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152. Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE) trial: methodology

Author

Demchuk, Andrew M., Goyal, Mayank, Menon, Bijoy K., Eesa, Muneer, Ryckborst, Karla J., Kamal, Noreen, Patil, Shivanand, Mishra, Sachin, Almekhlafi, Mohammed, Randhawa, Privia A., Roy, Daniel, Willinsky, Robert, Montanera, Walter, Silver, Frank L., Shuaib, Ashfaq, Rempel, Jeremy, Jovin, Tudor, Frei, Donald, Sapkota, Biggya, Thornton, Michael J., Poppe, Alexandre, Tampieri, Donatella, Lum, Cheemun, Weill, Alain, Sajobi, Tolulope T., and Hill, Michael D.

Published
2015
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153. Quantification of clot spatial heterogeneity and its impact on thrombectomy

Author

Liu, Yang, primary, Brinjikji, Waleed, additional, Abbasi, Mehdi, additional, Dai, Daying, additional, Arturo Larco, Jorge L, additional, Madhani, Sarosh Irfan, additional, Shahid, Adnan H, additional, Mereuta, Oana Madalina, additional, Nogueira, Raul G, additional, Kvamme, Peter, additional, Layton, Kennith F, additional, Delgado Almandoz, Josser E, additional, Hanel, Ricardo A, additional, Mendes Pereira, Vitor, additional, Almekhlafi, Mohammed A, additional, Yoo, Albert J, additional, Jahromi, Babak S, additional, Gounis, Matthew J, additional, Patel, Biraj, additional, Fitzgerald, Seán, additional, Doyle, Karen, additional, Haussen, Diogo C, additional, Al-Bayati, Alhamza R, additional, Mohammaden, Mahmoud, additional, Pisani, Leonardo, additional, Rodrigues, Gabriel Martins, additional, Thacker, Ike C, additional, Kayan, Yasha, additional, Copelan, Alexander, additional, Aghaebrahim, Amin, additional, Sauvageau, Eric, additional, Demchuk, Andrew M, additional, Bhuva, Parita, additional, Soomro, Jazba, additional, Nazari, Pouya, additional, Cantrell, Donald Robert, additional, Puri, Ajit S, additional, Entwistle, John, additional, Kadirvel, Ramanathan, additional, Cloft, Harry J, additional, Kallmes, David F, additional, and Savastano, Luis, additional

Published
2021
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156. Time-resolved assessment of cortical venous drainage on multiphase CT angiography in patients with acute ischemic stroke

Author

Singh, Nishita, primary, Bala, Fouzi, additional, Kim, B. J., additional, Najm, Mohamed, additional, Ahn, Seong Hwan, additional, Fainardi, Enrico, additional, Rubiera, Marta, additional, Khaw, Alexander V., additional, Zini, Andrea, additional, Goyal, Mayank, additional, Menon, Bijoy K., additional, and Almekhlafi, Mohammed, additional

Published
2021
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158. Worldwide anaesthesia use during endovascular treatment for medium vessel occlusion stroke

Author

Kappelhof, Manon, primary, Ospel, Johanna M, additional, Cimflova, Petra, additional, Kashani, Nima, additional, Singh, Nishita, additional, McDonough, Rosalie, additional, Sehgal, Arshia, additional, Almekhlafi, Mohammed A, additional, Fiehler, Jens, additional, Chen, Michael, additional, Sakai, Nobuyuki, additional, Majoie, Charles BLM, additional, and Goyal, Mayank, additional

Published
2021
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159. Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke

Author

Almekhlafi, Mohammed, Goyal, Mayank, Dippel, Diederik, Majoie, Charles, Campbell, Bruce, Muir, Keith, Demchuk, Andrew, Bracard, Serge, Guillemin, Francis, Jovin, Tudor, Mitchell, Peter, White, Philip, Hill, Michael, Brown, Scott, Saver, Jeffrey, Berkhemer, Olvert, Fransen, Puck, Beumer, Debbie, Van Den Berg, Lucie, Lingsma, Hester, Yoo, Albert, Schonewille, Wouter, Vos, Jan, Nederkoorn, Paul, Wermer, Marieke, Van Walderveen, Marianne, Staals, Julie, Hofmeijer, Jeannette, Van Oostayen, Jacques, Lycklama À Nijeholt, Geert, Boiten, Jelis, Brouwer, Patrick, Emmer, Bart, De Bruijn, Sebastiaan, Van Dijk, Lukas, Kappelle, L, Lo, Rob, Van Dijk, Ewoud, de Vries, Joost, De Kort, Paul, Van Rooij, Willem, Van Den Berg, Jan, Van Hasselt, Boudewijn, Aerden, Leo, Dallinga, René, Visser, Marieke, Bot, Joseph, Vroomen, Patrick, Eshghi, Omid, Schreuder, Tobien, Heijboer, Roel, Keizer, Koos, Tielbeek, Alexander, Den Hertog, Heleen, Gerrits, Dick, Van Den Berg-Vos, Renske, Karas, Giorgos, Steyerberg, Ewout, Flach, H, Marquering, Henk, Sprengers, Marieke, Jenniskens, Sjoerd, Beenen, Ludo, Van Den Berg, René, Koudstaal, Peter, Van Zwam, Wim, Roos, Yvo, van der Lugt, Aad, Van Oostenbrugge, Robert, Menon, Bijoy, Eesa, Muneer, Rempel, Jeremy, Thornton, John, Roy, Daniel, Willinsky, Robert, Sapkota, Biggya, Dowlatshahi, Dar, Frei, Donald, Kamal, Noreen, Montanera, Walter, Poppe, Alexandre, Ryckborst, Karla, Silver, Frank, Shuaib, Ashfaq, Tampieri, Donatella, Williams, David, Bang, Oh, Baxter, Blaise, Burns, Paul, Choe, Hana, Heo, Ji-Hoe, Holmstedt, Christine, Jankowitz, Brian, KELLY, Michael, Linares, Guillermo, Mandzia, Jennifer, Shankar, Jai, Sohn, Sung-Il, Swartz, Richard, Coutts, Shelagh, Smith, Eric, Morrish, William, Weill, Alain, Subramaniam, Suresh, Mitha, Alim, Wong, John, Lowerison, Mark, Sajobi, Tolulope, Bonafe, Alain, Diener, Hans, Levy, Elad, Pereira, Vitor, Albers, Gregory, Cognard, Christophe, Cohen, David, Hacke, Werner, Jansen, Olav, Mattle, Heinrich, Nogueira, Raul, Siddiqui, Adnan, Yavagal, Dileep, Devlin, Thomas, Lopes, Demetrius, Reddy, Vivek, du Mesnil de Rochemont, Richard, Singer, Oliver, Jahan, Reza, Kleinig, Timothy, Dewey, Helen, Churilov, Leonid, Yassi, Nawaf, Yan, Bernard, Dowling, Richard, Parsons, Mark, Oxley, Thomas, Wu, Teddy, Brooks, Mark, Simpson, Marion, Miteff, Ferdinand, Levi, Christopher, Krause, Martin, Harrington, Timothy, Faulder, Kenneth, Steinfort, Brendan, Priglinger, Miriam, Ang, Timothy, Scroop, Rebecca, Barber, Philip, McGuinness, Ben, Wijeratne, Tissa, Phan, Thanh, Chong, Winston, Chandra, Ronil, Bladin, Christopher, Badve, Monica, Rice, Henry, de Villiers, Laetitia, Ma, Henry, Desmond, Patricia, Donnan, Geoffrey, Davis, Stephen, Chamorro, Angel, Cobo, Erik, De Miquel, María, Molina, Carlos, Rovira, Alex, San Román, Luis, Serena, Joaquín, Abilleira, Sonia, Ribó, Marc, Millán, Mònica, Urra, Xabier, Cardona, Pere, López-Cancio, Elena, Tomasello, Alejandro, Castaño, Carlos, Blasco, Jordi, Aja, Lucía, Dorado, Laura, Quesada, Helena, Rubiera, Marta, Hernandez-Pérez, María, von Kummer, Rüdiger, Gallofré, Miquel, Dávalos, Antoni, Ford, Gary, Messow, Claudia-Martina, Ford, Ian, Murray, Alicia, Clifton, Andrew, Brown, Martin, Madigan, Jeremy, Lenthall, Rob, Robertson, Fergus, Dixit, Anand, Cloud, Geoffrey, Wardlaw, Joanna, Freeman, Janet, Ducrocq, Xavier, Mas, Jean, Soudant, Marc, Oppenheim, Catherine, Moulin, Thierry, University of Calgary, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Department of Radiology and Nuclear Medicine [Amsterdam], VU University Medical Center [Amsterdam], University of Melbourne, University of Glasgow, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), The Royal Melbourne Hospital, Newcastle University [Newcastle], Altair Development, David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), and University of California-University of California

