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1. Basilar artery occlusion management: Specialist perspectives from an international survey

Author

Edwards, C, Drumm, B, Siegler, JE, Schonewille, WJ, Klein, P, Huo, X, Chen, Y, Abdalkader, M, Qureshi, MM, Strbian, D, Liu, X, Hu, W, Ji, X, Li, C, Fischer, U, Nagel, S, Puetz, V, Michel, P, Alemseged, F, Sacco, S, Yamagami, H, Yaghi, S, Strambo, D, Kristoffersen, ES, Sandset, EC, Mikulik, R, Tsivgoulis, G, Masoud, HE, de Sousa, DA, Marto, JP, Lobotesis, K, Roi, D, Berberich, A, Demeestere, J, Meinel, TR, Rivera, R, Poli, S, Ton, MD, Zhu, Y, Li, F, Sang, H, Thomalla, G, Parsons, M, Campbell, BCV, Zaidat, OO, Chen, H-S, Field, TS, Raymond, J, Kaesmacher, J, Nogueira, RG, Jovin, TG, Sun, D, Liu, R, Qureshi, AI, Qiu, Z, Miao, Z, Banerjee, S, Nguyen, TN, Edwards, C, Drumm, B, Siegler, JE, Schonewille, WJ, Klein, P, Huo, X, Chen, Y, Abdalkader, M, Qureshi, MM, Strbian, D, Liu, X, Hu, W, Ji, X, Li, C, Fischer, U, Nagel, S, Puetz, V, Michel, P, Alemseged, F, Sacco, S, Yamagami, H, Yaghi, S, Strambo, D, Kristoffersen, ES, Sandset, EC, Mikulik, R, Tsivgoulis, G, Masoud, HE, de Sousa, DA, Marto, JP, Lobotesis, K, Roi, D, Berberich, A, Demeestere, J, Meinel, TR, Rivera, R, Poli, S, Ton, MD, Zhu, Y, Li, F, Sang, H, Thomalla, G, Parsons, M, Campbell, BCV, Zaidat, OO, Chen, H-S, Field, TS, Raymond, J, Kaesmacher, J, Nogueira, RG, Jovin, TG, Sun, D, Liu, R, Qureshi, AI, Qiu, Z, Miao, Z, Banerjee, S, and Nguyen, TN

Abstract

BACKGROUND AND PURPOSE: Two early basilar artery occlusion (BAO) randomized controlled trials did not establish the superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to EVT versus medical management may differ between clinician specialties. METHODS: We conducted an international survey (January 18, 2022 to March 31, 2022) regarding management strategies in acute BAO prior to the announcement of two trials indicating the superiority of EVT, and compared responses between interventionalists (INTs) and non-interventionalists (nINTs). Selection practices for routine EVT and perceptions of equipoise regarding randomizing to medical management based on neuroimaging and clinical features were compared between the two groups using descriptive statistics. RESULTS: Among the 1245 respondents (nINTs = 702), INTs more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p < .01). A similar proportion of INTs and nINTs responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific clinical circumstances (p = .45). Among respondents who would recommend EVT for BAO, there was no difference in the maximum prestroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p > .05), although nINTs more commonly preferred perfusion imaging (24.2% vs. 19.7%, p = .04). Among respondents who indicated they would randomize to medical management, INTs were more likely to randomize when the National Institutes of Health Stroke Scale was ≥10 (15.9% vs. 6.9%, p < .01). CONCLUSIONS: Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a BAO patient

