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Aktar M, Xiao Y, Tehrani AKZ, Tampieri D, Rivaz H, Kersten-Oertel M. SCANED: Siamese collateral assessment network for evaluation of collaterals from ischemic damage. Comput Med Imaging Graph 2024; 113:102346. [PMID: 38364600 DOI: 10.1016/j.compmedimag.2024.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
This study conducts collateral evaluation from ischemic damage using a deep learning-based Siamese network, addressing the challenges associated with a small and imbalanced dataset. The collateral network provides an alternative oxygen and nutrient supply pathway in ischemic stroke cases, influencing treatment decisions. Research in this area focuses on automated collateral assessment using deep learning (DL) methods to expedite decision-making processes and enhance accuracy. Our study employed a 3D ResNet-based Siamese network, referred to as SCANED, to classify collaterals as good/intermediate or poor. Utilizing non-contrast computed tomography (NCCT) images, the network automates collateral identification and assessment by analyzing tissue degeneration around the ischemic site. Relevant features from the left/right hemispheres were extracted, and Euclidean Distance (ED) was employed for similarity measurement. Finally, dichotomized classification of good/intermediate or poor collateral is performed by SCANED using an optimal threshold derived from ROC analysis. SCANED provides a sensitivity of 0.88, a specificity of 0.63, and a weighted F1 score of 0.86 in the dichotomized classification.
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Affiliation(s)
- Mumu Aktar
- Concordia University, Gina Cody School of Engineering and Computer Science, 1455 De Maisonneuve Blvd. W., Montreal, H3g 1M8, Quebec, Canada.
| | - Yiming Xiao
- Concordia University, Gina Cody School of Engineering and Computer Science, 1455 De Maisonneuve Blvd. W., Montreal, H3g 1M8, Quebec, Canada
| | - Ali K Z Tehrani
- Concordia University, Gina Cody School of Engineering and Computer Science, 1455 De Maisonneuve Blvd. W., Montreal, H3g 1M8, Quebec, Canada
| | - Donatella Tampieri
- Queens University, Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston General Hospital 76 Stuart Street Kingston, K7L 2V7, Ontario, Canada
| | - Hassan Rivaz
- Concordia University, Gina Cody School of Engineering and Computer Science, 1455 De Maisonneuve Blvd. W., Montreal, H3g 1M8, Quebec, Canada
| | - Marta Kersten-Oertel
- Concordia University, Gina Cody School of Engineering and Computer Science, 1455 De Maisonneuve Blvd. W., Montreal, H3g 1M8, Quebec, Canada
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Diestro JDB, Fahed R, Omar AT, Hawkes C, Hendriks EJ, Enriquez C, Eesa M, Stotts G, Lee H, Nagendra S, Poppe A, Ducroux C, Lim T, Narvacan K, Rizzuto M, Alfalahi A, Nishi H, Sarma P, Itsekson Hayosh Z, Ignacio K, Boisseau W, Pimenta Ribeiro Pontes Almeida E, Benomar A, Almekhlafi MA, Milot G, Deshmukh A, Kishore K, Tampieri D, Wang J, Srivastava A, Roy D, Carpani F, Kashani N, Candale-Radu C, Singh N, Bres Bullrich M, Sarmiento R, Muir RT, Parra-Fariñas C, Reiter S, Deschaintre Y, Singh RJ, Bodani V, Katsanos A, Agid R, Zafar A, Pereira VM, Spears J, Marotta TR, Djiadeu P, Sharma S, Farrokhyar F. Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study. J Neurointerv Surg 2024:jnis-2023-021429. [PMID: 38453461 DOI: 10.1136/jnis-2023-021429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke. OBJECTIVE T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography. METHODS We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG). RESULTS The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81-1) for 71.4% (20/28) of raters in both groups. CONCLUSIONS Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fahed
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Abdelsimar Tan Omar
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christine Hawkes
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eef J Hendriks
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Clare Enriquez
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Muneer Eesa
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Grant Stotts
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Hubert Lee
- Division of Neurointerventional Neuroradiology, Division of Neurosurgery, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shashank Nagendra
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandre Poppe
- Department of Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Célina Ducroux
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy Lim
- Division of Diagnostic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karl Narvacan
- Department of Medical Imaging, St Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Michael Rizzuto
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Afra Alfalahi
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Koseikai Takeda hospital, Kyoto, Japan
| | - Pragyan Sarma
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Ze'ev Itsekson Hayosh
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Ignacio
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William Boisseau
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Anass Benomar
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada
| | - Genvieve Milot
- Department of Surgery (Neurosurgery), Centre Hospitalier de Quebec, Université Laval, Laval, Quebec, Canada
| | - Aviraj Deshmukh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Kislay Kishore
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Jeffrey Wang
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Abhilekh Srivastava
- Division of Neurology, Department of Medicine, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Roy
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montréal, Quebec, Canada
| | - Federico Carpani
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nima Kashani
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Claudia Candale-Radu
- Division of Neurology, Department of Internal Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nishita Singh
- Division of Neurology, Department of Internal Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert Sarmiento
- Division of Neurology, Department of Medicine, Vancouver General Hospital- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan T Muir
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Parra-Fariñas
- Divisions of Neuroradiology & Neurointervention, Department of Diagnostic & Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Reiter
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Ravinder-Jeet Singh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Vivek Bodani
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aristeidis Katsanos
- Division of Neurology, Department of Medicine, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ronit Agid
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Atif Zafar
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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3
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Lee P, Dhillon G, Pourafkari M, DaBreo D, Jaff Z, Appireddy R, Jin A, Boissé Lomax L, Durafourt BA, Boyd JG, Nasirzadeh AR, Tampieri D, Jalini S. Non-ECG-gated cardiac CT angiography in acute stroke is feasible and detects sources of embolism. Int J Stroke 2024; 19:189-198. [PMID: 37515467 PMCID: PMC10811964 DOI: 10.1177/17474930231193335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke, and more detailed cardiac imaging is not routinely done. AIMS This study aimed to determine whether non-ECG-gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. METHODS In this single-center prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. The primary outcomes of image quality, recruitment feasibility, impact on hyperacute time metrics, and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology, and impact on etiologic classification. RESULTS One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT time, door-to-needle time, and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (PE) (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. CONCLUSIONS Non-ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention.
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Affiliation(s)
- Peter Lee
- School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Gurmohan Dhillon
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Marina Pourafkari
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Dominique DaBreo
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Zardasht Jaff
- Division of Cardiology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Albert Jin
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Lysa Boissé Lomax
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Bryce A Durafourt
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - John Gordon Boyd
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Amir Reza Nasirzadeh
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
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4
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Holdsworth MB, Mocan MC, Leifso K, Tampieri D, Strube YNJ. Strabismus in early disseminated Lyme disease: case report and summary of the literature. Can J Ophthalmol 2024; 59:e89-e92. [PMID: 37816490 DOI: 10.1016/j.jcjo.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Affiliation(s)
| | - Mehmet Cem Mocan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Ill
| | - Kirk Leifso
- Department of Pediatrics, Kingston Health Sciences Centre, Queen's University, Kingston, ON
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON
| | - Yi Ning J Strube
- Department of Pediatrics, Kingston Health Sciences Centre, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, ON.
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5
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Heran M, Lindsay P, Gubitz G, Yu A, Ganesh A, Lund R, Arsenault S, Bickford D, Derbyshire D, Doucette S, Ghrooda E, Harris D, Kanya-Forstner N, Kaplovitch E, Liederman Z, Martiniuk S, McClelland M, Milot G, Minuk J, Otto E, Perry J, Schlamp R, Tampieri D, van Adel B, Volders D, Whelan R, Yip S, Foley N, Smith EE, Dowlatshahi D, Mountain A, Hill MD, Martin C, Shamy M. Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7 th Edition Practice Guidelines Update, 2022. Can J Neurol Sci 2024; 51:1-31. [PMID: 36529857 DOI: 10.1017/cjn.2022.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.
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Affiliation(s)
- Manraj Heran
- Division of Neuroradiology, University of British Columbia, Vancouver, Canada
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - Amy Yu
- Division of Neurology, Department of Medicine, and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aravind Ganesh
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Rebecca Lund
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Sacha Arsenault
- Stroke Services BC, Provincial Health Systems Authority, Vancouver, Canada
| | - Doug Bickford
- London Health Sciences Centre, London, Canada (Previous Appointment at Time of Participation)
| | - Donnita Derbyshire
- Saskatchewan College of Paramedics, Paramedic Practice Committee, Saskatoon, Canada
| | - Shannon Doucette
- Enhanced District Stroke Program, Royal Victoria Regional Health Centre, Barrie, Canada (Previous Appointment at Time of Participation)
| | - Esseddeeg Ghrooda
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Devin Harris
- Quality and Patient Safety Division, Interior Health, Kelowna, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Nick Kanya-Forstner
- Northern Ontario School of Medicine, Sudbury, Canada
- Timmins & District Hospital, Timmins, Canada
| | - Eric Kaplovitch
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Zachary Liederman
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Shauna Martiniuk
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Canada
| | | | - Genevieve Milot
- Department of Surgery, Laval University, Quebec City, Canada
| | - Jeffrey Minuk
- Division of Neurology, The Integrated Health and Social Services, University Network for West Central Montreal, Montreal, Canada
| | - Erica Otto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, Canada
| | | | - Brian van Adel
- Department of Neurointerventional Surgery, McMaster University, Hamilton, Canada
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada
| | - Ruth Whelan
- Royal University Hospital Stroke Program, Saskatoon, Canada
| | - Samuel Yip
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Norine Foley
- WorkHORSE Consulting Group, Epidemiology, London, Canada
| | - Eric E Smith
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Dar Dowlatshahi
- Department of Neurology, University of Ottawa, Ottawa, Canada
| | - Anita Mountain
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Michael D Hill
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Chelsy Martin
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Michel Shamy
- Department of Neurology, University of Ottawa, Ottawa, Canada
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Deo JK, Tampieri D, Durafourt BA. Subarachnoid Hemorrhage as a Delayed Manifestation of Reperfusion Injury Seven Weeks Following Carotid Endarterectomy. Can J Neurol Sci 2023:1-3. [PMID: 37799075 DOI: 10.1017/cjn.2023.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Jesmeen K Deo
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Donatella Tampieri
- Department of Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Bryce A Durafourt
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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7
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DesRoche CN, Johnson AP, Hore EB, Innes E, Silver I, Tampieri D, Kwan BYM, Ortiz Jimenez J, Boyd JG, Islam O. Feasibility and Cost Analysis of Portable MRI Implementation in a Remote Setting in Canada. Can J Neurol Sci 2023:1-27. [PMID: 37434471 DOI: 10.1017/cjn.2023.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To conduct feasibility and cost analysis of portable MRI implementation in a remote setting where MRI access is otherwise unavailable. METHODS Portable MRI (ultra-low field, 0.064T) was installed in Weeneebayko General Hospital, Moose Factory, Ontario. Adult patients, presenting with any indication for neuroimaging, were eligible for study inclusion. Scanning period was from November 14, 2021, to September 6, 2022. Images were sent via a secure PACS network for Neuroradiologist interpretation, available 24/7. Clinical indications, image quality, and report turnaround time were recorded. A cost analysis was conducted from a healthcare system's perspective in 2022 Canadian dollars, comparing cost of portable MRI implementation to transporting patients to a center with fixed MRI. RESULTS Portable MRI was successfully implemented in a remote Canadian location. Twenty-five patients received a portable MRI scan. All studies were of diagnostic quality. No clinically significant pathologies were identified on any of the studies. However, based on clinical presentation and limitations of portable MRI resolution, it is estimated that 11 (44%) of patients would require transfer to a center with fixed MRI for further imaging workup. Cost savings were $854,841 based on 50 patients receiving portable MRI over 1 year. Five-year budget impact analysis showed nearly $8 million dollars saved. CONCLUSIONS Portable MRI implementation in a remote setting is feasible, with significant cost savings compared to fixed MRI. This study may serve as a model to democratize MRI access, offer timely care and improved triaging in remote areas where conventional MRI is unavailable.