Subjects
[INFO.INFO-IM]Computer Science [cs]/Medical Imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. OBJECTIVE To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). DATA SOURCES PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020.

Published
2021
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163. Challenges of Acute Endovascular Stroke Trials

Author

Goyal, Mayank, Almekhlafi, Mohammed, Menon, Bijoy, Hill, Michael, Fargen, Kyle, Parsons, Mark, Bang, Oh Young, Siddiqui, Adnan, Andersson, Tommy, Mendes, Vitor, Davalos, Antoni, Turk, Aquilla, Mocco, J, Campbell, Bruce, Nogueira, Raul, Gupta, Rishi, Murphy, Sean, Jovin, Tudor, Khatri, Pooja, Miao, Zhongrong, Demchuk, Andrew, Broderick, Joseph P., and Saver, Jeffrey

Published
2014
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167. Recanalization and Functional Outcome in Patients with Cervico-cephalic Arterial Dissections

Author

Wadhwa, Ankur, Almekhlafi, Mohammed, Menon, Bijoy K., Demchuk, Andrew M., and Bal, Simerpreet

Abstract

ABSTRACT:Background:Cervico-cephalic arterial dissections (CeAD) are an important cause of stroke in young patients. This study aimed to determine the frequency and predictors of recanalization in spontaneous CeAD and to study the effect of recanalization on functional outcomes.Methods:We identified patients presenting with acute ischemic stroke secondary to CeAD from the CT angiography (CTA) database of the Calgary Stroke Program. Dissections were diagnosed based on standard clinical and imaging findings. At the discretion of treating stroke Neurologists, the patients were either treated with single antiplatelet or dual antiplatelet or triple therapy. Follow-up imaging with CTA, magnetic resonance imaging, and DSA was completed, and a Modified Rankin scale (mRS) was performed to determine the outcome.Results:Fifty-six patients with CeAdD were studied. Thirty-four patients (18 VAD; vertebral artery dissection and 16 CAD; carotid artery dissection) were followed up for recanalization. Complete recanalization was observed in 27 subjects; 13 patients with VAD recanalized in comparison to 14 with CAD (p = 0.40). All non-recanalized patients had hypertension. A good clinical outcome (mRS ≤ 2) was observed in 47 patients. Interestingly, the likelihood of a good neurological outcome was not influenced by recanalization status. There was no difference in clinical outcome for different sites in VAD, whereas patients with intracranial CAD had severe strokes (NIHSS > 21).Conclusions:CeAD has good recanalization rates and neurological outcomes, with recanalization seen even in vessels with initial complete occlusion. The presence of hypertension may influence recanalization. The efficacy of dual antiplatelets and heparin for early recanalization needs to be assessed in future clinical trials.

Published
2023
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168. Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke

Author

Ospel, Johanna M., primary, Volny, Ondrej, additional, Qiu, Wu, additional, Najm, Mohamed, additional, Hafeez, Moiz, additional, Abdalrahman, Sarah, additional, Fainardi, Enrico, additional, Rubiera, Marta, additional, Khaw, Alexander, additional, Shankar, Jai J., additional, Hill, Michael D., additional, Almekhlafi, Mohammed A., additional, Demchuk, Andrew M., additional, Goyal, Mayank, additional, and Menon, Bijoy K., additional

Published
2021
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170. Endovascular Device Choice and Tools for Recanalization of Medium Vessel Occlusions: Insights From the MeVO FRONTIERS International Survey

