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107. Modelling the Long-Term Health Outcome and Costs of Thrombectomy in Treating Stroke Patients with Large Ischaemic Core: Comparison between Clinical Trials and Real-World Data.

Author

Gao, Lan, Moodie, Marj, Levi, Christopher, Lin, Longting, Cheng, Xin, Kleinig, Timothy, Butcher, Ken, Yan, Bernard, Bivard, Andrew, and Parsons, Mark

Subjects
STROKE patients, STROKE units, CLINICAL trials, MEDICAL care costs, QUALITY-adjusted life years, NURSING home care
Abstract

Introduction: We aimed to assess the long-term health outcomes and costs of endovascular thrombectomy (EVT) using clinical trials and real-world evidence in patients with large ischaemic core. Methods: Both clinical trials and the INternational Stroke Perfusion Imaging REgistry (INSPIRE) were used. Patients with acute computed tomography perfusion scan with an ischaemic core of ≥70 mL were included. A Markov model was constructed to simulate the long-term costs and health outcomes (quality-adjusted life year) post-index stroke. Effectiveness of EVT (modified Rankin scale score at 3 months) was derived from the trials and INSPIRE registry (compared to matched patients not treated with EVT), respectively. Results: Based on the trial and real-world data, the overall results revealed varied health benefits and costs due to EVT, with reduced health benefits and increased costs from EVT treatment in everyday practice. The long-term simulation estimated that offering EVT to large vessel occlusion stroke patients with large ischaemic core was associated with greater benefits (1.12 vs. 0.25 quality-adjusted life year gains) and lower (−A$19,320) or higher costs (A$11,278), using trial and real-world data, respectively. The incremental cost of the EVT procedure (i.e., A$14,356) could be primarily offset to a different extent by the reduction in costs related to the nursing home care (−$31,986 vs. −A$1,874) in the clinical trial and real-world practice. Conclusions: Our results highlight the potential gaps when implementing an effective intervention in the real world and the importance of the rigorous selection of large infarct core patients for EVT. [ABSTRACT FROM AUTHOR]

Published
2023
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108. Endovascular thrombectomy for acute ischaemic stroke improves and maintains function in the very elderly: A multicentre propensity score matched analysis.

Author

Dunphy, Harriette, Garcia-Esperon, Carlos, Beom Hong, Jae, Manoczki, Csilla, Wilson, Duncan, Lim Alvin Chew, Beng, Beharry, James, Bivard, Andrew, Hasnain, Md Golam, Krauss, Martin, Collecutt, Wayne, Miteff, Ferdi, Spratt, Neil, Parsons, Mark W, Alan Barber, Peter, Ranta, Annemarei, Fink, John N, and Wu, Teddy Y

Published
2023
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110. Automated CT Perfusion Detection of the Acute Infarct Core in Ischemic Stroke: A Systematic Review and Meta-Analysis.

Author

Lim, Nicholas E., Chia, Benjamin, Bulsara, Max K., Parsons, Mark, Hankey, Graeme J., and Bivard, Andrew

Subjects
ISCHEMIC stroke, STROKE patients, CEREBRAL circulation, LACUNAR stroke, PERFUSION
Abstract

