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Siegler JE, Shaikh H, Khalife J, Oak S, Zhang L, Abdalkader M, Klein P, Nguyen TN, Kass‐Hout T, Morsi RZ, Heit JJ, Regenhardt RW, Diestro JDB, Cancelliere NM, Ghozy S, Sweid A, Naamani KE, Amllay A, Meyer L, Dusart A, Bellante F, Forestier G, Rouchaud A, Saleme S, Mounayer C, Fiehler J, Kühn AL, Puri AS, Dyzmann C, Kan PT, Colasurdo M, Marnat G, Berge J, Barreau X, Sibon I, Nedelcu S, Henninger N, Marotta TR, Das AS, Stapleton CJ, Rabinov JD, Ota T, Dofuku S, Yeo LL, Tan BY, Martinez‐Gutierrez JC, Salazar‐Marioni S, Sheth SA, Renieri L, Capirossi C, Mowla A, Tjoumakaris SI, Jabbour P, Khandelwal P, Biswas A, Clarençon F, Elhorany M, Premat K, Valente I, Pedicelli A, Filipe JP, Varela R, Quintero‐Consuegra M, Gonzalez NR, Möhlenbruch MA, Jesser J, Costalat V, Schiphorst AT, Yedavalli V, Harker P, Chervak LM, Aziz Y, Bullrich MB, Sposato L, Gory B, Hecker C, Killer‐Oberpfalzer M, Griessenauer CJ, Thomas AJ, Hsieh C, Liebeskind DS, Radu RA, Alexandre AM, Tancredi I, Faizy TD, Fahed R, Weyland C, Patel AB, Pereira VM, Lubicz B, Guenego A, Dmytriw AA. Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis. SVIN 2023. [DOI: 10.1161/svin.123.000931] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND
For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry.
METHODS
Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups.
RESULTS
Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9;
P
<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11;
P
=0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%;
P
=0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98];
P
=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09];
P
=0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18];
P
=0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models.
CONCLUSION
In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.
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Sim JJL, Ling RR, Neo VSQ, Tan FL, Djohan AH, Yeo LL, Chan KA, Lim Y, Tan BY, Yeo TC, Chan MY, Poh KK, Kong WK, Yip JW, Chong YF, Sharma VK, Kuntjoro I, Sia CH. The Impact of Cognitive Impairment on Clinical Outcomes After Transcatheter Aortic Valve Implantation (from a Systematic Review and Meta-Analysis). Am J Cardiol 2022; 185:63-70. [DOI: 10.1016/j.amjcard.2022.09.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 12/13/2022]
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Li TY, Sia CH, Chan BP, Ho JS, Leow AS, Chan MY, Kojodjojo P, Galupo MJ, Teoh HL, Sharma VK, Seet RC, Yeo LL, Tan BYQ. Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios Are Associated with Recurrent Ischemic Stroke in Patients with Embolic Stroke of Undetermined Source. J Stroke 2022; 24:421-424. [PMID: 36221946 PMCID: PMC9561212 DOI: 10.5853/jos.2022.00486] [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: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tony Y.W. Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Correspondence: Ching-Hui Sia Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, 119228, Singapore Tel: +65-6779-5555 Fax: +65-6872-2998 E-mail:
| | - Bernard P.L. Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jamie S.Y. Ho
- Academic Foundation Year Program, Royal Free Hospital NHS Trust, London, UK
| | - Aloysius S. Leow
- Department of Medicine, National University Health System, Singapore
| | - Mark Y. Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mary Joyce Galupo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Raymond C.S. Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L.L. Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Benjamin Yong-Qiang Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
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4
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Ng TP, Wong C, Leong ELE, Tan BY, Chan MYY, Yeo LL, Yeo TC, Wong RC, Leow AS, Ho JSY, Sia CH. Simultaneous cardio-cerebral infarction: a meta-analysis. QJM 2022; 115:374-380. [PMID: 34051098 DOI: 10.1093/qjmed/hcab158] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/23/2021] [Revised: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/INTRODUCTION Cardio-cerebral infarction (CCI), which involves the simultaneous occurrence of acute ischaemic stroke and acute myocardial infarction, has a reported incidence of 0.0009%. Treatment of CCI presents a dilemma to physicians as both conditions are time critical. Despite the need for standardized treatment protocols, published data are sparse. AIM We aimed to summarize the reported cardio-cerebral infarction cases in the literature. DESIGN Meta-analysis. METHODS Four databases, Pubmed, Embase, Scopus and Google Scholar were searched until 25 August 2020. A title and abstract sieve, full-text review and extraction of data were conducted independently by three authors. RESULTS A total of 44 cases of CCI were identified from 37 case reports and series; 15 patients (34.1%) were treated using percutaneous coronary intervention (PCI) with stent, 8 patients (18.2%) were treated with a PCI without stent, 10 patients (22.7%) were treated via a cerebral vessel thrombectomy and 8 patients (18.2%) were treated via a thrombectomy of a coronary vessel. For medications, 20 patients (45.5%) were treated with thrombolytics, 10 patients (22.7%) were treated with anticoagulants, 8 patients (18.2%) were treated with antiplatelets and 11 patients (25.0%) were treated with anticoagulants and antiplatelets. Of 44 patients, 10 patients died, and 9 of those were due to cardiac causes. Among the 44 patients, days to death was observed to be a median of 2.0 days (interquartile range (IQR): 1.5, 4.0). The modified Rankin Score was measured in nine patients, with a median score of 2.0 (IQR: 1.0, 2.5) being reported. DISCUSSION/CONCLUSION The condition of CCI has substantial morbidity and mortality, and further studies are needed to examine the optimal diagnostic and treatment strategies of these patients.
