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Yassi N, Zhao H, Churilov L, Wu TY, Ma H, Nguyen HT, Cheung A, Meretoja A, Mai DT, Kleinig T, Jeng JS, Choi PMC, Duc PD, Brown H, Ranta A, Spratt N, Cloud GC, Wang HK, Grimley R, Mahawish K, Cho DY, Shah D, Nguyen TMP, Sharma G, Yogendrakumar V, Yan B, Harrison EL, Devlin M, Cordato D, Martinez-Majander N, Strbian D, Thijs V, Sanders LM, Anderson D, Parsons MW, Campbell BCV, Donnan GA, Davis SM. Tranexamic acid versus placebo in individuals with intracerebral haemorrhage treated within 2 h of symptom onset (STOP-MSU): an international, double-blind, randomised, phase 2 trial. Lancet Neurol 2024; 23:577-587. [PMID: 38648814 DOI: 10.1016/s1474-4422(24)00128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Tranexamic acid, an antifibrinolytic agent, might attenuate haematoma growth after an intracerebral haemorrhage. We aimed to determine whether treatment with intravenous tranexamic acid within 2 h of an intracerebral haemorrhage would reduce haematoma growth compared with placebo. METHODS STOP-MSU was an investigator-led, double-blind, randomised, phase 2 trial conducted at 24 hospitals and one mobile stroke unit in Australia, Finland, New Zealand, Taiwan, and Viet Nam. Eligible participants had acute spontaneous intracerebral haemorrhage confirmed on non-contrast CT, were aged 18 years or older, and could be treated with the investigational product within 2 h of stroke onset. Using randomly permuted blocks (block size of 4) and a concealed pre-randomised assignment procedure, participants were randomly assigned (1:1) to receive intravenous tranexamic acid (1 g over 10 min followed by 1 g over 8 h) or placebo (saline; matched dosing regimen) commencing within 2 h of symptom onset. Participants, investigators, and treating teams were masked to group assignment. The primary outcome was haematoma growth, defined as either at least 33% relative growth or at least 6 mL absolute growth on CT at 24 h (target range 18-30 h) from the baseline CT. The analysis was conducted within the estimand framework with primary analyses adhering to the intention-to-treat principle. The primary endpoint and secondary safety endpoints (mortality at days 7 and 90 and major thromboembolic events at day 90) were assessed in all participants randomly assigned to treatment groups who did not withdraw consent to use any data. This study was registered with ClinicalTrials.gov, NCT03385928, and the trial is now complete. FINDINGS Between March 19, 2018, and Feb 27, 2023, 202 participants were recruited, of whom one withdrew consent for any data use. The remaining 201 participants were randomly assigned to either placebo (n=98) or tranexamic acid (n=103; intention-to-treat population). Median age was 66 years (IQR 55-77), and 82 (41%) were female and 119 (59%) were male; no data on race or ethnicity were collected. CT scans at baseline or follow-up were missing or of inadequate quality in three participants (one in the placebo group and two in the tranexamic acid group), and were considered missing at random. Haematoma growth occurred in 37 (38%) of 97 assessable participants in the placebo group and 43 (43%) of 101 assessable participants in the tranexamic acid group (adjusted odds ratio [aOR] 1·31 [95% CI 0·72 to 2·40], p=0·37). Major thromboembolic events occurred in one (1%) of 98 participants in the placebo group and three (3%) of 103 in the tranexamic acid group (risk difference 0·02 [95% CI -0·02 to 0·06]). By 7 days, eight (8%) participants in the placebo group and eight (8%) in the tranexamic acid group had died (aOR 1·08 [95% CI 0·35 to 3·35]) and by 90 days, 15 (15%) participants in the placebo group and 19 (18%) in the tranexamic acid group had died (aOR 1·61 [95% CI 0·65 to 3·98]). INTERPRETATION Intravenous tranexamic acid did not reduce haematoma growth when administered within 2 h of intracerebral haemorrhage symptom onset. There were no observed effects on other imaging endpoints, functional outcome, or safety. Based on our results, tranexamic acid should not be used routinely in primary intracerebral haemorrhage, although results of ongoing phase 3 trials will add further context to these findings. FUNDING Australian Government Medical Research Future Fund.
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Affiliation(s)
- Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
| | - Henry Zhao
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Huy-Thang Nguyen
- Department of Cerebrovascular Disease, 115 Hospital, Ho Chi Minh City, Viet Nam
| | - Andrew Cheung
- Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Duy Ton Mai
- Stroke Center, Bach Mai Hospital, Hanoi Medical University, VNU University of Medicine and Pharmacy, Hanoi, Viet Nam
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jiann-Shing Jeng
- Stroke Centre and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Philip M C Choi
- Department of Neuroscience, Box Hill Hospital, Eastern Health, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Phuc Dang Duc
- Stroke Department, 103 Military Hospital, Hanoi, Viet Nam
| | - Helen Brown
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Neil Spratt
- Department of Neurology, John Hunter Hospital, and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Geoffrey C Cloud
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Yanchao, Taiwan
| | - Rohan Grimley
- Department of Medicine, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Karim Mahawish
- Department of Internal Medicine, Palmerston North Hospital, Palmerston North, New Zealand
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Darshan Shah
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Vignan Yogendrakumar
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Emma L Harrison
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Devlin
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Dennis Cordato
- Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland; Department of Neurology, University of Helsinki, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland; Department of Neurology, University of Helsinki, Helsinki, Finland
| | - Vincent Thijs
- The Florey, Stroke Theme, Heidelberg, VIC, Australia; Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
| | - Lauren M Sanders
- Department of Neurosciences, St Vincent's Hospital, Melbourne, VIC, Australia
| | | | - Mark W Parsons
- Department of Neurology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
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Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage. Front Neurol 2024; 15:1359760. [PMID: 38645743 PMCID: PMC11026700 DOI: 10.3389/fneur.2024.1359760] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59-79), median baseline ICH volume 11.5 (IQR 4.3-28.9) mL, and median baseline CRP 2.5 (IQR 1.5-7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000-0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90-1.05, p = 0.51 and HR 0.98; 95%CI 0.93-1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.
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Affiliation(s)
- Oluwaseun A. Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Isabel C. Hostettler
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Teddy Y. Wu
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Calvin Heal
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Duncan Wilson
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Darshan G. Shah
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andy Vail
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Gagan Sharma
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M. Davis
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David J. Werring
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Atte Meretoja
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Stuart M. Allan
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Adrian R. Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
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Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Churilov L, Johns H, Sitton CW, Yogendrakumar V, Ng FC, Pujara DK, Blackburn S, Sundararajan S, Hu YC, Herial NA, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Cheung A, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, Gandhi CD, Al-Mufti F, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Kleinig TJ, Shaker F, Al Shaibi F, Toth G, Abdulrazzak MA, Sharma G, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Samaniego EA, Maali L, Lechtenberg CG, Renú A, Vora N, Nguyen T, Fifi JT, Tjoumakaris SI, Jabbour P, Tsivgoulis G, Pereira VM, Lansberg MG, DeGeorgia M, Sila CA, Bambakidis N, Hill MD, Davis SM, Wechsler L, Grotta JC, Ribo M, Albers GW, Campbell BC. Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles. JAMA 2024; 331:750-763. [PMID: 38324414 PMCID: PMC10851143 DOI: 10.1001/jama.2024.0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/28/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Importance Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain. Objective To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect. Design, Setting, and Participants An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022. Intervention EVT vs MM. Main Outcomes and Measures Primary outcome was functional outcome-90-day mRS score (0, no symptoms, to 6, death) assessed by adjusted generalized OR (aGenOR; values >1 represent more favorable outcomes). Benefit of EVT vs MM was assessed across levels of ischemic injury defined by noncontrast CT using ASPECTS score and by the volume of brain with severely reduced blood flow on CT perfusion or restricted diffusion on MRI. Results Among 352 patients randomized, 336 were analyzed (median age, 67 years; 139 [41.4%] female); of these, 168 (50%) were randomized to EVT, and 2 additional crossover MM patients received EVT. In an ordinal analysis of mRS at 90 days, EVT improved functional outcomes compared with MM within ASPECTS categories of 3 (aGenOR, 1.71 [95% CI, 1.04-2.81]), 4 (aGenOR, 2.01 [95% CI, 1.19-3.40]), and 5 (aGenOR, 1.85 [95% CI, 1.22-2.79]). Across strata for CT perfusion/MRI ischemic core volumes, aGenOR for EVT vs MM was 1.63 (95% CI, 1.23-2.16) for volumes ≥70 mL, 1.41 (95% CI, 0.99-2.02) for ≥100 mL, and 1.47 (95% CI, 0.84-2.56) for ≥150 mL. In the EVT group, outcomes worsened as ASPECTS decreased (aGenOR, 0.91 [95% CI, 0.82-1.00] per 1-point decrease) and as CT perfusion/MRI ischemic core volume increased (aGenOR, 0.92 [95% CI, 0.89-0.95] per 10-mL increase). No heterogeneity of EVT treatment effect was observed with or without mismatch, although few patients without mismatch were enrolled. Conclusion and Relevance In this exploratory analysis of a randomized clinical trial of patients with extensive ischemic stroke, EVT improved clinical outcomes across a wide spectrum of infarct volumes, although enrollment of patients with minimal penumbra volume was low. In EVT-treated patients, clinical outcomes worsened as presenting ischemic injury estimates increased. Trial Registration ClinicalTrials.gov Identifier: NCT03876457.
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Affiliation(s)
- Amrou Sarraj
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | - Michael Chen
- Rush University Medical Center, Chicago, Illinois
| | - Leonid Churilov
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah Johns
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | - Vignan Yogendrakumar
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Felix C. Ng
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Deep K. Pujara
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Sophia Sundararajan
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Yin C. Hu
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Nabeel A. Herial
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Juan F. Arenillas
- Hospital Clínico Universitario Valladolid—University of Valladolid, Valladolid, Spain
| | | | | | | | - Osman Kozak
- Abington Jefferson Health, Abington, Pennsylvania
| | - Bernard Yan
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Andrew Cheung
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | - Teddy Y. Wu
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | - Fawaz Al-Mufti
- Westchester Medical Center, New York Medical College, Valhalla
| | | | | | | | | | - Steven Warach
- Dell Medical School at The University of Texas at Austin–Ascension Texas, Austin
| | | | - Faris Shaker
- McGovern Medical School at UTHealth, Houston, Texas
| | - Faisal Al Shaibi
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | | | - Gagan Sharma
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Abhishek Ray
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Sunshine
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Amanda Opaskar
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Kelsey R. Duncan
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Wei Xiong
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Laith Maali
- University of Kansas Medical Center, Kansas City
| | | | - Arturo Renú
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nirav Vora
- Riverside Methodist Hospital, OhioHealth, Columbus
| | | | | | | | - Pascal Jabbour
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Georgios Tsivgoulis
- Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Michael DeGeorgia
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Cathy A. Sila
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Nicholas Bambakidis
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Stephen M. Davis
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Marc Ribo
- Hospital Vall d’Hebrón, Barcelona, Spain
| | | | - Bruce C. Campbell
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia
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Manoharan V, Sharma G, Devana SK, Sharma S, Avti P, Chandramouli S. A prospective case-control study on the evaluation of oxidative stress in renal stone formers. Urolithiasis 2024; 52:18. [PMID: 38165517 DOI: 10.1007/s00240-023-01514-7] [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: 09/14/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
Association of increased oxidative stress (OS) with the pathophysiology of renal stone formation has not been explored greatly in the field of urolithiasis. In this prospective case-control study, we measured 24-h urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in patients with urolithiasis and compared them with matched healthy controls. We also measured 24-h urinary uric acid, calcium, oxalate, and citrate levels in patients with renal stone disease and studied their relation with urinary 8-OHdG levels. Seventy-five cases of renal stone disease and 75 well-matched controls were included. Median 24-h urinary 8-OHdG levels were significantly higher in cases compared to controls (7.6 vs. 3.7 µg/g of creatinine; p < 0.000). Receiver-operating curve (ROC) analysis for 8-OHdG between cases and controls revealed an area under the curve of 0.90. At 8-OHdG (µg/g of creatinine) value of 5 or more, a sensitivity and a specificity of 84% each were obtained. A positive correlation between 8-OHdG (µg/g of creatinine) and 24-h urinary oxalate level was noted (r = 0.461, p = 0.000). No correlation between 8-OHdG (µg/g of creatinine) and other variables was noted. On multivariate linear regression analysis, we noted 24-h urinary oxalate levels to be an independent predictor of urinary 8-OHdG levels. OS is significantly higher in patients with renal stone diseases compared to healthy controls. Urinary oxalate levels were significantly correlated with urinary 8-OHdG levels.
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Affiliation(s)
- V Manoharan
- Department of Urology, PGIMER, Chandigarh, India
| | - G Sharma
- Department of Urology, PGIMER, Chandigarh, India
| | - S K Devana
- Department of Urology, PGIMER, Chandigarh, India.
| | - S Sharma
- Department of Biochemistry, PGIMER, Chandigarh, India
| | - P Avti
- Department of Biophysics, PGIMER, Chandigarh, India
| | - S Chandramouli
- Department of General Surgery, PGIMER, Chandigarh, India
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Sahay SC, Kesarwani P, Sharma G, Tiwari A. Sahay's modification of Winter's shunt technique for priapism. Indian J Urol 2024; 40:72-73. [PMID: 38314082 PMCID: PMC10836460 DOI: 10.4103/iju.iju_407_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
| | - P. Kesarwani
- Department of Urology, Max Superspeciality Hospital, Delhi, India
| | - G. Sharma
- Department of Urology, Max Superspeciality Hospital, Delhi, India
| | - A. Tiwari
- Department of Urology, Max Superspeciality Hospital, Delhi, India
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Dinesh K, White N, Baker L, Sowden JE, Behrens-Spraggins S, Wood E, Charles J, Herrmann DN, Sharma G, Eichinger K. Disease-specific wearable sensor algorithms for profiling activity, gait, and balance in individuals with Charcot-Marie-Tooth disease type 1A. J Peripher Nerv Syst 2023; 28:368-381. [PMID: 37209301 DOI: 10.1111/jns.12562] [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: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND/AIMS Charcot-Marie-Tooth Disease type 1A (CMT1A), the most common inherited peripheral neuropathy, is characterized by progressive sensory loss and weakness, which results in impaired mobility. Increased understanding of the genetics and pathophysiology of CMT1A has led to development of potential therapeutic agents, necessitating clinical trial readiness. Wearable sensors may provide useful outcome measures for future trials. METHODS Individuals with CMT1A and unaffected controls were recruited for this 12-month study. Participants wore sensors for in-clinic assessments and at-home, from which activity, gait, and balance metrics were derived. Mann-Whitney U tests were used to analyze group differences for activity, gait, and balance parameters. Test-retest reliability of gait and balance parameters and correlations of these parameters with clinical outcome assessments (COAs) were examined. RESULTS Thirty individuals, 15 CMT1A, and 15 controls, participated. Gait and balance metrics demonstrated moderate to excellent reliability. CMT1A participants had longer step durations (p < .001), shorter step lengths (p = .03), slower gait speeds (p < .001), and greater postural sway (p < .001) than healthy controls. Moderate correlations were found between CMT-Functional Outcome Measure and step length (r = -0.59; p = .02), and gait speed (r = 0.64; p = .01); 11 out of 15 CMT1A participants demonstrated significant increases in stride duration between the first and last quarter of the 6-min walk test, suggesting fatigue. INTERPRETATION In this initial study, gait and balance metrics derived from wearable sensors were reliable and associated with COAs in individuals with CMT1A. Larger longitudinal studies are needed to confirm our findings and evaluate sensitivity and utility of these disease-specific algorithms for clinical trial use.
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Affiliation(s)
- K Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - N White
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - L Baker
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J E Sowden
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - S Behrens-Spraggins
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - E Wood
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J Charles
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - D N Herrmann
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - G Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - K Eichinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Yogendrakumar V, Churilov L, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu T, Shah D, Bailey P, Dewey HM, Choi PMC, Ma A, Wijeratne T, Garcia-Esperon C, Cloud G, Chandra RV, Cordato DJ, Yan B, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM, Campbell BCV. Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke: A Post Hoc Analysis of the EXTEND-IA TNK Trials. Neurology 2023; 100:e1900-e1911. [PMID: 36878701 PMCID: PMC10159769 DOI: 10.1212/wnl.0000000000207138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The safety and efficacy of tenecteplase (TNK) in patients with tandem lesion (TL) stroke is unknown. We performed a comparative analysis of TNK and alteplase in patients with TLs. METHODS We first compared the treatment effect of TNK and alteplase in patients with TLs using individual patient data from the EXTEND-IA TNK trials. We evaluated intracranial reperfusion at initial angiographic assessment and 90-day modified Rankin scale (mRS) with ordinal logistic and Firth regression models. Because 2 key outcomes, mortality and symptomatic intracranial hemorrhage (sICH), were few in number among those who received alteplase in the EXTEND-IA TNK trials, we generated pooled estimates for these outcomes by supplementing trial data with estimates of incidence obtained through a meta-analysis of studies identified in a systematic review. We then calculated unadjusted risk differences to compare the pooled estimates for those receiving alteplase with the incidence observed in the trial among those receiving TNK. RESULTS Seventy-one of 483 patients (15%) in the EXTEND-IA TNK trials possessed a TL. In patients with TLs, intracranial reperfusion was observed in 11/56 (20%) of TNK-treated patients vs 1/15 (7%) alteplase-treated patients (adjusted odds ratio 2.19; 95% CI 0.28-17.29). No significant difference in 90-day mRS was observed (adjusted common odds ratio 1.48; 95% CI 0.44-5.00). A pooled study-level proportion of alteplase-associated mortality and sICH was 0.14 (95% CI 0.08-0.21) and 0.09 (95% CI 0.04-0.16), respectively. Compared with a mortality rate of 0.09 (95% CI 0.03-0.20) and an sICH rate of 0.07 (95% CI 0.02-0.17) in TNK-treated patients, no significant difference was observed. DISCUSSION Functional outcomes, mortality, and sICH did not significantly differ between patients with TLs treated with TNK and those treated with alteplase. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that TNK is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and sICH compared with alteplase in patients with acute stroke due to TLs. However, the CIs do not rule out clinically important differences. TRIAL REGISTRATION INFORMATION: clinicaltrials.gov/ct2/show/NCT02388061; clinicaltrials.gov/ct2/show/NCT03340493.
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Affiliation(s)
- Vignan Yogendrakumar
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia.
| | - Leonid Churilov
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Peter J Mitchell
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Timothy J Kleinig
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Nawaf Yassi
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Vincent Thijs
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Teddy Wu
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Darshan Shah
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Peter Bailey
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Helen M Dewey
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Philip M C Choi
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Alice Ma
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Tissa Wijeratne
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Carlos Garcia-Esperon
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Geoffrey Cloud
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Ronil V Chandra
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Dennis J Cordato
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Bernard Yan
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Gagan Sharma
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Patricia M Desmond
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Mark W Parsons
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Geoffrey A Donnan
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Stephen M Davis
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Bruce C V Campbell
- From the Department of Medicine and Neurology (V.Y., L.C., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville; Melbourne Medical School (L.C., V.T.), University of Melbourne, Heidelberg; Department of Radiology (P.J.M., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (T.J.K., B.Y., P.M.D.), Royal Adelaide Hospital; Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Parkville, Australia; Department of Neurology (T. Wu), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane; Department of Neurology (P.B.), Gold Coast University Hospital, Southport; Department of Neurosciences (H.M.D., P.M.C.C.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton; Royal North Shore Hospital (A.M.), New South Wales; Department of Medicine and Neurology (T. Wijeratne), Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans; Department of Neurology (C.G.-E.), John Hunter Hospital, Newcastle, New South Wales; Department of Neurology (G.C.), Alfred Hospital, Melbourne; Department of Neuroscience (G.C.), Central Clinical School, Monash University, Melbourne; NeuroInterventional Radiology Unit (R.V.C.), Monash Health, Monash University; and Department of Neurology (D.J.C., M.W.P.), Liverpool Hospital, University of New South Wales, Sydney, Australia
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Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Blackburn S, Sitton CW, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Wallace AN, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Cardona-Portela P, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Elijovich L, Tekle W, Samaniego EA, Maali L, Abdulrazzak MA, Psychogios MN, Shuaib A, Pujara DK, Shaker F, Johns H, Sharma G, Yogendrakumar V, Ng FC, Rahbar MH, Cai C, Lavori P, Hamilton S, Nguyen T, Fifi JT, Davis S, Wechsler L, Pereira VM, Lansberg MG, Hill MD, Grotta JC, Ribo M, Campbell BC, Albers GW. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med 2023; 388:1259-1271. [PMID: 36762865 DOI: 10.1056/nejmoa2214403] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations. METHODS We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome. RESULTS The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P<0.001). A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional independence (relative risk, 2.97; 95% CI, 1.60 to 5.51). Mortality was similar in the two groups. In the thrombectomy group, arterial access-site complications occurred in 5 patients, dissection in 10, cerebral-vessel perforation in 7, and transient vasospasm in 11. Symptomatic intracranial hemorrhage occurred in 1 patient in the thrombectomy group and in 2 in the medical-care group. CONCLUSIONS Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.).
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Affiliation(s)
- Amrou Sarraj
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ameer E Hassan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael G Abraham
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Santiago Ortega-Gutierrez
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Scott E Kasner
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - M Shazam Hussain
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael Chen
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Spiros Blackburn
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Clark W Sitton
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Leonid Churilov
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Sophia Sundararajan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Yin C Hu
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Nabeel A Herial
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Pascal Jabbour
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Daniel Gibson
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Adam N Wallace
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Juan F Arenillas
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Jenny P Tsai
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ronald F Budzik
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - William J Hicks
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Osman Kozak
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Bernard Yan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Dennis J Cordato
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Nathan W Manning
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Mark W Parsons
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ricardo A Hanel
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Amin N Aghaebrahim
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Teddy Y Wu
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Pere Cardona-Portela
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Natalia Pérez de la Ossa
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Joanna D Schaafsma
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Jordi Blasco
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Navdeep Sangha
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Steven Warach
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Chirag D Gandhi
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Timothy J Kleinig
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Daniel Sahlein
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Lucas Elijovich
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Wondwossen Tekle
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Edgar A Samaniego
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Laith Maali
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - M Ammar Abdulrazzak
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Marios N Psychogios
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ashfaq Shuaib
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Deep K Pujara
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Faris Shaker
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Hannah Johns
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Gagan Sharma
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Vignan Yogendrakumar
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Felix C Ng
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Mohammad H Rahbar
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Chunyan Cai
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Philip Lavori
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Scott Hamilton
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Thanh Nguyen
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Johanna T Fifi
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Stephen Davis
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Lawrence Wechsler
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Vitor M Pereira
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Maarten G Lansberg
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael D Hill
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - James C Grotta
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Marc Ribo
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Bruce C Campbell
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Gregory W Albers
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
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Sharma G, Vela R, Powell L, Malloy C, Jessen M, Peltz M. Metabolic Analysis of Human Hearts Preserved with a Novel Hypothermic Perfusion System. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1696] [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: 04/05/2023] Open
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Sharma G, Vela R, Powell L, Mizerska M, Deja S, Burgess S, Malloy C, Jessen M, Peltz M. Metabolic Indicators in Donor Hearts Following Conventional and Temperature Controlled Storage. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.883] [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: 04/05/2023] Open
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Yogendrakumar V, Churilov L, Guha P, Beharry J, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu TY, Brown H, Dewey HM, Wijeratne T, Yan B, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM, Campbell BCV. Tenecteplase Treatment and Thrombus Characteristics Associated With Early Reperfusion: An EXTEND-IA TNK Trials Analysis. Stroke 2023; 54:706-714. [PMID: 36727510 DOI: 10.1161/strokeaha.122.041061] [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: 02/03/2023]
Abstract
BACKGROUND Intracranial occlusion site, contrast permeability, and clot burden are thrombus characteristics that influence alteplase-associated reperfusion. In this study, we assessed the reperfusion efficacy of tenecteplase and alteplase in subgroups based on these characteristics in a pooled analysis of the EXTEND-IA TNK trial (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke). METHODS Patients with large vessel occlusion were randomized to treatment with tenecteplase (0.25 or 0.4 mg/kg) or alteplase before thrombectomy in hospitals across Australia and New Zealand (2015-2019). The primary outcome, early reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion on first-pass angiogram. We compared the effect of tenecteplase versus alteplase overall, and in subgroups, based on the following measured with computed tomography angiography: intracranial occlusion site, contrast permeability (measured via residual flow grades), and clot burden (measured via clot burden scores). We adjusted for covariates using mixed effects logistic regression models. RESULTS Tenecteplase was associated with higher odds of early reperfusion (75/369 [20%] versus alteplase: 9/96 [9%], adjusted odds ratio [aOR], 2.18 [95% CI, 1.03-4.63]). The difference between thrombolytics was notable in occlusions with low clot burden (tenecteplase: 66/261 [25%] versus alteplase: 5/67 [7%], aOR, 3.93 [95% CI, 1.50-10.33]) when compared to high clot burden lesions (tenecteplase: 9/108 [8%] versus alteplase: 4/29 [14%], aOR, 0.58 [95% CI, 0.16-2.06]; Pinteraction=0.01). We did not observe an association between contrast permeability and tenecteplase treatment effect (permeability present: aOR, 2.83 [95% CI, 1.00-8.05] versus absent: aOR, 1.98 [95% CI, 0.65-6.03]; Pinteraction=0.62). Tenecteplase treatment effect was superior with distal M1 or M2 occlusions (53/176 [30%] versus alteplase: 4/42 [10%], aOR, 3.73 [95% CI, 1.25-11.11]), but both thrombolytics had limited efficacy with internal carotid artery occlusions (tenecteplase 1/73 [1%] versus alteplase 1/19 [5%], aOR, 0.22 [95% CI, 0.01-3.83]; Pinteraction=0.16). CONCLUSIONS Tenecteplase demonstrates superior early reperfusion versus alteplase in lesions with low clot burden. Reperfusion efficacy remains limited in internal carotid artery occlusions and lesions with high clot burden. Further innovation in thrombolytic therapies are required.
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Affiliation(s)
- Vignan Yogendrakumar
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - Leonid Churilov
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - Prodipta Guha
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - James Beharry
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.).,Department of Medicine, Austin Health, Heidelberg, Australia (J.B., V.T.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia (P.J.M., B.Y., P.M.D.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Australia (T.J.K.)
| | - Nawaf Yassi
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.).,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)
| | - Vincent Thijs
- Department of Medicine, Austin Health, Heidelberg, Australia (J.B., V.T.).,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (V.T.)
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, New Zealand (T.Y.W.)
| | - Helen Brown
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia (H.B.)
| | - Helen M Dewey
- Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Clayton, Victoria, Australia (H.M.D.)
| | - Tissa Wijeratne
- Melbourne Medical School, Department of Medicine and Neurology, University of Melbourne and Western Health, St Albans, Australia (T.W.)
| | - Bernard Yan
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.).,Department of Radiology, Royal Melbourne Hospital, Parkville, Australia (P.J.M., B.Y., P.M.D.)
| | - Gagan Sharma
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - Patricia M Desmond
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia (P.J.M., B.Y., P.M.D.)
| | - Mark W Parsons
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.).,Department of Neurology, Liverpool Hospital, Sydney, Australia (M.W.P.)
| | - Geoffrey A Donnan
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - Stephen M Davis
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
| | - Bruce C V Campbell
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (V.Y., L.C., P.G., J.B., N.Y., B.Y., G.S., M.W.P., G.A.D., S.M.D., B.C.V.C.)
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Yogendrakumar V, Beharry J, Churilov L, Alidin K, Ugalde M, Pesavento L, Weir L, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu TY, Shah DG, Dewey HM, Wijeratne T, Yan B, Desmond PM, Sharma G, Parsons MW, Donnan GA, Davis SM, Campbell BCV, Bush S, Scroop R, Simpson M, Brooks M, Asadi H, Ang T, Miteff F, Levi C, Rodrigues E, Zhao H, Alemseged F, Ng F, Salvaris P, Garcia‐Esperon C, Bailey P, Rice H, de Villiers L, Choi P, Brown H, Redmond K, Leggett D, Fink J, Collecutt W, Kraemer T, Cordato D, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, O’Brien B, Clissold B, Clissold A, Cloud G, Bolitho L, Bonavia L, Bhattacharya A, Wright A, Mamun A, O’Rourke F, Worthington J, Wong A, Ma H, Phan T, Chong W, Chandra R, Slater L, Krause M, Harrington T, Faulder K, Steinfort B, Bladin C. Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke. Ann Neurol 2023; 93:489-499. [PMID: 36394101 DOI: 10.1002/ana.26547] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/17/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tenecteplase improves reperfusion compared to alteplase in patients with large vessel occlusions. To determine whether this improvement varies across the spectrum of thrombolytic agent to reperfusion assessment times, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates. METHODS Patients with large vessel occlusion and treatment with thrombolysis were pooled from the Melbourne Stroke Registry, and the EXTEND-IA and EXTEND-IA TNK trials. The primary outcome, thrombolytic-induced reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at imaging reassessment. We compared the treatment effect of tenecteplase and alteplase, accounting for thrombolytic to assessment exposure times, via Poisson modeling. We compared 90-day outcomes of patients who achieved reperfusion with a thrombolytic to patients who achieved reperfusion via endovascular therapy using ordinal logistic regression. RESULTS Among 893 patients included in the primary analysis, thrombolytic-induced reperfusion was observed in 184 (21%) patients. Tenecteplase was associated with higher rates of reperfusion (adjusted incidence rate ratio [aIRR] = 1.50, 95% confidence interval [CI] = 1.09-2.07, p = 0.01). Findings were consistent in patient subgroups with first segment (aIRR = 1.41, 95% CI = 0.93-2.14) and second segment (aIRR = 2.07, 95% CI = 0.98-4.37) middle cerebral artery occlusions. Increased thrombolytic to reperfusion assessment times were associated with reperfusion (tenecteplase: adjusted risk ratio [aRR] = 1.08 per 15 minutes, 95% CI = 1.04-1.13 vs alteplase: aRR = 1.06 per 15 minutes, 95% CI = 1.00-1.13). No significant treatment-by-time interaction was observed (p = 0.87). Reperfusion via thrombolysis was associated with improved 90-day modified Rankin Scale scores (adjusted common odds ratio = 2.15, 95% CI = 1.54-3.01) compared to patients who achieved reperfusion following endovascular therapy. INTERPRETATION Tenecteplase, compared to alteplase, increases prethrombectomy reperfusion, regardless of the time from administration to reperfusion assessment. Prethrombectomy reperfusion is associated with better clinical outcomes. ANN NEUROL 2023;93:489-499.
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Affiliation(s)
- Vignan Yogendrakumar
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - James Beharry
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Khairunnisa Alidin
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa Ugalde
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Lauren Pesavento
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Weir
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Vincent Thijs
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Darshan G Shah
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Helen M Dewey
- Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Tissa Wijeratne
- Melbourne Medical School, Department of Medicine and Neurology, University of Melbourne and Western Health, Sunshine Hospital, St Albans, Victoria, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Prasad S, Sharma G, Devana SK, Kumar S, Sharma S. Is tranexamic acid associated with decreased need for blood transfusion in percutaneous nephrolithotomy: a systematic review and meta-analysis. Ann R Coll Surg Engl 2023; 105:99-106. [PMID: 36720263 PMCID: PMC9889173 DOI: 10.1308/rcsann.2021.0259] [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] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Bleeding is a common complication after percutaneous nephrolithotomy (PNL) for renal stone disease. Tranexamic acid (TXA) has been found to reduce mortality and blood transfusion in surgical and trauma patients. This review aimed to assess the safety and efficacy of TXA in patients undergoing PNL. METHODS A systematic literature review was performed to recognise all randomised controlled trials (RCTs) comparing the use of TXA in PNL. The primary outcome of the study was to compare the need for blood transfusion with and without TXA. FINDINGS Six RCTs with 1,323 patients were included in this review. Haemoglobin fall was lower in the TXA group compared with the control group, and the need for blood transfusion was reduced by 67% (odds ratio (OR) 0.33, confidence interval (CI) (0.21, 0.52), p<0.00001). However, blood loss was comparable for the two groups (mean difference -116.9, CI (-244.5,10.7) p=0.07). Length of stay and duration of surgery was significantly shorter with TXA. Furthermore, both minor and major complications were lower in the TXA group. Stone-free rate was higher with the TXA group. No thromboembolic complications were noted in the TXA group. CONCLUSIONS TXA is safe and efficacious for PNL with a reduction in need for blood transfusion and without an attending increase in complication rates.
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Affiliation(s)
- S Prasad
- MM Institute of Medical Sciences and Research, Ambala, India
| | | | | | | | - S Sharma
- VMMC and Safdarjung Hospital, New Delhi, India
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Sharma G, Shah M, Ahluwalia P, Gautam G, Dasgupta P, Challacombe B, Bhandari M, Ahlawat R, Rawal S, Buffi N, Sivaraman A, Porter J, Rogers C, Mottire, Abaza R, Rha K, Moon D, Yuvaraja T, Parekh D, Capitanio U, Maes K, Porpiglia F, Turkeri L. Off-clamp versus on-clamp robot-assisted partial nephrectomy: A propensity-matched analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01060-6] [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: 02/12/2023]
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15
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Sharma G, Sharma R, Saxena R, Rajni E, Prakash Mamoria V. [Pharmacological importance of novel spiro derivatives against human pathogenic fungi]. Biomed Khim 2023; 69:55-61. [PMID: 36857427 DOI: 10.18097/pbmc20236901055] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Human mycoses have become a threat to health world-wide. Unfortunately there are only a limited number of antimycotic drugs in use. In the present study, antifungal activity of earlier synthesized spiro-1,4-dihydropyridines (1,4-DHPs) was investigated. The antifungal activity of spiro-1,4-DHPs compounds were screened against Aspergillus flavus, A. fumigatus, and Candida albicans by using Disc Diffusion and Modified Microdilution method. Among six spiro-1,4-DHPs compounds tested all of them showed stronger antifungal activity possibly through inhibiting the synthesis of chitin in cell wall against A. flavus, A. fumigatus, and C. albicans as compared to fluconazole, a standard antifungal drug. The combination of compounds showed that the synthesized compounds had synergistic, additive effects as compared to currently used drugs as an antifungal agent. These results indicated that these designed compounds were potential chitin synthase inhibitors and had excellent antimycotic activity for the treatment of fungal infections.
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Affiliation(s)
- G Sharma
- Department of Chemistry, MPS International, Jaipur, Rajasthan, India
| | - R Sharma
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - R Saxena
- Department of Biotechnology, Invertis University, Bareilly, Uttar Pradesh, India
| | - E Rajni
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - V Prakash Mamoria
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Yogendrakumar V, Churilov L, Guha P, Beharry J, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu TY, Brown H, Dewey HM, Wijeratne TH, Yan B, Sharma G, Desmond P, Parsons MW, Donnan GA, Davis S, Campbell B. Abstract 92: Tenecteplase Treatment And Thrombus Characteristics Associated With Early Reperfusion -
An EXTEND-IA TNK Trials Analysis. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.92] [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:
Intracranial occlusion site, contrast permeability, and clot burden are thrombus characteristics that influence alteplase-associated reperfusion. In this study, we assessed the reperfusion efficacy of tenecteplase and alteplase in subgroups based on these characteristics in a pooled analysis of the EXTEND-IA TNK trials.
Methods:
Patients with large vessel occlusion (LVO) were randomized to treatment with tenecteplase (0.25mg/kg or 0.4mg/kg) or alteplase (0.9mg/kg) prior to thrombectomy. The primary outcome, early reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion on initial angiographic assessment. We compared the treatment effect of tenecteplase versus alteplase overall, and in subgroups based on intracranial occlusion site, the presence of contrast permeability (measured via residual flow grades), and clot burden (measured via clot burden scores), whilst adjusting for relevant covariates using mixed effects logistic regression models.
Results:
Among the 465 patients in the primary analysis, early reperfusion occurred in 18% (84/465). Tenecteplase was associated with a higher odds of early reperfusion (tenecteplase: 75/369 [20%] vs. alteplase: 9/96 [9%], aOR: 2.18 [95%CI: 1.03-4.63]). The difference between thrombolytics was most notable in distal M1 or M2 occlusions (tenecteplase: 53/176 [30%] vs. alteplase: 4/42 [10%], aOR: 3.73 [95%CI: 1.25-11.11]), thrombi with contrast permeability (tenecteplase: 38/160 [24%] vs. alteplase: 5/48 [10%], aOR: 2.83 [95%CI: 1.00-8.05]), and in low clot burden occlusions (tenecteplase: 66/261 [25%] vs. alteplase: 5/67 [7%], aOR: 3.93 [95%CI: 1.50-10.33]). Both thrombolytics had limited early reperfusion efficacy in proximal occlusions (ICA: tenecteplase 1/73 [1%] vs. alteplase 1/19 [5%]) and in high clot burden occlusions (tenecteplase: 9/108 [8%] vs. alteplase: 4/29 [14%], aOR: 0.58 [95%CI: 0.16-2.06]).
Conclusions:
Tenecteplase demonstrates superior early reperfusion versus alteplase in distal LVO, in contrast-permeable thrombi, and in lesions with low clot burden. Reperfusion efficacy remains limited in ICA occlusions and lesions with high clot burden. Further improvements in intravenous thrombolytics are required.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Teddy Y Wu
- Christchurch Hosp, Christchurch, New Zealand
| | - Helen Brown
- Princess Alexandra Hosp, Woolloongabba, Australia
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Singh LP, Sharma G. Dielectric spectroscopy investigation of relaxation processes in the low-frequency regime and validity of the Stokes–Einstein–Nernst/Stokes–Einstein–Debye relation in poly(propylene glycol). Macromol Res 2023. [DOI: 10.1007/s13233-022-00104-7] [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: 01/27/2023]
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18
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Sarraj A, Albers GW, Mitchell PJ, Hassan AE, Abraham MG, Blackburn S, Sharma G, Yassi N, Kleinig TJ, Shah DG, Wu TY, Hussain MS, Tekle WG, Gutierrez SO, Aghaebrahim AN, Haussen DC, Toth G, Pujara D, Budzik RF, Hicks W, Vora N, Edgell RC, Slavin S, Lechtenberg CG, Maali L, Qureshi A, Rosterman L, Abdulrazzak MA, AlMaghrabi T, Shaker F, Mir O, Arora A, Martin-Schild S, Sitton CW, Churilov L, Gupta R, Lansberg MG, Nogueira RG, Grotta JC, Donnan GA, Davis SM, Campbell BCV. Thrombectomy Outcomes With General vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From the EXTEND-IA Trials and SELECT Study. Neurology 2023; 100:e336-e347. [PMID: 36289001 PMCID: PMC9869759 DOI: 10.1212/wnl.0000000000201384] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice. METHODS In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes. RESULTS Of 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13-22], non-GA: 16 [11-20], p < 0.001) and ischemic core volume (GA: 15.0 mL [3.2-38.0] vs non-GA: 9.0 mL [0.0-31.0], p < 0.001). In addition, GA was associated with longer last known well to arterial access (203 minutes [157-267] vs 186 minutes [138-252], p = 0.002), but similar procedural time (35.5 minutes [23-59] vs 34 minutes [22-54], p = 0.51). Of 182 matched pairs using propensity scores, baseline characteristics were similar. In the propensity score-matched pairs, GA was independently associated with worse functional outcomes (adjusted common odds ratio [adj. cOR]: 0.64, 95% CI: 0.44-0.93, p = 0.021) and higher neurologic worsening (GA: 14.9% vs non-GA: 8.9%, aOR: 2.10, 95% CI: 1.02-4.33, p = 0.045). Patients with poor collaterals had worse functional outcomes with GA (adj. cOR: 0.47, 95% CI: 0.29-0.76, p = 0.002), whereas no difference was observed in those with good collaterals (adj. cOR: 0.93, 95% CI: 0.50-1.74, p = 0.82), p interaction: 0.07. No difference was observed in infarct growth overall and in patients with good collaterals, whereas patients with poor collaterals demonstrated larger infarct growth with GA with a significant interaction between collaterals and anesthesia type on infarct growth rate (p interaction: 0.020). DISCUSSION GA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score-matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT. TRIAL REGISTRATION INFORMATION EXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587).
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Affiliation(s)
- Amrou Sarraj
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX.
| | - Gregory W Albers
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Peter J Mitchell
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Ameer E Hassan
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Michael G Abraham
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Spiros Blackburn
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Gagan Sharma
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Nawaf Yassi
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Timothy J Kleinig
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Darshan G Shah
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Teddy Y Wu
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Muhammad Shazam Hussain
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Wondwoseen G Tekle
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Santiago Ortega Gutierrez
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Amin Nima Aghaebrahim
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Diogo C Haussen
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Gabor Toth
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Deep Pujara
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Ronald F Budzik
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - William Hicks
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Nirav Vora
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Randall C Edgell
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Sabreena Slavin
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Colleen G Lechtenberg
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Laith Maali
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Abid Qureshi
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Lee Rosterman
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Mohammad Ammar Abdulrazzak
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Tareq AlMaghrabi
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Faris Shaker
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Osman Mir
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Ashish Arora
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Sheryl Martin-Schild
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Clark W Sitton
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Leonid Churilov
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Rishi Gupta
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Maarten G Lansberg
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Raul G Nogueira
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - James C Grotta
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Geoffrey Alan Donnan
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Stephen M Davis
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
| | - Bruce C V Campbell
- From the Case Western Reserve University (A.S.), Neurology; University Hospitals Cleveland Medical Center (A.S., D.P.), Neurology, OH; Stanford University (G.W.A., M.G.L.), Neurology, CA; The Royal Melbourne Hospital - University of Melbourne (P.J.M.), Radiology, Parkville, Victoria, Australia; University of Texas Rio Grande Valley - Valley Baptist Medical Center (A.E.H., W.G.T.), Harlingen; University of Kansas Medical Center (M.G.A., S.S., C.G.L., L.M., A.Q., L.R.), Neurology and Radiology; UTHealth McGovern Medical School (S.B., F.S.), Neurosurgery, Houston TX; The Royal Melbourne Hospitals (G.S., N.Y., L.C., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Neurology; The Walter and Eliza Hall Institute of Medical Research (N.Y.), Population Health and Immunity, Parkville, Victoria; Royal Adelaide Hospital (T.J.K.), Neurology, Adelaide, South Australia; Gold Coast University Hospital (D.G.S.), Neurology, Southport, Queensland, Australia; Christchurch Hospital (T.Y.W.), Neurology, Christchurch, Canterbury, New Zealand; Cleveland Clinic (M.S.H., G.T., M.A.A.), Cerebrovascular Unit, OH; University of Iowa Hospitals (S.O.G.), Neurosurgery; Baptist Health (A.N.A.), Lyerly Neurosurgery, Jacksonville, FL; Emory University (D.C.H., R.G.N.), Neurology, Atlanta, GA; Riverside Methodist Hospital (R.F.B., W.H., N.V.), Colombia, OH; Saint Louis University (R.C.E.), Neurology, MO; University of Tabuk (T.A.), Neurology, KSA; Baylor Scott & White Health (O.M.), Neurology, Dallas, TX; Greensboro | Cone Health (A.A.), Neurology, Greensboro, NC; Touro Infirmary and New Orleans East Hospital (S.M.-S.), Neurology, LA; UTHealth McGovern Medical School (C.W.S.), Diagnostic and Interventional Radiology, Houston, TX; WellStar Health System (R.G.), Neurology, Marietta, GA; and Memorial Hermann Hospital Texas Medical Center (J.C.G.), Neurology, Houston, TX
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Sarraj A, Pujara DK, Churilov L, Sitton CW, Ng F, Hassan AE, Abraham MG, Blackburn SL, Sharma G, Yassi N, Kleinig T, Shah D, Wu TY, Tekle WG, Budzik RF, Hicks WJ, Vora N, Edgell RC, Haussen D, Ortega-Gutierrez S, Toth G, Maali L, Abdulrazzak MA, Al-Shaibi F, AlMaghrabi T, Yogendrakumar V, Shaker F, Mir O, Arora A, Duncan K, Sundararajan S, Opaskar A, Hu Y, Ray A, Sunshine J, Bambakidis N, Martin-Schild S, Hussain MS, Nogueira R, Furlan A, Sila CA, Grotta JC, Parsons M, Mitchell PJ, Donnan GA, Davis SM, Albers GW, Campbell BCV. Mediation of Successful Reperfusion Effect through Infarct Growth and Cerebral Edema: A Pooled, Patient-Level Analysis of EXTEND-IA Trials and SELECT Prospective Cohort. Ann Neurol 2022; 93:793-804. [PMID: 36571388 DOI: 10.1002/ana.26587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Reperfusion therapy is highly beneficial for ischemic stroke. Reduction in both infarct growth and edema are plausible mediators of clinical benefit with reperfusion. We aimed to quantify these mediators and their interrelationship. METHODS In a pooled, patient-level analysis of the EXTEND-IA trials and SELECT study, we used a mediation analysis framework to quantify infarct growth and cerebral edema (midline shift) mediation effect on successful reperfusion (modified Treatment in Cerebral Ischemia ≥ 2b) association with functional outcome (modified Rankin Scale distribution). Furthermore, we evaluated an additional pathway to the original hypothesis, where infarct growth mediated successful reperfusion effect on midline shift. RESULTS A total 542 of 665 (81.5%) eligible patients achieved successful reperfusion. Baseline clinical and imaging characteristics were largely similar between those achieving successful versus unsuccessful reperfusion. Median infarct growth was 12.3ml (interquartile range [IQR] = 1.8-48.4), and median midline shift was 0mm (IQR = 0-2.2). Of 249 (37%) demonstrating a midline shift of ≥1mm, median shift was 2.75mm (IQR = 1.89-4.21). Successful reperfusion was associated with reductions in both predefined mediators, infarct growth (β = -1.19, 95% confidence interval [CI] = -1.51 to -0.88, p < 0.001) and midline shift (adjusted odds ratio = 0.36, 95% CI = 0.23-0.57, p < 0.001). Successful reperfusion association with improved functional outcome (adjusted common odds ratio [acOR] = 2.68, 95% CI = 1.86-3.88, p < 0.001) became insignificant (acOR = 1.39, 95% CI = 0.95-2.04, p = 0.094) when infarct growth and midline shift were added to the regression model. Infarct growth and midline shift explained 45% and 34% of successful reperfusion effect, respectively. Analysis considering an alternative hypothesis demonstrated consistent results. INTERPRETATION In this mediation analysis from a pooled, patient-level cohort, a significant proportion (~80%) of successful reperfusion effect on functional outcome was mediated through reduction in infarct growth and cerebral edema. Further studies are required to confirm our findings, detect additional mediators to explain successful reperfusion residual effect, and identify novel therapeutic targets to further enhance reperfusion benefits. ANN NEUROL 2023.
