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1. Intravenous Thrombolysis

Author: Alrohimi, Anas, Shuaib, Ashfaq, Parthasarathy, Rajsrinivas, Kate, Mahesh Pundlik, Ovbiagele, Bruce, editor, and Kim, Anthony S., editor
Published: 2024
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2. Tenecteplase Versus Alteplase in Medium Vessel Occlusion Ischemic Stroke: A Secondary Analysis of the Alteplase Compared to Tenecteplase Randomized Trial

Author: Fouzi Bala, Nishita Singh, Katrina Ignacio, Ibrahim Alhabli, Ayoola Ademola, Anas Alrohimi, Houman Khosravani, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Thalia Field, Gary Hunter, Faysal Benali, MacKenzie Horn, Andrew Demchuk, Michael Hill, Tolulope Sajobi, Brian Buck, Richard Swartz, Mohammed Almekhlafi, and Bijoy K. Menon
Subjects: stroke, occlusion, mechanical thrombectomy, alteplase, thrombolysis, ischemic, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose The safety and efficacy of tenecteplase in patients with ischemic stroke due to medium vessel occlusion (MeVO) are not well studied. We aimed to compare tenecteplase with alteplase in stroke due to MeVO. Methods Patients with baseline M2-middle cerebral artery (MCA), M3/M4-MCA, P2/P3/P4-posterior cerebral artery (PCA), A2/A3/A4-anterior cerebral artery (ACA) occlusions from the Alteplase Compared to Tenecteplase (AcT) trial were included. Primary outcome was the proportion of 90-day modified Rankin Scale (mRS) 0–1. Secondary outcomes were 90-day mRS 0–2, ordinal mRS, mortality, quality of life measures (EuroQol 5-Dimension 5-Level, EuroQol visual analog scale), and symptomatic intracerebral hemorrhage (sICH). Initial and final successful reperfusion were reported in patients undergoing endovascular thrombectomy (EVT). Results Among 1,558 patients with available baseline computed tomography angiography; 455 (29.2%) had MeVO of which 27.5% (125/455) were proximal M2; 16.3% (74/455) were distal M2; 35.2% (160/455) were M3/M4; 7.5% (34/455) were A2/A3/A4; and 13.6% (62/455) were P2/P3/P4 occlusions. EVT was performed in 87/455 (19.1%) patients. mRS 0–1 at 90 days was achieved in 37.9% in the tenecteplase versus 34.7% in the alteplase group (adjusted risk ratio [aRR] 1.07; 95% confidence interval [CI] 0.91–1.25). Rates of 90-day mRS 0–2, sICH, and mortality were similar in both groups. No statistical difference was noted in initial successful reperfusion rates (13.0% vs. 7.5%) among the 87 patients who underwent endovascular thrombectomy. However, final successful reperfusion was higher in the tenecteplase group (71.7% vs. 60.0%, aRR 1.29, 95% CI 1.04–1.61). Conclusion Intravenous tenecteplase had comparable safety, functional outcomes and quality of life compared to intravenous alteplase among patients with MeVO. Among those treated with EVT, tenecteplase was associated with higher successful reperfusion rates than alteplase.
Published: 2024
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3. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial

Author: Salluzzi, Marina, Blenkin, Nicole, Dueck, Ashley, Doram, Craig, Zhang, Qiao, Kenney, Carol, Ryckborst, Karla, Bohn, Shelly, Collier, Quentin, Taylor, Frances, Lethebe, B. Cord, Jambula, Anitha, Sage, Kayla, Toussaint, Lana, Save, Supryia, Lee, Jaclyn, Laham, N, Sultan, A.A., Deepak, A., Sitaram, A., Demchuk, Andrew M., Lockey, A., Micielli, A., Wadhwa, A., Arabambi, B., Graham, B., Bogiatzi, Chrysi, Doshi, Darshan, Chakraborty, D., Kim, Diana, Vasquez, D, Singh, D, Tse, Dominic, Harrison, E., Smith, E.E., Teleg, E., Klourfeld, E., Klein, G., Sebastian, I.A., Evans, J, Hegedus, J, Kromm, J, Lin, K, Ignacio, K, Ghavami, Kimia, Ismail, M., Moores, M., Panzini, M.A., Boyko, M., Almekhlafi, M.A., Newcommon, Nancy, Maraj, N., Imoukhuede, O., Volny, O., Stys, Peter, Couillard, Phillipe, Ojha, P., Eswaradass, P., Joundi, Raed, Singh, R., Asuncion, R.M., Muir, R.T., Dey, S., Mansoor, S., Wasyliw, S., Nagendra, S., Hu, Sherry, Althubait, S., Chen, S., Bal, S., Van Gaal, Stephen, Peters, Steven, Ray, Sucharita, Chaturvedi, S., Subramaniam, Suresh, Fu, Vivian, Villaluna, K., Maclean, G., King-Azote, P., Ma, C., Plecash, A., Murphy, C., Gorman, J., Wilson, L., Zhou, L., Benevente, O., Teal, P., Yip, S., Mann, S., Dewar, B., Demetroff, M., Shamloul, R., Beardshaw, R., Roberts, S., Blaquiere, D., Stotts, G., Shamy, M., Bereznyakova, O., Fahed, R., Alesefir, W., Lavoie, Suzy, Hache, A., Collard, K, Mackey, A., Gosselin-Lefebvre, S., Verreault, S., Beauchamp, B., Lambourn, L., Khaw, A., Mai, L., Sposato, L., Bres Bullrich, M., Azarpazhooh, R., Fridman, S., Kapoor, A., Southwell, A., Bardi, E., Fatakdawala, I., Kamra, M, Lopes, K., Popel, N., Norouzi, V., Liu, A., Liddy, A.M., Ghoari, B., Hawkes, C., Enriquez, C.A., Gladstone, D.J., Manosalva Alzate, H.A., Khosravani, H., Hopyan, J.J., Sivakumar, K., Son, M., Boulos, M.I., Hamind, M.A., Swartz, R.H., Murphy, R., Reiter, S., Fitzpatrick, T., Bhandari, V., Good, J., Penn, M., Naylor, M., Frost, S., Cayley, A., Akthar, F., Williams, J., Kalman, L., Crellin, L., Wiegner, R., Singh, R.S., Stewart, T., To, W., Singh, S., Pikula, A., Jaigobin, C., Carpani, F., Silver, F., Janssen, H., Schaafsma, J., del Campo, M., Alskaini, M., Rajendram, P., Fairall, P., Granfield, B., Crawford, D., Jabs, J., White, L., Sivakumar, L., Piquette, L., Nguyen, T., Nomani, A., Wagner, A., Alrohimi, A., Butt, A., D'Souza, A., Gajurel, B., Vekhande, C., Kamble, H., Kalashyan, H., Lloret, M., Benguzzi, M., Arsalan, N., Ishaque, N., Ashayeriahmadabad, R., Samiento, R., Hosseini, S., Kazi, S., Das, S., Sugumar, T., Selchen, D., Kostyrko, P., Muccilli, A., Saposnik, A.G., Vandervelde, C., Ratnayake, K., McMillan, S., Katsanos, A., Shoamanesh, A., Sahlas, D.J., Naidoo, V., Todorov, V., Toma, H., Brar, J., Lee, J., Horton, M., Shand, E., Weatherby, S., Jin, A., Durafourt, B., Jalini, S., Gardner, A., Tyson, C., Junk, E., Foster, K., Bolt, K., Sylvain, N., Maley, S., Urroz, L., Peeling, L., Kelly, M., Whelan, R., Cooley, R., Teitelbaum, J., Boutayeb, A., Moore, A., Cole, E., Waxman, L., Ben-Amor, N., Sanchez, R., Khalil, S., Nehme, A., Legault, C., Tampieri, D., Ehrensperger, E., Vieira, L., Cortes, M., Angle, M., Hannouche, M., Badawy, M., Werner, K., Wieszmuellner, S., Langer, A., Gisold, A., Zach, H., Rommer, P., Macher, S., Blechinger, S., Marik, W., Series, W., Baumgartinger, M., Krebs, S., Koski, J., Eirola, S., Ivanoff, T., Erakanto, A., Kupari, L., Sibolt, G., Panula, J., Tomppo, L., Tiainen, M., Ahlstrom, M., Martinez Majander, N., Suomalainen, O., Raty, S., Levi, C., Kerr, E., Allen, J., Kaauwai, L.P., Belevski, L., Russell, M., Ormond, S., Chew, A., Loiselle, A., Royan, A., Hughes, B., Garcia Esperon, C., Pepper, E., Miteff, F., He, J., Lycett, M., Min, M., Murray, N., Pavey, N., Starling