Author

Kashani, Nima, primary, Cimflova, Petra, additional, Ospel, Johanna M., additional, Singh, Nishita, additional, Almekhlafi, Mohammed A., additional, Rempel, Jeremy, additional, Fiehler, Jens, additional, Chen, Michael, additional, Sakai, Nobuyuki, additional, Agid, Ronit, additional, Heran, Manraj, additional, Kappelhof, Manon, additional, and Goyal, Mayank, additional

Published
2021
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171. Predictors and clinical impact of infarct progression rate in the ESCAPE-NA1 trial

Author

Ospel, Johanna Maria, primary, McDonough, Rosalie, additional, Demchuk, Andrew M, additional, Menon, Bijoy K, additional, Almekhlafi, Mohammed A, additional, Nogueira, Raul G, additional, McTaggart, Ryan A, additional, Poppe, Alexandre Y, additional, Buck, Brian H, additional, Roy, Daniel, additional, Haussen, Diogo C, additional, Chapot, René, additional, Field, Thalia S, additional, Jayaraman, Mahesh V, additional, Tymianski, Michael, additional, Hill, Michael D, additional, and Goyal, Mayank, additional

Published
2021
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175. Quantification of clot spatial heterogeneity and its impact on thrombectomy.

Author

Yang Liu, Brinjikji, Waleed, Abbasi, Mehdi, Daying Dai, Arturo Larco, Jorge L., Madhani, Sarosh Irfan, Shahid, Adnan H., Mereuta, Oana Madalina, Nogueira, Raul G., Kvamme, Peter, Layton, Kennith F., Delgado Almandoz, Josser E., Hanel, Ricardo A., Pereira, Vitor Mendes, Almekhlafi, Mohammed A., Yoo, Albert J., Jahromi, Babak S., Gounis, Matthew J., Patel, Biraj, and Fitzgerald, Sean

Subjects
CEREBRAL embolism & thrombosis, INTRAVENOUS therapy, ISCHEMIC stroke, BLOOD platelets, MANN Whitney U Test, TREATMENT effectiveness, THROMBECTOMY, DESCRIPTIVE statistics, ERYTHROCYTES, TISSUE plasminogen activator, PLATELET-rich fibrin, EVALUATION
Abstract

Background Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis. Methods We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann-Whitney test and an artificial neural network (ANN) model. Results For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration. Conclusions Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity. [ABSTRACT FROM AUTHOR]

Published
2022
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176. Impact of workflow times on successful reperfusion after endovascular treatment in the late time window

Author

Alhabli, Ibrahim, Benali, Faysal, Hill, Michael D, Murphy, Sean, Toni, Danilo, Patrik, Michel, Casetta, Ilaria, Power, Sarah, Saia, Valentina, Pracucci, Giovanni, Mangiafico, Salvatore, Boyle, Karl, Nannoni, Stefania, Fainardi, Enrico, Thornton, John, Kim, Beom Joon, Menon, Bijoy K, Almekhlafi, Mohammed A, and Bala, Fouzi

Abstract

Background and Purpose Successful and complete reperfusion should be the aim of every endovascular thrombectomy (EVT) procedure. However, the effect of time delays on successful reperfusion in late window stroke patients presenting 6-to-24 h from onset has not been investigated.Materials and Methods We pooled individual patient-level data from seven trials and registries for anterior circulation stroke patients treated with EVT between 6 and 24 h from onset. We explored the impact of delays across multiple interval times, including onset to hospital arrival; hospital arrival to arterial puncture; imaging to arterial puncture; and onset to arterial puncture. Our primary outcome was successful reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2b–3. Logistic regression analyses were performed to assess the association between each of the interval times and successful reperfusion.Results We included 608 patients. The median age was 70 years (IQR 58–79), and 307 (50.5%) were females. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion had lower NIHSS scores (median 15 [IQR11–19] vs 17 [11–21], p= .02) and significantly shorter hospital arrival to arterial puncture time (90 min [60–150] vs 110 min [84.5–150], p= .01) than unsuccessful reperfusion. The odds of successful reperfusion decreased by 15% for every one-hour delay in arrival-to-puncture time (adjusted odds ratio 0.85, 95% CI: 0.75–0.95). Other workflow times did not impact the rate of successful reperfusion.Conclusion Faster hospital arrival to arterial puncture time is associated with higher odds of successful reperfusion in late window stroke patients.

