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867 results on '"Almekhlafi, Mohammed A"'

251. Quantification of clot spatial heterogeneity and its impact on thrombectomy

Author

Liu, Yang, Brinjikji, Waleed, Abbasi, Mehdi, Dai, Daying, 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, Mendes Pereira, Vitor, Almekhlafi, Mohammed A, Yoo, Albert J, Jahromi, Babak S, Gounis, Matthew J, Patel, Biraj, Fitzgerald, Seán, Doyle, Karen, Haussen, Diogo C, Al-Bayati, Alhamza R, Mohammaden, Mahmoud, Pisani, Leonardo, Rodrigues, Gabriel Martins, Thacker, Ike C, Kayan, Yasha, Copelan, Alexander, Aghaebrahim, Amin, Sauvageau, Eric, Demchuk, Andrew M, Bhuva, Parita, Soomro, Jazba, Nazari, Pouya, Cantrell, Donald Robert, Puri, Ajit S, Entwistle, John, Kadirvel, Ramanathan, Cloft, Harry J, Kallmes, David F, and Savastano, Luis

Abstract

BackgroundCompositional 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.MethodsWe 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.ResultsFor 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.ConclusionsClot 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.

Published
2022
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252. Delayed Guillain-Barré Syndrome after Bariatric Surgery: A Report of Three Cases

Author

Sunbol, Alana H., Almaghrabi, Sarah, Al Aslany, Shahd J., Aldairi, Mashael M., Makhdum, Sara A., Trabulsi, Nora, Almekhlafi, Mohammed A., and Nassif, Mohammed

Subjects
Article Subject
Abstract

Surgeries carry a risk of complications. Polyneuropathies, including Guillain-Barré syndrome (GBS), are potential complications of bariatric surgery. The incidence of these conditions is expected to increase as these surgeries become increasingly popular. We present a case report of three patients who developed a polyneuropathy after bariatric surgery. GBS was diagnosed in each patient, with nutritional deficiencies being suspected as a contributing factor. All patients began a 5-day intravenous immunoglobulin course in addition to receiving rehabilitative support, multivitamins, intravenous thiamine, vitamin D (therapeutic dose), and selenium. The patients’ symptoms improved but did not completely resolve. GBS can be a complication of bariatric surgery. Although a clear cause-effect relationship cannot be established for the present cases, the cumulative literature on the subject suggests that it is important to include it as a potential risk when counseling patients for such surgeries.

Published
2018
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253. Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment

Author

Ospel, Johanna M., Menon, Bijoy K., Demchuk, Andrew M., Almekhlafi, Mohammed A., Kashani, Nima, Mayank, Arnuv, Fainardi, Enrico, Rubiera, Marta, Khaw, Alexander, Shankar, Jai J., Dowlatshahi, Dar, Puig, Josep, Sohn, Sung-Il, Ahn, Seong H., Poppe, Alexandre, Calleja, Ana, Hill, Michael D., and Goyal, Mayank

Abstract

Supplemental Digital Content is available in the text.

Published
2021
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254. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region—Results from the Safe Implementation of Treatments in Stroke (SITS)–Middle-East and North African (MENA)

Author

Rukn, Suhail Al, primary, Mazya, Michael V, additional, Hentati, Faycal, additional, Sassi, Samia Ben, additional, Nabli, Fatma, additional, Said, Zakharia, additional, Faouzi, Belahsen, additional, Hashim, Husnain, additional, Abd-Allah, Foad, additional, Mansouri, Benhan, additional, Kesraoui, Selma, additional, Gebeily, Souheil, additional, Abdulrahman, Husen, additional, Akhtar, Naveed, additional, Ahmed, Niaz, additional, Wahlgren, Nils, additional, Aref, Hany, additional, Almekhlafi, Mohammed, additional, and Moreira, Tiago, additional

Published
2019
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256. Abstract TP77: Collateral- vs Perfusion-Based Selection Paradigm of Late Window (6-24 hours) Patients With Acute Ischemic Stroke a Comparative Study of Decision Making Using Multi-Phase CTA and CT Perfusion

Author

Almekhlafi, Mohammed A, primary, Kunz, Wolfgang, additional, McTaggart, Ryan, additional, Najm, Mohammed, additional, Shankar, Jai Jai, additional, Khaw, Alexander, additional, Fainardi, Enrico, additional, Rubiera, Marta, additional, Jayaraman, Mahesh V, additional, Hill, Michael D, additional, Demchuk, Andrew, additional, Goyal, Mayank, additional, and Menon, Bijoy K, additional

Published
2019
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258. Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke

Author

Boers, Anna M. M., primary, Jansen, Ivo G. H., additional, Brown, Scott, additional, Lingsma, Hester F., additional, Beenen, Ludo F. M., additional, Devlin, Thomas G., additional, Román, Luis San, additional, Heo, Ji-Hoe, additional, Ribó, Marc, additional, Almekhlafi, Mohammed A., additional, Liebeskind, David S., additional, Teitelbaum, Jeanne, additional, Cuadras, Patricia, additional, du Mesnil de Rochemont, Richard, additional, Beaumont, Marine, additional, Brown, Martin M., additional, Yoo, Albert J., additional, Donnan, Geoffrey A., additional, Mas, Jean Louis, additional, Oppenheim, Catherine, additional, Dowling, Richard J., additional, Moulin, Thierry, additional, Agrinier, Nelly, additional, Lopes, Demetrius K., additional, Aja Rodríguez, Lucía, additional, Compagne, Kars C. J., additional, Al-Ajlan, Fahad S., additional, Madigan, Jeremy, additional, Albers, Gregory W., additional, Soize, Sebastien, additional, Blasco, Jordi, additional, Davis, Stephen M., additional, Nogueira, Raul G., additional, Dávalos, Antoni, additional, Menon, Bijoy K., additional, van der Lugt, Aad, additional, Muir, Keith W., additional, Roos, Yvo B. W. E. M., additional, White, Phil, additional, Mitchell, Peter J., additional, Demchuk, Andrew M., additional, van Zwam, Wim H., additional, Jovin, Tudor G., additional, van Oostenbrugge, Robert J., additional, Dippel, Diederik W. J., additional, Campbell, Bruce C. V., additional, Guillemin, Francis, additional, Bracard, Serge, additional, Hill, Michael D., additional, Goyal, Mayank, additional, Marquering, Henk A., additional, and Majoie, Charles B. L. M., additional

Published
2019
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262. Current and future usefulness and potential of virtual simulation in improving outcomes and reducing complications in endovascular treatment of unruptured intracranial aneurysms.