de Barros, R., Gangadharan, S., Dunkerton, S., Waller, S., Canento Sanchez, T., Wellings, T., Edmonds, G., Whittaker, K.A., Ewing, M., Lee, P., Singkang, R., McDonald, A., Dos Santos, A., Shin, C., Jackson, D., Tsoleridis, J., Fisicchia, L., Parsons, N., Shenoy, N., Smith, S., Sharobeam, A., Balabanski, A., Park, A., Williams, C., Pavlin-Premri, D., Rodrigues, E., Alemseged, F., Ng, F., Zhao, H., Beharry, J., Ng, J.L., Williamson, J., Wong, J.Z.W., Li, K., Kwan, M.K., Valente, M., Yassi, N., Yogendrakumar, V., McNamara, B., Buchanan, C., McCarthy, C., Thomas, G., Stephens, K., Chung, M., Chung, M.F., Tang, M., Busch, T., Frost, T., Lee, R., Stuart, N., Pachani, N., Menon, A., Borojevic, B., Linton, C.M., Garcia, G., Callaly, E.P., Dewey, H., Liu, J., Chen, J., Wong, J., Nowak, K., To, K., Lizak, N.S., Bhalala, O., Park, P., Tan, P., Martins, R., Cody, R., Forbes, R., Chen, S.K., Ooi, S., Tu, S., Dang, Y.L., Ling, Z., Cranefield, J., Drew, R., Tan, A., Kurunawai, C., Harvey, J., Mahadevan, J.J., Cagi, L., Palanikumar, L., Chia, L.N., Goh, R., El-Masri, S., Urbi, B., Rapier, C., Berrill, H., McEvoy, H., Dunning, R., Kuriakose, S., Chad, T., Sapaen, V., Sabet, A., Shah, D., Yeow, D., Lilley, K., Ward, K., Mozhy Mahizhnan, M., Tan, M., Lynch, C., Coveney, S., Tobin, K., McCabe, J., Marnane, M., Murphy, S., Large, M., Moynihan, B., Boyle, K., Sanjuan, E., Sanchis, M., Boned, S., Pancorbo, O., Sala, V., Garcia, L., Garcia-Tornel, A., Juega, J., Pagola, J., Santana, K., Requena, M., Muchada, M., Olive, M., Lozano, P.J., Rubiera, M., Deck, M., Rodriguez, N., Gomez, B., Reyes Munoz, F.J., Gomez, A.S., Sanz, A.C., Garcia, E.C., Penacoba, G., Ramos, M.E., de Lera Alfonso, M., Feliu, A, Pardo, L., Ramirez, P., Murillo, A., Lopez Dominguez, D., Rodriguez, J., Terceno Izaga, M., Reina, M., Viturro, S.B., Bojaryn, U., Vera Monge, V.A., Silva Blas, Y., R Siew, R., Agustin, S J, Seet, C., Tianming, T., d'Emden, A., Murray, A., Welch, A., Hatherley, K., Day, N., Smith, W., MacRae, E., Mitchell, E.S., Mahmood, A., Elliot, J., Neilson, S., Biswas, V., Brown, C., Lewis, A., Ashton, A., Werring, D., Perry, R., Muhammad, R., Lee, Y.C., Black, A., Robinson, A., Williams, A., Banaras, A., Cahoy, C., Raingold, G., Marinescu, M., Atang, N., Bason, N., Francia, N., Obarey, S., Feerick, S., Joseph, J., Schulz, U., Irons, R., Benjamin, J., Quinn, L., Jhoots, M., Teal, R., Ford, G., Harston, G., Bains, H., Gbinigie, I., Mathieson, P., Sim, C.H., Hayter, E., Kennedy, K., Binnie, L., Priestley, N., Williams, R., Ghatala, R., Stratton, S., Blight, A., Zhang, L., Davies, A., Duffy, H., Roberts, J., Homer, J., Roberts, K., Dodd, K., Cawley, K., Martin, M., Leason, S., Cotgreave, S., Taylor, T., Nallasivan, A., Haider, S., Chakraborty, T., Webster, T., Gil, A., Martin, B., Joseph, B., Cabrera, C., Jose, D., Man, J., Aquino, J., Sebastian, S., Osterdahl, M., Kwan, M., Matthew, M., Ike, N., Bello, P., Wilding, P., Fuentes, R., Shah, R., Mashate, S., Patel, T., Nwanguma, U., Dave, V., Haber, A., Lee, A., O'Sullivan, A., Drumm, B., Dawson, A.C., Matar, T., Roberts, D., Taylor, E., Rounis, E., El-Masry, A., O'Hare, C., Kalladka, D., Jamil, S., Auger, S., Raha, O., Evans, M., Vonberg, F., Kalam, S., Ali Sheikh, A., Jenkins, I.H., George, J., Kwan, J., Blagojevic, J., Saeed, M., Haji-Coll, M., Tsuda, M., Sayed, M., Winterkron, N., Thanbirajah, N., Vittay, O., