization treatment procedures and stroke complex treatment]. DER NERVENARZT 2020; 91:908-919. [PMID: 32894302 DOI: 10.1007/s00115-020-00983-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The guidelines of the German Society for Neurology regarding the diagnostics and treatment of acute ischemic stroke contain the general recommendation of treatment on a stroke unit (SU) and the use of recanalizing treatment (intravenous thrombolysis, IVT; mechanical thrombectomy, MT) in appropriate patients. The nationwide availability of all three components represents a large organizational and healthcare political challenge. OBJECTIVE Updated nationwide analysis of treatment rates in Germany based on a regionalized evaluation. METHODS Based on the patient's place of residence, nationwide data of all hospitalized patients were evaluated using the German diagnosis-related groups (DRG) statistics from 2018 and compared with previous years. The rates for SU treatment, IVT and MT in the 412 German regional districts were analyzed. The 412 regions were grouped according to the degree of urbanization. RESULTS Nationwide, a total of 224,647 patient cases with a main diagnosis of acute ischemic stroke were treated in 1382 hospitals in Germany in 2018. Overall, relatively high treatment rates were determined (SU = 73.3%; IVT = 16.4%; MT = 6.5%). Only 10.2% of treatments in the SU were performed on a SU located at a hospital with no neurology department. The regionalized analysis showed large treatment ranges for all three therapeutic components, with significantly lower treatment rates in regions with a lower degree of urbanization (SU, IVT, MT rates: urban = 75.4%, 17.4%, 7.5% and rural = 67.1%; 15.4%, 5.3%, respectively). CONCLUSION Hospitalized healthcare in Germany shows high treatment rates for both SU admission and acute recanalization treatment in patients with acute ischemic stroke; however, there is further optimization potential in rural regions.
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Coverage of the requirements of first and second level stroke unit in Italy. Neurol Sci 2020; 42:1073-1079. [PMID: 32737805 PMCID: PMC7870770 DOI: 10.1007/s10072-020-04616-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
Background and aim In the scientific literature, there is unanimous consensus that hospitalization in stroke unit (SU) is the most important treatment for stroke patients. In this regard, the Act number 70/2015 by the Italian government identified specific skills that contribute to a classification of SU and outlined a “hub and spoke” stroke network. The aim of our study was to check the coverage of requirements of first and second level SU in the national territory and to shed light on any deficit or misdistribution of resources. Material and methods In 2019, a survey on the current situation related to stroke care in Italy was carried out by the Italian Society of Neurology (SIN), The Italian Stroke Organization (ISO), and the Association for the Fight against Stroke (A.L.I.Ce). Results First level SU was found to be 58 against a requirement, according to the Act 70/2015, of 240. Second level SU was found to be 52 compared with an expected requirement of 60. Neurointerventionists were 280 nationally, with a requirement of 240. A misdistribution of resources within individual regions was often seen. Conclusions The survey demonstrated a severe shortage of beds dedicated to cerebrovascular diseases, mainly because of lack of first level SU, especially in central and southern Italy. It also suggests that the current hub and spoke system is not yet fully implemented across the country and that resources should be better distributed in order to ensure uniform and fair care for all stroke patients on the whole territory. Electronic supplementary material The online version of this article (10.1007/s10072-020-04616-x) contains supplementary material, which is available to authorized users.
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Behrndtz A, Johnsen SP, Valentin JB, Gude MF, Blauenfeldt RA, Andersen G, Majoie CB, Fisher M, Simonsen CZ. TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion: Prioritize IV or endovascular treatment-A randomized trial. Int J Stroke 2020; 15:103-108. [PMID: 31446847 DOI: 10.1177/1747493019869830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. AIM For patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome. SAMPLE SIZE We aim to randomize 600 patients, 1:1. DESIGN A national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed. OUTCOMES The primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients. DISCUSSION Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.
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Affiliation(s)
- Anne Behrndtz
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aarhus, Denmark
| | - Jan B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aarhus, Denmark
| | - Martin F Gude
- Pre-hospital Emergency Medical Services, Central Denmark Region, Department of Clinical medicine, Aarhus, Denmark
| | | | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Charles Blm Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, The Netherlands
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Tian DC, Shi K, Zhu Z, Yao J, Yang X, Su L, Zhang S, Zhang M, Gonzales RJ, Liu Q, Huang D, Waters MF, Sheth KN, Ducruet AF, Fu Y, Lou M, Shi FD. Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow. Ann Neurol 2018; 84:717-728. [PMID: 30295338 PMCID: PMC6282815 DOI: 10.1002/ana.25352] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The present study was undertaken to determine the efficacy of coadministration of fingolimod with alteplase in acute ischemic stroke patients in a delayed time window. METHODS This was a prospective, randomized, open-label, blinded endpoint clinical trial, enrolling patients with internal carotid artery or middle cerebral artery proximal occlusion within 4.5 to 6 hours from symptom onset. Patients were randomly assigned to receive alteplase alone or alteplase with fingolimod. All patients underwent pretreatment and 24-hour noncontrast computed tomography (CT)/perfusion CT/CT angiography. The coprimary endpoints were the decrease of National Institutes of Health Stroke Scale scores over 24 hours and the favorable shift of modified Rankin Scale score (mRS) distribution at day 90. Exploratory outcomes included vessel recanalization, anterograde reperfusion, and retrograde reperfusion of collateral flow. RESULTS Each treatment group included 23 patients. Compared with alteplase alone, patients receiving fingolimod plus alteplase exhibited better early clinical improvement at 24 hours and a favorable shift of mRS distribution at day 90. In addition, patients who received fingolimod and alteplase exhibited a greater reduction in the perfusion lesion accompanied by suppressed infarct growth by 24 hours. Fingolimod in conjunction with alteplase significantly improved anterograde reperfusion of downstream territory and prevented the failure of retrograde reperfusion from collateral circulation. INTERPRETATION Fingolimod may enhance the efficacy of alteplase administration in the 4.5- to 6-hour time window in patients with a proximal cerebral arterial occlusion and salvageable penumbral tissue by promoting both anterograde reperfusion and retrograde collateral flow. These findings are instructive for the design of future trials of recanalization therapies in extended time windows. Ann Neurol 2018;84:725-736.
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Affiliation(s)
- De-Cai Tian
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaibin Shi
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Zilong Zhu
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Jia Yao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoxia Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Su
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Sheng Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Meixia Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Rayna J Gonzales
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ
| | - Qiang Liu
- Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - DeRen Huang
- Neuroscience Center, Mount Carmel Health System, Westerville, OH
| | - Michael F Waters
- Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Andrew F Ducruet
- Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Ying Fu
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Lou
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Fu-Dong Shi
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
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Fifi JT, Dabus G, Mack WJ, Mocco J, Pride L, Arthur AS, Albuquerque FC. In the thrombectomy era, triage in the field improves care. J Neurointerv Surg 2018; 10:607-608. [DOI: 10.1136/neurintsurg-2018-014136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/04/2022]
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