Author

Ospel, Johanna Maria, Kashani, Nima, Mayank, Arnuv, Liebig, Thomas, Kaesmacher, Johannes, Holtmannspötter, Markus, Shankar, Jai, Almekhlafi, Mohammed A., Mitha, Alim P., Wong, John H., and Goyal, Mayank

Subjects
PREVENTION of surgical complications, INTRACRANIAL aneurysm surgery, BIOLOGICAL models, ENDOVASCULAR surgery, HEALTH care teams, INTERNATIONAL relations, QUALITY assurance, VIRTUAL reality, TREATMENT effectiveness, DATA analysis software, DESCRIPTIVE statistics
Abstract

Background Simulation training has been used in the aviation industry and surgical specialties for many years, but integration into neurointerventional practice is lagging behind. Objective To investigate how neurointerventionalists perceive the usefulness and limitations of simulation tools for the treatment of unruptured intracranial aneurysms (UIAs), and to identify simulation applications that were perceived to be most valuable for endovascular UIA treatment. Methods A web-based international multidisciplinary survey was conducted among neurointerventionalists. Participants were asked for their perceptions on the usefulness of current simulation tools and the potential impact of future simulation tools in endovascular UIA treatment. They identified simulation applications that could add most value to endovascular UIA treatment and help to specifically reduce endovascular UIA treatment complications. Results 233 neurointerventionalists from 38 countries completed the survey, most of whom (157/233 (67.4%)) had access to a simulator as a trainee, but only 15.3% used it frequently. Most participants (1 17/233 (50.2%)) considered currently available simulation tools relatively useful for endovascular UIA treatment, with greater value for trainees than for staff. Simulation of new devices (147/233 (63.1%)) and virtual practice runs in individual patient anatomy (1 19/233 (51.1%)) were considered most valuable for reducing endovascular UIA treatment complications. Conclusion Although neurointerventionalists perceived currently available simulation tools relatively useful, they did not use them regularly during their training. A priori testing of new devices and practice runs in individual patient anatomy in a virtual environment were thought to have the greatest potential for reducing endovascular UIA treatment complications. [ABSTRACT FROM AUTHOR]

Published
2021
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263. Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke.

Author

Kunz, Wolfgang G., Hunink, Myriam G., Almekhlafi, Mohammed A., Menon, Bijoy K., Saver, Jeffrey L., Dippel, Diederik W. J., Majoie, Charles B. L. M., Jovin, Tudor G., Davalos, Antoni, Bracard, Serge, Guillemin, Francis, Campbell, Bruce C. V., Mitchell, Peter J., White, Philip, Muir, Keith W., Brown, Scott, Demchuk, Andrew M., Hill, Michael D., Goyal, Mayank, and HERMES Collaborators

Published
2020
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265. Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging.

Author

Goyal, Mayank, Ospel, Johanna M., Menon, Bijoy, Almekhlafi, Mohammed, Jayaraman, Mahesh, Fiehler, Jens, Psychogios, Marios, Chapot, Rene, van der Lugt, Aad, Liu, Jianmin, Yang, Pengfei, Agid, Ronit, Hacke, Werner, Walker, Melanie, Fischer, Urs, Asdaghi, Negar, McTaggart, Ryan, Srivastava, Padma, Nogueira, Raul G., and Moret, Jacques

Published
2020
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268. Therapeutic Hypothermia in Acute Ischemic Stroke—a Systematic Review and Meta-Analysis.

Author

Kuczynski, Andrea M, Marzoughi, Sina, Al Sultan, Abdulaziz S., Colbourne, Frederick, Menon, Bijoy K., van Es, Adriaan C. G. M., Berez, Aaron L., Goyal, Mayank, Demchuk, Andrew M., and Almekhlafi, Mohammed A.

Abstract

Purpose of Review: Therapeutic hypothermia (TH) in stroke demonstrates robust neuroprotection in animals but clinical applications remain controversial. We assessed current literature on the efficacy of TH in ischemic stroke. Recent Findings: We conducted a meta-analysis comparing TH versus controls in studies published until June 2019. Controlled studies reporting on ≥ 10 adults with acute ischemic stroke were included. Primary outcome was functional independence (modified Rankin Scale [mRS] ≤ 2). Twelve studies (n = 351 TH, n = 427 controls) were included. Functional independence did not differ between groups (RR 1.17, 95% CI 0.93–1.46, random-effects p = 0.2). Five studies reported individual mRS outcomes and demonstrated a shift toward better outcome with TH (unadjusted cOR 1.57, 95% CI 1.01–2.44, p = 0.05). Overall complications were higher with TH (RR 1.18, 95% CI 1.06–1.32, p < 0.01). Summary: We did not observe an overall beneficial effect of TH in this analysis although some studies showed a shift toward better outcome. TH was associated with increased complications. [ABSTRACT FROM AUTHOR]

Published
2020
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271. Distribution and current problems of acute endovascular therapy for large artery occlusion from a two-year national survey in Japan.

Author

Takagi, Toshinori, Yoshimura, Shinichi, Sakai, Nobuyuki, Iihara, Koji, Oishi, Hidenori, Hirohata, Masaru, Matsumaru, Yuji, Matsumoto, Yasushi, Yamagami, Hiroshi, Menon, Bijoy K, Almekhlafi, Mohammed, Holodinsky, Jessalyn K, Kamal, Noreen, Hill, Michael D, and Goyal, Mayank

Subjects
CURRENT distribution, REGIONAL differences, ARTERIES
Abstract

Background: Endovascular treatment is recommended in clinical practice in Japan. However, its utilization and comprehensiveness are less well described. Aims: To report endovascular treatment utilization and overall geographical coverage in Japan and to analyze regional differences in the number of endovascular treatments, specialists, and endovascular treatment-capable hospitals. Methods: A national survey of members of the Japanese Society for NeuroEndovascular Therapy (JSNET) was conducted in 2017 and 2018. The total number of endovascular treatment cases per year was estimated, and the number of endovascular treatment cases per 100,000 people was calculated using the 2015 census. The distribution of treatment hospitals and JSNET specialists was mapped and the population coverage rate was determined. Results: The total number of endovascular treatment cases in Japan increased by 34.5% from 2016 (7702) to 2017 (10,360). The number of endovascular treatment-capable hospitals in Japan increased from 597 in 2016 to 693 in 2017, with an average annual caseload of 14.9 in 2017. The number of JSNET specialists per hospital decreased from 1.81 in 2016 to 1.76 in 2017 because of the increase in endovascular treatment-capable hospitals. Only 50 (7.2%) hospitals had > 40 endovascular treatment cases annually. The majority (97.7%) of the Japanese population lives within a 60-min drive of any endovascular treatment-capable hospital. However, only 70.4% live within a 60-min drive of a high-volume center (>40 cases annually). Conclusions: Utilization of endovascular treatment in Japan is increasing; however, the number of cases per hospital remains low, as is the number of specialists per endovascular treatment-capable hospital. Increased number of specialists and centralization of endovascular treatment services may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Published
2020
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273. Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

Author

Goyal, Mayank, primary, Almekhlafi, Mohammed A., additional, Cognard, Christoph, additional, McTaggart, Ryan, additional, Blackham, Kristine, additional, Biondi, Alessandra, additional, van der Lugt, Aad, additional, Majoie, Charles B. L. M., additional, van Zwam, Wim H., additional, van der Worp, H. Bart, additional, and Hill, Michael D., additional

Published
2018
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278. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