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Aktar M, Reyes J, Tampieri D, Rivaz H, Xiao Y, Kersten-Oertel M. Deep learning for collateral evaluation in ischemic stroke with imbalanced data. Int J Comput Assist Radiol Surg 2023; 18:733-740. [PMID: 36635594 DOI: 10.1007/s11548-022-02826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Collateral evaluation is typically done using visual inspection of cerebral images and thus suffers from intra- and inter-rater variability. Large open databases of ischemic stroke patients are rare, limiting the use of deep learning methods in treatment decision-making. METHODS We adapted a pre-trained EfficientNet B0 network through transfer learning to improve collateral evaluation using slice-based and subject-level classification. Our method uses stacking and overlapping of 2D slices from a patient's 4D computed tomography angiography (CTA) and a majority voting scheme to determine a patient's final collateral grade based on all classified 2D MIPs. Class imbalance is handled in the evaluation process by using the focal loss with class weight to penalize the majority class. RESULTS We evaluated our method using a nine-fold cross-validation performed with 83 subjects. Mean sensitivity of 0.71, specificity of 0.84, and a weighted F1 score of 0.71 in multi-class (good, intermediate, and poor) classification were obtained. Considering treatment effect, a dichotomized decision is also made for collateral scoring of a subject based on two classes (good/intermediate and poor) which achieves a sensitivity of 0.89 and specificity of 0.96 with a weighted F1 score of 0.95. CONCLUSION An automatic and robust collateral assessment method that mitigates the issues with the small imbalanced dataset was developed. Computer-aided evaluation of collaterals can help decision-making of ischemic stroke treatment strategy in clinical settings.
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Affiliation(s)
- Mumu Aktar
- Computer Science and Software Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, QC, H3G 1M8, Canada.
| | - Jonatan Reyes
- Computer Science and Software Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, QC, H3G 1M8, Canada
| | - Donatella Tampieri
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada
| | - Hassan Rivaz
- Electrical and Computer Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, QC, H3G 1M8, Canada
| | - Yiming Xiao
- Computer Science and Software Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, QC, H3G 1M8, Canada
| | - Marta Kersten-Oertel
- Computer Science and Software Engineering, Concordia University, 1455 boul. De Maisonneuve O., Montreal, QC, H3G 1M8, Canada
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9
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Cerase A, Tampieri D, Miracco C, Grazzini I. Diagnostic neuroradiology of intracranial meningiomas presenting with hemorrhagic onset: a double center 14-year experience. Emerg Radiol 2023; 30:175-185. [PMID: 36707465 DOI: 10.1007/s10140-023-02115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings. METHODS This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma. Clinical features and neuroradiological findings of intracranial meningiomas presenting with hemorrhage have been reviewed. RESULTS Twenty-four patients (1.8%, 16 females, 8 males, age range: 29-88 years) were found to have spontaneous hemorrhagic onset of the newly diagnosed meningioma. A sudden onset occurred in 23/24 patients. Sixteen patients showed isolated intralesional hemorrhage, four had subdural hematomas, and the remaining four presented combined intralesional and subarachnoid (n = 2) or intraventricular (n = 2) hemorrhages. In 13 patients, CT showed both the hemorrhage and the meningioma. In the other 11 patients, diagnosis was achieved by emergency or early surgery (n = 5), MRI (n = 5), and DSA (n = 1). CONCLUSIONS The presence of an underlying meningioma has to be considered in the differential diagnosis of spontaneous intracranial hemorrhage, although this is a rare event. CT, MRI, and occasionally DSA were useful to obtain the diagnosis; however, in up to a fifth of patients, this was achieved at surgery.
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Affiliation(s)
- Alfonso Cerase
- Unit of Neuroimaging, Diagnostic and Functional Neuroradiology, Clinical Department of Neurological and Motor Sciences, Azienda Ospedaliero-Universitaria Senese, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy
| | - Donatella Tampieri
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada
| | - Clelia Miracco
- Unit of Pathology, Clinical Department of Oncology, Azienda Ospedaliero-Universitaria Senese and Department of Medicine, Surgery, and Neurosciences, University of Siena, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy
| | - Irene Grazzini
- Department of Diagnostic Imaging, Section of Neuroradiology, San Donato National Health System Hospital, Pietro Nenni Street, 52100, Arezzo, Tuscany, Italy.
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10
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Gariscsak PJ, Salaheen Z, Godfrey C, Tampieri D, Appireddy R. Objective performance metrics in human robotic neuroendovascular interventions: a scoping review protocol. JBI Evid Synth 2022; 20:2815-2823. [PMID: 36081373 DOI: 10.11124/jbies-21-00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to review the available information on objective performance metrics used during robotic neuroendovascular intervention procedures on humans. INTRODUCTION Robotic neuroendovascular intervention is defined as any endovascular procedure within the vasculature of the central nervous system with the assistance of a robotic system for diagnostic or therapeutic procedures. Robotic systems are described as a 2-component system consisting of a patient-side mechanical robot, and a separate operator control station. Robotic neuroendovascular intervention is a growing field and there is a need to establish objective performance metrics for furthering evidence-based reporting of the literature. INCLUSION CRITERIA This scoping review will consider all studies involving humans that utilize robotic neuroendovascular intervention. We will consider all types of studies, reports, and reviews as well as gray literature. Studies will be included if they describe the use of an objective performance metric during robotic neuroendovascular intervention. This review is not limited to a particular country or health care system, and will consider all study designs, regardless of their rigor or language. METHODS Utilizing a 3-step framework as a guide, we will perform a systematic search in Embase, Cochrane Library, and MEDLINE. Available literature from inception to the present will be considered. Studies will be independently screened according to the inclusion criteria by 2 reviewers based on title, abstract, and full text. Data will be extracted, sorted, and presented in both a narrative summary as well as table and diagram based on the objective of the scoping review.
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Affiliation(s)
| | - Zaid Salaheen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christina Godfrey
- School of Nursing, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | | | - Ramana Appireddy
- Department of Medicine, Queen's University, Kingston, ON, Canada
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11
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Huang YT, Giacomini PS, Massie R, Venkateswaran S, Trudelle AM, Fadda G, Sharifian-Dorche M, Boudjani H, Poliquin-Lasnier L, Airas L, Saveriano AW, Ziller MG, Miller E, Martinez-Rios C, Wilson N, Davila J, Rush C, Longbrake EE, Longoni G, Macaron G, Bernard G, Tampieri D, Antel J, Brais B, La Piana R. The White Matter Rounds experience: The importance of a multidisciplinary network to accelerate the diagnostic process for adult patients with rare white matter disorders. Front Neurol 2022; 13:928493. [PMID: 35959404 PMCID: PMC9359417 DOI: 10.3389/fneur.2022.928493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Adult genetic leukoencephalopathies are rare neurological disorders that present unique diagnostic challenges due to their clinical and radiological overlap with more common white matter diseases, notably multiple sclerosis (MS). In this context, a strong collaborative multidisciplinary network is beneficial for shortening the diagnostic odyssey of these patients and preventing misdiagnosis. The White Matter Rounds (WM Rounds) are multidisciplinary international online meetings attended by more than 30 physicians and scientists from 15 participating sites that gather every month to discuss patients with atypical white matter disorders. We aim to present the experience of the WM Rounds Network and demonstrate the value of collaborative multidisciplinary international case discussion meetings in differentiating and preventing misdiagnoses between genetic white matter diseases and atypical MS. Methods We retrospectively reviewed the demographic, clinical and radiological data of all the subjects presented at the WM Rounds since their creation in 2013. Results Seventy-four patients (mean age 44.3) have been referred and discussed at the WM Rounds since 2013. Twenty-five (33.8%) of these patients were referred by an MS specialist for having an atypical presentation of MS, while in most of the remaining cases, the referring physician was a geneticist (23; 31.1%). Based on the WM Rounds recommendations, a definite diagnosis was made in 36/69 (52.2%) patients for which information was available for retrospective review. Of these diagnosed patients, 20 (55.6%) had a genetic disease, 8 (22.2%) had MS, 3 (8.3%) had both MS and a genetic disorder and 5 (13.9%) had other non-genetic conditions. Interestingly, among the patients initially referred by an MS specialist, 7/25 were definitively diagnosed with MS, 5/25 had a genetic condition (e.g., X-linked adrenoleukodystrophy and hereditary small vessel diseases like Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and COL4A1-related disorder), and one had both MS and a genetic demyelinating neuropathy. Thanks to the WM Rounds collaborative efforts, the subjects who currently remain without a definite diagnosis, despite extensive investigations performed in the clinical setting, have been recruited in research studies aimed at identifying novel forms of genetic MS mimickers. Conclusions The experience of the WM Rounds Network demonstrates the benefit of collective discussions on complex cases to increase the diagnostic rate and decrease misdiagnosis in patients with rare or atypical white matter diseases. Networks of this nature allow physicians and scientists to compare and share information on challenging cases from across the world, provide a basis for future multicenter research studies, and serve as model for other rare diseases.
