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D'Anna L, Ornello R, Foschi M, Romoli M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Jamil S, Jenkins H, Kwan J, Patel M, Rane N, Roi D, Singh A, Venter M, Kalladka D, Malik A, Halse O, Sacco S, Banerjee S, Lobotesis K. Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation. J Thromb Thrombolysis 2024; 57:445-452. [PMID: 38127260 PMCID: PMC10961279 DOI: 10.1007/s11239-023-02923-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK.
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tsering Dolkar
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Orsolya Vittay
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Luke Dixon
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Paul Bentley
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Zoe Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Charles Hall
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Sohaa Jamil
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Harri Jenkins
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Joseph Kwan
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Maneesh Patel
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Neil Rane
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Dylan Roi
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Abhinav Singh
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Marius Venter
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Dheeraj Kalladka
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Abid Malik
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Omid Halse
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Soma Banerjee
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
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2
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D'Anna L, Barba L, Foschi M, Romoli M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Halse O, Jamil S, Jenkins H, Kalladka D, Kwan J, Malik A, Patel M, Rane N, Roi D, Singh A, Venter M, Banerjee S, Lobotesis K. Safety and outcomes of different endovascular treatment techniques for anterior circulation ischaemic stroke in the elderly: data from the Imperial College Thrombectomy Registry. J Neurol 2024; 271:1366-1375. [PMID: 37982851 PMCID: PMC10896784 DOI: 10.1007/s00415-023-12077-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Although previous studies investigated the main predictors of outcomes after endovascular thrombectomy (EVT) in patients aged 80 years and older, less is known about the impact of the procedural features on outcomes in elderly patients. The aim of this study was to investigate the influence of EVT technical procedures on the main 3-month outcomes in a population of patients aged 80 years and older. METHODS This observational, prospective, single-centre study included consecutive patients with acute LVO ischaemic stroke of the anterior circulation. The study outcomes were functional independence at 3 months after EVT (defined as a mRS score of 0-2), successful reperfusion (mTICI ≥ 2b), incidence of haeamorrhagic transformation, and 90-day all cause of mortality. RESULTS Our cohort included 497 patients with acute ischaemic stroke due to LVO treated with EVT. Among them, 105 (21.1%) patients were aged ≥ 80 years. In the elderly group, multivariable regression analysis showed that thromboaspiration technique vs stent-retriever was the single independent predictor of favourable post-procedural TICI score (OR = 7.65, 95%CI = 2.22-26.32, p = 0.001). CONCLUSIONS Our study suggests that EVT for LVO stroke in the elderly could be safe. The use of thromboaspiration was associated with positive reperfusion outcome in this population. Further studies in larger series are warranted to confirm the present results and to evaluate the safety and efficacy of EVT in the elderly and oldest adults.
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Affiliation(s)
- Lucio D'Anna
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK.
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Lorenzo Barba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tsering Dolkar
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Orsolya Vittay
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Luke Dixon
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Paul Bentley
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Zoe Brown
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Charles Hall
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Omid Halse
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Sohaa Jamil
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Harri Jenkins
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Dheeraj Kalladka
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Joseph Kwan
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Abid Malik
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Maneesh Patel
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Neil Rane
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Dylan Roi
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Abhinav Singh
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Marius Venter
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Soma Banerjee
- Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
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3
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D'Anna L, Romoli M, Foschi M, Abu-Rumeileh S, Dolkar T, Vittay O, Dixon L, Bentley P, Brown Z, Hall C, Jamil S, Jenkins H, Kwan J, La Cava R, Patel M, Rane N, Roi D, Singh A, Venter M, Halse O, Malik A, Kalladka D, Banerjee S, Lobotesis K. Outcomes of mechanical thrombectomy in orally anticoagulated patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Imperial College Thrombectomy Registry. J Neurol 2023; 270:5827-5834. [PMID: 37596423 PMCID: PMC10632297 DOI: 10.1007/s00415-023-11926-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Mechanical thrombectomy (MT) remains an effective treatment for patients with acute ischemic stroke receiving oral anticoagulation (OAC) and large vessel occlusion (LVO). However, to date, it remains unclear whether MT is safe in patients on treatment with OAC. AIMS In our study, we performed a propensity-matched analysis to investigate the safety and efficacy of MT in patients with acute ischemic stroke receiving anticoagulants. A propensity score method was used to target the causal inference of the observational study design. METHODS This observational, prospective, single-centre