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Affiliation(s)
- Amrou Sarraj
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Deep K Pujara
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Leonid Churilov
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | - Clark W Sitton
- Department of Diagnostic and Interventional Radiology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Felix Ng
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | - Ameer E Hassan
- University of Texas Rio Grande Valley-Valley Baptist Medical Center, Harlingen, TX, USA
| | - Michael G Abraham
- Department of Neurology and Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Spiros L Blackburn
- Department of Neurosurgery, UTHealth McGovern Medical School, Houston, TX, USA
| | - Gagan Sharma
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | - Nawaf Yassi
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia.,Walter and Eliza Hall Institute of Medical Research, Population Health and Immunity, Parkville, Victoria, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Darshan Shah
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Wondwossen G Tekle
- University of Texas Rio Grande Valley-Valley Baptist Medical Center, Harlingen, TX, USA
| | | | | | - Nirav Vora
- Riverside Methodist Hospital, Colombia, OH, USA
| | - Randall C Edgell
- Department of Neurology, Saint Louis University, Saint Louis, MO, USA
| | - Diogo Haussen
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Gabor Toth
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Laith Maali
- Department of Neurology and Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Faisal Al-Shaibi
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Tareq AlMaghrabi
- Department of Neurology, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Vignan Yogendrakumar
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | - Faris Shaker
- Department of Neurosurgery, UTHealth McGovern Medical School, Houston, TX, USA
| | - Osman Mir
- Department of Neurology, Baylor Scott & White Health, Dallas, TX, USA
| | - Ashish Arora
- Department of Neurology, Greensboro
- Cone Health, Greensboro, NC, USA
| | - Kelsey Duncan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sophia Sundararajan
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amanda Opaskar
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Yin Hu
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Abhishek Ray
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey Sunshine
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nicholas Bambakidis
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA
| | | | - Raul Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anthony Furlan
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Cathy A Sila
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James C Grotta
- Department of Neurology, Memorial Hermann Hospital Texas Medical Center, Houston, TX, USA
| | - Mark Parsons
- Department of Neurology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital-University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
| | | | - Bruce C V Campbell
- Department of Neurology, Royal Melbourne Hospitals, University of Melbourne, Parkville, Victoria, Australia
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Sharma G, Sharma R, Rajni E, Saxena R. Synergistic, Antidermatophytic Activity and Chemical Composition of Essential Oils against Zoonotic Dermatophytosis. Russ J Bioorg Chem 2022. [DOI: 10.1134/s1068162022060218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kobo O, Raisi-Estabragh Z, Elbadawi A, Velagapudi P, Sharma G, Petersen SE, Roguin A, Mamas MA. Patterns and outcomes of cardiovascular emergency department encounters for men and women in the USA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
We described sex-differential disease patterns and outcomes of over 20.6 million cardiovascular emergency department (ED) encounters in the USA.
Methods and results
We analysed primary cardiovascular encounters from the Nationwide Emergency Department Sample (between 2016–2018). We grouped the documented cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; average age was 67 [54,78] years. Men had greater overall baseline co-morbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common ED encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation (AF)/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (AMI, 10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, AF/flutter, supraventricular tachycardia, pulmonary embolism, or ischaemic stroke. Men were more likely to present with AMI or cardiac arrest. In logistic regression models adjusted for baseline covariates, women with intracranial haemorrhage had higher risk of hospitalisation and death. Women with ischaemic stroke had higher risk of hospitalisation and death in ED. Women presenting with pulmonary embolism were less likely to be hospitalised but were more likely to die. Women with aortic aneurysm/dissection had higher risk of hospitalisation and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, AF/flutter, AMI, or cardiac arrest.
Conclusion
In this large nationally representative sample of cardiovascular ED presentations, we demonstrate significant sex differences in disease distribution, hospitalisation, and death.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Kobo
- Hillel Yaffe Medical Center , Hadera , Israel
| | | | - A Elbadawi
- Baylor College of Medicine , Houston , United States of America
| | - P Velagapudi
- University of Nebraska Medical Center , Omaha , United States of America
| | - G Sharma
- The Johns Hopkins Hospital , Baltimore , United States of America
| | - S E Petersen
- William Harvey Research Institute , London , United Kingdom
| | - A Roguin
- Hillel Yaffe Medical Center , Hadera , Israel
| | - M A Mamas
- Keele University , Keele , United Kingdom
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22
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Dubey Tiwari K, Sharma G, Prakash M, Parihar M, Dawane V. Effects of high glutamate concentrations on mitochondria of human neuroblastoma SH-SY5Y cells. Annales Pharmaceutiques Françaises 2022; 81:457-465. [PMID: 36252868 DOI: 10.1016/j.pharma.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/17/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The excess amount of glutamate in neurons is associated with the excitotoxicity and neurodegenerative diseases. Glutamate induces neurotoxicity primarily by immense influx of Ca2+ arising from overstimulation of the NMDA subtype of glutamate receptors. The neuronal death induced by the overstimulation of glutamate receptors depends critically on a sustained increase in mitochondrial Ca2+ influx and impairment in mitochondrial functions. The mitochondrial impairment is an important contributor to the glutamate-induced neuronal toxicity and thus provides an important target for the intervention. The present study investigates the effects of high glutamate concentrations on mitochondrial functions. RESULTS Here, we have shown that the higher concentration of glutamate treatment caused a significant elevation in the N-methyl-D-aspartate (NMDA) receptors expression and elevated the intra-mitochondrial calcium accumulation in SHSY5Y neuronal cells. As a result of an accumulation of intra-mitochondrial calcium, there is a concentration-dependent elevation in ROS in the mitochondria. Tyrosine nitration of several mitochondrial proteins was increased while the mitochondrial membrane potential was dissipated. Furthermore, glutamate treatments also resulted in mitochondrial membrane permeability transition. CONCLUSIONS These findings suggest that treatment of high glutamate concentration causes impairment of mitochondrial functions by an increase in intra-mitochondrial calcium, ROS production, dissipation of mitochondrial membrane potential and mitochondrial permeability transition pore opening in human neuroblastoma SHSY5Y cells.
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Sharma G, ahlawat R, karthikeyan R, kummetha L, gautam S. POS-030 CLINICAL PROFILE AND OUTCOMES IN CHRONIC KIDNEY DISEASE STAGE 5 PATIENTS ON DIALYSIS HOSPITALIZED WITH COVID-19 INFECTION. Kidney Int Rep 2022. [PMCID: PMC9475101 DOI: 10.1016/j.ekir.2022.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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24
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Tan Z, Parsons M, Bivard A, Sharma G, Mitchell P, Dowling R, Bush S, Churilov L, Xu A, Yan B. Comparison of Computed Tomography Perfusion and Multiphase Computed Tomography Angiogram in Predicting Clinical Outcomes in Endovascular Thrombectomy. Stroke 2022; 53:2926-2934. [PMID: 35748291 DOI: 10.1161/strokeaha.122.038576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with acute stroke who undergo endovascular thrombectomy, the relative prognostic power of computed tomography perfusion (CTP) parameters compared with multiphase CT angiogram (mCTA) is unknown. We aimed to compare the predictive accuracy of mCTA and CTP parameters on clinical outcomes. METHODS We included patients with acute ischemic stroke who had anterior circulation large vessel occlusion within 24 hours of onset in Melbourne Brain Centre at the Royal Melbourne Hospital. All patients underwent CTP for endovascular thrombectomy, and the mCTA collateral score was determined using CTP-reconstructed mCTA images. The primary outcome was 90-day functional outcomes defined by modified Rankin Scale. Multivariable logistic regression models analyzed associations between mCTA and CTP parameters and 90-day functional outcomes. The ability to discriminate 90 days-functional outcomes was compared between mCTA collateral score and CTP parameters using receiver operating curve analysis and C statistics. RESULTS One hundred and twenty patients were included. The median age was 69 years (interquartile range, 60-79), the median baseline National Institutes of Health Stroke Scale score was 14 (interquartile range, 9-19). The baseline ischemic core volume, defined by CTP-based relative cerebral blood flow <30%, was associated with excellent functional outcome (modified Rankin Scale score 0-1; odds ratio, 0.942 [-0.897 to -0.989]; P=0.015) and poor functional outcome (modified Rankin Scale score 5-6; odds ratio, 1.032 [1.007-1.056]; P=0.010) at 90 days in the analysis of multivariable regression. There was no significant association between the mCTA score and excellent functional outcome (P=0.58) or poor functional outcome (P=0.155). The relative cerebral blood flow <30%-based regression model best fit the data for the 90-day poor functional outcome (C statistic, 0.834). CONCLUSIONS The CTP-based ischemic core volume may provide better discrimination for 90-day functional outcomes for patients with acute stroke undergoing endovascular thrombectomy than the mCTA collateral score.
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Affiliation(s)
- Zefeng Tan
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.).,Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.).,Department of Neurology, the First People's Hospital of Foshan, China (Z.T.)
| | - Mark Parsons
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.).,Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Andrew Bivard
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.)
| | - Gagan Sharma
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.)
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Richard Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Steven Bush
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Leonid Churilov
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.)
| | - Anding Xu
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.)
| | - Bernard Yan
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., L.C., B.Y.).,Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
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25
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Chand S, Mihooliya KN, Sahoo DK, Prasad JP, Sharma G. L-asparaginase from Bacillus flexus strain SS: Isolation, Screening, Production Process Optimization, Purification, and Anticancer Activity. APPL BIOCHEM MICRO+ 2022. [DOI: 10.1134/s0003683822040032] [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: 11/23/2022]
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26
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Sarraj A, Campbell BCV, Christensen S, Sitton CW, Khanpara S, Riascos RF, Pujara D, Shaker F, Sharma G, Lansberg MG, Albers GW. Accuracy of CT Perfusion-Based Core Estimation of Follow-up Infarction: Effects of Time Since Last Known Well. Neurology 2022; 98:e2084-e2096. [PMID: 35450966 PMCID: PMC9169942 DOI: 10.1212/wnl.0000000000200269] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the accuracy of baseline CT perfusion (CTP) ischemic core estimates. METHODS From SELECT (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke), a prospective multicenter cohort study of imaging selection, patients undergoing endovascular thrombectomy who achieved complete reperfusion (modified Thrombolysis In Cerebral Ischemia score 3) and had follow-up diffusion-weighted imaging (DWI) available were evaluated. Follow-up DWI lesions were coregistered to baseline CTP. The difference between baseline CTP core (relative cerebral blood flow [rCBF] <30%) volume and follow-up infarct volume was classified as overestimation (core ≥10 mL larger than infarct), adequate, or underestimation (core ≥25 mL smaller than infarct) and spatial overlap was evaluated. RESULTS Of 101 included patients, median time from last known well (LKW) to imaging acquisition was 138 (82-244) minutes. The median baseline ischemic core estimate was 9 (0-31.9) mL and median follow-up infarct volume was 18.4 (5.3-68.7) mL. All 6/101 (6%) patients with overestimation of the subsequent infarct volume were imaged within 90 minutes of LKW and achieved rapid reperfusion (within 120 minutes of CTP). Using rCBF <20% threshold to estimate ischemic core in patients presenting within 90 minutes eliminated overestimation. Volumetric correlation between the ischemic core estimate and follow-up imaging improved as LKW time to imaging acquisition increased: Spearman ρ <90 minutes 0.33 (p = 0.049), 90-270 minutes 0.63 (p < 0.0001), >270 minutes 0.86 (p < 0.0001). Assessment of the spatial overlap between baseline CTP ischemic core lesion and follow-up infarct demonstrated that a median of 3.2 (0.0-9.0) mL of estimated core fell outside the subsequent infarct. These regions were predominantly in white matter. DISCUSSION Significant overestimation of irreversibly injured ischemic core volume was rare, was only observed in patients who presented within 90 minutes of LKW and achieved reperfusion within 120 minutes of CTP acquisition, and occurred primarily in white matter. Use of a more conservative (rCBF <20%) threshold for estimating ischemic core in patients presenting within 90 minutes eliminated all significant overestimation cases. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT03876457.
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Affiliation(s)
- Amrou Sarraj
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Bruce C V Campbell
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Soren Christensen
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Clark W Sitton
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Shekhar Khanpara
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Roy F Riascos
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Deep Pujara
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Faris Shaker
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Gagan Sharma
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Maarten G Lansberg
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
| | - Gregory W Albers
- From the Department of Neurology (A.S.), Case Western Reserve University-University Hospitals Cleveland Medical Center, OH; Department of Neurology (B.C.V.C., G.S.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurology (S.C., M.G.L., G.W.A.), Stanford University Medical Center, CA; Departments of Diagnostic and Interventional Imaging (C.W.S., S.K., R.F.R.) and Neurology (F.S.), UTHealth McGovern Medical School, Houston, TX; and Department of Neurology (D.P.), University Hospitals Cleveland Medical Center, OH
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Gale D, Heider K, Ruiz-Valdepenas A, Hackinger S, Perry M, Marsico G, Rundell V, Wulff J, Sharma G, Knock H, Castedo J, Cooper W, Zhao H, Smith CG, Garg S, Anand S, Howarth K, Gilligan D, Harden SV, Rassl DM, Rintoul RC, Rosenfeld N. Residual ctDNA after treatment predicts early relapse in patients with early-stage non-small cell lung cancer. Ann Oncol 2022; 33:500-510. [PMID: 35306155 PMCID: PMC9067454 DOI: 10.1016/j.annonc.2022.02.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Identification of residual disease in patients with localized non-small cell lung cancer (NSCLC) following treatment with curative intent holds promise to identify patients at risk of relapse. New methods can detect circulating tumour DNA (ctDNA) in plasma to fractional concentrations as low as a few parts per million, and clinical evidence is required to inform their use. PATIENTS AND METHODS We analyzed 363 serial plasma samples from 88 patients with early-stage NSCLC (48.9%/28.4%/22.7% at stage I/II/III), predominantly adenocarcinomas (62.5%), treated with curative intent by surgery (n = 61), surgery and adjuvant chemotherapy/radiotherapy (n = 8), or chemoradiotherapy (n = 19). Tumour exome sequencing identified somatic mutations and plasma was analyzed using patient-specific RaDaR™ assays with up to 48 amplicons targeting tumour-specific variants unique to each patient. RESULTS ctDNA was detected before treatment in 24%, 77% and 87% of patients with stage I, II and III disease, respectively, and in 26% of all longitudinal samples. The median tumour fraction detected was 0.042%, with 63% of samples <0.1% and 36% of samples <0.01%. ctDNA detection had clinical specificity >98.5% and preceded clinical detection of recurrence of the primary tumour by a median of 212.5 days. ctDNA was detected after treatment in 18/28 (64.3%) of patients who had clinical recurrence of their primary tumour. Detection within the landmark timepoint 2 weeks to 4 months after treatment end occurred in 17% of patients, and was associated with shorter recurrence-free survival [hazard ratio (HR): 14.8, P <0.00001] and overall survival (HR: 5.48, P <0.0003). ctDNA was detected 1-3 days after surgery in 25% of patients yet was not associated with disease recurrence. Detection before treatment was associated with shorter overall survival and recurrence-free survival (HR: 2.97 and 3.14, P values 0.01 and 0.003, respectively). CONCLUSIONS ctDNA detection after initial treatment of patients with early-stage NSCLC using sensitive patient-specific assays has potential to identify patients who may benefit from further therapeutic intervention.
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Affiliation(s)
- D Gale
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - K Heider
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - A Ruiz-Valdepenas
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Hackinger
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - M Perry
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - G Marsico
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - V Rundell
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - J Wulff
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - G Sharma
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - H Knock
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - J Castedo
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - W Cooper
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - H Zhao
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - C G Smith
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Garg
- Cancer Molecular Diagnostics Laboratory, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S Anand
- Cancer Molecular Diagnostics Laboratory, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - K Howarth
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - D Gilligan
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK
| | | | - D M Rassl
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R C Rintoul
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Department of Oncology, University of Cambridge Hutchison-MRC Research Centre, Cambridge Biomedical Campus, Cambridge, UK.
| | - N Rosenfeld
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK.
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Bivard A, Zhao H, Churilov L, Campbell BCV, Coote S, Yassi N, Yan B, Valente M, Sharobeam A, Balabanski AH, Dos Santos A, Ng JL, Yogendrakumar V, Ng F, Langenberg F, Easton D, Warwick A, Mackey E, MacDonald A, Sharma G, Stephenson M, Smith K, Anderson D, Choi P, Thijs V, Ma H, Cloud GC, Wijeratne T, Olenko L, Italiano D, Davis SM, Donnan GA, Parsons MW. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial. Lancet Neurol 2022; 21:520-527. [DOI: 10.1016/s1474-4422(22)00171-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 12/19/2022]
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29
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Ng FC, Yassi N, Sharma G, Brown SB, Goyal M, Majoie CBLM, Jovin TG, Hill MD, Muir KW, Saver JL, Guillemin F, Demchuk AM, Menon BK, San Roman L, White P, van der Lugt A, Ribo M, Bracard S, Mitchell PJ, Davis SM, Sheth KN, Kimberly WT, Campbell BCV. Correlation Between Computed Tomography-Based Tissue Net Water Uptake and Volumetric Measures of Cerebral Edema After Reperfusion Therapy. Stroke 2022; 53:2628-2636. [PMID: 35450438 DOI: 10.1161/strokeaha.121.037073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral edema after large hemispheric infarction is associated with poor functional outcome and mortality. Net water uptake (NWU) quantifies the degree of hypoattenuation on unenhanced-computed tomography (CT) and is increasingly used to measure cerebral edema in stroke research. Hemorrhagic transformation and parenchymal contrast staining after thrombectomy may confound NWU measurements. We investigated the correlation of NWU measured postthrombectomy with volumetric markers of cerebral edema and association with functional outcomes. METHODS In a pooled individual patient level analysis of patients presenting with anterior circulation large hemispheric infarction (core 80-300 mL or Alberta Stroke Program Early CT Score ≤5) in the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set, cerebral edema was defined as the volumetric expansion of the ischemic hemisphere expressed as a ratio to the contralateral hemisphere(rHV). NWU and midline-shift were compared with rHV as the reference standard on 24-hour follow-up CT, adjusted for hemorrhagic transformation and the use of thrombectomy. Association between edema markers and day 90 functional outcomes (modified Rankin Scale) was assessed using ordinal logistic regression. RESULTS Overall (n=144), there was no correlation between NWU and rHV (rs=0.055, P=0.51). In sub-group analyses, a weak correlation between NWU with rHV was observed after excluding patients with any degree of hemorrhagic transformation (rs=0.211, P=0.015), which further improved after excluding thrombectomy patients (rs=0.453, P=0.001). Midline-shift correlated strongly with rHV in all sub-group analyses (rs>0.753, P=0.001). Functional outcome at 90 days was negatively associated with rHV (adjusted common odds ratio, 0.46 [95% CI, 0.32-0.65]; P<0.001) and midline-shift (adjusted common odds ratio, 0.85 [95% CI, 0.78-0.92]; P<0.001) but not NWU (adjusted common odds ratio, 1.00 [95% CI, 0.97-1.03]; P=0.84), adjusted for age, baseline National Institutes of Health Stroke Scale, and thrombectomy. Prognostic performance of NWU improved after excluding patients with hemorrhagic transformation and thrombectomy (adjusted odds ratio, 0.90 [95% CI, 0.80-1.02]; P=0.10). CONCLUSIONS NWU correlated poorly with conventional markers of cerebral edema and was not associated with clinical outcome in the presence of hemorrhagic transformation and thrombectomy. Measuring NWU postthrombectomy requires validation before implementation into clinical research. At present, the use of NWU should be limited to baseline CT, or follow-up CT only in patients without hemorrhagic transformation or treatment with thrombectomy.
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Affiliation(s)
- Felix C Ng
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.).,Austin Health, Heidelberg, Australia (F.C.N.)
| | - Nawaf Yassi
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)
| | - Gagan Sharma
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.)
| | | | - Mayank Goyal
- Department of Radiology, University of Calgary, Foothills Hospital, AB, Canada (M.G.)
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, the Netherlands (C.B.L.M.M.)
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Health Care, Camden, NJ (T.G.J.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, AB, Canada (M.D.H., A.M.D., B.K.M.)
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, California Stanford Stroke Center, Stanford University (J.L.S.)
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology INSERM 1433, University of Lorraine and University Hospital of Nancy, France (F.G.)
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, AB, Canada (M.D.H., A.M.D., B.K.M.)
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, AB, Canada (M.D.H., A.M.D., B.K.M.)
| | - Luis San Roman
- Department of Radiology, Hospital Clínic, Barcelona, Spain (L.S.R.)
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands (A.v.d.L.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain (M.R.)
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, Université de Lorraine, Inserm, IADI, CHRU Nancy, France (S.B.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (P.J.M.)
| | - Stephen M Davis
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.)
| | - Kevin N Sheth
- Department of Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - W Taylor Kimberly
- Center for Genomic Medicine and Department of Neurology, Massachusetts General Hospital, Boston (W.T.K.)
| | - Bruce C V Campbell
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.)
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30
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Ng FC, Churilov L, Yassi N, Kleinig TJ, Thijs V, Wu T, Shah D, Dewey H, Sharma G, Desmond P, Yan B, Parsons M, Donnan G, Davis S, Mitchell P, Campbell B. Prevalence and Significance of Impaired Microvascular Tissue Reperfusion Despite Macrovascular Angiographic Reperfusion (No-Reflow). Neurology 2022; 98:e790-e801. [PMID: 34906976 DOI: 10.1212/wnl.0000000000013210] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relevance of impaired microvascular tissue-level reperfusion despite complete upstream macrovascular angiographic reperfusion (no-reflow) in human stroke remains controversial. We investigated the prevalence and clinical-radiologic features of this phenomenon and its associations with outcomes in 3 international randomized controlled thrombectomy trials with prespecified follow-up perfusion imaging. METHODS In a pooled analysis of the Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA; ClinicalTrials.gov NCT01492725), Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK; NCT02388061), and Determining the Optimal Dose of Tenecteplase Before Endovascular Therapy for Ischaemic Stroke (EXTEND-IA TNK Part 2; NCT03340493) trials, patients undergoing thrombectomy with final angiographic expanded Treatment in Cerebral Infarction score of 2c to 3 score for anterior circulation large vessel occlusion and 24-hour follow-up CT or MRI perfusion imaging were included. No-reflow was defined as regions of visually demonstrable persistent hypoperfusion on relative cerebral blood volume or flow maps within the infarct and verified quantitatively by >15% asymmetry compared to a mirror homolog in the absence of carotid stenosis or reocclusion. RESULTS Regions of no-reflow were identified in 33 of 130 patients (25.3%), encompassed a median of 60.2% (interquartile range 47.8%-70.7%) of the infarct volume, and involved both subcortical (n = 26 of 33, 78.8%) and cortical (n = 10 of 33, 30.3%) regions. Patients with no-reflow had a median 25.2% (interquartile range 16.4%-32.2%, p < 0.00001) relative cerebral blood volume interside reduction and 19.1% (interquartile range 3.9%-28.3%, p = 0.00011) relative cerebral blood flow reduction but similar mean transit time (median -3.3%, interquartile range -11.9% to 24.4%, p = 0.24) within the infarcted region. Baseline characteristics were similar between patients with and those without no-reflow. The presence of no-reflow was associated with hemorrhagic transformation (adjusted odds ratio [aOR] 1.79, 95% confidence interval [CI] 2.32-15.57, p = 0.0002), greater infarct growth (β = 11.00, 95% CI 5.22-16.78, p = 0.00027), reduced NIH Stroke Scale score improvement at 24 hours (β = -4.06, 95% CI 6.78-1.34, p = 0.004) and being dependent or dead at 90 days as assessed by the modified Rankin Scale (aOR 3.72, 95% CI 1.35-10.20, p = 0.011) in multivariable analysis. DISCUSSION Cerebral no-reflow in humans is common, can be detected by its characteristic perfusion imaging profile using readily available sequences in the clinical setting, and is associated with posttreatment complications and being dependent or dead. Further studies evaluating the role of no-reflow in secondary injury after angiographic reperfusion are warranted. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that cerebral no-reflow on CT/MRI perfusion imaging at 24 hours is associated with posttreatment complications and poor 3-month functional outcome.