Author

Boers, Anna M M, primary, Jansen, Ivo G H, additional, Beenen, Ludo F M, additional, Devlin, Thomas G, additional, San Roman, Luis, additional, Heo, Ji Hoe, additional, Ribó, Marc, additional, Brown, Scott, additional, Almekhlafi, Mohammed A, additional, Liebeskind, David S, additional, Teitelbaum, Jeanne, additional, Lingsma, Hester F, additional, van Zwam, Wim H, additional, Cuadras, Patricia, additional, du Mesnil de Rochemont, Richard, additional, Beaumont, Marine, additional, Brown, Martin M, additional, Yoo, Albert J, additional, van Oostenbrugge, Robert J, additional, Menon, Bijoy K, additional, Donnan, Geoffrey A, additional, Mas, Jean Louis, additional, Roos, Yvo B W E M, additional, Oppenheim, Catherine, additional, van der Lugt, Aad, additional, Dowling, Richard J, additional, Hill, Michael D, additional, Davalos, Antoni, additional, Moulin, Thierry, additional, Agrinier, Nelly, additional, Demchuk, Andrew M, additional, Lopes, Demetrius K, additional, Aja Rodríguez, Lucia, additional, Dippel, Diederik W J, additional, Campbell, Bruce C V, additional, Mitchell, Peter J, additional, Al-Ajlan, Fahad S, additional, Jovin, Tudor G, additional, Madigan, Jeremy, additional, Albers, Gregory W, additional, Soize, Sebastien, additional, Guillemin, Francis, additional, Reddy, Vivek K, additional, Bracard, Serge, additional, Blasco, Jordi, additional, Muir, Keith W, additional, Nogueira, Raul G, additional, White, Phil M, additional, Goyal, Mayank, additional, Davis, Stephen M, additional, Marquering, Henk A, additional, and Majoie, Charles B L M, additional

Published
2018
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279. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

Author

Boers, Anna M. M., Jansen, Ivo G. H., Beenen, Ludo F. M., Devlin, Thomas G., San Roman, Luis, Heo, Ji Hoe, Ribo, Marc, Brown, Scott, Almekhlafi, Mohammed A., Liebeskind, David S., Teitelbaum, Jeanne, Lingsma, Hester F., van Zwam, Wim H., Cuadras, Patricia, de Rochemont, Richard du Mesnil, Beaumont, Marine, Brown, Martin M., Yoo, Albert J., van Oostenbrugge, Robert J., Menon, Bijoy K., Donnan, Geoffrey A., Mas, Jean Louis, Roos, Yvo B. W. E. M., Oppenheim, Catherine, van der Lugt, Aad, Dowling, Richard J., Hill, Michael D., Davalos, Antoni, Moulin, Thierry, Agrinier, Nelly, Demchuk, Andrew M., Lopes, Demetrius K., Aja Rodriguez, Lucia, Dippel, Diederik W. J., Campbell, Bruce C. V., Mitchell, Peter J., Al-Ajlan, Fahad S., Jovin, Tudor G., Madigan, Jeremy, Albers, Gregory W., Soize, Sebastien, Guillemin, Francis, Reddy, Vivek K., Bracard, Serge, Blasco, Jordi, Muir, Keith W., Nogueira, Raul G., White, Phil M., Goyal, Mayank, Davis, Stephen M., Marquering, Henk A., Majoie, Charles B. L. M., Boers, Anna M. M., Jansen, Ivo G. H., Beenen, Ludo F. M., Devlin, Thomas G., San Roman, Luis, Heo, Ji Hoe, Ribo, Marc, Brown, Scott, Almekhlafi, Mohammed A., Liebeskind, David S., Teitelbaum, Jeanne, Lingsma, Hester F., van Zwam, Wim H., Cuadras, Patricia, de Rochemont, Richard du Mesnil, Beaumont, Marine, Brown, Martin M., Yoo, Albert J., van Oostenbrugge, Robert J., Menon, Bijoy K., Donnan, Geoffrey A., Mas, Jean Louis, Roos, Yvo B. W. E. M., Oppenheim, Catherine, van der Lugt, Aad, Dowling, Richard J., Hill, Michael D., Davalos, Antoni, Moulin, Thierry, Agrinier, Nelly, Demchuk, Andrew M., Lopes, Demetrius K., Aja Rodriguez, Lucia, Dippel, Diederik W. J., Campbell, Bruce C. V., Mitchell, Peter J., Al-Ajlan, Fahad S., Jovin, Tudor G., Madigan, Jeremy, Albers, Gregory W., Soize, Sebastien, Guillemin, Francis, Reddy, Vivek K., Bracard, Serge, Blasco, Jordi, Muir, Keith W., Nogueira, Raul G., White, Phil M., Goyal, Mayank, Davis, Stephen M., Marquering, Henk A., and Majoie, Charles B. L. M.

Abstract

Background Follow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement. Objective To examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality. Methods Data of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (48 hours) was evaluated. Results Of 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14-120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of >= 133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15-131) vs 22 mL (IQR 8-71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (rho=0.60(95% CI 0.56 to 0.64) and rho=0.55(95% CI 0.50 to 0.60), respectively). Conclusions In patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI.