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Affiliation(s)
- T P Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - E L E Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10 , 119228, Singapore
| | - B Y Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road , NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - M Y-Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - T-C Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - R C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road , 119074, Singapore
| | - A S Leow
- Internal Medicine Residency, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - J S-Y Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK
| | - C-H Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore , 5 Lower Kent Ridge Road, 119074, Singapore
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Tharmaraja T, Ho JS, Sia CH, Lim NA, Chong YF, Lim AY, Rathakrishnan RR, Yeo LL, Sharma VK, Tan BY. Sodium-glucose cotransporter 2 inhibitors and neurological disorders: a scoping review. Ther Adv Chronic Dis 2022; 13:20406223221086996. [PMID: 35432846 PMCID: PMC9006360 DOI: 10.1177/20406223221086996] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of antidiabetic medications with a favourable cardiovascular, renal and overall safety profile. Given the limited treatment options available for neurological disorders, it is important to determine whether the pleiotropic effects of SGLT2i can be utilised in their prevention and management. Methods All articles published before 20 March 2021 were systematically searched in MEDLINE, EMBASE, Scopus, Web of Science, APA PsycINFO and ClinicalTrials.gov. Overall, 1395 titles were screened, ultimately resulting in 160 articles being included in the qualitative analysis. Screening and data extraction were conducted by two independent authors and studies were excluded if they were not an original research study. Findings Of the 160 studies, 134 addressed stroke, 19 cognitive impairment, 4 epilepsy and 4 movement disorders, encompassing a range from systematic reviews and randomised controlled trials to bioinformatic and animal studies. Most animal studies demonstrated significant improvements in behavioural and neurological deficits, which were reflected in beneficial changes in neurovascular units, synaptogenesis, neurotransmitter levels and target receptors' docking energies. The evidence from the minority clinical literature was conflicting and many studies did not reach statistical significance. Interpretation SGLT2i may exert neurological benefits through three mechanisms: reduction in cardiovascular risk factors, augmentation of ketogenesis and anti-inflammatory pathways. Most clinical studies were observational, meaning that a causal relationship could not be established, while randomised controlled trials were heterogeneous and powered to detect cardiovascular or renal outcomes. We suggest that a longitudinal study should be conducted and specifically powered to detect neurological outcomes.
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Affiliation(s)
- Thahesh Tharmaraja
- Intensive Care Unit, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamie S.Y. Ho
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Amanda Y.L. Lim
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
| | - Rahul R. Rathakrishnan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L.L. Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road Level 11, 119228 Singapore
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Benjamin Y.Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
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Siow I, Tan BY, Lee KS, Ong N, Toh E, Gopinathan A, Yang C, Bhogal P, Lam E, Spooner O, Meyer L, Fiehler J, Papanagiotou P, Kastrup A, Alexandrou M, Zubel S, Wu Q, Mpotsaris A, Maus V, Anderson T, Gontu V, Arnberg F, Lee TH, Chan BP, Seet RC, Teoh HL, Sharma VK, Yeo LL. Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion. J Stroke 2022; 24:128-137. [PMID: 35135066 PMCID: PMC8829485 DOI: 10.5853/jos.2021.02082] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.
Methods This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).
Results Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not as Comorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).
Conclusions Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.
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Affiliation(s)
- Isabel Siow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Y.Q. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Keng Siang Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalie Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emma Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Erika Lam
- Stroke Department, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Oliver Spooner
- Stroke Department, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany
| | - Maria Alexandrou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany
| | - Seraphine Zubel
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Qingyu Wu
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Volker Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Tommy Anderson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Vamsi Gontu
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fabian Arnberg
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Tsong Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Bernard P.L. Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Raymond C.S. Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vijay K. Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L.L. Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Correspondence: Leonard L.L. Yeo Division of Neurology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Rd, 119074, Singapore Tel: +65-9061-6139 Fax: +65-6777-8065 E-mail:
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Yeo LL, Bhogal P, Tan BY. Short Cuts to Improve Stroke Outcomes by Prehospital Triage. Stroke 2020; 51:3192-3194. [DOI: 10.1161/strokeaha.120.032486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leonard L.L. Yeo
- Division of neurology, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.)