Introduction: In patients with acute ischemic stroke, the location and volume of an irreversible infarct core determine prognosis and treatment. We aimed to determine if automated CT perfusion (CTP) is non-inferior to diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) in predicting the acute infarct core. Methods: In this systematic review and meta-analysis, we searched MEDLINE and EMBASE from 1960 to December 2020. Five outcome measures were examined: volumetric difference, volumetric correlation, sensitivity and specificity at the patient level, Dice coefficient, and sensitivity and specificity at the voxel level. A random-effects meta-analysis was performed for volumetric difference and correlation. Results: From 3,986 studies retrieved, 48 studies met our inclusion criteria with 46 studies on anterior circulation, one study on posterior circulation, and one study on lacunar infarct strokes. In anterior circulation stroke, there were no significant mean volumetric differences between CTP and acute DWI (cerebral blood flow [CBF] 0.52 mL, 95% CI [−0.07, 1.11], I2 0.0%; relative CBF [rCBF] 3.01 mL, 95% CI [−0.46, 6.48], I2 82.6%; relative cerebral blood volume [rCBV] −12.84 mL, 95% CI [−38.56, 12.88], I2 96.2%) and between CTP and delayed DWI or FLAIR (rCBF −1.29 mL, 95% CI [−6.49, 3.92], I2 91.8%; rCBV −5.80 mL, 95% CI [−16.20, 4.60], I2 84.2%). Mean correlation between CTP and acute DWI was 0.90 (95% CI [0.80, 0.95], I2 60.0%) for rCBF and 0.84 (95% CI [0.58, 0.94], I2 93.5%) for rCBV. Mean correlation between CTP and delayed DWI or FLAIR was 0.74 (95% CI [0.57, 0.85], I2 94.6%) for rCBF and 0.90 (95% CI [0.69, 0.97], I2 93.1%) for rCBV. Sensitivity and specificity at the patient level were reported by three studies and Dice coefficient by four studies. Statistical analysis could not be performed for sensitivity and specificity at the voxel level. Limited evidence was available for posterior circulation or lacunar infarct strokes. Conclusion: Due to significant heterogeneity and insufficient high-quality studies reporting each outcome, there is insufficient evidence to reliably determine the accuracy of CTP prediction of the infarct core compared to DWI or FLAIR. [ABSTRACT FROM AUTHOR]

Published
2023
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113. Abstract 129: Electromagnetic Portable Brain Imaging For Stroke

Author

Dos Santos, Angela, primary, Balabanski, Anna, additional, Cook, David, additional, Crozier, Stuart, additional, Bialkowski, Konstanty, additional, Langenberg, Francesca, additional, Bivard, Andrew, additional, Bishop, Lara, additional, Easton, Damien, additional, Donnan, Geoffrey A, additional, and Davis, Stephen, additional

Published
2022
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114. TACTICS - Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship: evaluating the effectiveness of an ‘implementation intervention’ in providing better patient access to reperfusion therapies: protocol for a non-randomised controlled stepped wedge cluster trial in acute stroke

Author

Ryan, Annika, primary, Paul, Christine L, additional, Cox, Martine, additional, Whalen, Olivia, additional, Bivard, Andrew, additional, Attia, John, additional, Bladin, Christopher, additional, Davis, Stephen M, additional, Campbell, Bruce C V, additional, Parsons, Mark, additional, Grimley, Rohan S, additional, Anderson, Craig, additional, Donnan, Geoffrey A, additional, Oldmeadow, Christopher, additional, Kuhle, Sarah, additional, Walker, Frederick R, additional, Hood, Rebecca J, additional, Maltby, Steven, additional, Keynes, Angela, additional, Delcourt, Candice, additional, Hatchwell, Luke, additional, Malavera, Alejandra, additional, Yang, Qing, additional, Wong, Andrew, additional, Muller, Claire, additional, Sabet, Arman, additional, Garcia-Esperon, Carlos, additional, Brown, Helen, additional, Spratt, Neil, additional, Kleinig, Timothy, additional, Butcher, Ken, additional, and Levi, Christopher R, additional

Published
2022
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115. Bringing CT Scanners to the Skies: Design of a CT Scanner for an Air Mobile Stroke Unit

Author

Kwok, Jun Sheng, primary, Fox, Kate, additional, Bil, Cees, additional, Langenberg, Francesca, additional, Balabanski, Anna H., additional, Santos, Angela Dos, additional, Bivard, Andrew, additional, Gardiner, Fergus, additional, Bladin, Christopher, additional, Parsons, Mark, additional, Zhao, Henry, additional, Coote, Skye, additional, Levi, Christopher, additional, De Aizpurua, Henry, additional, Campbell, Bruce, additional, Davis, Stephen M., additional, Donnan, Geoffrey A., additional, Easton, Damien, additional, and Pang, Toh Yen, additional