Published
2018

280. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Author

Halliday, Alison, Bulbulia, Richard, Bonati, Leo H, Chester, Johanna, Cradduck-Bamford, Andrea, Peto, Richard, Pan, Hongchao, Halliday, Alison, Bulbulia, Richard, Bonati, Leo H, Peto, Richard, Pan, Hongchao, Potter, John, Henning Eckstein, Hans, Farrell, Barbara, Flather, Marcus, Mansfield, Averil, Mihaylova, Boby, Rahimi, Kazim, Simpson, David, Thomas, Dafydd, Sandercock, Peter, Gray, Richard, Molyneux, Andrew, Shearman, Cliff P, Rothwell, Peter, Belli, Anna, Herrington, Will, Judge, Parminder, Leopold, Peter, Mafham, Marion, Gough, Michael, Cao, Piergiorgio, MacDonald, Sumaira, Bari, Vasha, Berry, Clive, Bradshaw, S, Brudlo, Wojciech, Clarke, Alison, Chester, Johanna, Cox, Robin, Cradduck-Bamford, Andrea, Fathers, Susan, Gaba, Kamran, Gray, Mo, Hayter, Elizabeth, Holliday, Constance, Kurien, Rijo, Lay, Michael, le Conte, Steffi, McManus, Jessica, Madgwick, Zahra, Morris, Dylan, Munday, Andrew, Pickworth, Sandra, Ostasz, Wiktor, Poorthuis, Michiel, Richards, Sue, Teixeira, Louisa, Tochlin, Sergey, Tully, Lynda, Wallis, Carol, Willet, Monique, Young, Alan, Casana, Renato, Malloggi, Chiara, Odero Jr, Andrea, Silani, Vincenzo, Parati, Gianfranco, Malchiodi, Giuseppe, Malferrari, Giovanni, Strozzi, Francesco, Tusini, Nicola, Vecchiati, Enrico, Coppi, Gioacchino, Lauricella, Antonio, Moratto, Roberto, Silingardi, Roberto, Veronesi, Jessica, Zini, Andrea, Ferrero, Emanuele, Ferri, Michelangelo, Gaggiano, Andrea, Labate, Carmelo, Nessi, Franco, Psacharopulo, Daniele, Viazzo, Andrea, Malacrida, Giovanni, Mazzaccaro, Daniela, Meola, Giovanni, Modafferi, Alfredo, Nano, Giovanni, Occhiuto, Maria Teresa, Righini, Paolo, Stegher, Silvia, Chiarandini, Stefano, Griselli, Filippo, Lepidi, Sandro, Pozzi Mucelli, Fabio, Naccarato, Marcello, D'Oria, Mario, Ziani, Barbara, Stella, Andrea, Dieng, Mortalla, Faggioli, Gianluca, Gargiulo, Mauro, Palermo, Sergio, Pini, Rodolfo, Puddu, Giovanni Maria, Vacirca, Andrea, Angiletta, Domenico, Desantis, Claudio, Marinazzo, Davide, Mastrangelo, Giovanni, Regina, Guido, Pulli, Raffaele, Bianchi, Paolo, Cireni, Lea, Coppi, Elisabetta, Pizzirusso, Rocco, Scalise, Filippo, Sorropago, Giovanni, Tolva, Valerio, Caso, Valeria, Cieri, Enrico, DeRango, Paola, Farchioni, Luca, Isernia, Giacomo, Lenti, Massimo, Parlani, Gian Battista, Pupo, Guglielmo, Pula, Grazia, Simonte, Gioele, Verzini, Fabio, Carimati, Federico, Delodovici, Maria Luisa, Fontana, Federico, Piffaretti, Gabriele, Tozzi, Matteo, Civilini, Efrem, Poletto, Giorgio, Reimers, Bernhard, Praquin, Barbara, Ronchey, Sonia, Capoccia, Laura, Mansour, Wassim, Sbarigia, Enrico, Speziale, Francesco, Sirignano, Pasqualino, Toni, Danilo, Galeotti, Roberto, Gasbarro, Vincenzo, Mascoli, Francesco, Rocca, Tiberio, Tsolaki, Elpiniki, Bernardini, Giulia, DeMarco, Ester, Giaquinta, Alessia, Patti, Francesco, Veroux, Massimiliano, Veroux, Pierfrancesco, Virgilio, Carla, Mangialardi, Nicola, Orrico, Matteo, Di Lazzaro, Vincenzo, Montelione, Nunzio, Spinelli, Francesco, Stilo, Francesco, Cernetti, Carlo, Irsara, Sandro, Maccarrone, Giuseppe, Tonello, Diego, Visonà, Adriana, Zalunardo, Beniamino, Chisci, Emiliano, Michelagnoli, Stefano, Troisi, Nicola, Masato, Maela, Dei Negri, Massimo, Pacchioni, Andrea, Saccà, Salvatore, Amatucci, Giovanni, Cannizzaro, Alfredo, Accrocca, Federico, Ambrogi, Cesare, Barbazza, Renzo, Marcucci, Giustino, Siani, Andrea, Bajardi, Guido, Savettieri, Giovanni, Argentieri, Angelo, Corbetta, Riccardo, Odero, Attilio, Quaretti, Pietro, Thyrion, Federico Z, Cappelli, Alessandro, Benevento, Domenico, De Donato, Gianmarco, Mele, Maria Agnese, Palasciano, Giancarlo, Pieragalli, Daniela, Rossi, Alessandro, Setacci, Carlo, Setacci, Francesco, Palombo, Domenico, Perfumo, Maria Cecilia, Martelli, Edoardo, Paolucci, Aldo, Trimarchi, Santi, Grassi, Viviana, Grimaldi, Luigi, La Rosa, Giuliana, Mirabella, Domenico, Scialabba, Matteo, Sichel, Leonildo, D'Angelo, Costantino L, Fadda, Gian Franco, Kasemi, Holta, Marino, Mario, Burzotta, Francesco, Codispoti, Francesco Alberto, Ferrante, Angela, Tinelli, Giovanni, Tshomba, Yamume, Vincenzoni, Claudio, Amis, Deborah, Anderson, Dawn, Catterson, Martin, Clarke, Mike, Davis, Michelle, Dixit, Anand, Dyker, Alexander, Ford, Gary, Jackson, Ralph, Kappadath, Sreevalsan, Lambert, David, Lees, Tim, Louw, Stephen, McCaslin, James, Parr, Noala, Robson, Rebecca, Stansby, Gerard, Wales, Lucy, Wealleans, Vera, Wilson, Lesley, Wyatt, Michael, Baht, Hardeep, Balogun, Ibrahim, Burger, Ilse, Cosier, Tracy, Cowie, Linda, Gunathilagan, Gunaratnam, Hargroves, David, Insall, Robert, Jones, Sally, Rudenko, Hannah, Schumacher, Natasha, Senaratne, Jawaharlal, Thomas, George, Thomson, Audrey, Webb, Tom, Brown, Ellen, Esisi, Bernard, Mehrzad, Ali, MacSweeney, Shane, McConachie, Norman, Southam, Alison, Sunman, Wayne, Abdul-Hamiq, Ahmed, Bryce, Jenny, Chetter, Ian, Ettles, Duncan, Lakshminarayan, Raghuram, Mitchelson, Kim, Rhymes, Christopher, Robinson, Graham, Scott, Paul, Vickers, Alison, Ashleigh, Ray, Butterfield, Stephen, Gamble, Ed, Ghosh, Jonathan, McCollum, Charles N, Welch, Mark, Welsh, Sarah, Wolowczyk, Leszek, Donnelly, Mary, D'Souza, Stephen, Egun, Anselm A, Gregary, Bindu, Joseph, Thomas, Kelly, Christine, Punekar, Shuja, Rahi, M Asad, Raj, Sonia, Seriki, Dare, Thomson, George, Brown, James, Durairajan, Ragunath, Grunwald, Iris, Guyler, Paul, Harman, Paula, Jakeways, Matthew, Khuoge, Christopher, Kundu, Ashish, Loganathan, Thayalini, Menon, Nisha, Prabakaran, Raji