study included consecutive patients with acute LVO ischemic stroke of the anterior circulation. Demographic, neuro-imaging and clinical data were collected and compared according to the anticoagulation status at baseline, patients on OAC vs those not on OAC. The primary study outcomes were the occurrence of any intracerebral haemorrhage (ICH) and symptomatic ICH. The secondary study outcomes were functional independence at 90 days after stroke (defined as modified Rankin Scale (mRS) scores of 0 through 2), mortality at 3 months and successful reperfusion rate according to the modified treatment in cerebral infarction (mTICI) score. RESULTS Overall, our cohort included 573 patients with acute ischemic stroke and LVO treated with MT. After propensity score matching, 495 patients were matched (99 OAC group vs 396 no OAC group). There were no differences in terms of clinical characteristics between the two groups, except for the rate of intravenous thrombolysis less frequently given in the OAC group. There was no significant difference in terms of the rate of any ICH and symptomatic ICH between the two groups. With regards to the secondary study outcome, there was no significant difference in terms of the rate of successful recanalization post-procedure and functional independence at 3 months between the two groups. Patients in the OAC group showed a reduced mortality rate at 90 days compared to the patients with no previous use of anticoagulation (20.2% vs 21.2%, p = 0.031). Logistic regression analysis did not reveal a statistically significant influence of the anticoagulation status on the likelihood of any ICH (OR = 0.95, 95% CI = 0.46-1.97, p = 0.900) and symptomatic ICH (OR = 4.87, 95% CI = 0.64-37.1, p = 0.127). Our analysis showed also that pre-admission anticoagulant use was not associated with functional independence at 90 days after stroke (OR = 0.76, 95% CI = 0.39-1.48, p = 0.422) and rate of successful reperfusion (OR = 0.81, 95% CI = 0.38-1.72, p = 0.582). CONCLUSION According to our findings anticoagulation status at baseline did not raise any suggestion of safety and efficacy concerns when MT treatment is provided according to the standard guidelines. Confirmation of these results in larger controlled prospective cohorts is necessary.
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Affiliation(s)
- Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK.
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tsering Dolkar
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Orsolya Vittay
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Luke Dixon
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Paul Bentley
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Zoe Brown
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Charles Hall
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Sohaa Jamil
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Harri Jenkins
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Joseph Kwan
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Roberta La Cava
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Maneesh Patel
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Neil Rane
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Dylan Roi
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Abhinav Singh
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
| | - Marius Venter
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Omid Halse
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Abid Malik
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Dheeraj Kalladka
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Soma Banerjee
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Kyriakos Lobotesis
- Neuroradiology, Department of Imaging, Charing Cross Hospital, Imperial College London, NHS Healthcare Trust, London, UK
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4
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Edwards C, Drumm B, Siegler JE, Schonewille WJ, Klein P, Huo X, Chen Y, Abdalkader M, Qureshi MM, Strbian D, Liu X, Hu W, Ji X, Li C, Fischer U, Nagel S, Puetz V, Michel P, Alemseged F, Sacco S, Yamagami H, Yaghi S, Strambo D, Kristoffersen ES, Sandset EC, Mikulik R, Tsivgoulis G, Masoud HE, de Sousa DA, Marto JP, Lobotesis K, Roi D, Berberich A, Demeestere J, Meinel TR, Rivera R, Poli S, Ton MD, Zhu Y, Li F, Sang H, Thomalla G, Parsons M, Campbell BCV, Zaidat OO, Chen HS, Field TS, Raymond J, Kaesmacher J, Nogueira RG, Jovin TG, Sun D, Liu R, Qureshi AI, Qiu Z, Miao Z, Banerjee S, Nguyen TN. Basilar artery occlusion management: Specialist perspectives from an international survey. J Neuroimaging 2023; 33:422-433. [PMID: 36781295 DOI: 10.1111/jon.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/04/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Two early basilar artery occlusion (BAO) randomized controlled trials did not establish the superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to EVT versus medical management may differ between clinician specialties. METHODS We conducted an international survey (January 18, 2022 to March 31, 2022) regarding management strategies in acute BAO prior to the announcement of two trials indicating the superiority of EVT, and compared responses between interventionalists (INTs) and non-interventionalists (nINTs). Selection practices for routine EVT and perceptions of equipoise regarding randomizing to medical management based on neuroimaging and clinical features were compared between the two groups using descriptive statistics. RESULTS Among the 1245 respondents (nINTs = 702), INTs more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p < .01). A similar proportion of INTs and nINTs responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific clinical circumstances (p = .45). Among respondents who would recommend EVT for BAO, there was no difference in the maximum prestroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p > .05), although nINTs more commonly preferred perfusion imaging (24.2% vs. 19.7%, p = .04). Among respondents who indicated they would randomize to medical management, INTs were more likely to randomize when the National Institutes of Health Stroke Scale was ≥10 (15.9% vs. 6.9%, p < .01). CONCLUSIONS Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a BAO patient to medical treatment. There were small differences in preference for advanced neuroimaging for patient selection, although these preferences were unsupported by clinical trial data at the time of the survey.