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Affiliation(s)
- Yu Tong Huang
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Rami Massie
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Sunita Venkateswaran
- Department of Pediatrics, Division of Neurology, CHEO, University of Ottawa, Ottawa, ON, Canada
| | | | - Giulia Fadda
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Maryam Sharifian-Dorche
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Hayet Boudjani
- Department of Neurology, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | | | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Alexander W. Saveriano
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Matthias Georg Ziller
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Neurology, St. Mary's Hospital, Montreal, QC, Canada
| | - Elka Miller
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | | | - Nagwa Wilson
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Jorge Davila
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Carolina Rush
- Division of Neurology, Neuroscience Department, University of Ottawa, Ottawa, ON, Canada
| | - Erin E. Longbrake
- Department of Neurology, Yale MS Center, Yale School of Medicine, North Haven, CT, United States
| | - Giulia Longoni
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Gabrielle Macaron
- Department of Neurology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Geneviève Bernard
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Center, Montreal, QC, Canada,Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, QC, Canada,Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Donatella Tampieri
- Department of Diagnostic Radiology, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada
| | - Jack Antel
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Roberta La Piana
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada,*Correspondence: Roberta La Piana
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12
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Onofrj V, Tampieri D, Cianfoni A, Ventura E. Ethic Statement Correction: Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis. Neurointervention 2021; 16:303. [PMID: 33902262 PMCID: PMC8561034 DOI: 10.5469/neuroint.2020.00255.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Valeria Onofrj
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Donatella Tampieri
- Department of Radiology, Queen's University at Kingston, Kingston, ON, Canada
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elisa Ventura
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
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13
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McDougall CG, Johnston SC, Hetts SW, Gholkar A, Barnwell SL, Vazquez Suarez JC, Massó Romero J, Chaloupka JC, Bonafe A, Wakhloo AK, Tampieri D, Dowd CF, Fox AJ, Turk AS. Five-year results of randomized bioactive versus bare metal coils in the treatment of intracranial aneurysms: the Matrix and Platinum Science (MAPS) Trial. J Neurointerv Surg 2020; 13:930-934. [PMID: 33298509 DOI: 10.1136/neurintsurg-2020-016906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND No randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix2 coils to BMCs. The primary objective was to compare the rates of target aneurysm recurrence (TAR) at 12 months. Secondary objectives included angiographic outcomes at TAR or 12 months and TAR at 5 years. METHODS A total of 626 patients were randomized to BMCs or Matrix2 coils. Detailed methods and 1-year results have been published previously. RESULTS Of 580 patients eligible for 5-year follow-up, 431 (74.3%) completed follow-up or reached TAR. Matrix2 coils were non-inferior to BMCs (P=0.8) but did not confer any benefit. Core lab reported post-treatment residual aneurysm filling (Raymond III) correlated with TAR (P<0.0001) and with aneurysm hemorrhage after treatment (P<0.008). Repeat aneurysmal hemorrhage after treatment, but before hospital discharge, occurred in three patients treated for acutely ruptured aneurysms. Additionally, two patients treated for unruptured aneurysms experienced a first hemorrhage during follow-up. All five hemorrhages resulted from aneurysms with Raymond III residual aneurysm filling persisting after initial treatment. After 5 years follow-up, 2/626 (0.3%) patients are known to have had target aneurysm rupture following hospital discharge. The annualized rate of delayed hemorrhage after coiling was 2/398/5=0.001 (0.1%) per year for unruptured aneurysms and 0 for ruptured aneurysms. CONCLUSIONS After 5 years Matrix2 coils were non-inferior to BMCs but no benefit was demonstrated. Post-treatment residual angiographic aneurysm filling (Raymond III) is strongly associated with TAR (P<0.0001) and post-treatment aneurysmal hemorrhage (P=0.008).
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Affiliation(s)
- Cameron G McDougall
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Claiborne Johnston
- Dean's Office, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Steven W Hetts
- Interventional Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Anil Gholkar
- Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Stanley L Barnwell
- Neurological Surgery and Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Javier Massó Romero
- Interventional Neuroradiology, Hospital Universitario de Donostia, San Sebastian, Spain
| | - John C Chaloupka
- Neurosurgery and Radiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Alain Bonafe
- Neuroradiology, Hopital Gui de Chauliac, Montpellier, France
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | - Christopher F Dowd
- Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Allan J Fox
- Neuroradiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aquilla S Turk
- Neurointerventional Surgery, Radiology, and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Onofrj V, Tampieri D, Cianfoni A, Ventura E. Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis. Neurointervention 2020; 16:70-77. [PMID: 33264834 PMCID: PMC7946551 DOI: 10.5469/neuroint.2020.00255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Abstract
Cerebral peri-aneurysmal edema (PE) is typically associated with giant partially-thrombosed aneurysms and less frequently with smaller aneurysms treated with endovascular embolization. An understanding of the pathophysiologic mechanism of PE is still limited. We report 3 cases of cerebral aneurysms associated with PE. We describe 2 cases of giant partially thrombosed aneurysms surrounded by vasogenic edema with apposition of an intramural and juxtamural thrombus. Our third case is a smaller aneurysm inciting vasogenic edema several years after coil embolization. Vessel-wall magnetic resonance imaging (MRI) showed avid wall enhancement and an enhancing thrombus embedded within the coils, reflecting inflammation of the aneurysm wall and proliferation of the vasa vasorum. Thrombosis within the aneurysmal sac and walls, both in native and treated aneurysms, may promote inflammatory changes and sustain the occurrence of PE. Vessel-wall MRI has a potential role in the evaluation process of this subgroup of aneurysms.
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Affiliation(s)
- Valeria Onofrj
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Donatella Tampieri
- Department of Radiology, Queen's University at Kingston, Kingston, ON, Canada
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elisa Ventura
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
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15
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Accogli A, Brais B, Tampieri D, La Piana R. Long-Standing Psychiatric Features as the Only Clinical Presentation of Vanishing White Matter Disease. J Neuropsychiatry Clin Neurosci 2020; 31:276-279. [PMID: 31046592 DOI: 10.1176/appi.neuropsych.18110279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea Accogli
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Bernard Brais
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Donatella Tampieri
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Roberta La Piana
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
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16
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Rousseau PN, La Piana R, Chai XJ, Chen JK, Klein D, Tampieri D. Brain functional organization and structure in patients with arteriovenous malformations. Neuroradiology 2019; 61:1047-1054. [PMID: 31222381 DOI: 10.1007/s00234-019-02245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Developmental in nature, brain arteriovenous malformations (AVM) have the potential to affect whole brain organization. Here we investigated the impact of AVM on functional and structural brain organization using resting-state functional MRI (rsfMRI) and cortical thickness measures. METHODS We investigated brain functional organization and structure using rsfMRI in conjunction with cortical thickness analyses in 23 patients with cerebral arteriovenous malformations (AVMs) and 20 healthy control subjects. RESULTS Healthy controls showed the expected anti-correlation between activity in the default mode network (DMN) and frontal areas that are part of the attentional control network. By contrast, patients demonstrated a disruption of this anti-correlation. Disruptions to this anti-correlation were even observed in a subgroup of patients with lesions remote from the main nodes of the DMN and were unrelated to differences in perfusion. Functional connectivity differences were accompanied by reduced cortical thickness in frontal attentional areas in patients compared to the controls. CONCLUSIONS These results contribute to the discussion that AVMs affect whole brain networks and not simply the area surrounding the lesion.
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Affiliation(s)
- Paul-Noel Rousseau
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada. .,Department of Neuroradiology, Montreal Neurological Institute, McGill University, Montreal, QC, H3G 2A8, Canada.
| | - Roberta La Piana
- Department of Neuroradiology, Montreal Neurological Institute, McGill University, Montreal, QC, H3G 2A8, Canada
| | - Xiaoqian J Chai
- Cognitive Neurology/Neuropsychology Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jen-Kai Chen
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Denise Klein
- Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada.,Centre for Research on Brain, Language and Music, McGill University, Montreal, QC, H3G 2A8, Canada
| | - Donatella Tampieri
- Department of Neuroradiology, Montreal Neurological Institute, McGill University, Montreal, QC, H3G 2A8, Canada.,Queen's University, Kingston, Ontario, Canada
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Abstract
PURPOSE Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. METHODS Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. RESULTS Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. CONCLUSIONS MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.
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Affiliation(s)
- Ali Alamer
- 1 Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Canada.,2 Department of Radiology, Qassim College of Medicine, Qassim University, Saudi Arabia
| | - Donatella Tampieri
- 1 Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Canada
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Vosberg DE, Beaulé V, Torres-Berrío A, Cooke D, Chalupa A, Jaworska N, Cox SML, Larcher K, Zhang Y, Allard D, Durand F, Dagher A, Benkelfat C, Srour M, Tampieri D, La Piana R, Joober R, Lepore F, Rouleau G, Pascual-Leone A, Fox MD, Flores C, Leyton M, Théoret H. Neural function in DCC mutation carriers with and without mirror movements. Ann Neurol 2019; 85:433-442. [PMID: 30666715 PMCID: PMC6444183 DOI: 10.1002/ana.25418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 01/08/2023]
Abstract
Objective Recently identified mutations of the axon guidance molecule receptor gene, DCC, present an opportunity to investigate, in living human brain, mechanisms affecting neural connectivity and the basis of mirror movements, involuntary contralateral responses that mirror voluntary unilateral actions. We hypothesized that haploinsufficient DCC+/− mutation carriers with mirror movements would exhibit decreased DCC mRNA expression, a functional ipsilateral corticospinal tract, greater “mirroring” motor representations, and reduced interhemispheric inhibition. DCC+/− mutation carriers without mirror movements might exhibit some of these features. Methods The participants (n = 52) included 13 DCC+/− mutation carriers with mirror movements, 7 DCC+/− mutation carriers without mirror movements, 13 relatives without the mutation or mirror movements, and 19 unrelated healthy volunteers. The multimodal approach comprised quantitative real time polymerase chain reaction, transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI) under resting and task conditions, and measures of white matter integrity. Results Mirror movements were associated with reduced DCC mRNA expression, increased ipsilateral TMS‐induced motor evoked potentials, increased fMRI responses in the mirroring M1 and cerebellum, and markedly reduced interhemispheric inhibition. The DCC+/− mutation, irrespective of mirror movements, was associated with reduced functional connectivity and white matter integrity. Interpretation Diverse connectivity abnormalities were identified in mutation carriers with and without mirror movements, but corticospinal effects and decreased peripheral DCC mRNA appeared driven by the mirror movement phenotype. ANN NEUROL 2019;85:433–442.
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Affiliation(s)
- Daniel E Vosberg
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Vincent Beaulé
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Angélica Torres-Berrío
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Danielle Cooke
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Amanda Chalupa
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Natalia Jaworska
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Institute of Mental Health Research, affiliated with the University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvia M L Cox
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Kevin Larcher
- Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Yu Zhang
- Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Dominique Allard
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - France Durand
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alain Dagher
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Chawki Benkelfat
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Myriam Srour
- Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Roberta La Piana
- Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Franco Lepore
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Guy Rouleau
- Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael D Fox
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Cecilia Flores
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Marco Leyton
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Hugo Théoret
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, Mahadevan J, Chong W, Mitchell PJ, Coulthard A, Rowley HA, Sanelli PC, Tampieri D, Brouwer PA, Fiehler J, Kocer N, Vilela P, Rovira A, Fischer U, Caso V, van der Worp B, Sakai N, Matsumaru Y, Yoshimura SI, Anxionnat R, Desal H, Biscoito L, Pumar JM, Diaz O, Fraser JF, Linfante I, Liebeskind DS, Nogueira RG, Hacke W, Brainin M, Yan B, Soderman M, Taylor A, Pongpech S, Tanaka M, Terbrugge K. Standards of Practice in Acute Ischemic Stroke Intervention: International Recommendations. AJNR Am J Neuroradiol 2018; 39:E112-E117. [PMID: 30442688 DOI: 10.3174/ajnr.a5853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne (URCA), Reims, Frane
| | - Mahesh V Jayaraman
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Istvan Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Joshua A Hirsch
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Blaise Baxter
- Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Shigeru Miyachi
- Neuroendovascular Therapy Centre, Aichi Medical University, Aichi-gun, Japan
| | | | | | - Peter J Mitchell
- The University of Melbourne, The Royal Hospital of Melbourne, Parkville, Victoria, Australia
| | - Alan Coulthard
- University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Pina C Sanelli
- Northwell Health Donald and Barbara Zucker School of Medicine, New York, New York, USA
| | | | | | - Jens Fiehler
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Naci Kocer
- Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Pedro Vilela
- Hospital Garcia de Orta, Hospital da Luz, Lisbon, Portugal
| | - Alex Rovira
- Hospital Univesitari Vall d'Hebron, Barcelona, Spain
| | - Urs Fischer
- Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - Italo Linfante
- Herbert Wertheim College of Medicine, Florida International University, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA
| | | | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Bernard Yan
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | | | - Allan Taylor
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Karel Terbrugge
- University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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20
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Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, Mahadevan J, Chong W, Mitchell PJ, Coulthard A, Rowley HA, Sanelli PC, Tampieri D, Brouwer PA, Fiehler J, Kocer N, Vilela P, Rovira A, Fischer U, Caso V, van der Worp B, Sakai N, Matsumaru Y, Yoshimura SI, Anxionnat R, Desal H, Biscoito L, Pumar JM, Diaz O, Fraser JF, Linfante I, Liebeskind DS, Nogueira RG, Hacke W, Brainin M, Yan B, Soderman M, Taylor A, Pongpech S, Tanaka M, Karel T. Standards of practice in acute ischemic stroke intervention: International recommendations. Interv Neuroradiol 2018; 25:31-37. [PMID: 30352535 DOI: 10.1177/1591019918800457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This article was first published in JNIS. Cite this article as: Pierot L, Jayaraman MV, Szikora I, et al. Standards of practice in acute ischemic stroke intervention: international recommendations. Journal of NeuroInterventional Surgery. Published Online First: 28 August 2018. doi: 10.1136/neurintsurg-2018-014287.
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Affiliation(s)
- Laurent Pierot
- 1 Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Mahesh V Jayaraman
- 2 Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Istvan Szikora
- 3 National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Joshua A Hirsch
- 4 Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Blaise Baxter
- 5 Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Shigeru Miyachi
- 6 Neuroendovascular Therapy Center, Aichi Medical University, Aichi-gun, Japan
| | | | | | - Peter J Mitchell
- 9 The University of Melbourne, The Royal Hospital of Melbourne, Parkville, Victoria, Australia
| | - Alan Coulthard
- 10 University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Pina C Sanelli
- 12 Northwell Health Donald and Barbara Zucker School of Medicine, New York, USA
| | | | | | - Jens Fiehler
- 15 University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Naci Kocer
- 16 Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Pedro Vilela
- 17 Hospital Garcia de Orta, Hospital da Luz, Lisbon, Portugal
| | - Alex Rovira
- 18 Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Urs Fischer
- 19 Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | | | | | - Nobuyuki Sakai
- 22 Kobe City Medical Center General Hospital, Kobe, Japan
| | | | | | | | | | | | | | | | | | - Italo Linfante
- 30 Herbert Wertheim College of Medicine, Florida International University, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, USA
| | | | - Raul G Nogueira
- 32 Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Werner Hacke
- 33 University of Heidelberg, Heidelberg, Germany
| | | | - Bernard Yan
- 35 Melbourne Brain Center at Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | | | - Allan Taylor
- 36 Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Terbrugge Karel
- 39 University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, 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Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala 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VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, Mahadevan J, Chong W, Mitchell PJ, Coulthard A, Rowley HA, Sanelli PC, Tampieri D, Brouwer PA, Fiehler J, Kocer N, Vilela P, Rovira A, Fischer U, Caso V, van der Worp B, Sakai N, Matsumaru Y, Yoshimura SI, Anxionnat R, Desal H, Biscoito L, Pumar JM, Diaz O, Fraser JF, Linfante I, Liebeskind DS, Nogueira RG, Hacke W, Brainin M, Yan B, Soderman M, Taylor A, Pongpech S, Tanaka M, Karel T. Standards of practice in acute ischemic stroke intervention: international recommendations. J Neurointerv Surg 2018; 10:1121-1126. [DOI: 10.1136/neurintsurg-2018-014287] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 11/03/2022]
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Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N, Bhogal S, Boyle K, Braun L, Goddard T, Heran MKS, Kanya-Forster N, Lang E, Lavoie P, McClelland M, O’Kelly C, Pageau P, Pettersen J, Purvis H, Shamy M, Tampieri D, vanAdel B, Verbeek R, Blacquiere D, Casaubon L, Ferguson D, Hegedus Y, Jacquin GJ, Kelly M, Kamal N, Linkewich B, Lum C, Mann B, Milot G, Newcommon N, Poirier P, Simpkin W, Snieder E, Trivedi A, Whelan R, Eustace M, Smitko E, Butcher K. Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Int J Stroke 2018; 13:949-984. [DOI: 10.1177/1747493018786616] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.
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Affiliation(s)
- JM Boulanger
- Charles-LeMoyne Hospital, Neurology, Longueuil, Quebec, Canada
- Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Quebec, Canada
| | - MP Lindsay
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - G Gubitz
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
- Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Stroke Consortium, Oakville, Ontario, Canada
| | - EE Smith
- Calgary Stroke Program, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - G Stotts
- Canadian Stroke Consortium, Oakville, Ontario, Canada
- Ottawa Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - N Foley
- workHORSE Consulting Services, London, Ontario, Canada
| | - S Bhogal
- workHORSE Consulting Services, London, Ontario, Canada
| | - K Boyle
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Braun
- Emergency Medical Services, Winnipeg, Manitoba, Canada
| | - T Goddard
- Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Valley Regional Hospital, Kentville, Nova Scotia, Canada
| | - MKS Heran
- Vancouver General Hospital, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Kanya-Forster
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Timmins & District Hospital, Timmins, Ontario, Canada
| | - E Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Association of Emergency Physicians, Ottawa, Ontario, Canada
| | - P Lavoie
- Department of Surgery, Laval University, Quebec, Canada
| | - M McClelland
- Interior Health Research Department, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - C O’Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - P Pageau
- Canadian Association of Emergency Physicians, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Pettersen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - H Purvis
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - M Shamy
- Ottawa Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - D Tampieri
- Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - B vanAdel
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - R Verbeek
- Canadian Association of Emergency Physicians, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - D Blacquiere
- Canadian Stroke Consortium, Oakville, Ontario, Canada
- Saint John Regional Health Centre, Saint John, New Brunswick, Canada
| | - L Casaubon
- Canadian Stroke Consortium, Oakville, Ontario, Canada
- University Health Network (Toronto Western Hospital) Stroke Program, Toronto, Ontario, Canada
| | - D Ferguson
- Saint John Regional Health Centre, Saint John, New Brunswick, Canada
| | - Y Hegedus
- Vancouver Island Health Authority, Vancouver, British Columbia, Canada
| | - GJ Jacquin
- Centre hospitalier de l’université de Montréal, Montreal, Quebec, Canada
| | - M Kelly
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - N Kamal
- Calgary Stroke Program, Calgary, Alberta, Canada
| | - B Linkewich
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C Lum
- Ottawa Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - B Mann
- Alberta Health Services, Edmonton, Alberta, Canada
| | - G Milot
- CHU de Québec, Laval University, Laval, Quebec, Canada
| | - N Newcommon
- Calgary Stroke Program, Calgary, Alberta, Canada
| | - P Poirier
- Paramedic Association of Canada, Ottawa, Ontario, Canada
| | - W Simpkin
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - E Snieder
- Ottawa Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - A Trivedi
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R Whelan
- University Hospital, Saskatoon, Saskatchewan, Canada
| | - M Eustace
- Health Sciences Centre, St. Johns, Newfoundland, Canada
| | - E Smitko
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - K Butcher
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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Wannamaker R, Guinand T, Menon BK, Demchuk A, Goyal M, Frei D, Bharatha A, Jovin TG, Shankar J, Krings T, Baxter B, Holmstedt C, Swartz R, Dowlatshahi D, Chan R, Tampieri D, Choe H, Burns P, Gentile N, Rempel J, Shuaib A, Buck B, Bivard A, Hill M, Butcher K. Computed Tomographic Perfusion Predicts Poor Outcomes in a Randomized Trial of Endovascular Therapy. Stroke 2018; 49:1426-1433. [DOI: 10.1161/strokeaha.117.019806] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/02/2018] [Accepted: 04/03/2018] [Indexed: 12/30/2022]
Abstract
Background and Purpose—
In the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times), patients with large vessel occlusions and small infarct cores identified with computed tomography (CT)/CT angiography were randomized to endovascular therapy or standard of care. CT perfusion (CTP) was obtained in some cases but was not used to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome.
Methods—
All CTP data acquired in ESCAPE patients were analyzed centrally using a semiautomated perfusion threshold-based approach. A penumbral pattern was defined as an infarct core <70 mL, penumbral volume >15 mL, and a total hypoperfused volume:core volume ratio of >1.8. The primary outcome was good functional outcome at 90 days (modified Rankin Scale score, 0–2).
Results—
CTP was acquired in 138 of 316 ESCAPE patients. Penumbral patterns were present in 116 of 128 (90.6%) of patients with interpretable CTP data. The rate of good functional outcome in penumbral pattern patients (53 of 114; 46%) was higher than that in nonpenumbral patients (2 of 12; 17%;
P
=0.041). In penumbral patients, endovascular therapy increased the likelihood of a good clinical outcome (34 of 58; 57%) compared with those in the control group (19 of 58; 33%; odds ratio, 2.68; 95% confidence interval, 1.25–5.76;
P
=0.011). Only 3 of 12 nonpenumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect.
Conclusions—
The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Nonpenumbral patients were much less likely to achieve good outcomes.
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Affiliation(s)
| | - Taurian Guinand
- From the Division of Neurology (R.W., T.G., A.S., B. Buck, K.B.)
| | - Bijoy K. Menon
- Division of Neurology, University of Calgary, Alberta, Canada (B.K.M., A.D., M.G., M.H.)
| | - Andrew Demchuk
- Division of Neurology, University of Calgary, Alberta, Canada (B.K.M., A.D., M.G., M.H.)
| | - Mayank Goyal
- Division of Neurology, University of Calgary, Alberta, Canada (B.K.M., A.D., M.G., M.H.)
| | - Donald Frei
- Department of Medical Imaging, Swedish Medical Center, Denver, CO (D.F.)
| | - Aditya Bharatha
- Department of Medical Imaging, St. Michael’s Hospital (A. Bharatha)
| | | | - Jai Shankar
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada (J.S.)
| | | | - Blaise Baxter
- Department of Radiology, University of Tennessee, Chattanooga (B. Baxter)
| | - Christine Holmstedt
- Division of Neurology, Medical University of South Carolina, Charleston (C.H.)
| | - Richard Swartz
- Division of Neurology (R.S.), University of Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Division of Neurology, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (D.D.)
| | - Richard Chan
- Division of Neurology, University of Western Ontario, London, Canada (R.C.)
| | - Donatella Tampieri
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada (D.T.)
| | - Hana Choe
- Neurovascular Associates, Abington Jefferson Health, Philadelphia, PA (H.C.)
| | - Paul Burns
- Division of Neurology, Royal Victoria Hospital, Belfast, United Kingdom (P.B.)
| | - Nina Gentile
- Division of Neurology, Temple University, Philadelphia, PA (N.G.)
| | - Jeremy Rempel
- Department of Diagnostic Imaging (J.R.), University of Alberta, Edmonton, Canada
| | - Ashfaq Shuaib
- From the Division of Neurology (R.W., T.G., A.S., B. Buck, K.B.)
| | - Brian Buck
- From the Division of Neurology (R.W., T.G., A.S., B. Buck, K.B.)
| | - Andrew Bivard
- Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia (A. Bivard)
| | - Michael Hill
- Division of Neurology, University of Calgary, Alberta, Canada (B.K.M., A.D., M.G., M.H.)
| | - Kenneth Butcher
- From the Division of Neurology (R.W., T.G., A.S., B. Buck, K.B.)
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Alsahlawi A, Alsidieri G, Karamchandani J, Tampieri D, Sirhan D. Early Rupture of Distal Aica Pseudoaneurysm Posttranslabyrnith Approach for Vestibular Schwannoma. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - G. Alsidieri
- Montreal Neurological Institute, Montreal, Québec, Canada
| | | | - D. Tampieri
- Montreal Neurological Institute, Montreal, Québec, Canada
| | - D. Sirhan
- Montreal Neurological Institute, Montreal, Québec, Canada
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño 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N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Evans JW, Graham BR, Pordeli P, Al-Ajlan FS, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Brennan P, Williams D, Roy D, Poppe AY, Jovin TG, Devlin T, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Iancu D, Shankar J, Barber PA, Demchuk AM, Goyal M, Hill MD, Menon BK. Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial. AJNR Am J Neuroradiol 2017; 39:102-106. [PMID: 29191873 DOI: 10.3174/ajnr.a5462] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial. MATERIALS AND METHODS Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0-2, mRS 0-1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses. RESULTS There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0-2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage. CONCLUSIONS Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy.
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Affiliation(s)
- J W Evans
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - B R Graham
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - P Pordeli
- Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - F S Al-Ajlan
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.)
| | - R Willinsky
- Department of Medical Imaging (R.W., W.J.M.)
| | | | | | - A Shuaib
- Medicine (Neurology) (A.S.), University of Alberta, Edmonton, Alberta, Canada
| | - P Brennan
- Departments of Neuroradiology (P.B.)
| | - D Williams
- Geriatric and Stroke Medicine (D.W.), Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Roy
- Departments of Radiology (D.R.)
| | - A Y Poppe
- Neurosciences (A.Y.P.), Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - T G Jovin
- Department of Neurology (T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - B W Baxter
- Department of Radiology (B.W.B), Erlanger Hospital, University of Tennessee, Chattanooga, Tennessee
| | | | - F L Silver
- Division of Neurology (F.L.S., C.F.), Department of Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D F Frei
- Colorado Neurological Institute (D.F.F., D.T.), Engelwood, Colorado
| | - C Fanale
- Division of Neurology (F.L.S., C.F.), Department of Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D Tampieri
- Colorado Neurological Institute (D.F.F., D.T.), Engelwood, Colorado
| | - J Teitelbaum
- Montreal Neurological Institute (J.T.), McGill University, Montreal, Quebec, Canada
| | - D Iancu
- Department of Radiology (D.I.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J Shankar
- Department of Neuroradiology (J.S.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - P A Barber
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - A M Demchuk
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - M Goyal
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - M D Hill
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.).,Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada
| | - B K Menon
- From the Departments of Clinical Neurosciences and Radiology (J.W.E., B.R.G., F.S.A.-A., P.A.B., A.M.D., M.G., M.D.H., B.K.M.) .,Community Health Sciences and Department of Medicine (P.P., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (P.A.B., A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.,Foothills Medical Centre (B.K.M.), Calgary, Alberta, Canada
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Polito V, La Piana R, Del Pilar Cortes M, Tampieri D. Assessment of clot length with multiphase CT angiography in patients with acute ischemic stroke. Neuroradiol J 2017; 30:593-599. [PMID: 29068254 DOI: 10.1177/1971400917736928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Existing stroke literature demonstrates that rapid recanalization of vessels improves long-term prognosis after acute ischemic stroke. However, further optimization of the speed of the thrombectomy procedure, used to recanalize a blocked vessel, is limited by our minimal knowledge of the clot dimensions pre-procedure. Knowing the clot dimensions would allow planning of the thrombectomy procedure with the appropriate size and length of stent retriever, and determination of the correct site of the stent deployment ensuring total coverage of the clot by the stent retriever. Methods We performed a feasibility study to assess if multiphase computed tomography angiography (mCTA) can be used to estimate clot length by comparing CTA imaging data with imaging data obtained from conventional digital subtraction angiography (DSA). A retrospective chart review was performed of patients with clots in the proximal middle cerebral artery and adequate collateral circulation, who underwent both mCTA and DSA. Results Clot length was not significantly different on 3D mCTA versus mCTA MIPs, nor was it significantly different on MIP mCTA versus DSA. Pathological evidence also supported our ability to measure clot length on mCTA. Conclusions We suggest that mCTA is a reliable and valid measure of clot length in acute ischemic stroke patients.
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Affiliation(s)
- Vanessa Polito
- Department of Neuroradiology, 55981 Montreal Neurological Hospital and Institute , McGill University, Montreal, Quebec, Canada
| | - Roberta La Piana
- Department of Neuroradiology, 55981 Montreal Neurological Hospital and Institute , McGill University, Montreal, Quebec, Canada
| | - Maria Del Pilar Cortes
- Department of Neuroradiology, 55981 Montreal Neurological Hospital and Institute , McGill University, Montreal, Quebec, Canada
| | - Donatella Tampieri
- Department of Neuroradiology, 55981 Montreal Neurological Hospital and Institute , McGill University, Montreal, Quebec, Canada
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Caron-Cantin M, Gagné T, Tampieri D, Cortés MD. Radiologist Contribution to Improved Nasogastric Tube Placement for Hospitalized Neurological Patients. J Am Coll Radiol 2017; 14:787-789. [PMID: 28089107 DOI: 10.1016/j.jacr.2016.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Thierry Gagné
- Institut de Recherche en Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Donatella Tampieri
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; and the Department of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada
| | - Maria delPilar Cortés
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; and the Department of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada.
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Xiao Y, Alamer A, Fonov V, Lo BWY, Tampieri D, Collins DL, Rivaz H, Kersten-Oertel M. Towards Automatic Collateral Circulation Score Evaluation in Ischemic Stroke Using Image Decompositions and Support Vector Machines. Lecture Notes in Computer Science 2017. [DOI: 10.1007/978-3-319-67564-0_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ganesh A, Al-Ajlan FS, Sabiq F, Assis Z, Rempel JL, Butcher K, Thornton J, Kelly P, Roy D, Poppe AY, Jovin TG, Devlin T, Baxter BW, Krings T, Casaubon LK, Frei DF, Choe H, Tampieri D, Teitelbaum J, Lum C, Mandzia J, Phillips SJ, Bang OY, Almekhlafi MA, Coutts SB, Barber PA, Sajobi T, Demchuk AM, Eesa M, Hill MD, Goyal M, Menon BK. Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke 2016; 47:2993-2998. [DOI: 10.1161/strokeaha.116.014852] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/06/2016] [Accepted: 09/30/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
Methods—
The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I–III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days.
Results—
From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [
P
=0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11–0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09–0.74; adjusted for age, type of treatment, and follow-up scan).
Conclusions—
INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01778335.
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Affiliation(s)
- Aravind Ganesh
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Fahad S. Al-Ajlan
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Farahna Sabiq
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Zarina Assis
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jeremy L. Rempel
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Kenneth Butcher
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - John Thornton
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Peter Kelly
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Daniel Roy
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Alexandre Y. Poppe
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Tudor G. Jovin
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Thomas Devlin
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Blaise W. Baxter
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Timo Krings
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Leanne K. Casaubon
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Donald F. Frei
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Hana Choe
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Donatella Tampieri
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jeanne Teitelbaum
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Cheemun Lum
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Jennifer Mandzia
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Stephen J. Phillips
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Oh Young Bang
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Mohammed A. Almekhlafi
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Shelagh B. Coutts
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Philip A. Barber
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Tolulope Sajobi
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Andrew M. Demchuk
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Muneer Eesa
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Michael D. Hill
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Mayank Goyal
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
| | - Bijoy K. Menon
- From the Departments of Clinical Neurosciences and Radiology (A.G., F.S.A.-A., F.S., Z.A., S.B.C., P.A.B., A.M.D., M.E., M.D.H., M.G., B.K.M.), Departments of Community Health Sciences and Medicine (S.B.C., T.S., M.D.H., B.K.M.), and Hotchkiss Brain Institute (S.B.C., P.A.B., A.M.D., M.D.H., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Division of Neuroradiology (T.K.), and Division of Neurology, Department of Medicine (L.K.C.), UHN, Toronto Western Hospital,
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Aljared T, Farmer JP, Tampieri D. Feasibility and value of preoperative embolization of a congenital choroid plexus tumour in the premature infant: An illustrative case report with technical details. Interv Neuroradiol 2016; 22:732-735. [PMID: 27605545 DOI: 10.1177/1591019916665346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/25/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022] Open
Abstract
We present a case of a preterm boy (born at 35 weeks of pregnancy) who was delivered urgently by a caesarean section due to placental abruption. The baby was found to have a tense fontanelle leading to imaging that showed a 5.5 cm right intraventricular mass centred in the atrium, hydrocephalus and extensive surrounding vasogenic oedema. The mass was avidly enhancing with a few large associated vessels suggesting high vascularity. The condition of the baby was acutely deteriorating. He had multiple seizures followed by persistent low level of consciousness in the third day of life. His clinical decline prompted decision to proceed with surgical resection and preoperative embolization. A large single feeder (the right posterolateral choroidal artery) was embolized leading to near complete obliteration of the tumour blush. Embolization likely facilitated subsequent surgery the next day. This is based on an estimated blood loss of 250 ml in this 3 kg baby without haemodynamic instability. Gross total resection was achieved with a single surgery and the diagnosis was choroid plexus papilloma. Utilization of this combined approach in this preterm baby had led to survival in this potentially curable disease.
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Shankar JJS, Quateen A, Weill A, Tampieri D, Del Pilar Cortes M, Fahed R, Patro S, Kaderali Z, Lum C, Lesiuk H, Ahmed U, Peeling L, Kelly ME, Iancu D. Canadian Registry of LVIS Jr for Treatment of Intracranial Aneurysms (CaRLA). J Neurointerv Surg 2016; 9:849-853. [PMID: 27543629 DOI: 10.1136/neurintsurg-2016-012611] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stents reduce the rate of angiographic recurrence of intracranial aneurysms. The newest stent for intracranial use is the Low-profile Visible Intraluminal Support device (LVIS Jr). OBJECTIVE To assess the efficacy of the new stent in a multicenter retrospective registry. MATERIALS AND METHOD Centers across Canada using LVIS Jr were contacted and asked to participate in a retrospective registry of consecutive patients treated with LVIS Jr for intracranial aneurysms between January 2013 and July 2015. RESULTS A total of 102 patients, with saccular aneurysms in 100 patients (72 women; age range 21-78 years; mean 56.0 years; median 57.5 years) were treated with a LVIS Jr stent. The mean maximum diameter of the dome and neck of the aneurysm and dome to neck ratios were 8.3 mm±7.7 mm, 4.4 mm±1.9 mm, and 1.86±1.22, respectively. Angiographic complications arose in 23 patients, clinical complications in 9 patients, and only 3% of permanent neurological deficits occurred. Death occurred in 1 patient, unrelated to the stent. The ruptured status of the aneurysms (OR=3.29; p=0.046) and use of LVIS Jr for bailout (OR=2.54; p=0.053) showed a trend towards significant association with higher angiographic complications. At the last available follow-up, 68 class I, 20 class II, and 12 class III results were seen. CONCLUSIONS The LVIS Jr stent is a safe and effective device for stent-assisted coiling, with 3% permanent neurological complications. Stent-assisted coiling continues to be technically challenging in cases of ruptured aneurysms and bailout situations.
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Affiliation(s)
- Jai Jai Shiva Shankar
- Department of Diagnostic Imaging, QE II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Aiman Quateen
- Division of Neuroradiology, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada
| | - Alain Weill
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Hopital Notre-Dame, Montreal, Quebec, Canada
| | - Donatella Tampieri
- Departments of Radiology, Neurology, and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - Maria Del Pilar Cortes
- Department of Radiology, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - Robert Fahed
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Hopital Notre-Dame, Montreal, Quebec, Canada
| | - Satya Patro
- Division of Neuroradiology, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada
| | - Zul Kaderali
- Section of Neurosurgery, Health Sciences Centre, Winnipeg, Canada
| | - Cheemun Lum
- Division of Neuroradiology, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada
| | - Howard Lesiuk
- Department of Neurosurgery, The Ottawa Hospital, Ottawa, Canada
| | - Uzair Ahmed
- Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada
| | - Lissa Peeling
- Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada
| | - Michael E Kelly
- Departments of Neurosurgery, Medical Imaging, Biomedical Engineering, & Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Canada
| | - Daniela Iancu
- Division of Neuroradiology, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada
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Onofrj V, Cortes M, Tampieri D. The insidious appearance of the dissecting aneurysm: Imaging findings and related pathophysiology. A report of two cases. Interv Neuroradiol 2016; 22:638-642. [PMID: 27511816 DOI: 10.1177/1591019916659265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
Intracranial dissecting aneurysms have been frequently reported to present with fairly challenging and time-variable imaging findings that can be mostly explained by the pathological mechanisms that underline the dissection. We present two cases of spontaneous dissecting aneurysm of the supraclinoid ICA, both clinically presenting with SAH, but characterized by different progression of clinical symptoms and imaging. However, in both cases an outpouch and a mild fusiform dilation of the supraclinoid ICA was present in the initial CTA performed after the occurrence of symptoms. These findings were well depicted by the MPR reformats performed retrospectively. We postulate that this finding may represent the point of initial transmural dissection and we recommend that careful analysis of the CTA MRP reformatted images should be performed in order to detect this finding promptly.
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Affiliation(s)
- Valeria Onofrj
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Canada.,Dipartimento di Diagnostica Radiologica e Bioimmagini, Policlinico Agostino Gemelli, Italy
| | - Maria Cortes
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Canada
| | - Donatella Tampieri
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Canada
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Al-Ajlan FS, Goyal M, Demchuk AM, Minhas P, Sabiq F, Assis Z, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Thornton J, Williams D, Roy D, Poppe AY, Jovin TG, Sapkota BL, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Lum C, Dowlatshahi D, Shankar JJ, Barber PA, Hill MD, Menon BK. Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial. Stroke 2016; 47:777-81. [PMID: 26892284 DOI: 10.1161/strokeaha.115.012424] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume. METHODS The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 315 enrolled subjects (endovascular treatment n=165; control n=150), 314 subject's infarct volumes at 24 to 48 hours on magnetic resonance imaging (n=254) or computed tomography (n=60) were measured. Post-treatment infarct volumes were compared by treatment assignment and recanalization/reperfusion status. Appropriate statistical models were used to assess relationship between baseline clinical and imaging variables, post-treatment infarct volume, and functional status at 90 days (modified Rankin Scale). RESULTS Median post-treatment infarct volume in all subjects was 21 mL (interquartile range =65 mL), in the intervention arm, 15.5 mL (interquartile range =41.5 mL), and in the control arm, 33.5 mL (interquartile range =84 mL; P<0.01). Baseline National Institute of Health Stroke Scale (P<0.01), site of occlusion (P<0.01), baseline noncontrast computed tomographic scan Alberta Stroke Program Early CT score (ASPECTS) (P<0.01), and recanalization (P<0.01) were independently associated with post-treatment infarct volume, whereas age, sex, treatment type, intravenous alteplase, and time from onset to randomization were not (P>0.05). Post-treatment infarct volume (P<0.01) and delta National Institute of Health Stroke Scale (P<0.01) were independently associated with 90-day modified Rankin Scale, whereas laterality (left versus right) was not. CONCLUSIONS These results support the primary results of the ESCAPE trial and show that the biological underpinning of the success of endovascular therapy is a reduction in infarct volume. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
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Affiliation(s)
- Fahad S Al-Ajlan
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Mayank Goyal
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Priyanka Minhas
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Farahna Sabiq
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Zarina Assis
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Robert Willinsky
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Walter J Montanera
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jeremy L Rempel
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Ashfaq Shuaib
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - John Thornton
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - David Williams
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Daniel Roy
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Alexandre Y Poppe
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Tudor G Jovin
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Biggya L Sapkota
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Blaise W Baxter
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Timo Krings
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Frank L Silver
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Donald F Frei
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Christopher Fanale
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Donatella Tampieri
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jeanne Teitelbaum
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Cheemun Lum
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Dar Dowlatshahi
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Jai J Shankar
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Philip A Barber
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Michael D Hill
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.)
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.).
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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: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
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Al-ajlan F, Goyal M, Menon BK, Demchuk AM, Eesa M, Rempel JL, Thornton J, Roy D, Roy D, Jovin TG, Willinsky RA, Sapkota B, Lum C, Frei DF, Montanera WJ, Poppe AY, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Hill MD. Abstract TP14: Final Infarct Volume as an Early Indicator the Clinical Outcome: Insight from ESCAPE Trial. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The goal of reperfusion therapy in acute ischemic stroke is to limit the extension of the ischemic core. The objectives of the present study were to assess the relationship between endovascular treatment and final infarct volume.
Methods and Results:
ESCAPE is a multicenter prospective randomized open-label trial with blinded outcome evaluation that enrolled 315 patients (endovascular treatment n=165; control n=150). Of these, 314 patient infarct volumes at 24 hours on CT or MRI were measured blinded to clinical data. Because infarct volumes were non-normally distributed, final infarct volumes were analysed by quartiles. Final infarct volumes were compared by treatment assignment and recanalization/reperfusion status measured by 2-8h CT angiogram in the control group and by formal angiography in the intervention arm.
Results:
Median final infarct volume among all study participants was 21 mL (IQR: 7 to 72). Median final infarct volume in endovascular treatment arm at 15.5 mL (IQR: 5 to 46.5) was significantly lower than median final infarct volume in control arm 33.5 mL (IQR: 11 to 95; P=0.0004). Small infarcts, defined as 1st quartile of infarct volumes were more common in the endovascular group compared to control (relative risk [RR] 1.5, CI95 1.02-2.3). Successful recanalization and reperfusion was highly associated with small infarcts (RR 2.2, CI95 1.4-3.4). The proportion of large hemispheric stroke (defined as an infarct volume in the 4th quartile) was much less frequent in the endovascular treatment arm (RR 0.6, CI95 0.3-0.8).
Conclusions:
This analysis supports the primary results of ESCAPE trial as endovascular treatment was associated with significantly smaller final infarct volumes. Recanalization/reperfusion was associated with smaller final infarct volume.
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Affiliation(s)
- Fahad Al-ajlan
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
| | | | - Bijoy K Menon
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
| | | | | | | | | | - Daniel Roy
- Universite de Montreal, Montreal, Canada
| | - Daniel Roy
- Universite de Montreal, Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hana Choe
- Abington Memorial Hosp, Abington, PA
| | | | | | | | | | | | - Michael D Hill
- Clinical Neurosciences, Univ of Calgary, Calgary, Canada
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Arrighi HM, Barakos J, Barkhof F, Tampieri D, Jack C, Melançon D, Morris K, Ketter N, Liu E, Brashear HR. Amyloid-related imaging abnormalities-haemosiderin (ARIA-H) in patients with Alzheimer's disease treated with bapineuzumab: a historical, prospective secondary analysis. J Neurol Neurosurg Psychiatry 2016; 87:106-12. [PMID: 25669746 PMCID: PMC4717448 DOI: 10.1136/jnnp-2014-309493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/19/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Amyloid-related imaging abnormalities due to haemosiderin deposition (ARIA-H) occur in patients with mild to moderate dementia due to Alzheimer's disease (AD) and have been reported with increased incidence in clinical trials of amyloid-lowering therapies under development for AD. OBJECTIVE Our objective was to explore the relationship between the incidences of ARIA-H during treatment with placebo and different doses of bapineuzumab, a humanised monoclonal antibody directed against amyloid β. METHODS Two neuroradiologists independently reviewed 2572 GRE/T2* MRI sequences from 262 participants in two phase two clinical trials of bapineuzumab and an open-label extension study. Readers were blinded to the participant's therapy, APOE ε4 genotype and medical history. RESULTS Several risk factors for small ARIA-H <10 mm (microhaemorrhages) were identified: APOE ε4, bapineuzumab treatment, pre-existing small ARIA-H and use of antithrombotics. The HR (95%CI) for incident ARIA-H <10 mm associated with the number of APOE ε4 alleles was 11.9 (3.3 to 42.5) for 2 versus no alleles and 3.5 (1.0 to 12.0) for 1 versus no allele. The HR for bapineuzumab therapy was 3.5 (1.0 to 12.0); for the presence of baseline ARIA-H <10 mm, it was 3.5 (1.6 to 7.8), and for the use of antithrombotic agents it was 2.2 (1.0 to 4.8). The incidence rate for ARIA-H <10 mm was elevated only in the initial 6 months of active treatment and declined after this interval to a rate similar to that observed in the group treated with placebo. CONCLUSIONS ARIA-H represents a spectrum of MRI findings due to haemosiderin deposition that appears to be related to impaired vascular integrity. The increased risk for ARIA-H associated with APOE ε4 allele frequency, pre-existing ARIA-H, treatment with bapineuzumab and use of antithrombotic agents provides additional support for this hypothesis of loss of integrity of cerebral vessels due to amyloid burden. TRIAL REGISTRATION NCT00112073 and NCT00606476.