Published
2022
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116. Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

Author

Gao, Lan, primary, Bivard, Andrew, additional, Parsons, Mark, additional, Spratt, Neil J., additional, Levi, Christopher, additional, Butcher, Kenneth, additional, Kleinig, Timothy, additional, Yan, Bernard, additional, Dong, Qiang, additional, Cheng, Xin, additional, Lou, Min, additional, Yin, Congguo, additional, Chen, Chushuang, additional, Wang, Peng, additional, Lin, Longting, additional, Choi, Philip, additional, Miteff, Ferdinand, additional, and Moodie, Marj, additional

Published
2021
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117. Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic

Author

Tran, Lucinda, primary, Lin, Longting, additional, Spratt, Neil, additional, Bivard, Andrew, additional, Chew, Beng Lim Alvin, additional, Evans, James W., additional, O'Brien, William, additional, Levi, Christopher, additional, Ang, Timothy, additional, Alanati, Khaled, additional, Pepper, Elizabeth, additional, Garcia-Esperon, Carlos, additional, and Parsons, Mark, additional

Published
2021
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122. Assessing the Relative Value of CT Perfusion Compared to Non-contrast CT and CT Angiography in Prognosticating Reperfusion-Eligible Acute Ischemic Stroke Patients

Author

Bivard, Andrew, primary, Levi, Christopher, additional, Lin, Longting, additional, Cheng, Xin, additional, Aviv, Richard, additional, Spratt, Neil J., additional, Kleinig, Tim, additional, Butcher, Kenneth, additional, Chen, Chushuang, additional, Dong, Qiang, additional, and Parsons, Mark, additional

Published
2021
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123. The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study

Author

Bhaskar, Sonu, Stanwell, Peter, Bivard, Andrew, Spratt, Neil, Walker, Rhonda, Kitsos, Gemma, Parsons, Mark, Evans, Malcolm, Jordan, Louise, Nilsson, Michael, Attia, John, and Levi, Christopher

Subjects
United States. National Institutes of Health -- Analysis, Mortality -- Analysis, Epidemiology -- Analysis, Stroke -- Patient outcomes -- Prognosis -- Analysis, Ischemia -- Patient outcomes -- Prognosis -- Analysis, Health
Abstract

Byline: Sonu. Bhaskar, Peter. Stanwell, Andrew. Bivard, Neil. Spratt, Rhonda. Walker, Gemma. Kitsos, Mark. Parsons, Malcolm. Evans, Louise. Jordan, Michael. Nilsson, John. Attia, Christopher. Levi Background and Purpose: Epidemiological studies [...]

Published
2017

124. Implementation of multimodal computed tomography in a telestroke network: Five‐year experience

Author

Garcia-Esperon, Carlos, Dinkelspiel, Frode Soderhjelm, Miteff, Ferdi, Gangadharan, Shyam, Wellings, Tom, O'Brien, Bill, Evans, James, Lillicrap, Tom, Demeestere, Jelle, Bivard, Andrew, Parsons, Mark, Levi, Chris, Spratt, Neil James, Peake, Rachel, Hughes, James, Dark, Lisa, Ryan, Nick, Shepherd, Matt, Ali, Osama, Wills, James, Minett, Fiona, Birnie, Jaclyn, Buzio, Amanda, Bruce, Iain, Tankel, Alan, Parrey, Kim, Kinchington, Matthew, Pepper, Elizabeth, Loiselle, Andre, Waller, Sophie, Chew, Alvin, Russell, Michelle, Royan, Angela, and Roworth, Brett