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Affiliation(s)
- Felix C Ng
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia.
| | - Leonid Churilov
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Nawaf Yassi
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Timothy John Kleinig
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Vincent Thijs
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Teddy Wu
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Darshan Shah
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Helen Dewey
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Gagan Sharma
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Patricia Desmond
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Bernard Yan
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Mark Parsons
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Geoffrey Donnan
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Stephen Davis
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Peter Mitchell
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Bruce Campbell
- From the Department of Medicine and Neurology (F.C.N., L.C., N.Y., G.S., B.Y., M.P., G.D., S.D., B.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, Florey Institute of Neuroscience and Mental Health (L.C., V.T., H.D.), and Department of Radiology (P.D., B.Y., P.M.), Royal Melbourne Hospital, University of Melbourne, Parkville; Department of Neurology (F.C.N., V.T.), Austin Hospital, Austin Health; Department of Medicine (Austin Health) (L.C.), University of Melbourne, Heidelberg, Victoria; Population Health and Immunity Division (N.Y.), Walter and Eliza Hall Institute of Medical Research, Parkville; Department of Neurology (T.J.K.), Royal Adelaide Hospital, South Australia, Australia; Department of Neurology (T.W.), Christchurch Hospital, New Zealand; Department of Neurology (D.S.), Princess Alexandra Hospital, Brisbane, Queensland; and Department of Neurosciences (H.D.), Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
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31
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Sarraj A, Parsons M, Bivard A, Hassan AE, Abraham MG, Wu T, Kleinig T, Lin L, Chen C(A, Levi C, Dong Q, Cheng X, Butcher KS, Choi P, Yassi N, Shah D, Sharma G, Pujara D, Shaker F, Blackburn S, Dewey H, Thijs V, Sitton CW, Donnan GA, Mitchell PJ, Yan B, Grotta JG, Albers GW, Davis SM, Campbell B. Endovascular Thrombectomy versus Medical Management in Isolated
M2
Occlusions: Pooled
Patient‐Level
Analysis from the
EXTEND‐IA
Trials,
INSPIRE
and
SELECT
Studies. Ann Neurol 2022; 91:629-639. [DOI: 10.1002/ana.26331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Amrou Sarraj
- Case Western Reserve University, Neurology Cleveland OH USA
- University Hospitals Cleveland Medical Center Cleveland OH USA
| | - Mark Parsons
- The University of New South Wales, Neurology Sydney NSW Australia
| | - Andrew Bivard
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
- The University of Newcastle, Stroke and Brain Injury Center Callaghan NSW, Australia Australia
| | - Ameer E Hassan
- University of Texas Rio Grande Valley ‐ Valley Baptist Medical Center, Neurology Harlingen TX USA
| | | | - Teddy Wu
- Christchurch Hospital, Neurology Christchurch New Zealand
| | - Timothy Kleinig
- Royal Adelaide Hospital, Neurology Adelaide South Australia Australia
| | - Longting Lin
- John Hunter Hospital University of Newcastle, Neurology Australia
| | | | - Christopher Levi
- John Hunter Hospital University of Newcastle, Neurology Australia
| | - Qiang Dong
- Huashan Hospital Fudan University, Neurology Shanghai China
| | - Xin Cheng
- Huashan Hospital Fudan University, Neurology Shanghai China
| | - Ken S Butcher
- The University of New South Wales, Neurology Sydney NSW Australia
| | - Philip Choi
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Nawaf Yassi
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
- The Walter and Eliza Hall Institute of Medical Research, Population Health and Immunity Division Parkville Australia
| | - Darshan Shah
- Gold Coast University Hospital, Neurology Southport Queensland Australia
| | - Gagan Sharma
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
| | - Deep Pujara
- University Hospitals Cleveland Medical Center Cleveland OH USA
| | - Faris Shaker
- UTHealth McGovern Medical School, Neurosurgery Houston TX USA
| | | | - Helen Dewey
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne Heidelberg VIC AUS
| | - Clark W Sitton
- UTHealth McGovern Medical School, Diagnostic and Interventional Imaging Houston TX USA
| | - Geoffrey A Donnan
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
| | - Peter J Mitchell
- The Royal Melbourne Hospital University of Melbourne, Radiology Parkville Victoria Australia
| | - Bernard Yan
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
| | - James G Grotta
- Memorial Hermann – Texas Medical Center, Neurology Houston TX USA
| | - Gregory W. Albers
- Stanford University Medical Center, Neurology and Neurological Sciences Stanford CA USA
| | - Stephen M Davis
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
| | - Bruce Campbell
- The Melbourne Brain Centre, The Royal Melbourne Hospital University of Melbourne, Neurology Parkville Victoria Australia
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Ng FC, Churilov L, Yassi N, Kleinig TJ, Thijs V, Wu TY, Shah DG, Dewey HM, Sharma G, Desmond PM, Yan B, Parsons MW, Donnan GA, Davis SM, Mitchell PJ, Leigh R, Campbell BCV. Reduced Severity of Tissue Injury Within the Infarct May Partially Mediate the Benefit of Reperfusion in Ischemic Stroke. Stroke 2022; 53:1915-1923. [PMID: 35135319 DOI: 10.1161/strokeaha.121.036670] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging data suggest tissue within the infarct lesion is not homogenously damaged following ischemic stroke but has a gradient of injury. Using blood-brain-barrier (BBB) disruption as a marker of tissue injury, we tested whether therapeutic reperfusion improves clinical outcome by reducing the severity of tissue injury within the infarct in patients with ischemic stroke. METHODS In a pooled analysis of patients treated for anterior circulation large vessel occlusion in the EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) and EXTEND-IA part-2 (Determining the Optimal Dose of Tenecteplase Before Endovascular Therapy for Ischaemic Stroke) trials, post-treatment BBB permeability at 24 hours was calculated based on the extent of T1-brightening by extravascular gadolinium on T2* perfusion-weighted imaging and measured within the diffusion-weighted-imaging lesion. First, to determine the clinical significance of BBB disruption as a marker of severity of tissue injury, we examined the association between post-treatment BBB permeability and functional outcome. Second, we performed an exploratory (reperfusion, BBB permeability, functional outcome) mediation analysis to estimate the proportion of the reperfusion-outcome relationship that is mediated by change in BBB permeability. RESULTS In the 238 patients analyzed, an increased BBB permeability measured within the infarct at 24 hours was associated with a reduced likelihood of favorable outcome (90-day modified Rankin Scale score of ≤2) after adjusting for age, baseline National Institutes of Health Stroke Scale, premorbid modified Rankin Scale, infarct topography, laterality, thrombolytic agent, sex, parenchymal hematoma, and follow-up infarct volume (adjusted odds ratio, 0.86 [95% CI, 0.75-0.98], P=0.023). Mediation analysis suggested reducing the severity of tissue injury (as estimated by BBB permeability) accounts for 18.2% of the association between reperfusion and favorable outcome, as indicated by a reduction in the regression coefficient of reperfusion after addition of BBB permeability as a covariate. CONCLUSIONS In patients with ischemic stroke, reduced severity of tissue injury within the infarct, as determined by assessing the integrity of the BBB, is independently associated with improved functional outcome. In addition to reducing diffusion-weighted imaging-defined infarct volume, reperfusion may also improve clinical outcome by reducing tissue injury severity within the infarct.
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Affiliation(s)
- Felix C Ng
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.).,Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia (F.C.N., V.T.)
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.).,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. (L.C., V.T., B.C.V.C.).,Melbourne Medical School, The University of Melbourne, Heidelberg, Victoria, Australia (L.C.)
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.).,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Australia (T.J.K.)
| | - Vincent Thijs
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. (L.C., V.T., B.C.V.C.).,Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia (F.C.N., V.T.)
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, New Zealand (T.Y.W.)
| | - Darshan G Shah
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia (D.G.S.)
| | - Helen M Dewey
- Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Australia (H.M.D.)
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.)
| | - Patricia M Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (P.M.D., B.Y., P.J.M.)
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.).,Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (P.M.D., B.Y., P.J.M.)
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.)
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.)
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (P.M.D., B.Y., P.J.M.)
| | - Richard Leigh
- Department of Neurology, John Hopkins University, Baltimore, MD (R.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (F.C.N., L.C., N.Y., G.S., B.Y., M.W.P., G.A.S., S.M.D., B.C.V.C.).,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. (L.C., V.T., B.C.V.C.)
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Yogendrakumar V, churilov L, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu TY, Shah D, Dewey HM, Wijeratne T, Yan B, Sharma G, Desmond P, Parsons M, Donnan GA, Davis S, Campbell B. Abstract 44: Safety Of Tenecteplase And Alteplase In Tandem Lesion Stroke: A Pooled Analysis Of The Extend-IA TNK Trials. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.44] [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
Introduction:
The efficacy of tenecteplase (TNK) in patients with tandem lesions (TL) in the anterior circulation is unknown. The longer half-life of TNK could potentially lead to increased hemorrhage, especially in patients who require stenting of the extracranial internal carotid artery (eICA) and subsequent antiplatelet therapy. We assessed the efficacy and safety of TNK in a pooled analysis of the EXTEND-IA TNK trials.
Methods:
We compared the treatment effect of TNK (pooled analysis of 0.25 and 0.40mg/kg dosing) with alteplase (tPA), stratifying for TL presence. A TL was defined as a combination of eICA pathology (ipsilateral stenosis >70% or occlusion) and intracranial LVO. Outcomes evaluated include 90-day mRS, intracranial reperfusion at initial angiographic assessment, mortality, ICH (symptomatic [sICH] and parenchymal hematoma [PH]). Treatment effect was adjusted for baseline NIHSS, age, and time from symptom onset to puncture via mixed effects proportional odds and logistic regression models.
Results:
Of 483 patients with an anterior circulation occlusion, 71/483 (15%) patients had a TL and 43/71 (61%) patients required eICA stenting. In TL patients, reperfusion at initial angiographic assessment was observed in 11/56 (20%) of patients treated with TNK vs. 1/15 (7%) patients treated with tPA (aOR:3.71; 95% CI:0.42-32.75). sICH was observed in 4/71(6%) TL vs 7/412 (2%) nonTL patients (p=0.04). Among TL patients, sICH occurred in 4/56 (7%) patients treated with TNK vs 0/15 (0%) tPA treated patients (p=0.57); sICH occurred in 2/40 (5%) of the 0.25mg/kg TNK group and 2/16 (12.5%) of the 0.40mg/kg TNK group. PH was observed in 6/56 (11%) patients treated with TNK vs 0/15 (0%) tPA treated patients (p=0.33). 90-day mRS (TNK median 2 vs. tPA median 4, acOR:1.21; 95% CI:0.42-3.48), mortality (TNK: 5 [9%] vs. tPA: 3 [20%], aOR:0.45; 95% CI:0.08-2.50), and eICA stenting (TNK: 35 [64%] vs. tPA: 8 [57%], p=0.65) rates did not differ between the two treatment groups.
Conclusions:
Although patients with TL in the anterior circulation were at higher risk of hemorrhagic complications, these did not significantly differ between the TNK and tPA groups. A numeric increase in bleeding with TNK was not accompanied by an increase in mortality or worse functional outcome.
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Yogendrakumar V, Wu TY, Churilov L, Tatlisumak T, Strbian D, Jeng JS, Kleinig TJ, Sharma G, Campbell BCV, Zhao H, Hsu CY, Meretoja A, Donnan GA, Davis SM, Yassi N. Does tranexamic acid affect intraventricular hemorrhage growth in acute ICH? An analysis of the STOP-AUST trial. Eur Stroke J 2022; 7:15-19. [DOI: 10.1177/23969873211072402] [Citation(s) in RCA: 1] [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: 09/01/2021] [Accepted: 12/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Trials of tranexamic acid (TXA) in acute intracerebral hemorrhage (ICH) have focused on the imaging outcomes of intraparenchymal hematoma growth. However, intraventricular hemorrhage (IVH) growth is also strongly associated with outcome after ICH. Revised definitions of hematoma expansion incorporating IVH growth have been proposed. Aims We sought to evaluate the effect of TXA on IVH growth. Methods We analyzed data from the STOP-AUST trial, a prospective randomized trial comparing TXA to placebo in ICH patients presenting ≤ 4.5 h from symptom onset with a CT-angiography spot sign. New IVH development at follow-up, any interval IVH growth, and IVH growth ≥ 1 mL were compared between the treatment groups using logistic regression. The treatment effect of TXA against placebo using conventional (> 6 mL or 33%), and revised definitions of hematoma expansion (> 6 mL or 33% or IVH expansion ≥ 1 mL, > 6 mL or 33%, or any IVH expansion, and > 6 mL or 33% or new IVH development) were also assessed. Treatment effects were adjusted for baseline ICH volume. Results The analysis population consisted of 99 patients (50 placebo, 49 TXA). New IVH development at follow-up was observed in 6/49 (12%) who received TXA and 13/50 (26%) who received placebo (aOR: 0.38 [95% CI: 0.13–1.13]). Any interval IVH growth was observed in 12/49 (25%) who received TXA versus 26/50 (32%) receiving placebo (aOR: 0.69 [95% CI: 0.28–1.66]). IVH growth ≥ 1 mL did not differ between the two groups. Using revised definitions of hematoma expansion, no significant difference in treatment effect was observed between TXA and placebo. Conclusions IVH may be attenuated by TXA following ICH; however, studies with larger cohorts are required to investigate this further. Registration http://www.clinicaltrials.gov ; Unique identifier: NCT01702636.
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Affiliation(s)
- Vignan Yogendrakumar
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Leonid Churilov
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gagan Sharma
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Bruce CV Campbell
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Henry Zhao
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Geoffrey A Donnan
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M Davis
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Nawaf Yassi
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
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Bala M, Sharma A, Sharma G. Spatial Variation of Trace Metals between Industrial and Rural Dwelling Birds of India. NEPT 2021. [DOI: 10.46488/nept.2021.v20i05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A large quantity of trace metals has been continuously polluting the environment as a result of increasing urbanization and industrial processes. In 2016-2017, the metal (Cd, Cu, Cr, Ni, Pb, and Zn) levels were determined in fecal pellets of Blue Rock Pigeon (Columba livia) at Bais Godam (industrial location) in Jaipur and Chittora (rural location) in Rajasthan, India. Fecal pellets in industrial regions which are under higher anthropogenic influence exhibited higher metal concentrations when compared with the fecal pellets of the same species in rural area which have minimal anthropogenic input, with statistically significant industrial-rural differences in the metal concentrations except for Ni. Results obtained in this study, as well as the comparison with literature data, indicated that concentrations of Cr and Cu were high in fecal pellets of Blue Rock Pigeon in the industrial region of the present study. Furthermore, many significant correlations were also observed between metal levels in the industrial region which could be attributed to a similar source. Moreover, contamination levels of pigeon excrement serve as one of the most compelling indicators in terrestrial systems for the monitoring of metal pollution levels.
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Sharma G, Anthal S, Deshmukh MB, Mohire PP, Bhosale TR, Sudarsanakumar C, Kant R. Synthesis and Crystal Structure Analysis of 3,3'-[(3-Sulfanyl Phenyl)Methylene]Bis(4-Hydroxy-2H-1-Benzopyran-2-One) : 5-Methyl-1,3-Thiazol-2(3H)-Imine. CRYSTALLOGR REP+ 2021. [DOI: 10.1134/s1063774521070166] [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: 11/23/2022]
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Yassi N, Zhao H, Churilov L, Campbell BCV, Wu T, Ma H, Cheung A, Kleinig T, Brown H, Choi P, Jeng JS, Ranta A, Wang HK, Cloud GC, Grimley R, Shah D, Spratt N, Cho DY, Mahawish K, Sanders L, Worthington J, Clissold B, Meretoja A, Yogendrakumar V, Ton MD, Dang DP, Phuong NTM, Nguyen HT, Hsu CY, Sharma G, Mitchell PJ, Yan B, Parsons MW, Levi C, Donnan GA, Davis SM. Tranexamic acid for intracerebral haemorrhage within 2 hours of onset: protocol of a phase II randomised placebo-controlled double-blind multicentre trial. Stroke Vasc Neurol 2021; 7:158-165. [PMID: 34848566 PMCID: PMC9067256 DOI: 10.1136/svn-2021-001070] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Rationale Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth. Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework. Hypothesis In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. Sample size estimates A sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients. Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo. Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours, defined as either ≥33% relative increase or ≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan. Discussion We describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments.