Published
2023

2. SARS-CoV-2 and Stroke Characteristics A Report From the Multinational COVID-19 Stroke Study Group

Author

Shahjouei, S, Tsivgoulis, G, Farahmand, G, Koza, E, Mowla, A, Sadr, AV, Kia, A, Far, AV, Mondello, S, Cernigliaro, A, Ranta, A, Punter, M, Khodadadi, F, Naderi, S, Sabra, M, Ramezani, M, Harandi, AA, Olulana, O, Chaudhary, D, Lyoubi, A, Campbell, BC, Arenillas, JF, Bock, D, Montaner, J, Neshin, SAS, de Sousa, DA, Tenser, MS, Aires, A, Alfonso, MDL, Alizada, O, Azevedo, E, Goyal, N, Babaeepour, Z, Banihashemi, G, Bonati, LH, Cereda, CW, Chang, JJ, Crnjakovic, M, De Marchis, GM, Del Sette, M, Ebrahimzadeh, SA, Farhoudi, M, Gandoglia, I, Goncalves, B, Griessenauer, CJ, Hanci, MM, Katsanos, AH, Krogias, C, Leker, RR, Lotman, L, Mai, J, Male, S, Malhotra, K, Malojcic, B, Mesquita, T, Ghasemi, AM, Aref, HM, Afshar, ZM, Moon, J, Niemela, M, Jahromi, BR, Nolan, L, Pandhi, A, Park, J-H, Marto, JP, Purroy, F, Ranji-Burachaloo, S, Carreira, NR, Requena, M, Rubiera, M, Sajedi, SA, Sargento-Freitas, J, Sharma, VK, Steiner, T, Tempro, K, Turc, G, Ahmadzadeh, Y, Almasi-Dooghaee, M, Assarzadegan, F, Babazadeh, A, Baharvandat, H, Cardoso, FB, Dev, A, Ghorbani, M, Hamidi, A, Hasheminejad, ZS, Komachali, SH-A, Khorvash, F, Kobeissy, F, Mirkarimi, H, Mohammadi-Vosough, E, Misra, D, Noorian, AR, Nowrouzi-Sohrabi, P, Paybast, S, Poorsaadat, L, Roozbeh, M, Sabayan, B, Salehizadeh, S, Saberi, A, Sepehrnia, M, Vahabizad, F, Yasuda, TA, Ghabaee, M, Rahimian, N, Harirchian, MH, Borhani-Haghighi, A, Azarpazhooh, MR, Arora, R, Ansari, S, Avula, V, Li, J, Abedi, V, Zand, R, Shahjouei, S, Tsivgoulis, G, Farahmand, G, Koza, E, Mowla, A, Sadr, AV, Kia, A, Far, AV, Mondello, S, Cernigliaro, A, Ranta, A, Punter, M, Khodadadi, F, Naderi, S, Sabra, M, Ramezani, M, Harandi, AA, Olulana, O, Chaudhary, D, Lyoubi, A, Campbell, BC, Arenillas, JF, Bock, D, Montaner, J, Neshin, SAS, de Sousa, DA, Tenser, MS, Aires, A, Alfonso, MDL, Alizada, O, Azevedo, E, Goyal, N, Babaeepour, Z, Banihashemi, G, Bonati, LH, Cereda, CW, Chang, JJ, Crnjakovic, M, De Marchis, GM, Del Sette, M, Ebrahimzadeh, SA, Farhoudi, M, Gandoglia, I, Goncalves, B, Griessenauer, CJ, Hanci, MM, Katsanos, AH, Krogias, C, Leker, RR, Lotman, L, Mai, J, Male, S, Malhotra, K, Malojcic, B, Mesquita, T, Ghasemi, AM, Aref, HM, Afshar, ZM, Moon, J, Niemela, M, Jahromi, BR, Nolan, L, Pandhi, A, Park, J-H, Marto, JP, Purroy, F, Ranji-Burachaloo, S, Carreira, NR, Requena, M, Rubiera, M, Sajedi, SA, Sargento-Freitas, J, Sharma, VK, Steiner, T, Tempro, K, Turc, G, Ahmadzadeh, Y, Almasi-Dooghaee, M, Assarzadegan, F, Babazadeh, A, Baharvandat, H, Cardoso, FB, Dev, A, Ghorbani, M, Hamidi, A, Hasheminejad, ZS, Komachali, SH-A, Khorvash, F, Kobeissy, F, Mirkarimi, H, Mohammadi-Vosough, E, Misra, D, Noorian, AR, Nowrouzi-Sohrabi, P, Paybast, S, Poorsaadat, L, Roozbeh, M, Sabayan, B, Salehizadeh, S, Saberi, A, Sepehrnia, M, Vahabizad, F, Yasuda, TA, Ghabaee, M, Rahimian, N, Harirchian, MH, Borhani-Haghighi, A, Azarpazhooh, MR, Arora, R, Ansari, S, Avula, V, Li, J, Abedi, V, and Zand, R

Abstract

[Figure: see text].

Published
2021

3. Global Outcome Assessment Life-long after stroke in young adults initiative-the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

Author

Ekker, MS, Jacob, MA, van Dongen, MME, Aarnio, K, Annamalai, AK, Arauz, A, Arnold, M, Barboza, MA, Bolognese, M, Brouns, R, Chuluun, B, Chuluunbaatar, E, Dagvajantsan, B, Debette, S, Don, A, Enzinger, C, Ekizoglu, E, Fandler-Hoefler, S, Fazekas, F, Fromm, A, Gattringer, T, Gulli, G, Hoffmann, M, Hora, TF, Jern, C, Jood, K, Kamouchi, M, Kim, YS, Kitazono, T, Kittner, SJ, Kleinig, TJ, Klijn, CJM, Korv, J, Lee, T-H, Leys, D, Maaijwee, NAM, Martinez-Majander, N, Marto, JP, Mehndiratta, MM, Mifsud, V, Montanaro, VV, Owolabi, MO, Patel, VB, Phillips, MC, Piechowski-Iozwiak, B, Pikula, A, Luis Ruiz-Sandoval, J, Sarnowski, B, Schreuder, FHBM, Swartz, RH, Tan, KS, Tanne, D, Tatlisumak, T, Thijs, V, Tuladhar, AM, Viana-Baptista, M, Vibo, R, Wu, TY, Yesilot, N, Waje-Andreassen, U, Pezzini, A, Putaala, J, de Leeuw, F-E, Ekker, MS, Jacob, MA, van Dongen, MME, Aarnio, K, Annamalai, AK, Arauz, A, Arnold, M, Barboza, MA, Bolognese, M, Brouns, R, Chuluun, B, Chuluunbaatar, E, Dagvajantsan, B, Debette, S, Don, A, Enzinger, C, Ekizoglu, E, Fandler-Hoefler, S, Fazekas, F, Fromm, A, Gattringer, T, Gulli, G, Hoffmann, M, Hora, TF, Jern, C, Jood, K, Kamouchi, M, Kim, YS, Kitazono, T, Kittner, SJ, Kleinig, TJ, Klijn, CJM, Korv, J, Lee, T-H, Leys, D, Maaijwee, NAM, Martinez-Majander, N, Marto, JP, Mehndiratta, MM, Mifsud, V, Montanaro, VV, Owolabi, MO, Patel, VB, Phillips, MC, Piechowski-Iozwiak, B, Pikula, A, Luis Ruiz-Sandoval, J, Sarnowski, B, Schreuder, FHBM, Swartz, RH, Tan, KS, Tanne, D, Tatlisumak, T, Thijs, V, Tuladhar, AM, Viana-Baptista, M, Vibo, R, Wu, TY, Yesilot, N, Waje-Andreassen, U, Pezzini, A, Putaala, J, and de Leeuw, F-E

Abstract

INTRODUCTION: Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients. METHODS AND ANALYSIS: The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence. ETHICS AND DISSEMINATION: Ethical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

Published
2019

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