Subjects
Male, 0301 basic medicine, Time Factors, medicine.medical_treatment, telestroke, Perfusion scanning, Multimodal Imaging, Cohort Studies, 0302 clinical medicine, PERFUSION, Thrombolytic Therapy, Pharmacology (medical), Pharmacology & Pharmacy, ACUTE ISCHEMIC-STROKE, Prospective Studies, Prospective cohort study, Stroke, Aged, 80 and over, Penumbra, core, Thrombolysis, Middle Aged, Telemedicine, 3. Good health, Psychiatry and Mental health, Female, Original Article, multimodal CT, Radiology, New South Wales, acute stroke therapy, Life Sciences & Biomedicine, CT, medicine.medical_specialty, 03 medical and health sciences, Hematoma, Reperfusion therapy, Physiology (medical), MANAGEMENT, medicine, Humans, TELEMEDICINE, Aged, Retrospective Studies, HEALTH-CARE PROFESSIONALS, THROMBOLYSIS, Pharmacology, Science & Technology, business.industry, Neurosciences, Retrospective cohort study, Original Articles, penumbra, EFFICACY, medicine.disease, 030104 developmental biology, CT perfusion, Neurosciences & Neurology, Tomography, X-Ray Computed, business, 030217 neurology & neurosurgery
Abstract

AIMS: Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. METHODS: Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. RESULTS: A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. CONCLUSION: Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH. ispartof: CNS NEUROSCIENCE & THERAPEUTICS vol:26 issue:3 pages:367-373 ispartof: location:England status: published

Published
2019

127. Whole blood viscosity is associated with baseline cerebral perfusion in acute ischemic stroke

Author

Gyawali, Prajwal, Lillicrap, Thomas Patrick, Tomari, Shinya, Bivard, Andrew, Holliday, Elizabeth, Parsons, Mark, Levi, Christopher, Garcia-Esperon, Carlos, Spratt, Neil, Gyawali, Prajwal, Lillicrap, Thomas Patrick, Tomari, Shinya, Bivard, Andrew, Holliday, Elizabeth, Parsons, Mark, Levi, Christopher, Garcia-Esperon, Carlos, and Spratt, Neil

Abstract

Whole blood viscosity (WBV) is the intrinsic resistance to flow developed due to the frictional force between adjacent layers of flowing blood. Elevated WBV is an independent risk factor for stroke. Poor microcirculation due to elevated WBV can prevent adequate perfusion of the brain and might act as an important secondary factor for hypoperfusion in acute ischaemic stroke. In the present study, we examined the association of WBV with basal cerebral perfusion assessed by CT perfusion in acute ischaemic stroke. Confirmed acute ischemic stroke patients (n = 82) presenting in hours were recruited from the single centre. Patients underwent baseline multimodal CT (non-contrast CT, CT angiography and CT perfusion). Where clinically warranted, patients also underwent follow-up DWI. WBV was measured in duplicate within 2 h after sampling from 5-mL EDTA blood sample. WBV was significantly correlated with CT perfusion parameters such as perfusion lesion volume, ischemic core volume and mismatch ratio; DWI volume and baseline NIHSS. In a multivariate linear regression model, WBV significantly predicted acute perfusion lesion volume, core volume and mismatch ratio after adjusting for the effect of occlusion site and collateral status. Association of WBV with hypoperfusion (increased perfusion lesion volume, ischaemic core volume and mismatch ratio) suggest the role of erythrocyte rheology in cerebral haemodynamic of acute ischemic stroke. The present findings open new possibilities for therapeutic strategies targeting erythrocyte rheology to improve cerebral microcirculation in stroke.