O, Sinha, Devesh, Thompson, Vicky, Tysoe, Sharon, Briley, Dennis, Darby, Chris, Hands, Linda, Howard, Dominic, Kuker, Wilhelm, Schulz, Ursula, Teal, Rachel, Barer, David, Brown, Andrew, Crawford, Susan, Dunlop, Paul, Krishnamurthy, Ramesh, Majmudar, Nikhil, Mitchell, Duncan, Myint, Min P, O'Brien, Richard, O'Connell, Janice, Sattar, Naweed, Vetrivel, Shanmugam, Beard, Jonathan, Cleveland, Trevor, Gaines, Peter, Humphreys, John, Jenkins, Alison, King, Craig, Kusuma, Daniel, Lindert, Ralph, Lonsdale, Robbie, Nair, Raj, Nawaz, Shah, Okhuoya, Faith, Turner, Douglas, Venables, Graham, Dorman, Paul, Hughes, Andrea, Jones, Deborah, Mendelow, David, Rodgers, Helen, Raudoniitis, Aidas, Enevoldson, Peter, Nahser, Hans, O'Brien, Imelda, Torella, Francesco, Watling, Dave, White, Richard, Brown, Pauline, Dutta, Dipankar, Emerson, Lorraine, Hilltout, Paula, Kulkarni, Sachin, Morrison, Jackie, Poskitt, Keith, Slim, Fiona, Smith, Sarah, Tyler, Amanda, Waldron, Joanne, Whyman, Mark, Bajoriene, Milda, Baker, Lucy, Colston, Amanda, Eliot-Jones, Bekky, Gramizadeh, Gita, Lewis-Clarke, Catherine, McCafferty, Laura, Oliver, Deborah, Palmer, Debbie, Patil, Abhijeet, Pegler, Suzannah, Ramadurai, Gopi, Roberts, Aisling, Sargent, Tracey, Siddegowda, Shivaprasad, Singh-Ranger, Ravi, Williams, Akintunde, Williams, Lucy, Windebank, Steve, Zuromskis, Tadas, Alwis, Lanka, Angus, Jane, Asokanathan, Asaipillai, Fornolles, Caroline, Hardy, Diana, Hunte, Sophy, Justin, Frances, Phiri, Duke, Mitabouana-Kibou, Marie, Sekaran, Lakshmanan, Sethuraman, Sakthivel, Tate, Margaret L, Akyea-Mensah, Joyce, Ball, Stephen, Chrisopoulou, Angela, Keene, Elizabeth, Phair, Alison, Rogers, Steven, Smyth, John V, Bicknell, Colin, Chataway, Jeremy, Cheshire, Nicholas, Clifton, Andrew, Eley, Caroline, Gibbs, Richard, Hamady, Mohammad, Hazel, Beth, James, Alex, Jenkins, Michael, Khanom, Nyma, Lacey, Austin, Mireskandari, Maz, O'Reilly, Joanna, Pereira, Antony, Sachs, Tina, Wolfe, John, Brown, Ellen, Davey, Philip, Rogers, Gill, Smith, Gemma, Tervit, Gareth, Nichol, Ian, Parry, Andrew, Young, Gavin, Ashley, Simon, Barwell, James, Dix, Francis, Nor, Azlisham M, Parry, Chris, Birt, Angela, Davies, Paul, George, Jim, Graham, Anne, Jonker, Leon, Joseph, Thomas, Kelsall, Nicci, Potts, Caroline, Wilson, Toni, Clifton, Andrew, Crinnion, Jamie, Cuenoud, Larissa, Aleksic, Nikola, Babic, Srdan, Ilijevski, Nenad, Radak, Đorde, Sagic, Dragan, Tanaskovic, Slobodan, Colic, Momcilo, Cvetic, Vladimir, Davidovic, Lazar, Jovanovic, Dejana R, Koncar, Igor, Mutavdžic, Perica, Sladojevic, Miloš, Tomic, Ivan, Debus, Eike S, Grzyska, Ulrich, Otto, Dagmar, Thomalla, Götz, Barlinn, Jessica, Gerber, Johannes, Haase, Kathrin, Hartmann, Christian, Ludwig, Stefan, Pütz, Volker, Reeps, Christian, Schmidt, Christine, Weiss, Norbert, Werth, Sebastian, Winzer, Simon, Gemper, Janine, Günther, Albrecht, Heiling, Bianka, Jochmann, Elisabeth, Karvouniari, Panagiota, Klingner, Carsten, Mayer, Thomas, Schubert, Julia, Schulze-Hartung, Friederike, Zanow, Jürgen, Bausback, Yvonne, Borger, Franka, Botsios, Spiridon, Branzan, Daniela, Bräunlich, Sven, Hölzer, Henryk, Lenzer, Janin, Piorkowski, Christopher, Richter, Nadine, Schuster, Johannes, Scheinert, Dierk, Schmidt, Andrej, Staab, Holger, Ulrich, Matthias, Werner, Martin, Berger, Hermann, Biró, Gábor, Eckstein, Hans-Henning, Kallmayer, Michael, Kreiser, Kornelia, Zimmermann, Alexander, Berekoven, Bärbel, Frerker, Klaus, Gordon, Vera, Torsello, Giovanni, Arnold, Sebastian, Dienel, Cora, Storck, Martin, Biermaier, Bernhard, Gissler, Hans Martin, Klötzsch, Christof, Pfeiffer, Tomas, Schneider, Ralph, Söhl, Leander, Wennrich, Michael, Alonso, Angelika, Keese, Michael, Groden, Christoph, Cöster, Andreas, Engelhardt, Andreas, Ratusinski, Christoph-Maria, Berg, Bengt, Delle, Martin, Formgren, Johan, Gillgren, Peter, Jarl, Lotta, Kall, Torbjörn B, Konrad, Peter, Nyman, Niklas, Skiöldebrand, Claes, Steuer, Johnny, Takolander, Rabbe, Malmstedt, Jonas, Acosta, Stefan, Björses, Katarina, Brandt, Kerstin, Dias, Nuno, Gottsäter, Anders, Holst, Jan, Kristmundsson, Thorarinn, Kühme, Tobias, Kölbel, Tilo, Lindblad, Bengt, Lindh, Mats, Malina, Martin, Ohrlander, Tomas, Resch, Tim, Rönnle, Viola, Sonesson, Björn, Warvsten, Margareta, Zdanowski, Zbigniew, Campbell, Erik, Kjellin, Per, Lindgren, Hans, Nyberg, Johan, Petersen, Björn, Plate, Gunnar, Pärsson, Håkan, Qvarfordt, Peter, Ignatenko, Pavel, Karpenko, Andrey, Starodubtsev, Vladimir, Chernyavsky, Mikhail A, Golovkova, Maria S, Komakha, Boris B, Zherdev, Nikolay N, Belyasnik, Andrey, Chechulov, Pavel, Kandyba, Dmitry, Stepanishchev, Igor, Csobay-Novák, Csaba, Dósa, Edit, Entz, László, Nemes, Balázs, Szeberin, Zoltán, Barzó, Pál, Bodosi, Mihaly, Fákó, Eniko, Fülöp, Béla, Németh, Tamás, Pazdernyik, Szilárd, Skoba, Krisztina, Vörös, Erika, Chatzinikou, Eleni, Giannoukas, Athanasios, Karathanos, Christos, Koutsias, Stylianos, Kouvelos, Georgios, Matsagkas, Miltiadis, Ralli, Styliani, Rountas, Christos, Rousas, Nikolaos, Spanos, Konstantinos, Brountzos, Elias, Kakisis, John D, Lazaris, Andreas, Moulakakis, Konstantinos G, Stefanis, Leonidas, Tsivgoulis, Georgios, Vasdekis, Spyros, Antonopoulos, Constantine