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Affiliation(s)
- Christopher Edwards
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Brian Drumm
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | | | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Muhammad M Qureshi
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.,Radiation Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Patrik Michel
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Davide Strambo
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Else C Sandset
- Department of Neurology, The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Robert Mikulik
- Department of Neurology, International Clinical Research Center, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hesham E Masoud
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Kyriakos Lobotesis
- Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Dylan Roi
- Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Anne Berberich
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | - Thomas R Meinel
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo, Santiago, Chile
| | - Sven Poli
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam.,Vietnam National University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Yuyou Zhu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Parsons
- Sydney Brain Center, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, Ohio, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Thalia S Field
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Raymond
- Neuroradiologie Interventionelle, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Adnan I Qureshi
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Zhongming Qiu
- Hanoi Medical University, Hanoi, Vietnam.,Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Soma Banerjee
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
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Edwards C, Drumm B, Siegler JE, Schonewille WJ, Klein P, Huo X, Chen Y, Strbian D, Liu X, Hu W, Ji X, Li C, Fischer U, Nagel S, Puetz V, Michel P, Alemseged F, Sacco S, Yamagami H, Abdalkader M, Yaghi S, Strambo D, Kristoffersen ES, Sandset EC, Mikulik R, Tsivgoulis G, Aguiar De Sousa D, Pedro Marto J, Lobotesis K, Roi D, Berberich A, Demeestere J, Meinel TR, Rivera R, Poli S, Duy Ton M, Zhu Y, Li F, Sang H, Thomalla G, Parsons M, Campbell BC, Chen HS, Raymond J, Nogueira RG, Jovin TG, Qiu Z, Miao Z, Banerjee S, Nguyen TN. Abstract TP153: Basilar Artery Occlusion Management: Specialist Perspectives From After The BEST Of BASICS Study. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp153] [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: 02/05/2023]
Abstract
Background:
Two early basilar artery occlusion (BAO) randomized controlled trials did not establish superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to medical management may differ between clinician specialties.
Methods:
We conducted an international survey (1/1/22-3/31/22) regarding management strategies in acute BAO prior to the announcement of 2 trials indicating superiority of EVT, and compared responses between interventionalists (INT) and non-interventionalists (nINT). Selection practices for routine EVT based on neuroimaging and clinical features were compared between the two groups using descriptive statistics.
Results:
Among the 1245 respondents (nINT=702), INT more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p<0.01). A similar proportion of INT and nINT responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific circumstances (p=0.45). Among respondents who would recommend EVT, there was no difference in the maximum pre-stroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p>0.05), although nINT more commonly preferred perfusion imaging (24.2% vs. 19.7%, p=0.04). Among respondents who indicated they would randomize to medical management, INT were more likely to randomize when the NIHSS was ≥10 (15.9% vs. 6.9%, p<0.01).
Conclusions:
Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a patient to medical treatment. There were small differences in preference of advanced neuroimaging, although these preferences were unsupported by clinical trial data.