Published
2025
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177. Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials

Author

Almekhlafi, Mohammed A., Goyal, Mayank, Dippel, Diederik W. J., Majoie, Charles B. L. M., Campbell, Bruce C. V., Muir, Keith W., Demchuk, Andrew M., Bracard, Serge, Guillemin, Francis, Jovin, Tudor G., Mitchell, Peter, White, Philip, Hill, Michael D., Brown, Scott, Saver, Jeffrey L., HERMES Trialists Collaboration, van Zwam, Wim, van Oostenbrugge, Robert Jan, Almekhlafi, Mohammed A., Goyal, Mayank, Dippel, Diederik W. J., Majoie, Charles B. L. M., Campbell, Bruce C. V., Muir, Keith W., Demchuk, Andrew M., Bracard, Serge, Guillemin, Francis, Jovin, Tudor G., Mitchell, Peter, White, Philip, Hill, Michael D., Brown, Scott, Saver, Jeffrey L., HERMES Trialists Collaboration, van Zwam, Wim, and van Oostenbrugge, Robert Jan

Abstract

This meta-analysis evaluates outcomes along the full health-related quality-of-life range associated with time to endovascular thrombectomy in patients with ischemic stroke.Question What are the lifetime consequences associated with care process delays in patients with ischemic stroke who are treated with endovascular thrombectomy? Findings In this meta-analysis of pooled individual patient data from 406 adults in 7 randomized trials, delays in delivering endovascular thrombectomy were associated with marked reductions in healthy life-years after treatment. In the time interval from hospital arrival to endovascular procedure start, every 1 second of delay was associated with loss of 2.2 hours of healthy life. Meaning In this study, care delays in delivering endovascular thrombectomy to ischemic stroke patients were associated with substantial losses of healthy life-years; health care organization and workflow optimization should be a priority to facilitate faster reperfusion for acute stroke patients.Importance The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. Objective To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). Data Sources PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020. Study Selection All randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time were included. Data Extraction/Synthesis Patient-level data regarding presenting clinical and imaging features and fu

Published
2021

179. Influence of intravenous alteplase on endovascular treatment decision-making in acute ischemic stroke due to primary medium-vessel occlusion: a case-based survey study

Author

Kappelhof, Manon, primary, Ospel, Johanna, additional, Kashani, Nima, additional, Cimflova, Petra, additional, Singh, Nishita, additional, Almekhlafi, Mohammed A, additional, Menon, Bijoy K, additional, Fiehler, Jens, additional, Chen, Michael, additional, Sakai, Nobuyuki, additional, and Goyal, Mayank, additional

Published
2021
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180. Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy

Author

Mereuta, Oana Madalina, primary, Abbasi, Mehdi, additional, Fitzgerald, Seán, additional, Dai, Daying, additional, Kadirvel, Ram, additional, Hanel, Ricardo A, additional, Yoo, Albert J, additional, Almekhlafi, Mohammed A, additional, Layton, Kennith F, additional, Delgado Almandoz, Josser E, additional, Kvamme, Peter, additional, Mendes Pereira, Vitor, additional, Jahromi, Babak S, additional, Nogueira, Raul G, additional, Gounis, Matthew J, additional, Patel, Biraj, additional, Aghaebrahim, Amin, additional, Sauvageau, Eric, additional, Bhuva, Parita, additional, Soomro, Jazba, additional, Demchuk, Andrew M, additional, Thacker, Ike C, additional, Kayan, Yasha, additional, Copelan, Alexander, additional, Nazari, Pouya, additional, Cantrell, Donald Robert, additional, Haussen, Diogo C, additional, Al-Bayati, Alhamza R, additional, Mohammaden, Mahmoud, additional, Pisani, Leonardo, additional, Rodrigues, Gabriel Martins, additional, Puri, Ajit S, additional, Entwistle, John, additional, Meves, Alexander, additional, Arturo Larco, Jorge L, additional, Savastano, Luis, additional, Cloft, Harry J, additional, Kallmes, David F, additional, Doyle, Karen M, additional, and Brinjikji, Waleed, additional