- Yong Loo Lin School of Medicine, National University of Singapore (L.L.L.Y., B.Y.Q.T.)
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, St. Bartholomew’s and The Royal London Hospital, United Kingdom (P.B.)
| | - Benjamin Y.Q. Tan
- Division of neurology, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.)
- Yong Loo Lin School of Medicine, National University of Singapore (L.L.L.Y., B.Y.Q.T.)
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Yushan B, Tan BY, Ngiam NJ, Chan BP, Luen TH, Sharma VK, Sia CH, Dalakoti M, Chong SS, Kojodjojo P, Yeo LL. Association between Bilateral Infarcts Pattern and Detection of Occult Atrial Fibrillation in Embolic Stroke of Undetermined Source (ESUS) Patients with Insertable Cardiac Monitor (ICM). J Stroke Cerebrovasc Dis 2019; 28:2448-2452. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/09/2019] [Accepted: 06/22/2019] [Indexed: 01/09/2023] Open
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9
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Teng RS, Tan BY, Miny S, Syn NL, Ho AF, Ngiam NJ, Yeo LL, Choong AM, Sharma VK. Effect of Pretreatment Blood Pressure on Outcomes in Thrombolysed Acute Ischemic Stroke Patients: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2019; 28:906-919. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/16/2018] [Accepted: 12/08/2018] [Indexed: 11/26/2022] Open
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10
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Sharma VK, Tan BY, Sim MY, Kulkarni A, Seow PA, Hong CS, Du Z, Wong LY, Chen J, Chee EY, Ng BS, Low Y, Ngiam NJ, Yeo LL, Teoh HL, Paliwal PR, Rathakrishnan R, Sinha AK, Chan BP, Butcher K, Anderson CS. Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients. Medicine (Baltimore) 2018; 97:e12721. [PMID: 30290680 PMCID: PMC6200458 DOI: 10.1097/md.0000000000012721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND RATIONALE Uncertainty persists over the optimal management of blood pressure (BP) in the early phase of acute ischemic stroke (AIS). This study aims to determine the safety and effects of intensive BP lowering on cerebral blood flow (CBF) and functional in AIS patients treated with intravenous thrombolysis. METHODS In a randomized controlled trial, 54 thrombolysed AIS patients with a systolic BP of 160 to 180 mm Hg will be randomized to early intensive BP lowering (systolic target range 140-160 mm Hg) or guideline-based BP management (systolic range 160-180 mm Hg) during first 72-hours using primarily intravenous labetalol. We hypothesize that early intensive BP lowering will not reduce CBF by 20% and/or increase the volume of hypoperfused tissue by >20% on computed tomographic perfusion. Clinical outcome will be assessed using a dichotomized modified Rankin scale (scores 0-1 as excellent outcome vs scores 2-6 as dead or dependent) at 90 days. Other outcome would be symptomatic intracerebral hemorrhage. The trial is registered at ClinicalTrials.gov, NCT03443596. CONCLUSION This randomized study will provide important information about the physiological effects of BP reduction on cerebral perfusion after intravenous thrombolysis in AIS.