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Affiliation(s)
- Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Henry Zhao
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Henry Ma
- Department of Neurology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Andrew Cheung
- Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Helen Brown
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Philip Choi
- Department of Neurology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| | - Jiann-Shing Jeng
- Stroke Centre and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Annemarei Ranta
- Department of Medicine, Dunedin School of Medicine, University of Otago, Wellington, New Zealand
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, Yanchao, Kaohsiung, Taiwan
| | - Geoffrey C Cloud
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Rohan Grimley
- Department of Medicine, Sunshine Coast University Hospital, Nambour, Queensland, Australia
| | - Darshan Shah
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Neil Spratt
- Department of Neurology, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Karim Mahawish
- Department of Internal Medicine, Palmerston North Hospital, Palmerston North, New Zealand
| | - Lauren Sanders
- Department of Neurology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - John Worthington
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ben Clissold
- Department of Neurology, Geelong Hospital, Geelong, Victoria, Australia
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Vignan Yogendrakumar
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
| | - Duc Phuc Dang
- Stroke Department, 103 Military Hospital, Hanoi, Hanoi, Viet Nam
| | | | - Huy-Thang Nguyen
- Department of Cerebrovascular Disease, 115 Hospital, Ho Chi Minh City, Viet Nam
| | - Chung Y Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Sydney, New South Wales, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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Bivard A, Churilov L, Ma H, Levi C, Campbell B, Yassi N, Meretoja A, Zhao H, Sharma G, Chen C, Davis S, Donnan G, Yan B, Parsons M. Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging. CNS Neurosci Ther 2021; 28:139-144. [PMID: 34786868 PMCID: PMC8673699 DOI: 10.1111/cns.13756] [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: 08/21/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022] Open
Abstract
Aims We reprocessed the Extending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND) perfusion imaging with a different automated software with the aim of comparing mismatch eligibility and outcomes. Methods EXTEND baseline perfusion imaging data were reprocessed using autoMIStar software to identify patients who were eligible based on the same target mismatch criteria as per the original trial. Results From the 225 patients fulfilling RAPID‐based mismatch criteria randomized in the EXTEND study, 196 (87%) patients met the revised mismatch criteria. Most common reasons for not meeting revised criteria were core >70 ml (n = 9), and no perfusion lesion/lack of penumbral tissue (n = 20). The revised perfusion lesion volumes were significantly smaller compared to the original RAPID volumes (median 68 ml IQR 34–102 ml vs. 42 ml 16–92 ml, p = 0.036). Of the patients who met the revised mismatch criteria, 40% receiving alteplase had modified Rankin Scale (mRS) 0–1 at 3‐month compared to 28% with placebo (Adjusted Odds Ratio (OR) = 2.23, CI 1.08–4.58, p = 0.028). In contrast, in the original mismatch cohort, 35% receiving alteplase had mRS 0–1 at 3‐month compared to 30% with placebo (adjusted OR = 1.88, p = 0.056). Conclusions These data reinforce the benefit of alteplase in the later time window, and suggest that differences in automated perfusion imaging software outputs may be clinically relevant.
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Affiliation(s)
- Andrew Bivard
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Henry Ma
- Department of Medicine, School of Clinical Science, Monash University, Clayton, VIC, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Atte Meretoja
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Henry Zhao
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Chushuang Chen
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Stephen Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Geoffrey Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Mark Parsons
- Department of Neurology Liverpool Hospital, Ingham Institute of Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, NSW, Australia
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Ng FC, Churilov L, Yassi N, Kleinig TJ, Thijs V, Wu TY, Shah D, Dewey HM, Sharma G, Desmond PM, Yan B, Parsons MW, Donnan GA, Davis SM, Mitchell PJ, Campbell BC. Association between pre-treatment perfusion profile and cerebral edema after reperfusion therapies in ischemic stroke. J Cereb Blood Flow Metab 2021; 41:2887-2896. [PMID: 33993795 PMCID: PMC8756469 DOI: 10.1177/0271678x211017696] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between reperfusion and edema is unclear, with experimental and clinical data yielding conflicting results. We investigated whether the extent of salvageable and irreversibly-injured tissue at baseline influenced the effect of therapeutic reperfusion on cerebral edema. In a pooled analysis of 415 patients with anterior circulation large vessel occlusion from the Tenecteplase-versus-Alteplase-before-Endovascular-Therapy-for-Ischemic-Stroke (EXTEND-IA TNK) part 1 and 2 trials, associations between core and mismatch volume on pre-treatment CT-Perfusion with cerebral edema at 24-hours, and their interactions with reperfusion were tested. Core volume was associated with increased edema (p < 0.001) with no significant interaction with reperfusion (p = 0.82). In comparison, a significant interaction between reperfusion and mismatch volume (p = 0.03) was observed: Mismatch volume was associated with increased edema in the absence of reperfusion (p = 0.009) but not with reperfusion (p = 0.27). When mismatch volume was dichotomized at the median (102 ml), reperfusion was associated with reduced edema in patients with large mismatch volume (p < 0.001) but not with smaller mismatch volume (p = 0.35). The effect of reperfusion on edema may be variable and dependent on the physiological state of the cerebral tissue. In patients with small to moderate ischemic core volume, the benefit of reperfusion in reducing edema is related to penumbral salvage.
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Affiliation(s)
- Felix C Ng
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Vincent Thijs
- Department of Neurology, Austin Hospital, Austin Health, Heidelberg, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Darshan Shah
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Helen M Dewey
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Eastern Health and Eastern Health Clinical School, Department of Neurosciences, Monash University, Clayton, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Patricia M Desmond
- Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Peter J Mitchell
- Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Bruce Cv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
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Arora K, Sharma G. What Makes Our Medical Laboratory Workforce Unique? Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.253] [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: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
A career in the medical laboratory requires advanced education and technical training. To assist both employers and employees, several government organizations conduct demographic, education, and wage surveys for the general U.S. labor market. Through its workforce surveys, the American Society of Clinical Pathology (ASCP) does the same for the medical laboratory professions. Our aim was to compare the findings of these surveys and identify similarities and dissimilarities between the general labor pool and the medical laboratory workforce.
Methods/Case Report
Since the 2021 ASCP Wage survey is currently open, we reviewed the findings described in ASCP’s 2019 Wage Survey of Medical Laboratories in the United States (Am J Clin Pathol 2021;155:649-673) with the publicly available information (for 2019) on demographics, educational attainment, and average hourly earnings available on the websites of U.S. Bureau of Labor Statistics (www.bls.gov) as well as United States Census (www.census.gov).
Results (if a Case Study enter NA)
In 2019, the male: female ratio was 52.9:47.1 in general labor pool and 19.1:80.9 in the medical laboratory workforce. The average age of a worker in the general labor pool was 41.9 years and was 42 years in the medical laboratory workforce. The average hourly earnings were $27.99/hour in the general labor pool and ranged from $16.64/hour (phlebotomists) to $53.95/hour (pathologists assistants) in the medical laboratory workforce, with the MLS/MT/CLS earning $30.02/hour to $52.53/hour. While 33.1% adults in the U.S. have attained a bachelor’s degree or above, 73.79% have attained this in the medical laboratory workforce.
Conclusion
Compared to the general labor pool, the medical laboratory workforce is a highly educated workforce and has a higher participation by women. The average worker age and average hourly wage are comparable. We encourage laboratorians to participate in ASCP surveys since such surveys reveal data that can drive better prospects for the medical laboratory workforce.
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Affiliation(s)
- K Arora
- PATHOLOGY AND LABORATORY MEDICINE, HENRY FORD HOSPITAL, Farmington Hills, Michigan, UNITED STATES
| | - G Sharma
- PATHOLOGY AND LABORATORY MEDICINE, HENRY FORD HOSPITAL, Farmington Hills, Michigan, UNITED STATES
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41
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Castle B, Vonlinsowe E, Cook B, Hayward J, Sharma G. POC Programs: A Brief Survey on Critical Value Thresholds, Instrumentation, Repeat Testing, and Training Documentation. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.070] [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: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Across the United States, Point of Care (POC) programs oversee glucometer testing and are often expected to enforce thresholds for critical values, as well as provide guidance on repeat testing. Additionally, POC must track training and ongoing competency assessments of glucometer operators. Our aim was to survey POC across North America to capture the current state of variation in these POC functions, and identify opportunities for standardization.
Methods/Case Report
In July of 2021, an online survey was created on www.surveymonkey.com and distributed via the POC listserv of the American Association for Clinical Chemistry (AACC). The survey listed nine questions regarding instrumentation, threshold levels for critical-high and critical-low, policies on repeat testing, and practices around documentation and record retention.
Results (if a Case Study enter NA)
Of the 63 responses received, almost all (95.2%, n=60) indicated that their institution defines glucometer critical value thresholds. Of these, the most common threshold for critical-high was 400 mg/dL (44.4%, n=28) and for critical-low was 50 mg/dL (39.7%, n=25). A majority (55.5%, n=35) of programs require repeat testing of results that exceeded critical limits. The most popular POC result management software (50.8%, n=32) was RALS (Abbott Diagnostics, Chicago, IL) and the most popular glucometer (56%, n=23) was Roche Accu- Chek Inform II (Roche Diagnostics, Basel, Switzerland). Regarding institutions that disclosed training and competency documentation practices (93.7%, n=59), a majority (57.6%, n=34) used online-only storage, followed by hybrid online- paper storage (32.2%, n=19), and paper-only storage (10.2%, n=6).
Conclusion
Our brief survey has uncovered variations and insights that should raise queries on the feasibility of standardized critical value thresholds, as well as uniform recommendations for retesting critical values. We observed widespread adoption of middleware, as well as online record-keeping. We hope that our findings will trigger further discussions and follow-up studies by other researchers in the POC field.
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Affiliation(s)
- B Castle
- Pathology, Henry Ford Health System, Detroit, Michigan, UNITED STATES
| | - E Vonlinsowe
- Pathology, Henry Ford Health System, Detroit, Michigan, UNITED STATES
| | - B Cook
- Pathology, Henry Ford Health System, Detroit, Michigan, UNITED STATES
| | - J Hayward
- Pathology, Henry Ford Health System, Detroit, Michigan, UNITED STATES
| | - G Sharma
- Pathology, Henry Ford Health System, Detroit, Michigan, UNITED STATES
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Tan Z, Parsons M, Bivard A, Sharma G, Mitchell P, Dowling R, Bush S, Xu A, Yan B. Optimal Tissue Reperfusion Estimation by Computed Tomography Perfusion Post-Thrombectomy in Acute Ischemic Stroke. Stroke 2021; 52:e760-e763. [PMID: 34670411 DOI: 10.1161/strokeaha.121.034581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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 Modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b is defined as successful reperfusion. However, mTICI has rarely been correlated with dynamic perfusion imaging postendovascular therapy for acute stroke. We aimed to study the proportion of tissue optimal reperfusion (TOR) postendovascular therapy across different grades of mTICI. METHODS We conducted a single-center retrospective analysis of patients with acute ischemic strokes who had endovascular therapy between 2018 and 2019. Computer tomography perfusion or magnetic resonance perfusion was performed before and after endovascular therapy. Tmax+6 volume reduction of >90% was defined as TOR. Comparisons of proportions of TOR in different grades of mTICI were performed. In the present study, the requirement for informed consents was waived. RESULTS Eighty-two patients were included. The difference in the proportion of TOR for TICI categories was statistically significant (mTICI score 0, 0%, mTICI score 2A, 0%, mTICI score 2b, 50.0%, mTICI score 2c, 80.0%, mTICI score 3, 81.3%, χ2=14.035, P=0.003). Multivariable logistic regression showed that lower age (odds ratio, 0.932, P=0.017), onset-to-tissue-type plasminogen activator time (odds ratio, 0.980, P=0.005) and TOR (odds ratio, 8.764, P=0.031) were associated with favorable functional outcome. CONCLUSIONS The proportion of TOR achieved by mTICI score of 2b was significantly lower than mTICI score of 2c and mTICI score of 3. TOR was associated with favorable functional outcome, and the degree of reperfusion was more strongly correlated with outcomes than the mTICI scores.
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Affiliation(s)
- Zefeng Tan
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.).,Department of Neurology, Shun De Hospital of Jinan University, Guangzhou, Guangdong, China (Z.T.).,Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Mark Parsons
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Andrew Bivard
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Gagan Sharma
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.)
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Richard Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Steven Bush
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
| | - Anding Xu
- Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China (Z.T., A.X.)
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Australia (Z.T., M.P., A.B., G.S., B.Y.).,Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Australia (P.M., R.D., S.B., B.Y.)
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Visser MJ, Yang JYM, Calamante F, Kean M, Adamson CL, Sharma G, Anderson V, Campbell BCV, Mackay MT. Automated Perfusion-Diffusion Magnetic Resonance Imaging in Childhood Arterial Ischemic Stroke. Stroke 2021; 52:3296-3304. [PMID: 34404238 DOI: 10.1161/strokeaha.120.032822] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Melissa J Visser
- Brain and Mind (M.J.V., V.A.), Murdoch Children's Research Institute, Parkville, Australia.,Melbourne School of Psychological Sciences (M.J.V., V.A.), University of Melbourne, Parkville, Australia
| | - Joseph Yuan-Mou Yang
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia.,Developmental Imaging (J.Y.-M.Y., C.L.A.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia.,Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery (J.Y.-M.Y.), Royal Children's Hospital, Parkville, Australia
| | - Fernando Calamante
- The University of Sydney, Sydney Imaging and School of Biomedical Engineering, Australia (F.C.)
| | - Michael Kean
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia
| | - Christopher L Adamson
- Developmental Imaging (J.Y.-M.Y., C.L.A.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Electrical and Electronic Engineering (C.L.A.), University of Melbourne, Parkville, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (G.S., B.C.V.C.), University of Melbourne, Parkville, Australia
| | - Vicki Anderson
- Brain and Mind (M.J.V., V.A.), Murdoch Children's Research Institute, Parkville, Australia.,Melbourne School of Psychological Sciences (M.J.V., V.A.), University of Melbourne, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (G.S., B.C.V.C.), University of Melbourne, Parkville, Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Australia (B.C.V.C.)
| | - Mark T Mackay
- Neuroscience Research (J.Y.-M.Y., M.K., M.T.M.), Murdoch Children's Research Institute, Parkville, Australia.,Department of Pediatrics (J.Y.-M.Y., V.A., M.T.M.), University of Melbourne, Parkville, Australia.,Department of Neurology (M.T.M.), Royal Children's Hospital, Parkville, Australia
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44
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Sharma G, Braga CB, Chen KE, Jia X, Ramanujam V, Collins BM, Rittner R, Mobli M. Structural basis for the binding of the cancer targeting scorpion toxin, ClTx, to the vascular endothelia growth factor receptor neuropilin-1. Curr Res Struct Biol 2021; 3:179-186. [PMID: 34401749 PMCID: PMC8358460 DOI: 10.1016/j.crstbi.2021.07.003] [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: 05/19/2021] [Revised: 06/23/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Chlorotoxin (ClTx) is a 36-residue disulfide-rich peptide isolated from the venom of the scorpion Leiurus quinquestriatus. This peptide has been shown to selectively bind to brain tumours (gliomas), however, with conflicting reports regarding its direct cellular target. Recently, the vascular endothelial growth factor receptor, neuropilin-1 (NRP1) has emerged as a potential target of the peptide. Here, we sought to characterize the details of the binding of ClTx to the b1-domain of NRP1 (NRP1-b1) using solution state nuclear magnetic resonance (NMR) spectroscopy. The 3D structure of the isotope labelled peptide was solved using multidimensional heteronuclear NMR spectroscopy to produce a well-resolved structural ensemble. The structure points to three putative protein-protein interaction interfaces, two basic patches (R14/K15/K23 and R25/K27/R36) and a hydrophobic patch (F6/T7/T8/H10). The NRP1-b1 binding interface of ClTx was elucidated using 15N chemical shift mapping and included the R25/K27/R36 region of the peptide. The thermodynamics of binding was determined using isothermal titration calorimetry (ITC). In both NMR and ITC measurements, the binding was shown to be competitive with a known NRP1-b1 inhibitor. Finally, combining all of this data we generate a model of the ClTx:NRP1-b1 complex. The data shows that the peptide binds to the same region of NRP1 that is used by the SARS-CoV-2 virus for cell entry, however, via a non-canonical binding mode. Our results provide evidence for a non-standard NRP1 binding motif, while also providing a basis for further engineering of ClTx to generate peptides with improved NRP1 binding for future biomedical applications. Structural details of the binding of the scorpion toxin, chlorotoxin (ClTx) to the VEGF receptor neuropilin-1 (NRP1). ClTx was produced in its native fold and isotope labelled using a new, high-yield, bacterial expression system. Multidimensional heteronuclear NMR experiments reveal the high-resolution structure of ClTx and its binding to NRP1. ClTx binds to NRP1 via a non-canonical primary sequence that satisfies the receptor binding motif through its tertiary fold.