Published
2021
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182. Management and outcome of patients with acute ischemic stroke and tandem carotid occlusion in the ESCAPE-NA1 trial

Author

Marko, Martha, primary, Cimflova, Petra, additional, Poppe, Alexandre Y, additional, Kashani, Nima, additional, Singh, Nishita, additional, Ospel, Johanna, additional, Mayank, Arnuv, additional, van Adel, Brian, additional, McTaggart, Ryan A, additional, Nogueira, Raul G, additional, Demchuk, Andrew M, additional, Rempel, Jeremy L, additional, Joshi, Manish, additional, Zerna, Charlotte, additional, Menon, Bijoy K, additional, Tymianski, Michael, additional, Hill, Michael D, additional, Goyal, Mayank, additional, and Almekhlafi, Mohammed A, additional

Published
2021
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183. Per pass analysis of thrombus composition retrieved by mechanical thrombectomy

Author

Abbasi, Mehdi, primary, Kvamme, Peter, additional, Layton, Kennith F, additional, Hanel, Ricardo A, additional, Almekhlafi, Mohammed A, additional, Delgado, Josser E, additional, Pereira, Vitor M, additional, Patel, Biraj M, additional, Jahromi, Babak S, additional, Yoo, Albert J, additional, Nogueira, Raul G, additional, Gounis, Matthew J, additional, Fitzgerald, Seán, additional, Mereuta, Oana M, additional, Dai, Daying, additional, Kadirvel, Ramanathan, additional, Kallmes, David F, additional, Doyle, Karen M, additional, Savastano, Luis E, additional, Cloft, Harry J, additional, Liu, Yang, additional, Thacker, Ike C, additional, Aghaebrahim, Amin, additional, Sauvageau, Eric, additional, Demchuk, Andrew M, additional, Kayan, Yasha, additional, Copelan, Alexander Z, additional, Entwistle, John, additional, Nazari, Pouya, additional, Cantrell, Donald Robert, additional, Bhuva, Parita, additional, Soomro, Jazba, additional, Haussen, Diogo C, additional, Al-Bayati, Alhamza, additional, Mohammaden, Mahmoud, additional, Pisani, Leonardo, additional, Rodrigues, Gabriel, additional, Puri, Ajit S, additional, and Brinjikji, Waleed, additional

Published
2021
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187. Predictors and clinical impact of infarct progression rate in the ESCAPE-NA1 trial.

Author

Ospel, Johanna Maria, McDonough, Rosalie, Demchuk, Andrew M., Menon, Bijoy K., Almekhlafi, Mohammed A., Nogueira, Raul G., McTaggart, Ryan A., Poppe, Alexandre Y., Buck, Brian H., Roy, Daniel, Haussen, Diogo C., Chapot, René, Field, Thalia S., Jayaraman, Mahesh V., Tymianski, Michael, Hill, Michael D., and Goyal, Mayank

Subjects
STROKE treatment, CEREBRAL angiography, CONFIDENCE intervals, INFARCTION, ISCHEMIC stroke, MULTIPLE regression analysis, MAGNETIC resonance imaging, BLOOD sugar, TREATMENT effectiveness, THROMBECTOMY, STATISTICAL sampling, COMPUTED tomography, REPERFUSION, CEREBRAL ischemia
Abstract

Background Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making, and outcome prognostication. Objective To estimate infarct progression rate in patients with AIS with large vessel occlusion (LVO) and determine its predictors and impact on clinical outcome. Methods Data are from the ESCAPE-NA1 Trial. Patients with AIS with time from last known well to randomization <6 hours and near-complete reperfusion following endovascular treatment were included. Infarct growth rate (mL/h) was estimated by dividing 24 hour infarct volume (measured by non-contrast CT or diffusion-weighted magnetic resonance imaging) by time from last known well to reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (modified Rankin Scale score 0-2) was determined using multivariable logistic regression. Results Four hundred and nine patients were included in the study. Median infarct progression rate was 4.74 mL/h (IQR 1.25-14.84). Collateral status (β: -0.81 (95% CI -1.20 to -0.41)), Alberta Stroke Program Early CT Score (ASPECTS, β: -0.34 (95% CI -0.46 to -0.23)), blood glucose(β: 0.09 (95% CI 0.02 to 0.16)), and National Institutes of Health Stroke Scale (NIHS score (β: 0.07 (95% CI 0.04 to 0.10)) were associated with logtransformed infarct progression rate. Clinical and imaging baseline variables explained 23% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1 mL/h increase: 0.96 (95% CI 0.95 to 0.98)). Conclusion In this sample of patients presenting within the early time window with LVO and nearcomplete recanalization, infarct progression rate was significantly associated with good outcome. A significant association between ASPECTS, collateral status, blood glucose, and NIHSS score was observed, but baseline imaging and clinical characteristics explained only a small proportion of the interindividual variance. More research on measurable factors affecting infarct growth is needed. [ABSTRACT FROM AUTHOR]