N, Bellenis, Ion, Maras, Dimitrios, Polydorou, Antonios, Polydorou, Victoria, Tavernarakis, Antonios, Ioannou, Nikolaos, Terzoudi, Maria, Lazarides, Miltos, Mantatzis, Michalis, Vadikolias, Kostas, Dzieciuchowicz, Lukasz, Gabriel, Marcin, Krasinski, Zbigniew, Oszkinis, Grzegorz, Pukacki, Fryderyk, Slowinski, Maciej, Stanišic, Michal-Goran, Staniszewski, Ryszard, Tomczak, Jolanta, Zielinski, Maciej, Myrcha, Piotr, Rózanski, Dorota, Drelichowski, Stanislaw, Iwanowski, Wojciech, Koncewicz, Katarzyna, Bialek, Pawel, Biejat, Zbigniew, Czepel, Wojciech, Czlonkowska, Anna, Dowzenko, Anatol, Jedrzejewska, Julia, Kobayashi, Adam, Leszczynski, Jerzy, Malek, Andrzej, Polanski, Jerzy, Proczka, Robert, Skorski, Maciej, Szostek, Mieczyslaw, Andziak, Piotr, Dratwicki, Maciej, Gil, Robert, Nowicki, Miroslaw, Pniewski, Jaroslaw, Rzezak, Jaroslaw, Seweryniak, Piotr, Dabek, Pawel, Juszynski, Michal, Madycki, Grzegorz, Pacewski, Bartosz, Raciborski, Witold, Slowinski, Piotr, Staszkiewicz, Walerian, Bombic, Martin, Chlouba, Vladimír, Fiedler, Jirí, Hes, Karel, Koštál, Petr, Sova, Jindrich, Kríž, Zdenek, Prívara, Mojmír, Reif, Michal, Staffa, Robert, Vlachovský, Robert, Vojtíšek, Bohuslav, Hrbác, Tomáš, Kuliha, Martin, Procházka, Václav, Roubec, Martin, Školoudík, David, Netuka, David, Šteklácová, Anna, Beneš III, Vladimír, Buchvald, Pavel, Endrych, Ladislav, Šercl, Miroslav, Campos Jr, Walter, Casella, Ivan B, de Luccia, Nelson, Estenssoro, André E V, Presti, Calógero, Puech-Leão, Pedro, Neves, Celso R B, da Silva, Erasmo S, Sitrângulo Jr, Cid J, Monteiro, José A T, Tinone, Gisela, Bellini Dalio, Marcelo, Joviliano, Edwaldo E, Pontes Neto, Octávio M, Serra Ribeiro, Mauricio, Cras, Patrick, Hendriks, Jeroen M H, Hoppenbrouwers, Mieke, Lauwers, Patrick, Loos, Caroline, Yperzeele, Laetitia, Geenens, Mia, Hemelsoet, Dimitri, van Herzeele, Isabelle, Vermassen, Frank, Astarci, Parla, Hammer, Frank, Lacroix, Valérie, Peeters, André, Verhelst, Robert, Cirelli, Silvana, Dormal, Pol, Grimonprez, Annelies, Lambrecht, Bart, Lerut, Philipe, Thues, Eddy, De Koster, Guy, Desiron, Quentin, Maertens de Noordhout, Alain, Malmendier, Danielle, Massoz, Mireille, Saad, Georges, Bosiers, Marc, Callaert, Joren, Deloose, Koen, Blanco Cañibano, Estrella, García Fresnillo, Beatriz, Guerra Requena, Mercedes, Morata Barrado, Pilar C, Muela Méndez, Miguel, Yusta Izquierdo, Antonio, Aparici Robles, Fernando, Blanes Orti, Paula, García Dominguez, Luis, Martínez López, Rafael, Miralles Hernández, Manuel, Tembl Ferrairo, José I, Chamorro, Ángel, Macho, Juan, Obach, Víctor, Riambau, Vincent, San Román, Luis, Ahlhelm, Frank J, Blackham, Kristine, Engelter, Stefan, Eugster, Thomas, Gensicke, Henrik, Gürke, Lorenz, Lyrer, Philippe, Mariani, Luigi, Maurer, Marina, Mujagic, Edin, Müller, Mandy, Psychogios, Marios, Stierli, Peter, Stippich, Christoph, Traenka, Christopher, Wolff, Thomas, Wagner, Benjamin, Wiegert, Martina M, Clarke, Sandra, Diepers, Michael, Gröchenig, Ernst, Gürke, Lorenz, Gruber, Philipp, Isaak, Andrej, Kahles, Timo, Marti, Regula, Nedeltchev, Krassen, Remonda, Luca, Stierli, Peter, Tissira, Nadir, Valença Falcão, Martina, de Borst, Gert J, Lo, Rob H, Moll, Frans L, Toorop, Raechel, van der Worp, Bart H, Vonken, Evert J, Kappelle, Jaap L, Jahrome, Ommid, Vos, Floris, Schuiling, Wouter, van Overhagen, Hendrik, Keunen, Rudolf W M, Knippenberg, Bob, Wever, Jan J, Lardenoije, Jan W, Reijnen, Michel, Smeets, Luuk, van Sterkenburg, Steven, Fraedrich, Gustav, Gizewski, Elke, Gruber, Ingrid, Knoflach, Michael, Kiechl, Stefan, Rantner, Barbara, Abdulamit, Timur, Bergeron, Patrice, Padovani, Raymond, Trastour, Jean-Christophe, Cardon, Jean-Marie, Le Gallou-Wittenberg, Anne, Allaire, Eric, Becquemin, Jean-Pierre, Cochennec-Paliwoda, Frédéric, Desgranges, Pascal, Hosseini, Hassan, Kobeiter, Hicham, Marzelle, Jean, Almekhlafi, Mohammed A, Bal, Simerpreet, Barber, Phillip A, Coutts, Shelagh B, Demchuk, Andrew M, Eesa, Muneer, Gillies, Michelle, Goyal, Mayank, Hill, Michael D, Hudon, Mark E, Jambula, Anitha, Kenney, Carol, Klein, Gary, McClelland, Marie, Mitha, Alim, Menon, Bijoy K, Morrish, William F, Peters, Steven, Ryckborst, Karla J, Samis, Greg, Save, Supriya, Smith, Eric E, Stys, Peter, Subramaniam, Suresh, Sutherland, Garnette R, Watson, Tim, Wong, John H, Zimmel, L, Flis, Vojko, Matela, Jože, Miksic, Kazimir, Milotic, Franko, Mrdja, Božidar, Stirn, Barbara, Tetickovic, Erih, Gasparini, Mladen, Grad, Anton, Kompara, Ingrid, Miloševic, Zoren, Palmiste, Veronika, Toomsoo, Toomas, Aidashova, Balzhan, Kospanov, Nursultan, Lyssenko, Roman, Mussagaliev, Daulet, Beyar, Rafi, Hoffman, Aaron, Karram, Tony, Kerner, Arthur, Nikolsky, Eugenia, Nitecki, Samy, Andonova, Silva, Bachvarov, Chavdar, Petrov, Vesko, Cvjetko, Ivan, Vidjak, Vinko, Halužan, Damir, Petrunic, Mladen, Liu, Bao, Liu, Chang-Wei, Bartko, Daniel, Beno, Peter, Rusnák, František, Zelenák, Kamil, Ezura, Masayuki, Inoue, Takashi, Kimura, Naoto, Kondo, Ryushi, Matsumoto, Yasushi, Shimizu, Hiroaki, Endo, Hidenori, Furui, Eisuke, Bakke, Søren, Krohg-Sørensen, Kristen, Nome, Terje, Skjelland, Mona, Tennøe, Bjørn, Albuquerque e Castro, João, Alves, Gonçalo, Bastos Gonçalves, Frederico, de Aragão Morais, José, Garcia, Ana C, Valentim, Hugo, Vasconcelos, Leonor, Belcastro, Fernando, Cura, Fernando, Zaefferer, Patricio, Abd-Allah, Foad, Eldessoki, Mohamed H, Heshmat Kassem, Hussein, Soliman Gharieb, Haytham, Colgan, Mary P, Haider, Syed N, Harbison, Joe, Madhavan, Prakash, Moore, Dermot, Shanik, Gregor, Kazan, Viviane, Nazzal, Munier, and Ramsey-Williams, Vicki