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Affiliation(s)
| | - Brian Drumm
- Imperial College London NHS Healthcare Trust, London, United Kingdom
| | | | | | | | | | - Yimin Chen
- Foshan Sanshui People’s Hosp, Foshan, China
| | | | - Xinfeng Liu
- Univ of Science and Technology of China, Heifei, China
| | - Wei Hu
- The First Affiliated Hosp of USTC, Hefei, China
| | | | | | | | | | | | - Patrik Michel
- Cntr? Hospier? Universitaire? Vaudois, Lausanne, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - João Pedro Marto
- Dept of Clinical Neurosciences, Lausanne Univ Hosp, Lausanne, Switzerland
| | | | - Dylan Roi
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | | | - Sven Poli
- Dept of Neurology & Stroke, Hertie Institute for Clinical Brain Rsch, Germany
| | | | - Yuyou Zhu
- The First Affiliated Hosp of USTC, Hefei, China
| | - Fengli Li
- Xinqiao Hosp of the Army Med Univ, Chongqing, China
| | - Hongfei Sang
- Affiliated Hangzhou First People’s Hosp, Hangzhou, China
| | | | | | | | - Hui-Sheng Chen
- General Hosp of Shenyang Military Region, Shenyang, China
| | - Jean Raymond
- Cntr Hospier de l’Universite de Montreal, Montreal, Canada
| | | | | | - Zhongming Qiu
- The 903rd Hosp of The Chinese People's Liberation Army, Chongqing, China
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6
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Malik A, Drumm B, D’Anna L, Brooks I, Low B, Raha O, Shabbir K, Vittay O, Kwan J, Brown Z, Halse O, Jamil S, Kalladka D, Venter M, Jenkins H, Rane N, Singh A, Patel M, Hall C, Fatania G, Roi D, Lobotesis K, Banerjee S. Correction: Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials. BMC Neurol 2022; 22:496. [PMID: 36539733 PMCID: PMC9764476 DOI: 10.1186/s12883-022-03015-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Abid Malik
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Brian Drumm
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Lucio D’Anna
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Isabelle Brooks
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Benjamin Low
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Oishik Raha
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Khawar Shabbir
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Orsolya Vittay
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Joseph Kwan
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Zoe Brown
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Omid Halse
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Sohaa Jamil
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Dheeraj Kalladka
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Marius Venter
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Harri Jenkins
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Neil Rane
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Abhinav Singh
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Maneesh Patel
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Charles Hall
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Gavin Fatania
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Dylan Roi
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Kyriakos Lobotesis
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
| | - Soma Banerjee
- grid.413820.c0000 0001 2191 5195Stroke Centre, Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London, W6 8RF UK
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7
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Drumm B, Herning A, Klein P, Raymond J, Abdalkader M, Huo X, Chen Y, Siegler JE, Peacock M, Schonewille WJ, Liu X, Hu W, Ji X, Li C, Alemseged F, Liu L, Nagel S, Strbian D, Rebello LC, Yaghi S, Qureshi MM, Fischer U, Tsivgoulis G, Kaesmacher J, Yamagami H, Puetz V, Sylaja PN, Marto JP, Sacco S, Kristoffersen ES, Demeestere J, Conforto AB, Meyer L, Kaiser DPO, Reiff T, Aydin K, Romoli M, Diana F, Lobotesis K, Roi D, Masoud HE, Ma A, Mohammaden MH, Doheim MF, Zhu Y, Sang H, Sun D, Ton MD, Raynald, Li F, Lapergue B, Hanning U, Yang Q, Lee JS, Thomalla G, Yang P, Liu J, Campbell BCV, Chen HS, Zaidat OO, Qiu Z, Nogueira RG, Miao Z, Nguyen TN, Banerjee S. Basilar artery occlusion management: An international survey of middle versus high-income countries. Interv Neuroradiol 2022:15910199221143190. [PMID: 36514286 DOI: 10.1177/15910199221143190] [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: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively). METHODS We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC. RESULTS Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01). CONCLUSIONS In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.
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Affiliation(s)
- Brian Drumm
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK
| | - Ana Herning
- Department of Neurology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Piers Klein
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jean Raymond
- Department of Radiology, Interventional Neuroradiology Division, 25443Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Mohamad Abdalkader
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Xiaochuan Huo
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - James E Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Meabh Peacock
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Xinfeng Liu
- Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xunming Ji
- Department of Neurosurgery, 71044Xuanwu Hospital, Beijing, China
| | - Chuanhui Li
- Department of Neurology, 71044Xuanwu Hospital, Beijing, China
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Liping Liu
- Department of Neurology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Daniel Strbian
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | | | - Shadi Yaghi
- Department of Neurology, 23325Rhode Island Hospital, 6752Brown University, Providence, RI, USA
| | - Muhammad M Qureshi
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, 27210University of Bern, Bern, Switzerland
- Department of Neurology, Basel University Hospital, 27209University of Basel, Bern, Switzerland
| | - Georgios Tsivgoulis
- Second Department of Neurology "Attikon" University Hospital, 68993National and Kapodistrian University of Athens, Athens, Greece
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Hiroshi Yamagami
- Department of Stroke Neurology, 13707National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Volker Puetz
- Department of Neurology, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - P N Sylaja
- 29354Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, 60483Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | | | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel P O Kaiser
- Dresden Neurovascular Center, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute for Neuroradiology, 39063University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tilman Reiff
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kubilay Aydin
- Interventional Neuroradiology, Koc University Hospital, 37516Istanbul University, Istanbul, Turkey
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Francesco Diana
- Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Kyriakos Lobotesis
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Dylan Roi
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hesham E Masoud
- Department of Neurology, 12302SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alice Ma
- 60086Royal North Shore Hospital, Sydney, Australia
| | | | - Mohamed F Doheim
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yuyou Zhu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dapeng Sun
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Mai Duy Ton
- Stroke Center, 434407Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam
- Vietnam National University-University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Raynald
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | | | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Götz Thomalla
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Hamburg, Germany
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, China
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Hui-Sheng Chen
- Department of Neurology, 74643General Hospital of Northern Theatre Command, Shenyang, China
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH, USA
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Beijing, China
| | - Thanh N Nguyen
- Department of Radiology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, 1836Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Soma Banerjee
- Department of Stroke Medicine, 8946Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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8
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Malik A, Drumm B, D’Anna L, Brooks I, Low B, Raha O, Shabbir K, Vittay O, Kwan J, Brown Z, Halse O, Jamil S, Kalladka D, Venter M, Jenkins H, Rane N, Singh A, Patel M, Hall C, Fatania G, Roi D, Lobotesis K, Banerjee S. Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials. BMC Neurol 2022; 22:415. [PMID: 36352362 PMCID: PMC9644544 DOI: 10.1186/s12883-022-02953-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy. Methods We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome. Results We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004). Conclusions Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02953-2.
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9
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Graham NSN, Zimmerman KA, Moro F, Heslegrave A, Maillard SA, Bernini A, Miroz JP, Donat CK, Lopez MY, Bourke N, Jolly AE, Mallas EJ, Soreq E, Wilson MH, Fatania G, Roi D, Patel MC, Garbero E, Nattino G, Baciu C, Fainardi E, Chieregato A, Gradisek P, Magnoni S, Oddo M, Zetterberg H, Bertolini G, Sharp DJ. Axonal marker neurofilament light predicts long-term outcomes and progressive neurodegeneration after traumatic brain injury. Sci Transl Med 2021; 13:eabg9922. [PMID: 34586833 DOI: 10.1126/scitranslmed.abg9922] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Neil S N Graham
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Federico Moro
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy.,Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Anestesia e Rianimazione, 20122, Milan, Italy
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.,UK Dementia Research Institute at UCL, London WC1N 3BG, UK
| | - Samia Abed Maillard
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Adriano Bernini
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - John-Paul Miroz
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Cornelius K Donat
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Maria Yanez Lopez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Niall Bourke
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Amy E Jolly
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Emma-Jane Mallas
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Eyal Soreq
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Mark H Wilson
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London W6 8RF, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Gavin Fatania
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Dylan Roi
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Maneesh C Patel
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Elena Garbero
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - Camelia Baciu
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Enrico Fainardi
- Department of Experimental and Clinical Sciences, Careggi University Hospital, University of Firenze, Florence 50139, Italy
| | - Arturo Chieregato
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Center, Ljubljana 1000, Slovenia
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento 38122, Italy
| | - Mauro Oddo
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland.,Medical Direction, CHUV Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal 431 41, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal 431 41, Sweden
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK.,Centre for Injury Studies, Imperial College London, London SW7 2AZ, UK
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10
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Gu B, Piebalgs A, Huang Y, Roi D, Lobotesis K, Longstaff C, Hughes AD, Chen R, Thom SA, Xu XY. Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation. Med Eng Phys 2019; 73:9-17. [PMID: 31402315 DOI: 10.1016/j.medengphy.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/03/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022]
Abstract
Acute ischaemic stroke can be treated by intravenous thrombolysis whereby tissue plasminogen activator (tPA) is infused to dissolve clots that block blood supply to the brain. In this study, we aim to examine the influence of clot location and size on lysis pattern and recanalisation by using a recently developed computational modelling framework for thrombolysis under physiological flow conditions. An image-based patient-specific model is reconstructed which consists of the internal carotid bifurcation with the A1 segment of anterior cerebral arteries and M1 segment of middle cerebral arteries, and the M1 bifurcation containing the M2 segments. By varying the clot size and location, 7 scenarios are simulated mimicking thrombolysis of M1 and M2 occlusions. Our results show that initial breakthrough always occurs along the inner curvature of the occluded cerebral artery, due to prolonged tPA residence time in the recirculation zone. For a given occlusion site, lysis completion time appears to increase almost quadratically with the initial clot volume; whereas for a given clot volume, the simulated M2 occlusions take up to 30% longer for complete lysis compared to the corresponding M1 occlusions.
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Affiliation(s)
- Boram Gu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Andris Piebalgs
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Yu Huang
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Dylan Roi
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, United Kingdom
| | - Kyriakos Lobotesis
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, United Kingdom
| | - Colin Longstaff
- Biotherapeutics Section, National Institute for Biological Standards and Control, South Mimms, Herts, United Kingdom
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom; MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom
| | - Rongjun Chen
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom.
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11
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White R, Moore K, Roi D, Gordon A, Wood A. Rationalising short-term EVAR follow-up: can we reduce the follow-up burden for both patients and radiologists? Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Piebalgs A, Gu B, Roi D, Lobotesis K, Thom S, Xu XY. Computational Simulations of Thrombolytic Therapy in Acute Ischaemic Stroke. Sci Rep 2018; 8:15810. [PMID: 30361673 PMCID: PMC6202379 DOI: 10.1038/s41598-018-34082-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 05/18/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Ischaemic stroke can occur when an artery to the brain is blocked by a blood clot. The use of thrombolytic agents, such as tissue plasminogen activator (tPA), to dissolve the occluding clot is limited by the risk of intracerebral haemorrhage (ICH), a known side effect associated with tPA. We developed a computational thrombolysis model for a 3D patient-specific artery coupled with a compartmental model for temporal concentrations of tPA and lysis proteins during intravenous infusion of tPA, in order to evaluate the effects of tPA dose on the efficacy of thrombolytic therapy and the risk of ICH. The model was applied to a 3-mm-long fibrin clot with two different fibrin fibre radii in the middle cerebral artery (MCA) - a setting relevant to ischaemic stroke, and results for different tPA dose levels and fibrin fibre radii were compared. Our simulation results showed that clot lysis was accelerated at higher tPA doses at the expense of a substantial increase in the risk of ICH. It was also found that a fine clot with a smaller fibre radius dissolved much slowly than a coarse clot due to a slower tPA penetration into the clots.
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Affiliation(s)
- Andris Piebalgs
- Faculty of Engineering, Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Boram Gu
- Faculty of Engineering, Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Dylan Roi
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W6 8RF, United Kingdom
| | - Kyriakos Lobotesis
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W6 8RF, United Kingdom
| | - Simon Thom
- Faculty of Medicine, National Heart & Lung Institute, Hammersmith Campus, Imperial College London, London, W12 0NN, United Kingdom
| | - Xiao Yun Xu
- Faculty of Engineering, Department of Chemical Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, United Kingdom.
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13
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Abstract
Krabbe's disease (KD) and metachromatic leucodystrophy (MLD) are both lysosomal storage disorders that share some common MRI features. Amongst the imaging findings useful to distinguish one from the other, optic chiasm/nerves thickening have been described as specific key features for differential diagnosis favouring KD. We report the first case of enlargement of the optic nerves and chiasm described in a patient with genetically confirmed MLD.
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