Published
2022
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188. Worldwide anaesthesia use during endovascular treatment for medium vessel occlusion stroke.

Author

Kappelhof, Manon, Ospel, Johanna M, Cimflova, Petra, Kashani, Nima, Singh, Nishita, McDonough, Rosalie, Sehgal, Arshia, Almekhlafi, Mohammed A, Fiehler, Jens, Chen, Michael, Sakai, Nobuyuki, Majoie, Charles BLM, and Goyal, Mayank

Subjects
ENDOVASCULAR surgery, PATIENT compliance, CONSCIOUS sedation, ANESTHESIA, ISCHEMIC stroke
Abstract

Introduction: The optimal anaesthesia approach for endovascular treatment (EVT) in acute ischaemic stroke is currently unknown. In stroke due to medium vessel occlusions (MeVO), the occluded vessels are particularly small and more difficult to access, especially in restless or uncooperative patients. In these patients, general anaesthesia (GA) may be preferred by physicians to prevent complications due to patient movement. We investigated physicians' approaches to anaesthesia during EVT for MeVO stroke. Methods: In a worldwide, case-based, online survey, physicians' preferred anaesthesia approach during EVT for MeVO stroke was categorized as "initial GA", "initial GA if necessary" (depending on patient cooperation), "no initial GA, but conversion if necessary" (start with local anaesthesia or conscious sedation), and "no GA". Preferred anaesthesia approaches were reported overall and stratified by physician and patient characteristics. Results: A total of 366 survey participants provided 1464 responses to 4 primary MeVO EVT case-scenarios. One-third of responses (489/1464 [33%]) favoured no initial GA, but conversion if necessary. Both initial GA and initial GA if necessary were preferred in 368/1464 (25%) of responses respectively. No GA was favoured in 244/1464 (17%). Occlusion location, respondent specialization (interventional neuroradiology), higher age, and female respondent sex were significantly associated with GA preference. GA was more often used in Europe than in other parts of the world (p < 0.001). Conclusions: Anaesthesia approaches in MeVO EVT vary across world regions and patient and physician factors. Most physicians in this survey preferred to start with local anaesthesia or conscious sedation and convert to GA if necessary. [ABSTRACT FROM AUTHOR]

Published
2022
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193. Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology

Author

Brinjikji, Waleed, primary, Nogueira, Raul G, additional, Kvamme, Peter, additional, Layton, Kennith F, additional, Delgado Almandoz, Josser E, additional, Hanel, Ricardo A, additional, Mendes Pereira, Vitor, additional, Almekhlafi, Mohammed A, additional, Yoo, Albert J, additional, Jahromi, Babak S, additional, Gounis, Matthew J, additional, Patel, Biraj, additional, Abbasi, Mehdi, additional, Fitzgerald, Seán, additional, Mereuta, Oana Madalina, additional, Dai, Daying, additional, Kadirvel, Ramanathan, additional, Doyle, Karen, additional, Savastano, Luis, additional, Cloft, Harry J, additional, Haussen, Diogo C, additional, Al-Bayati, Alhamza R, additional, Mohammaden, Mahmoud H, additional, Pisani, Leonardo, additional, Rodrigues, Gabriel Martins, additional, Thacker, Ike C, additional, Kayan, Yasha, additional, Copelan, Alexander, additional, Aghaebrahim, Amin, additional, Sauvageau, Eric, additional, Demchuk, Andrew M, additional, Bhuva, Parita, additional, Soomro, Jazba, additional, Nazari, Pouya, additional, Cantrell, Donald Robert, additional, Puri, Ajit S, additional, Entwistle, John, additional, Polley, Eric C, additional, and Kallmes, David F, additional