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Affiliation(s)
- H Michael Arrighi
- Janssen Research & Development, South San Francisco, California, USA
| | - Jerome Barakos
- California Pacific Medical Center, San Francisco, California, USA Synarc, Newark, California, USA
| | - Frederik Barkhof
- Department of Radiology, Image Analysis Centre, VU University Medical Center, Amsterdam, The Netherlands Department of Diagnostic Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Kristen Morris
- Janssen Alzheimer Immunotherapy R&D, South San Francisco, California, USA BioMarin, San Rafael, California, USA
| | - Nzeera Ketter
- Janssen Research & Development, South San Francisco, California, USA
| | - Enchi Liu
- Janssen Research & Development, South San Francisco, California, USA
| | - H Robert Brashear
- Janssen Research & Development, South San Francisco, California, USA
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dos Santos MP, Zhang J, Ghinda D, Glikstein R, Agid R, Rodesch G, Tampieri D, terBrugge KG. Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors. Neurosurg Focus 2015; 39:E16. [DOI: 10.3171/2015.5.focus1514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Intraspinal tumors comprise a large spectrum of neoplasms, including hemangioblastomas, paragangliomas, and meningiomas. These tumors have several common characteristic imaging features, such as highly vascular mass appearance in angiography, hypointense rim and serpentine flow voids in MRI, and intense enhancement after intravenous contrast administration. Due to their rich vascularity, these tumors represent a special challenge for surgical treatment. More recently, the surgical treatment of intraspinal vascular tumors has benefited from the combination of endovascular techniques used to better delineate these lesions and to promote preoperative reduction of volume and tissue blood flow. Endovascular embolization has been proven to be a safe procedure that facilitates the resection of these tumors; hence, it has been proposed as part of the standard of care in their management.
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Affiliation(s)
| | - Jingwen Zhang
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, and
- 2Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China; and
| | - Diana Ghinda
- 3Department of Surgery, Division of Neurosurgery, University of Ottawa
| | - Rafael Glikstein
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, and
| | - Ronit Agid
- 4Department of Medical Imaging, University Health Network, University of Toronto, Ontario
| | - Georges Rodesch
- 5Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
| | - Donatella Tampieri
- 6Montreal Neurological Institute, Departments of Radiology, Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Karel G. terBrugge
- 4Department of Medical Imaging, University Health Network, University of Toronto, Ontario
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Shankar JJS, Tampieri D, Iancu D, Cortes M, Agid R, Krings T, Wong J, Lavoie P, Ghostine J, Shettar B, Ritchie K, Weill A. SILK flow diverter for complex intracranial aneurysms: a Canadian registry. J Neurointerv Surg 2015; 8:273-8. [PMID: 25987591 DOI: 10.1136/neurintsurg-2015-011708] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/24/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The SILK flow diverter (SFD) is used for the treatment of complex intracranial aneurysms. Small case series have been reported in the literature but few studies with a large number of patients have been published. We present our experience with the SFD for the treatment of intracranial aneurysms in Canada. METHODS Centers across Canada using SFDs were contacted to fill out a case report form for patients treated with an SFD in their center. Individual centers were responsible for approval from their ethics committee. Image analysis was performed by individual operators. The case report forms were collected and the final analysis was performed. RESULTS A total of 92 patients were treated with SFDs in eight centers in Canada between January 2009 and August 2013. The aneurysms were located in the posterior circulation in 16 patients and in the anterior circulation in 76 patients. Most aneurysms (75%) were saccular in shape; 22% were fusiform and 3% were blister aneurysms. The size of the aneurysms varied from 2 to 60 mm with the neck varying from 2 to 60 mm. Perioperative morbidity and mortality were 8.7% and 2.2%, respectively. At the last available follow-up, 83.1% of the aneurysms were either completely or near-completely occluded. The rate of complications was higher for fusiform aneurysms (p<0.001). CONCLUSIONS The SFD appears to be an important tool for the treatment of complex intracranial aneurysms. Treatment outcomes and complication rates remain a problem, but should be considered in the context of available alternative interventions. Ongoing analysis of flow-diverting stents for radiographic and clinical performance is required.
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Affiliation(s)
- Jai Jai Shiva Shankar
- Division of Neuroradiology, Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donatella Tampieri
- Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - Daniela Iancu
- Division of Neuroradiology, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maria Cortes
- Department of Radiology, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - Ronit Agid
- Division of Neuroradiology, Department of Diagnostic Imaging, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Department of Radiology, University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - John Wong
- Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Jimmy Ghostine
- Department of Radiology, CHUM, Hopital Notre-Dame, Montreal, Quebec, Canada
| | - Basavraj Shettar
- Division of Neuroradiology, Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Krsita Ritchie
- Interdisciplinary Research Team, IWK, Dalhousie Universtiy, Halifax, Nova Scotia, Canada
| | - Alain Weill
- Department of Radiology, CHUM, Hopital Notre-Dame, Montreal, Quebec, Canada
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Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372:1019-30. [PMID: 25671798 DOI: 10.1056/nejmoa1414905] [Citation(s) in RCA: 4189] [Impact Index Per Article: 465.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation. METHODS We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis). RESULTS The trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P<0.001). The primary outcome favored the intervention (common odds ratio, 2.6; 95% confidence interval, 1.7 to 3.8; P<0.001), and the intervention was associated with reduced mortality (10.4%, vs. 19.0% in the control group; P=0.04). Symptomatic intracerebral hemorrhage occurred in 3.6% of participants in intervention group and 2.7% of participants in control group (P=0.75). CONCLUSIONS Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality. (Funded by Covidien and others; ESCAPE ClinicalTrials.gov number, NCT01778335.).
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Affiliation(s)
- Mayank Goyal
- The authors' affiliations are listed in the Appendix
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Demchuk AM, Goyal M, Menon BK, Eesa M, Ryckborst KJ, Kamal N, Patil S, Mishra S, Almekhlafi M, Randhawa PA, Roy D, Willinsky R, Montanera W, Silver FL, Shuaib A, Rempel J, Jovin T, Frei D, Sapkota B, Thornton JM, Poppe A, Tampieri D, Lum C, Weill A, Sajobi TT, Hill MD. Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE) trial: methodology. Int J Stroke 2014; 10:429-38. [PMID: 25546514 DOI: 10.1111/ijs.12424] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/12/2014] [Indexed: 01/21/2023]
Abstract
ESCAPE is a prospective, multicenter, randomized clinical trial that will enroll subjects with the following main inclusion criteria: less than 12 h from symptom onset, age > 18, baseline NIHSS >5, ASPECTS score of >5 and CTA evidence of carotid T/L or M1 segment MCA occlusion, and at least moderate collaterals by CTA. The trial will determine if endovascular treatment will result in higher rates of favorable outcome compared with standard medical therapy alone. Patient populations that are eligible include those receiving IV tPA, tPA ineligible and unwitnessed onset or wake up strokes with 12 h of last seen normal. The primary end-point, based on intention-to-treat criteria is the distribution of modified Rankin Scale scores at 90 days assessed using a proportional odds model. The projected maximum sample size is 500 subjects. Randomization is stratified under a minimization process using age, gender, baseline NIHSS, baseline ASPECTS (8-10 vs. 6-7), IV tPA treatment and occlusion location (ICA vs. MCA) as covariates. The study will have one formal interim analysis after 300 subjects have been accrued. Secondary end-points at 90 days include the following: mRS 0-1; mRS 0-2; Barthel 95-100, EuroQOL and a cognitive battery. Safety outcomes are symptomatic ICH, major bleeding, contrast nephropathy, total radiation dose, malignant MCA infarction, hemicraniectomy and mortality at 90 days.
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Affiliation(s)
- Andrew M Demchuk
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
ABSTRACT:Background:Transient focal lesions in the splenium of the corpus callosum (SCC) have been previously described in patients with epilepsy or without epilepsy but receiving antiepileptic drugs (AED).Case reports:Two epileptic patients were admitted to our long-term monitoring unit. Antiepileptic drugs were completely discontinued a few days later. One patient had no seizures. The other had three attacks, the last of which occurred two days before a brain magnetic resonance imaging (MRI) was performed. In both cases brain MRI showed a lesion in the SCC characterized by high signal on T2-weighted images and no enhancement after Gadolinium infusion. The patients were discharged with their pre-admission medications. A follow-up MRI five weeks later showed resolution of the SCC lesions.Conclusions:The pathogenesis of transient SCC lesions in epileptic patients is still unclear. In our patients, either the sudden AED withdrawal or the seizures activity may be presumed to be the cause, though an individual susceptibility must also be considered.
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Affiliation(s)
- Giovanna Carrara
- Department of Radiology, McGill University, Montreal Neurological Institute and Hospital, Montreal, QC, Canada
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McDougall CG, Johnston SC, Gholkar A, Barnwell SL, Vazquez Suarez JC, Massó Romero J, Chaloupka JC, Bonafe A, Wakhloo AK, Tampieri D, Dowd CF, Fox AJ, Imm SJ, Carroll K, Turk AS. Bioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial. AJNR Am J Neuroradiol 2014; 35:935-42. [PMID: 24481333 DOI: 10.3174/ajnr.a3857] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix(2) polyglycolic/polylactic acid biopolymer-modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death. MATERIALS AND METHODS This was a multicenter randomized noninferiority trial with blinded end point adjudication. We enrolled 626 patients, divided between Matrix(2) and bare metal coil groups. The primary outcome was target aneurysm recurrence at 12 ± 3 months. RESULTS At 455 days, at least 1 target aneurysm recurrence event had occurred in 14.6% of patients treated with bare metal coils and 13.3% of Matrix(2) (P = .76, log-rank test) patients; 92.8% of target aneurysm recurrence events were re-interventions for aneurysms that had not bled after treatment, and 5.8% of target aneurysm recurrence events resulted from hemorrhage or rehemorrhage, with or without retreatment. Symptomatic re-intervention occurred in only 4 (0.6%) patients. At 455 days, 95.8% of patients with unruptured aneurysms and 90.4% of those with ruptured aneurysms were independent (mRS ≤ 2). Target aneurysm recurrence was associated with incomplete initial angiographic aneurysm obliteration, presentation with rupture, and a larger aneurysmal dome and neck size. CONCLUSIONS Tested Matrix(2) coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements.