Abstract

Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.

Published
2021
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281. Radiologic Patterns of Intracranial Hemorrhage and Clinical Outcome after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial

Author

Ospel, Johanna M., Qiu, Wu, Menon, Bijoy K., Mayank, Arnuv, Demchuk, Andrew, McTaggart, Ryan, Nogueira, Raul G., Poppe, Alexandre Y., Jayaraman, Mahesh, Buck, Brian, Haussen, Diogo, Roy, Daniel, Joshi, Manish, Zerna, Charlotte, Almekhlafi, Mohammed, Tymianski, Michael, Hill, Michael D., and Goyal, Mayank

Abstract

Intracranial hemorrhage is a common finding after endovascular stroke treatment, with only the more severe radiologic subtypes being strongly associated with poor outcome, irrespective of infarct volume.

Published
2021
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282. A Detailed Analysis of Infarct Patterns and Volumes at 24-hour Noncontrast CT and Diffusion-weighted MRI in Acute Ischemic Stroke Due to Large Vessel Occlusion: Results from the ESCAPE-NA1 Trial

Author

Ospel, Johanna M., Menon, Bijoy K., Qiu, Wu, Kashani, Nima, Mayank, Arnuv, Singh, Nishita, Cimflova, Petra, Marko, Martha, Nogueira, Raul G., McTaggart, Ryan A., Demchuk, Andrew M., Poppe, Alexandre Y., Zerna, Charlotte, Joshi, Manish, Almekhlafi, Mohammed A., Haussen, Diogo, Cutting, Shawna, Coutts, Shelagh B., Roy, Daniel, Rohr, Axel, Iancu, Dana, Tymianski, Michael, Hill, Michael D., and Goyal, Mayank

Abstract

There is a strong association between infarct structure and clinical outcome independent of total infarct volume in patients with acute ischemic stroke due to large vessel occlusion.

Published
2021
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285. Abstract 160: Outcomes and Relationship to Time: Alteplase Administration in Patients With Large Vessel Occlusion in Non-intervention Group of the Hermes Collaboration

Author

Goyal, Mayank, primary, Almekhlafi, Mohammed, additional, Dippel, Diederik W, additional, Campbell, Bruce, additional, Muir, Keith, additional, Demchuk, Andrew, additional, Bracard, Serge, additional, Davalos, Antoni, additional, Guillemin, Francis, additional, Jovin, Tudor, additional, Menon, Bijoy K, additional, Mitchell, Peter, additional, Brown, Scott B, additional, White, Phil, additional, Majoie, Charles, additional, Saver, Jeffrey L, additional, and Hill, Michael D, additional

Published
2018
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286. Collateral Scoring on CT Angiogram Must Evaluate Phase and Regional Pattern

Author

Casault, Colin, primary, Al Sultan, Abdulaziz S., additional, Trivedi, Anurag, additional, Sohn, Sung Il, additional, Qazi, Emmad, additional, Bokyo, Matthew, additional, Almekhlafi, Mohammed, additional, d’Esterre, Christopher, additional, Goyal, Mayank, additional, Demchuk, Andrew M., additional, and Menon, Bijoy K., additional

Published
2017
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292. Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke

Author

d’Esterre, Christopher D., primary, Trivedi, Anurag, additional, Pordeli, Pooneh, additional, Boesen, Mari, additional, Patil, Shivanand, additional, Hwan Ahn, Seong, additional, Najm, Mohamed, additional, Fainardi, Enrico, additional, Shankar, Jai Jai Shiva, additional, Rubiera, Marta, additional, Almekhlafi, Mohammed A., additional, Mandzia, Jennifer, additional, Khaw, Alexander V., additional, Barber, Philip, additional, Coutts, Shelagh, additional, Hill, Michael D., additional, Demchuk, Andrew M., additional, Sajobi, Tolulope, additional, Forkert, Nils D., additional, Goyal, Mayank, additional, Lee, Ting-Yim, additional, and Menon, Bijoy K., additional

Published
2017
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294. Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

Author

Ohara, Tomoyuki, Menon, Bijoy K., Al-Ajlan, Fahad S., Horn, MacKenzie, Najm, Mohamed, Al-Sultan, Abdulaziz, Puig, Josep, Dowlatshahi, Dar, Calleja Sanz, Ana I., Sohn, Sung-Il, Ahn, Seong H., Poppe, Alexandre Y., Mikulik, Robert, Asdaghi, Negar, Field, Thalia S., Jin, Albert, Asil, Talip, Boulanger, Jean-Martin, Letteri, Federica, Dey, Sadanand, Evans, James W., Goyal, Mayank, Hill, Michael D., Almekhlafi, Mohammed, and Demchuk, Andrew M.

Abstract

Supplemental Digital Content is available in the text.

Published
2021
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295. Public Health and Cost Benefits of Successful Reperfusion After Thrombectomy for Stroke.

Author

Kunz, Wolfgang G., Almekhlafi, Mohammed A., Menon, Bijoy K., Saver, Jeffrey L., Hunink, Myriam G., Dippel, Diederik W.J., Majoie, Charles B.L.M., Liebeskind, David S., Jovin, Tudor G., Davalos, Antoni, Bracard, Serge, Guillemin, Francis, Campbell, Bruce C.V., Mitchell, Peter J., White, Philip, Muir, Keith W., Brown, Scott, Demchuk, Andrew M., Hill, Michael D., and Goyal, Mayank

Published
2020
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296. Endovascular Treatment Decision Making in Octogenarians and Nonagenarians: Insights from UNMASK EVT an International Multidisciplinary Study.

Author

Ospel, Johanna Maria, Kashani N, Nima, Menon, Bijoy, Almekhlafi, Mohammed, Wilson, Alexis, Fischer, Urs, Campbell, Bruce, Yoshimura, Shinichi, Turjman, Francis, Cherian, Mathew, Heo, Ji-Hoe, Hill, Michael, Saposnik, Gustavo, and Goyal, Mayank

Abstract

Background: Evidence for efficacy and safety in stroke patients ≥80 years is limited, since they were underrepresented in randomized thrombectomy trials. This study sought to explore how physicians approach endovascular therapy (EVT) decision making in octogenarians and nonagenarians under their current local resources under assumed ideal conditions, i.e. without external (monetary or infrastructural) limitations. Methods: In an international multidisciplinary survey, 607 physicians involved in acute stroke care were randomly assigned 10 out of a pool of 22 case scenarios with different evidence levels for EVT, 4 of which involved octogenarians and 2 nonagenarians, and asked how they would treat the patient in the given scenario A) under their current local resources and B) under assumed ideal conditions, i.e. with no external restraints. Decision rates were calculated and clustered multivariable regression analysis performed to determine adjusted measures of effect size for patient age. Results: In octogenarians, physicians decided in favor of EVT in 76.7% (all of which were level 2B evidence scenarios) under current local resources and in 80.2% under assumed ideal conditions. In nonagenarians, 74.0% decided in favor of EVT under current local resources (level 1A scenarios: 87.7%, level 2B scenarios: 60.3%) and 79.2% would offer EVT under assumed ideal conditions (level 1A scenarios: 91.3%, level 2B scenarios: 67.2%). Age was not a significant predictor for treatment decision under current local resources (adjusted odds ratio, OR: 0.99, confidence interval, CI: 0.96–1.02 per decile increase) and under assumed ideal conditions (adjusted OR: 1.00, CI 0.97–1.03 per decile increase). Conclusion: The vast majority of physicians participating in this survey would offer EVT to acute ischemic stroke patients above 80 years. [ABSTRACT FROM AUTHOR]

Published
2020
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297. Influence of Age on EVT Treatment Decision in Patients with Low ASPECTS: Results of a Multinational Survey and its Implications.