Published
2021
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194. Abstract 17: Time-Benefit Association is Magnified in Door-To-Puncture Window: Lose 1 Second, Lose 2.2 Hours of Healthy Life

Author

Almekhlafi, Mohammed A, primary, GOYAL, MAYANK, additional, Dippel, Diederik W, additional, Majoie, Charles B, additional, Campbell, Bruce, additional, Muir, Keith W, additional, Demchuk, Andrew M, additional, Bracard, Serge, additional, guillemin, francis, additional, Jovin, Tudor G, additional, Mitchell, Peter J, additional, White, Philip, additional, Hill, Michael D, additional, Brown, Scott, additional, and Saver, Jeffrey L, additional

Published
2021
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195. Abstract P490: Influence of Balloon Guide Catheter Use on Procedural & Clinical Outcomes in the Escape-NA1 Trial

Author

Ospel, Johanna, primary, Marko, Martha, additional, Singh, Nishita, additional, Cimflova, Petra, additional, Mayank, Arnuv, additional, Nogueira, Raul G, additional, McTaggart, Ryan A, additional, Demchuk, Andrew M, additional, Poppe, Alexandre Y, additional, Almekhlafi, Mohammed, additional, MENON, Bijoy K, additional, Hill, Michael D, additional, and Goyal, Mayank, additional

Published
2021
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196. Abstract P524: Impact of Intra-Procedural Workflow and Time Metrics of Establishing Fast Reperfusion on Clinical Outcomes in the ESCAPE-NA1 Trial

Author

Kashani, Nima, primary, Marko, Martha, additional, Cimflova, Petra, additional, Singh, Nishita, additional, Ospel, Johanna, additional, Mayank, Arnuv, additional, Nogueira, Raul, additional, McTaggart, Ryan, additional, Demchuk, Andrew M, additional, Poppe, Alexandre Y, additional, Hill, Michael D, additional, MENON, Bijoy K, additional, GOYAL, MAYANK, additional, and Almekhlafi, Mohammed A, additional

Published
2021
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197. Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Author

Singh, Nishita, primary, Marko, Martha, additional, Cimflova, Petra, additional, Ospel, Johanna, additional, Kashani, Nima, additional, Mayank, Arnuv, additional, Nogueira, Raul G, additional, Mctaggart, Ryan A, additional, Demchuk, Andrew M, additional, Poppe, Alexandre Y, additional, Hill, Michael D, additional, MENON, Bijoy K, additional, GOYAL, MAYANK, additional, and Almekhlafi, Mohammed, additional

Published
2021
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198. Abstract P550: Incidence, Predictors and Impact of Emboli in New Territory in Escape NA1 Trial

Author

Singh, Nishita, primary, Cimflova, Petra, additional, Marko, Martha, additional, Ospel, Johanna, additional, Kashani, Nima, additional, Mayank, Arnuv, additional, Nogueira, Raul G, additional, Mctaggart, Ryan A, additional, Demchuk, Andrew M, additional, Poppe, Alexandre Y, additional, Hill, Michael D, additional, MENON, Bijoy K, additional, GOYAL, MAYANK, additional, and Almekhlafi, Mohammed, additional

Published
2021
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199. Abstract P485: Predictors and Clinical Impact of Deep Grey Matter Infarction After Endovascular Treatment for Large Vessel Occlusion Stroke: Results From the Escape-NA1 Trial

Author

Ospel, Johanna, primary, Hill, Michael D, additional, Kashani, Nima, additional, Mayank, Arnuv, additional, Singh, Nishita, additional, Cimflova, Petra, additional, Marko, Martha, additional, Nogueira, Raul G, additional, McTaggart, Ryan A, additional, Demchuk, Andrew M, additional, Poppe, Alexandre Y, additional, Zerna, Charlotte, additional, Joshi, Manish, additional, MENON, Bijoy K, additional, Almekhlafi, Mohammed, additional, Tymianski, Michael, additional, and Goyal, Mayank, additional

Published
2021
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