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Affiliation(s)
- Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Health System
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Benjamin Y.Q. Tan
- Division of Neurology, Department of Medicine, National University Health System
| | - M. Ying Sim
- Division of Neurology, Department of Medicine, National University Health System
| | - Amit Kulkarni
- Division of Neurology, Department of Medicine, National University Health System
| | - Philip A. Seow
- Division of Neurology, Department of Medicine, National University Health System
| | - Chiew S. Hong
- Division of Neurology, Department of Medicine, National University Health System
| | - Zhengdao Du
- Division of Neurology, Department of Medicine, National University Health System
| | - Lily Y.H. Wong
- Division of Neurology, Department of Medicine, National University Health System
| | - Jintao Chen
- Division of Neurology, Department of Medicine, National University Health System
| | - Elaine Y.H. Chee
- Division of Neurology, Department of Medicine, National University Health System
| | - Bridget S.M. Ng
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Yingliang Low
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Nicholas J.H. Ngiam
- Division of Neurology, Department of Medicine, National University Health System
| | - Leonard L.L. Yeo
- Division of Neurology, Department of Medicine, National University Health System
| | - Hock L. Teoh
- Division of Neurology, Department of Medicine, National University Health System
| | - Prakash R. Paliwal
- Division of Neurology, Department of Medicine, National University Health System
| | - Rahul Rathakrishnan
- Division of Neurology, Department of Medicine, National University Health System
| | - Arvind K. Sinha
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Bernard P.L. Chan
- Division of Neurology, Department of Medicine, National University Health System
| | | | - Craig S. Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
- The George Institute China at Peking University Health Science Center, Beijing, PR China
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Tan BY, Ngiam NJ, Sunny S, Kong WY, Tam H, Sim TB, Leong BS, Bhartendu C, Paliwal PR, Seet RC, Chan BP, Teoh HL, Sharma VK, Yeo LL. Improvement in Door-to-Needle Time in Patients with Acute Ischemic Stroke via a Simple Stroke Activation Protocol. J Stroke Cerebrovasc Dis 2018; 27:1539-1545. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/30/2017] [Accepted: 01/01/2018] [Indexed: 12/26/2022] Open
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Paliwal P, Kazmi F, Teoh HL, Yeo LL, Seet RC, Yeo TT, Sein L, Chou N, Tan T, Chan BP, Sharma VK. Early Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction in Asian Patients: A Single-Center Study. World Neurosurg 2018; 111:e722-e728. [DOI: 10.1016/j.wneu.2017.12.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
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Yeo LL, Holmin S, Andersson T, Lundström E, Gopinathan A, Lim EL, Leong BS, Kuan WS, Ting E, Tan BY, Eide SE, Tay EL. Nongated Cardiac Computed Tomographic Angiograms for Detection of Embolic Sources in Acute Ischemic Stroke. Stroke 2017; 48:1256-1261. [DOI: 10.1161/strokeaha.117.016903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We assessed the feasibility of obtaining diagnostic quality images of the heart and thoracic aorta by extending the
z
axis coverage of a non–ECG-gated computed tomographic angiogram performed in the primary evaluation of acute stroke without increasing the contrast dose.
Methods—
Twenty consecutive patients with acute ischemic stroke within the 4.5 hours of symptom onset were prospectively recruited. We increased the longitudinal coverage to the domes of the diaphragm to include the heart. Contrast administration (Omnipaque 350) remained unchanged (injected at 3–4 mL/s; total 60–80 mL, triggered by bolus tracking). Images of the heart and aorta, reconstructed at 5 mm slice thickness in 3 orthogonal planes, were read by a radiologist and cardiologist, findings conveyed to the treating neurologist, and correlated with the transthoracic or transesophageal echocardiogram performed within the next 24 hours.
Results—
Of 20 patients studied, 3 (15%) had abnormal findings: a left ventricular thrombus, a Stanford type A aortic dissection, and a thrombus of the left atrial appendage. Both thrombi were confirmed by transesophageal echocardiography, and anticoagulation was started urgently the following day. None of the patients developed contrast-induced nephropathy on follow-up. The radiation dose was slightly increased from a mean of 4.26 mSV (range, 3.88–4.70 mSV) to 5.17 (range, 3.95 to 6.25 mSV).
Conclusions—
Including the heart and ascending aorta in a routine non–ECG-gated computed tomographic angiogram enhances an existing imaging modality, with no increased incidence of contrast-induced nephropathy and minimal increase in radiation dose. This may help in the detection of high-risk cardiac and aortic sources of embolism in acute stroke patients.
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Affiliation(s)
- Leonard L.L. Yeo
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Staffan Holmin
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Tommy Andersson
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Erik Lundström
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Anil Gopinathan
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Er Luen Lim
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Benjamin S.H. Leong
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Win Sen Kuan
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Eric Ting
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Benjamin Y.Q. Tan
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Sterling Ellis Eide
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
| | - Edgar L.K. Tay
- From the Division of Neurology, Department of Medicine, National University Health System, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Clinical Neuroscience (S.H., T.A., E.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology (S.H., T.A.) and Department of Neurology (E.L.), Karolinska University Hospital, Stockholm, Sweden; Department of Diagnostic Imaging (A.G., E.T., S.E.E.) and Emergency Medicine Department (E.L.L., B.S.H.L., W.S.K.), National University Hospital, National
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Paliwal P, Wakerley BR, Yeo LL, Ali KM, Ibrahim I, Wilder-Smith E, Sim TB, Pohlmann-Eden B, Rathakrishnan R. Early electroencephalography in patients with Emergency Room diagnoses of suspected new-onset seizures: Diagnostic yield and impact on clinical decision-making. Seizure 2015; 31:22-6. [DOI: 10.1016/j.seizure.2015.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/03/2015] [Accepted: 06/23/2015] [Indexed: 11/15/2022] Open
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