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Affiliation(s)
- C G McDougall
- From the Department of Neurosurgery (C.G.M.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - A Gholkar
- Department of Neuroradiology (A.G.), Regional Neurosciences Center, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S L Barnwell
- Departments of Neurological Surgery and Diagnostic Radiology (S.L.B.), Oregon Health and Science University, Portland, Oregon
| | - J C Vazquez Suarez
- Therapeutic Neuroradiology Unit (J.C.V.S.), University General Hospital of Alicante, Alicante, Spain
| | - J Massó Romero
- Department of Interventional Neuroradiology (J.M.R.), Hospital Donostia, San Sebastián, Spain
| | - J C Chaloupka
- Department of Neurosurgery and Radiology (J.C.C.), Mount Sinai Medical Center, Miami Beach, Florida
| | - A Bonafe
- Service de Neuroradiologie (A.B.), Hôspital Gui de Chauliac, Montpellier Cedex, France
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.K.W.), Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - D Tampieri
- Department of Diagnostic and Interventional Neuroradiology (D.T.), Montreal Neurological Institute, Montreal, Canada
| | - C F Dowd
- Department of Radiology (C.F.D.), University of California, San Francisco, San Francisco, California
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - S J Imm
- Stryker Corporation (S.J.I., K.C.), Fremont, California
| | - K Carroll
- Stryker Corporation (S.J.I., K.C.), Fremont, California
| | - A S Turk
- Departments of Neurointerventional Surgery, Radiology, and Neurosurgery (A.S.T.), Medical University of South Carolina, Charleston, South Carolina
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Al-Jehani H, Tampieri D, Cortes M, Melançon D. Re-growth of a posterior inferior cerebellar artery aneurysm after resection of the associated posterior fossa arteriovenous malformation. Interv Neuroradiol 2014; 20:61-6. [PMID: 24556301 DOI: 10.15274/inr-2014-10008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 08/25/2013] [Indexed: 11/12/2022] Open
Abstract
Arteriovenous malformation (AVM)-related aneurysms have been described in the literature. Their behavior varies based on their location in relation to and the activity of the shunting through the index AVM. The intuitive expectation supported by numerous reports is that these aneurysms should regress if the AVM is excluded from the circulation. We describe a case of 46-year-old man who presented with a posterior fossa AVM with an aneurysm on the posterior inferior cerebellar artery feeding the AVM. The nidus of the AVM was successfully excluded by glue embolization, with initial regression of the PICA aneurysm on serial imaging. Five years after the endovascular treatment, the aneurysm showed significant re-growth necessitating endovascular coiling. This case presents the re-growth of an AVM-related aneurysm and emphasizes the importance of long-term follow-up of such aneurysms even if the AVM is completely excluded.
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Affiliation(s)
- Hosam Al-Jehani
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University; Montreal, Quebec, Canada - Department of Neurosurgery, King Fahad University Hospital, Dammam University; Al-Khobar, Saudi Arabia-
| | - Donatella Tampieri
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University; Montreal, Quebec, Canada
| | - Maria Cortes
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University; Montreal, Quebec, Canada
| | - Denis Melançon
- Department of Neuroradiology, Montreal Neurological Institute and Hospital, McGill University; Montreal, Quebec, Canada
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Al-Jehani H, Tampieri D, Sinclair D. Basilar artery aneurysm presenting with hemiparkinsonism. Parkinsonism Relat Disord 2013; 20:346-8. [PMID: 24331580 DOI: 10.1016/j.parkreldis.2013.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/28/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Hosam Al-Jehani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada; Department of Neurosurgery, King Fahad University Hospital, Dammam University, Al-Khobar, Saudi Arabia.
| | - Donatella Tampieri
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada; Department of diagnostic and Interventional Neuroradiology, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - David Sinclair
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
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Rodesch G, Picard L, Berenstein A, Biondi A, Bracard S, Choi IS, Feng L, Hyogo T, Lefeuvre D, Leonardi M, Mayer T, Miyashi S, Muto M, Piske R, Pongpech S, Reul J, Söderman M, Sul DC, Tampieri D, Taylor A, Terbrugge K, Valavanis A, van den Berg R. Editorial: «Interventional Neuroradiology: a Neuroscience sub-specialty?». Interv Neuroradiol 2013; 19:521-3. [PMID: 24355160 DOI: 10.1177/159101991301900420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 11/17/2022] Open
Abstract
Interventional Neuroradiology (INR) is not bound by the classical limits of a speciality, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.
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Affiliation(s)
- Georges Rodesch
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Foch; Suresnes, France -
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, Schwartz M, Grimm S, Kumthekar P, Fralin S, Rice L, Drawz A, Helenowski I, Rademaker A, Raizer J, Schwartz K, Chang H, Nikolai M, Kurniali P, Olson K, Pernicone J, Sweeley C, Noel M, Sharma M, Gupta R, Suri V, Singh M, Sarkar C, Shibahara I, Sonoda Y, Saito R, Kanamori M, Yamashita Y, Kumabe T, Watanabe M, Suzuki H, Watanabe T, Ishioka C, Tominaga T, Shih K, Chowdhary S, Rosenblatt P, Weir AB, Shepard G, Williams JT, Shastry M, Hainsworth JD, Singer S, Riely GJ, Kris MG, Grommes C, Sanders MWCB, Arik Y, Seute T, Robe PAJT, Leijten FSS, Snijders TJ, Sturla L, Culhane JJ, Donahue J, Jeyapalan S, Suchorska B, Jansen N, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A, Niyazi M, Bartenstein P, Schnell O, Kreth FW, LaFougere C, Tonn JC, Taillandier L, Wittwer B, Blonski M, Faure G, De Carvalho M, Le Rhun E, Tanaka K, Sasayama T, Nishihara M, Mizukawa K, Kohmura E, Taylor S, Newell K, Graves L, Timmer M, Cramer C, Rohn G, Goldbrunner R, Turner S, Gergel T, Lacroix M, Toms S, Ueki K, Higuchi F, Sakamoto S, Kim P, Salgado MAV, Rueda AG, Urzaiz LL, Villanueva MG, Millan JMS, Cervantes ER, Pampliega RA, de Pedro MDA, Berrocal VR, Mena AC, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Hoekstra O, van Dongen G, Kaspers GJ, Schlamann A, von Bueren AO, Hagel C, Kramm C, Kortmann RD, Muller K, Friedrich C, Muller K, von Hoff K, Kwiecien R, Pietsch T, Warmuth-Metz M, Gerber NU, Hau P, Kuehl J, Kortmann RD, von Bueren AO, Rutkowski S, von Bueren AO, Friedrich C, von Hoff K, Kwiecien R, Muller K, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Walker J, Tremont I, Armstrong T, Wang H, Jiang C, Wang H, Jiang C, Warren P, Robert S, Lahti A, White D, Reid M, Nabors L, Sontheimer H, Wen P, Yung A, Mellinghoff I, Lamborn K, Ramkissoon S, Cloughesy T, Rinne M, Omuro A, DeAngelis L, Gilbert M, Chi A, Batchelor T, Colman H, Chang S, Nayak L, Massacesi C, DiTomaso E, Prados M, Reardon D, Ligon K, Wong ET, Elzinga G, Chung A, Barron L, Bloom J, Swanson KD, Elzinga G, Chung A, Wong ET, Wu W, Galanis E, Wen P, Das A, Fine H, Cloughesy T, Sargent D, Yoon WS, Yang SH, Chung DS, Jeun SS, Hong YK, Yust-Katz S, Milbourne A, Diane L, Gilbert M, Armstrong T, Zaky W, Weinberg J, Fuller G, Ketonen L, McAleer MF, Ahmed N, Khatua S, Zaky W, Olar A, Stewart J, Sandberg D, Foresman L, Ketonen L, Khatua S. NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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Rodesch G, Picard L, Berenstein A, Biondi A, Bracard S, Choi IS, Feng L, Hyogo T, Lefeuvre D, Leonardi M, Mayer T, Miyashi S, Muto M, Piske R, Pongpech S, Reul J, Söderman M, Suh DC, Tampieri D, Taylor A, Terbrugge K, Valavanis A, van den Berg R. «Interventional Neuroradiology: A Neuroscience Sub-Specialty?». Interv Neuroradiol 2013. [DOI: 10.1177/15910199130190s142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interventional Neuroradiology (INR) is not bound by the classical limits of a speciality, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.
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Affiliation(s)
- Georges Rodesch
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Foch; Suresnes, France
| | - Luc Picard
- Department of Clinical Neuroradiology, Hôpital Neurologique, Centre Hospitalier de Nancy; France
| | - Alex Berenstein
- Hyman-Newman Institute for Neurology and Neurosurgery, St Lukes Roosevelt and Beth Israël; New York, USA
| | | | - Serge Bracard
- Department of Clinical Neuroradiology, Hôpital Neurologique, Centre Hospitalier de Nancy; France
| | - In Sup Choi
- Department of Interventional Neuroradiology, Lahey Hospital and Medical Center; Boston, USA
| | - Ling Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University; Beijing, China
| | - Toshio Hyogo
- Neurosurgical clinic, Nakamura Memorial Hospital; Sapporo, Japan
| | - David Lefeuvre
- Division of Neurosurgery, Groote Schuur Hospital, University of Cape Town; South Africa
| | - Marco Leonardi
- Neuroradiology Unit, IRCCS Institute of Neurological Sciences, DIMES, University of Bologna, Italy
| | - Thomas Mayer
- Department of Neuroradiology, Center for Radiology, Friedrich Schiller University; Jena, Germany
| | - Shigeru Miyashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine; Nagoya, Japan
| | - Mario Muto
- Department of Neuroradiology, Ospedale Cardarelli; Naples, Italy
| | - Ronie Piske
- Department of Neuroradiology, Hospital Beneficencia Portoguesa; Sao Paolo, Brazil
| | | | - Jurgen Reul
- Depatment of Neuroradiology, BetaKlinik; Bonn, Germany
| | - Michael Söderman
- Department of Neuroradiology, Karolinska Hospital, Stockholm, Sweden
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center; Seoul, Korea
| | - Donatella Tampieri
- Department of Diagnostic and Interventional Neuroradiology, Montreal Neurological Hospital and Institute; Montreal, Canada
| | - Allan Taylor
- Division of Neurosurgery, Groote Schuur Hospital, University of Cape Town; South Africa
| | - Karel Terbrugge
- Department of Neuroradiology, Toronto Western Hospital; Toronto, Canada
| | - Anton Valavanis
- Department of Neuroradiology, University Hospital of Zurich; Zurich, Switzerland
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Rodesch G, Picard L, Berenstein A, Biondi A, Bracard S, Choi IS, Feng L, Hyogo T, Lefeuvre D, Leonardi M, Mayer T, Miyashi S, Muto M, Piske R, Pongpech S, Reul J, Soderman M, Chuh DS, Tampieri D, Taylor A, Terbrugge K, Valavanis A, van den Berg R. «Interventional Neuroradiology: a neuroscience sub-specialty?». Interv Neuroradiol 2013; 19:263-70. [PMID: 24070073 DOI: 10.1177/159101991301900301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 11/17/2022] Open
Abstract
Interventional Neuroradiology (INR) is not bound by the classical limits of a specialty, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.
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Affiliation(s)
- Georges Rodesch
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Foch; Suresnes, France - E-mail:
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