Author

Ospel, Johanna M, Kashani, Nima, Almekhlafi, Mohammed, Chapot, René, and Goyal, Mayank

Abstract

Since endovascular treatment (EVT) has become standard of care for acute ischemic stroke due to large vessel occlusion, numerous trials have been initiated to expand treatment eligibility criteria, e.g. for patients presenting beyond 24 h [[1]] and patients with so-called minor strokes (IN EXTREMIS study) [[3]]. Past EVT trials have enabled several prognostic factors for patient outcome to be determined, two of which are baseline imaging with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and patient age. Numerous studies have shown that although EVT might still be effective in old patients, the likelihood of achieving good outcome is reduced as patient age increases [[4]-[6]]. In case of a 40-year old patient, 87.5% of the physicians decided to proceed with EVT, but with increasing patient age, this rate continuously decreased: if the same patient was 80 years old, only 50.3% would still offer EVT (Fig. [Extracted from the article]

Published
2020
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298. Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms.

Author

Almekhlafi, Mohammed A., Sultan, Abdulaziz S. Al, Kuczynski, Andrea M., Brinjikji, Waleed, Menon, Bijoy K., Hill, Michael D., and Goyal, Mayank

Subjects
THROMBOEMBOLISM prevention, INTRACRANIAL aneurysm surgery, CONFIDENCE intervals, META-analysis, STROKE, SYSTEMATIC reviews, TRANSIENT ischemic attack, PLATELET aggregation inhibitors
Abstract

Background and purpose Thromboembolic events are recognized complications of aneurysm coiling. Objective To identify any protective effects of antiplatelet therapy use before coiling of unruptured aneurysms. Methods We conducted a meta-analysis of clinical studies published up to February 2019. We included studies reporting symptomatic thromboembolic events (defined as clinical stroke or transient ischemic attacks) in patients who received antiplatelet therapy before coiling of unruptured aneurysms using unassisted coiling, balloon assistance, or multiple microcatheters. We excluded ruptured aneurysms and those treated with stent coiling or flow diverters. Results We identified 14 studies (2486 patients). All were single-center studies and four were prospective. In three studies with a control (no treatment) arm, the pooled risk ratio for symptomatic thromboembolic events with versus without antiplatelet therapy was 0.33 (95% CI 0.17 to 0.92, p= 0.035). The cumulative risk of symptomatic thromboembolic events with single antiplatelet agents was 5.0% '56/1122' (95% CI 1.6% to 8.4%, I²83.63%), and with dual or multiple agents 2.7% '33/1237' (95% CI 1.0% to 3.0%, I²39.9%). The incidence of diffusion lesions was reported in seven studies. It was 50.5% '96/190' (95% CI 7.3% to 93.9%, I²94.4%) with single agents compared with 43.9% '196/446' (95% CI 25.9% to 61.9%, I²73.4%) with dual or multiple agents. Conclusion Periprocedural antiplatelet therapy was associated with a low symptomatic thromboembolic event after coiling-only for unruptured aneurysms. However, available evidence is of limited quality with significant heterogeneity, requiring evidence from randomized controlled trials. [ABSTRACT FROM AUTHOR]

Published
2020

299. Endovascular treatment decision in acute stroke: does physician gender matter? Insights from UNMASK EVT, an international, multidisciplinary survey.

Author

Ospel, Johanna Maria, Nima Kashani, Wilson, Alexis T., Fischer, Urs, Campbell, Bruce C. V., Sylaja, Pillai N., Shinichi Yoshimura, Rabinstein, Alejandro A., Turjman, Francis, Mitchell, Peter, Byung Moon Kim, Cherian, Mathew P., Ji Hoe Heo, Baxter, Blaise W., Podlasek, Anna, Foss, Mona, Menon, Bijoy K., Almekhlafi, Mohammed A., Demchuk, Andrew M., and Hill, Michael D.

Subjects
ENDOVASCULAR surgery, HEALTH care teams, SEX distribution, SURVEYS, DECISION making in clinical medicine
Abstract

Background and purpose Differences in the treatment practice of female and male physicians have been shown in several medical subspecialties. It is currently not known whether this also applies to endovascular stroke treatment. The purpose of this study was to explore whether there are differences in endovascular treatment decisions made by female and male stroke physicians and neurointerventionalists. Methods In an international survey, stroke physicians and neurointerventionalists were randomly assigned 10 case scenarios and asked how they would treat the patient: (A) assuming there were no external constraints and (B) given their local working conditions. Descriptive statistics were used to describe baseline demographics, and the adjusted OR for physician gender as a predictor of endovascular treatment decision was calculated using logistic regression. Results 607 physicians (97 women, 508 men, 2 who did not wish to declare) participated in this survey. Physician gender was neither a significant predictor for endovascular treatment decision under assumed ideal conditions (endovascular therapy was favored by 77.0% of female and 79.3% of male physicians, adjusted OR 1.03, P=0.806) nor under current local resources (endovascular therapy was favored by 69.1% of female and 76.9% of male physicians, adjusted OR 1.03, P=0.814). Conclusion Endovascular therapy decision making between male and female physicians did not differ under assumed ideal conditions or under current local resources. [ABSTRACT FROM AUTHOR]

Published
2020
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300. Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis.

Author

Podlasek, Anna, Al Sultan, Abdul Aziz, Assis, Zarina, Kashani, Nima, Goyal, Mayank, and Almekhlafi, Mohammed A.

Subjects
ADENOSINE triphosphate, ANTICOAGULANTS, ASPIRIN, ENDOVASCULAR surgery, CEREBRAL circulation, COMBINATION drug therapy, CONFIDENCE intervals, INTRACRANIAL aneurysms, META-analysis, PATIENT safety, SURGICAL stents, SYSTEMATIC reviews, RELATIVE medical risk, TREATMENT effectiveness, CLOPIDOGREL, DESCRIPTIVE statistics
Abstract

Background Thromboembolic complications are not uncommon in patients undergoing neurointerventional procedures. The use of flow diverting stents is associated with higher risks of these complications despite current dual antiplatelet regimens. Objective To explore contemporary evidence on the safety of emerging dual antiplatelet regimens in flow diverting stenting procedures. Methods We performed a systematic review and meta-analysis to identify relevant articles in electronic databases, and relevant references. Studies reporting the complications and mortality of flow diverting stenting procedures using acetyl salicylic acid (ASA) + ticagrelor or ASA + prasugrel compared with ASA + clopidogrel were included. results Of 452 potentially relevant studies, we identified 49 studies (2526 patients) which reported the safety of ticagrelor or prasugrel for pooled analysis, and five studies (1005 patients) for meta-analysis. The pooled overall mortality in all studies was 2.14%, ischemic complications 6.89%, and hemorrhagic complications 3.68%. The use of ticagrelor or prasugrel was associated with a lower risk of mortality compared with clopidogrel (RR=4.57, 95% CI 1.23 to 16.99; p=0.02). Considering ischemic events, ASA + clopidogrel was as safe as ASA + prasugrel (RR=0.55, 95% CI 0.11 to 2.74; p=0.47) and ASA + ticagrelor (RR=0.74, 95% CI 0.32 to 1.74; p=0.49). ASA +ticagrelor was not associated with a higher risk of hemorrhagic complications (RR=0.92, 95% CI 0.27 to 3.16; p=0.89). Conclusions Evidence suggests that dual antiplatelet regimens including ticagrelor or prasugrel are safe for patients undergoing flow diversion procedures. Regimens using ticagrelor were associated with better survival than those using clopidogrel in the included studies. [ABSTRACT FROM AUTHOR]

Published
2020
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