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Affiliation(s)
- Gagan Sharma
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, Australia
| | - Carolyne B. Braga
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, Australia
- Chemistry Institute, University of Campinas, P.O. Box 6154, 13083-970, Campinas, SP, Brazil
| | - Kai-En Chen
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Xinying Jia
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, Australia
| | | | - Brett M. Collins
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Roberto Rittner
- Chemistry Institute, University of Campinas, P.O. Box 6154, 13083-970, Campinas, SP, Brazil
| | - Mehdi Mobli
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, Australia
- Corresponding author.
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45
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Ng FC, Yassi N, Sharma G, Brown SB, Goyal M, Majoie CBLM, Jovin TG, Hill MD, Muir KW, Saver JL, Guillemin F, Demchuk AM, Menon BK, San Roman L, Liebeskind DS, White P, Dippel DWJ, Davalos A, Bracard S, Mitchell PJ, Wald MJ, Davis SM, Sheth KN, Kimberly WT, Campbell BCV. Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis. Stroke 2021; 52:3450-3458. [PMID: 34384229 DOI: 10.1161/strokeaha.120.033246] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline. METHODS In a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5. Risk of bias was assessed using the Cochrane tool. RESULTS Among 1764 patients, 177 presented with large hemispheric infarction. Thrombectomy and reperfusion were associated with functional improvement (thrombectomy common odds ratio =2.30 [95% CI, 1.32-4.00]; reperfusion common odds ratio =4.73 [95% CI, 1.66-13.52]) but not MLS (thrombectomy β=-0.27 [95% CI, -1.52 to 0.98]; reperfusion β=-0.78 [95% CI, -3.07 to 1.50]) when adjusting for age, National Institutes of Health Stroke Score, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume >130 mL or CT-Alberta Stroke Program Early CT Score ≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and National Institutes of Health Stroke Score (β=2.76 [95% CI, 0.33-5.20]) but not functional improvement (odds ratio, 1.71 [95% CI, 0.24-12.08]). CONCLUSIONS In patients presenting with large hemispheric infarction, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130 mL) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.
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Affiliation(s)
- Felix C Ng
- Department of Medicine and Neurology, Melbourne Brain Centre (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Department of Neurology, Austin Health, Heidelberg, Australia (F.C.N.)
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research. Parkville, Australia (N.Y.)
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | | | - Mayank Goyal
- Department of Radiology (M.G.), University of Calgary, Foothills Hospital, AB, Canada
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, the Netherlands (C.B.L.M.M.)
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Health Care, Camden, NJ (T.G.J.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine (M.D.H., A.M.D., B.K.M.), University of Calgary, Foothills Hospital, AB, Canada
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California, Los Angeles
- Stanford Stroke Center, Stanford University, CA (J.L.S.)
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology INSERM 1433, University of Lorraine, University Hospital of Nancy, France (F.G.)
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine (M.D.H., A.M.D., B.K.M.), University of Calgary, Foothills Hospital, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine (M.D.H., A.M.D., B.K.M.), University of Calgary, Foothills Hospital, AB, Canada
| | - Luis San Roman
- Department of Radiology, Hospital Clínic, Barcelona, Spain (L.S.R.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology (D.S.L.), University of California, Los Angeles
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (D.W.J.D.)
| | - Antoni Davalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (A.D.)
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, INSERM U 947, University of Lorraine and University Hospital of Nancy, France (S.B.)
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | | | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Kevin N Sheth
- Department of Neurology, Yale-New Haven Hospital, CT (K.N.S.)
| | - W Taylor Kimberly
- Centre for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Boston (W.T.K.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre (F.C.N., N.Y., G.S., S.M.D., B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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Pang H, Wong YS, Yip B, Hung A, Chu W, Lai K, Zheng YP, Chung T, Sharma G, Cheng J, Lam TP. Using ultrasound for screening scoliosis to reduce unnecessary radiographic radiation - a prospective diagnostic accuracy study on 442 schoolchildren. Stud Health Technol Inform 2021; 280:106-108. [PMID: 34190069 DOI: 10.3233/shti210445] [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] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children. Scoliosis screening programs frequently include the protocol of referring children screened positive with Scoliometer and Moiré Topography for confirmatory standard radiography. Despite being highly sensitive (88%) for detecting those who require specialist referral, the screening program was found to have more than 50% false positive rate that leads to unnecessary radiation exposure. Radiation-free ultrasound has been reported to be reliable for quantitative assessment of scoliosis curves. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the referral status for children initially screened positive for scoliosis. 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6° were recruited. Using x-ray as the gold standard, the sensitivity and specificity of ultrasound in predicting the correct referral status were 92.3% and 51.6% respectively. ROC curve analysis revealed an area under curve of 0.735 for ultrasound alone and 0.832 for ultrasound plus scoliometer measurement. The finding provided strong evidences on the accuracy of ultrasound in determining the referral status that could result in more than 50% reduction of unnecessary radiation exposure for children undergoing scoliosis screening.
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Affiliation(s)
- H Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Y S Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Bhk Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Alh Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wcw Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
| | - Kkl Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - Y P Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - Twh Chung
- Student Health Service, Department of Health, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - G Sharma
- Student Health Service, Department of Health, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jcy Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Balkrishna A, Mittal R, Sharma G, Arya V. Computational insights of phytochemical-driven disruption of RNA-dependent RNA polymerase-mediated replication of coronavirus: a strategic treatment plan against coronavirus disease 2019. New Microbes New Infect 2021; 41:100878. [PMID: 33815808 PMCID: PMC8010343 DOI: 10.1016/j.nmni.2021.100878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/19/2020] [Revised: 12/16/2020] [Accepted: 03/28/2021] [Indexed: 01/21/2023] Open
Abstract
The current pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised global health concerns. RNA-dependent RNA polymerase (RdRp) is the prime component of viral replication/proliferation machinery and is considered to be a potential drug target against SARS-CoV-2. The present study investigated the anti-RdRp activity of phytochemicals against SARS-CoV-2 infection. Virtual ligand screening was carried out to determine the potent compounds against RdRp. Molecular docking and an MD Simulation study were employed to evaluate the spatial affinity of selected phytochemicals for the active sites of RdRp. Structural stability of target compounds was determined using root mean square deviation computational analysis and drug-like abilities were investigated using ADMET. Bond distances between ligand and receptor were marked to predict the strength of interaction. Aloe, azadirachtin, columbin, cirsilineol, nimbiol, nimbocinol and sage exhibited the highest binding affinities and interacted with active sites of RdRp, surpassing the ability of chloroquine, lamivudine, favipiravir and remdesivir to target the same. All the natural metabolites exhibited stable conformation during MD Simulation of 101 ns at 310 K. Kinetic, potential and electrostatic energy were observed to be least in the case of natural metabolites in comparison with synthetic analogues. Deviations and fluctuations were observed to be structurally least in target phytochemicals. Physiochemical and biological properties of these compounds further validated their drug-like properties. Non-bonded distance was found to be short enough to form hydrogen bonding or hydrophobic interactions, which revealed that these target compounds can strongly bind with RdRp. The study found potential phytochemicals to disrupt the replication domain of SARS-CoV-2 by hindering RdRp. We therefore anticipate that the current findings could be considered as valuable for the development of an efficient preventive/therapeutic expedient against COVID-19.
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Affiliation(s)
- A. Balkrishna
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar, India
| | - R. Mittal
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar, India
| | - G. Sharma
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar, India
| | - V. Arya
- Patanjali Herbal Research Department, Patanjali Research Institute, Haridwar, India
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Rahman J, Charalambous A, Aled L, Leonard X, Parsons C, Cole G, Sharma G, Skuse K, Tran M. From the lecture theatre to your digital device: Reflections on the production of educational podcasts within undergraduate psychiatry training. Eur Psychiatry 2021. [PMCID: PMC9480439 DOI: 10.1192/j.eurpsy.2021.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionThe COVID-19 pandemic has highlighted a need for engaging online resources to enrich psychiatry training for undergraduate medical students. Podcasting is a well-established digital communication platform utilised daily in a myriad of capacities, including education. A group of medical students were tasked with creating their own educational podcasts covering specific aspects of psychiatry.ObjectivesEach pair was set a sub-topic of psychiatry and utilised software to produce educational resources. The objective of this project was to reflect upon production as well as explore the efficacy of podcasting as a tool within undergraduate training.MethodsThe medical students conducted research and contacted experts within the field to contribute to their podcasts. The majority of the students then conducted reviews of the literature surrounding podcasting within medical education, which informed the production of their own podcasts. From this, it was discussed how this project could impact future practice, and indicated that podcasts may become crucial asynchronous learning tools in medical education.ResultsLiterature review and first-hand experience of podcast production enabled the students to appreciate the advantages of podcasting and the potential for its widespread future applications. Their wider reading revealed that podcast-using study participants outperformed or matched their peers in assessments, and overwhelmingly enjoyed using podcasts over traditional teaching methods.ConclusionsThe use of podcasting can complement traditional psychiatry training and appeal to a generation of digital natives that prefer this learning style. Podcast production is also an excellent revision method, highlighting the advantages of peer-to-peer education in both learning and increasing engagement with psychiatry.DisclosureNo significant relationships.
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Chakraborty C, Sharma AR, Mallick B, Bhattacharya M, Sharma G, Lee SS. Evaluation of molecular interaction, physicochemical parameters and conserved pattern of SARS-CoV-2 Spike RBD and hACE2: in silico and molecular dynamics approach. Eur Rev Med Pharmacol Sci 2021; 25:1708-1723. [PMID: 33629340 DOI: 10.26355/eurrev_202102_24881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Recent pandemic virus SARS-CoV-2 is a global warning for the healthcare system. The spike protein of virus SARS-CoV-2 is significant because of two reasons. Firstly, the spike protein of this virus binds with the human ACE2 (hACE2) receptor. Secondly, it has several antigenic regions that might be targeted for vaccine development. However, the structural analytical data for the spike protein of this virus is not available. MATERIALS AND METHODS Here, we performed an analysis to understand the structural two subunits of S glycoprotein (S gp) of SARS-CoV-2. Further, an analysis of secondary structure components and the tertiary structure analysis of RBD was carried out. We also performed molecular interaction analysis between S gp of this virus and hACE2 as well as between SARS-CoV S gp and hACE2 to compare the binding properties of these two viruses. RESULTS We noted that the molecular interaction of SARS-CoV-2 S gp and hACE2 form eleven hydrogen bonds, while the molecular interaction of SARS-CoV S gp and hACE2 receptor form seven hydrogen bonds, indicating that the molecular interaction of SARS-CoV-2 S gp and hACE2 receptor is more stable than SARS-CoV S gp and hACE2 receptor. The pairwise sequence alignment of S gp SARS-CoV and SARS-CoV-2 shows several conserved residues of these two proteins. Besides, conserved pattern analysis of SARS-CoV-2 S gp and hACE2 revealed the presence of several highly conserved regions for these two proteins. The molecular dynamics simulation shows a stable interplay between SARS-CoV-2 S gp with the hACE2 receptor. CONCLUSIONS The present study might help determine the SARS-CoV-2 virus entrance mechanism into the human cell. Moreover, the understanding of the conserved regions may help in the process of therapeutic development from the infection of the deadly virus.
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Affiliation(s)
- C Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal, India.
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Kaur R, Kumari A, Sharma G, Singh D, Kaur R. Biodegradation of endocrine disrupting chemicals benzyl butyl phthalate and dimethyl phthalate by Bacillus marisflavi RR014. J Appl Microbiol 2021; 131:1274-1288. [PMID: 33599367 DOI: 10.1111/jam.15045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 11/27/2022]
Abstract
AIM The objectives of the present study were to explore the benzyl butyl phthalate (BBP) and dimethyl phthalate (DMP) degradation potential of Bacillus marisflavi RR014 isolated from the tap water of public toilet and also to optimize the phthalates degradation process using response surface methodology. METHODS AND RESULTS The minimal salt medium was used for the biodegradation analysis of phthalates. The quantification of phthalates and their intermediate metabolites identification were done by using UHPLC and LC-MS/MS respectively. The results revealed that B. marisflavi RR014 is capable of degrading both the phthalates under varying pH, temperature and salinity conditions. The formation of phthalic acid from the breakdown of BBP and DMP (500 mg l-1 ) in the medium was observed after 24 h. After 72 h, 61% of BBP and 98·9% of DMP in the medium was degraded as monitored by UHPLC. The identification of intermediate metabolites by LC-MS/MS revealed that hydrolysis of BBP and DMP produces phthalic acid. CONCLUSIONS The degradation rate of both the phthalates was increased as the parameters increased up to an optimum level. The three environmental factors (pH, temperature and salt concentration) strongly affect the rate of degradation of both the phthalates. The maximum degradation rate for both the phthalates was achieved at pH 7, temperature 35°C and salt concentration of 1% as observed from the central composite experimental design. SIGNIFICANCE AND IMPACT OF THE STUDY It is the first report on the phthalates biodegradation potential of B. marisflavi RR014 isolated from the tap water of public toilet. The bacterium is capable of degrading BBP and DMP under varying pH, temperature and salinity, therefore, ideal to treat the phthalate contaminated environments.
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Affiliation(s)
- R Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - A Kumari
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - G Sharma
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - D Singh
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India
| | - R Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
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