Published
2021

130. Contributors

Author

Ariyannur, Prasanth, primary, Arun, Peethambaran, additional, Arús, Carles, additional, Atkinson, Ian C., additional, Bachtiar, Velicia, additional, Behar, Kevin L., additional, Best, Jonathan G., additional, Bivard, Andrew, additional, Boer, Vincent O., additional, Brawn, Jennifer, additional, Card, Dallas, additional, Cecil, Kim C., additional, Ciccarelli, Olga, additional, De Feyter, Henk M., additional, de Graaf, Robin A., additional, De Stefano, Nicola, additional, Dennis, Andrea, additional, Gant, Nicholas, additional, Giorgio, Antonio, additional, Gruetter, Rolf, additional, Hetherington, Hoby, additional, Hill, Amber Michelle, additional, Juchem, Christoph, additional, Julià-Sapé, Margarida, additional, Klomp, Dennis W.J., additional, Lei, Hongxia, additional, Lin, Joanne C., additional, Majós, Carles, additional, Mlynárik, Vladimír, additional, Moffett, John R., additional, Namboodiri, Aryan M.A., additional, Near, Jamie, additional, Pan, Jullie, additional, Parsons, Mark, additional, Ross, Brian D., additional, Rothman, Douglas L., additional, Shen, Jun, additional, Sibson, Nicola R., additional, Sled, John G., additional, Stagg, Charlotte J., additional, Stanwell, Peter, additional, Taylor, Margot J., additional, Taylor, Matthew, additional, Thulborn, Keith R., additional, Turner, Clare E., additional, Vincent, Katy, additional, and Xin, Lijing, additional

Published
2014
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137. Endovascular Thrombectomy Versus Medical Management in Isolated M2 Occlusions: Pooled Patient‐Level Analysis from the EXTEND‐IA Trials, INSPIRE, and SELECT Studies.

Author

Sarraj, Amrou, Parsons, Mark, Bivard, Andrew, Hassan, Ameer E., Abraham, Michael G., Wu, Teddy, Kleinig, Timothy, Lin, Longting, Chen, Chushuang, Levi, Christopher, Dong, Qiang, Cheng, Xin, Butcher, Ken S., Choi, Philip, Yassi, Nawaf, Shah, Darshan, Sharma, Gagan, Pujara, Deep, Shaker, Faris, and Blackburn, Spiros

Subjects
ENDOVASCULAR surgery, PERFUSION imaging, ODDS ratio, CONFIDENCE intervals
Abstract

Objective: The objective of this study was to evaluate functional and safety outcomes of endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and stroke severity. Methods: In a pooled, patient‐level analysis of 3 randomized controlled trials (EXTEND‐IA, EXTEND‐and IA‐TNK parts 1 and 2) and 2 prospective nonrandomized studies (INSPIRE and SELECT), we evaluated EVT association with 90‐day functional independence (modified Rankin Scale [mRS] = 0–2) in isolated M2 occlusions as compared to medical management overall and in subgroups by mismatch profile status and stroke severity. Results: We included 517 patients (EVT = 195 and MM = 322), baseline median (interquartile range [IQR]) National Institutes of Health Stroke Scale (NIHSS) was 13 (8–19) in EVT versus 10 (6–15) in MM, p < 0.001. Pretreatment ischemic core did not differ (EVT = 10 [0–24] ml vs MM = 9 [3–21] ml, p = 0.59). Compared to MM, EVT was more frequently associated with functional independence (68.3 vs 61.6%, adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 1.25–4.67, p = 0.008, inverse probability of treatment weights [IPTW]‐OR = 1.75, 95% CI = 1.00–3.75, p = 0.05) with a shift toward better mRS outcomes (adjusted cOR = 2.02, 95% CI:1.23–3.29, p = 0.005), and lower mortality (5 vs 10%, aOR = 0.32, 95% CI = 0.12–0.87, p = 0.025). EVT was associated with higher functional independence in patients with a perfusion mismatch profile (EVT = 70.7% vs MM = 61.3%, aOR = 2.29, 95% CI = 1.09–4.79, p = 0.029, IPTW‐OR = 2.02, 1.08–3.78, p = 0.029), whereas no difference was found in those without mismatch (EVT = 43.8% vs MM = 62.7%, p = 0.17, IPTW‐OR: 0.71, 95% CI = 0.18–2.78, p = 0.62). Functional independence was more frequent with EVT in patients with moderate or severe strokes, as defined by baseline NIHSS above any thresholds from 6 to 10, whereas there was no difference between groups with milder strokes below these thresholds. Interpretation: In patients with M2 occlusion, EVT was associated with improved clinical outcomes when compared to MM. This association was primarily observed in patients with a mismatch profile and those with higher stroke severity. ANN NEUROL 2022;91:629–639 [ABSTRACT FROM AUTHOR]

Published
2022
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138. Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?

Author

Lim, Jeremy C., primary, Churilov, Leonid, additional, Bivard, Andrew, additional, Ma, Henry, additional, Dowling, Richard J., additional, Campbell, Bruce C.V., additional, Parsons, Mark W., additional, Davis, Stephen M., additional, Donnan, Geoffrey A., additional, Mitchell, Peter J., additional, and Yan, Bernard, additional

Published
2021
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139. Association of Reperfusion After Thrombolysis With Clinical Outcome Across the 4.5- to 9-Hours and Wake-up Stroke Time Window

Author

Campbell, Bruce C. V., primary, Ma, Henry, additional, Parsons, Mark W., additional, Churilov, Leonid, additional, Yassi, Nawaf, additional, Kleinig, Timothy J., additional, Hsu, Chung Y., additional, Dewey, Helen M., additional, Butcher, Kenneth S., additional, Yan, Bernard, additional, Desmond, Patricia M., additional, Wijeratne, Tissa, additional, Curtze, Sami, additional, Barber, P. Alan, additional, De Silva, Deidre A., additional, Thijs, Vincent, additional, Levi, Christopher R., additional, Bladin, Christopher F., additional, Sharma, Gagan, additional, Bivard, Andrew, additional, Donnan, Geoffrey A., additional, and Davis, Stephen M., additional

Published
2021
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140. What Is the “Optimal” Target Mismatch Criteria for Acute Ischemic Stroke?

Author

Chen, Chushuang, primary, Parsons, Mark W., additional, Levi, Christopher R., additional, Spratt, Neil J., additional, Lin, Longting, additional, Kleinig, Timothy, additional, Butcher, Kenneth, additional, Cheng, Xin, additional, Dong, Qiang, additional, O'Brien, Billy, additional, Avivi, Richard I., additional, Krause, Martin, additional, Sylaja, P. N., additional, Choi, Philip, additional, Bhuta, Sandeep, additional, Yin, Congguo, additional, Yang, Jianhong, additional, Wang, Peng, additional, Qiu, Weiwen, additional, and Bivard, Andrew, additional

Published
2021
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144. Additional file 1 of Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial

Author

Hasnain, Golam, Paul, Christine L., Attia, John R., Ryan, Annika, Kerr, Erin, Oldmeadow, Christopher, D’Este, Catherine A., Bivard, Andrew, Hubbard, Isobel J., Abul Hasnat Milton, and Levi, Christopher R.

Abstract

Additional file 1 : Supplement 1: CONSORT 2010 checklist of information to include when reporting a randomised trial. Supplement 2: Number and percentage of missing values, n (%), for each patient characteristics. Supplement 3: Table comparing the clinical and demographic features of patients with vs without mRS at 90 day. Supplement 4: Odds ratio after multiple imputation between intervention vs control during active and post intervention period. Supplement 5: Within group and between group change after multiple imputation between pre vs. Active and pre vs. post intervention period for the both intervention and control.

Published
2020
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145. Plasmin Generation Potential and Recanalization in Acute Ischaemic Stroke; an Observational Cohort Study of Stroke Biobank Samples

Author

National Health and Medical Research Council (Australia), Lillicrap, Thomas, Keragala, Charithani B., Draxler, Dominik F., Chan, Jilly, Ho, Heidi, Harman, Stevi, Niego, Be'eri, Holliday, Elizabeth, Levi, Christopher R., García-Esperon, Carlos, Spratt, Neil, Gyawali, Prajwal, Bivard, Andrew, Parsons, Michael W., Montaner, Joan, Bustamante, Alejandro, Fernández-Cadenas, Israel, Cloud, Geoffrey, Maguire, Jane, Lincz, Lisa, Kleinig, Timothy, Attia, John, Koblar, Simon, Hamilton-Bruce, Monica Anne, Choi, Philip, Worrall, Bradford B., Medcalf, Robert L., National Health and Medical Research Council (Australia), Lillicrap, Thomas, Keragala, Charithani B., Draxler, Dominik F., Chan, Jilly, Ho, Heidi, Harman, Stevi, Niego, Be'eri, Holliday, Elizabeth, Levi, Christopher R., García-Esperon, Carlos, Spratt, Neil, Gyawali, Prajwal, Bivard, Andrew, Parsons, Michael W., Montaner, Joan, Bustamante, Alejandro, Fernández-Cadenas, Israel, Cloud, Geoffrey, Maguire, Jane, Lincz, Lisa, Kleinig, Timothy, Attia, John, Koblar, Simon, Hamilton-Bruce, Monica Anne, Choi, Philip, Worrall, Bradford B., and Medcalf, Robert L.

Abstract

[Rationale] More than half of patients who receive thrombolysis for acute ischaemic stroke fail to recanalize. Elucidating biological factors which predict recanalization could identify therapeutic targets for increasing thrombolysis success., [Hypothesis] We hypothesize that individual patient plasmin potential, as measured by in vitro response to recombinant tissue-type plasminogen activator (rt-PA), is a biomarker of rt-PA response, and that patients with greater plasmin response are more likely to recanalize early., [Methods] This study will use historical samples from the Barcelona Stroke Thrombolysis Biobank, comprised of 350 pre-thrombolysis plasma samples from ischaemic stroke patients who received serial transcranial-Doppler (TCD) measurements before and after thrombolysis. The plasmin potential of each patient will be measured using the level of plasmin-antiplasmin complex (PAP) generated after in-vitro addition of rt-PA. Levels of antiplasmin, plasminogen, t-PA activity, and PAI-1 activity will also be determined. Association between plasmin potential variables and time to recanalization [assessed on serial TCD using the thrombolysis in brain ischemia (TIBI) score] will be assessed using Cox proportional hazards models, adjusted for potential confounders., [Outcomes] The primary outcome will be time to recanalization detected by TCD (defined as TIBI ≥4). Secondary outcomes will be recanalization within 6-h and recanalization and/or haemorrhagic transformation at 24-h. This analysis will utilize an expanded cohort including ~120 patients from the Targeting Optimal Thrombolysis Outcomes (TOTO) study., [Discussion] If association between proteolytic response to rt-PA and recanalization is confirmed, future clinical treatment may customize thrombolytic therapy to maximize outcomes and minimize adverse effects for individual patients.

Published
2020

146. Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia

Author

Gao, Lan, primary, Tan, Elise, additional, Moodie, Marj, additional, Parsons, Mark, additional, Spratt, Neil J., additional, Levi, Christopher, additional, Butcher, Kenneth, additional, Kleinig, Timothy, additional, Yan, Bernard, additional, Chen, Chushuang, additional, Lin, Longting, additional, Choi, Philip, additional, and Bivard, Andrew, additional

Published
2020
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150. Plasmin Generation Potential and Recanalization in Acute Ischaemic Stroke; an Observational Cohort Study of Stroke Biobank Samples

Author

Lillicrap, Thomas, primary, Keragala, Charithani B., additional, Draxler, Dominik F., additional, Chan, Jilly, additional, Ho, Heidi, additional, Harman, Stevi, additional, Niego, Be'eri, additional, Holliday, Elizabeth, additional, Levi, Christopher R., additional, Garcia-Esperon, Carlos, additional, Spratt, Neil, additional, Gyawali, Prajwal, additional, Bivard, Andrew, additional, Parsons, Mark W., additional, Montaner, Joan, additional, Bustamante, Alejandro, additional, Cadenas, Israel Fernandez, additional, Cloud, Geoffrey, additional, Maguire, Jane M., additional, Lincz, Lisa, additional, Kleinig, Timothy, additional, Attia, John, additional, Koblar, Simon, additional, Hamilton-Bruce, Monica Anne, additional, Choi, Philip, additional, Worrall, Bradford B., additional, and Medcalf, Robert L., additional

Published
2020
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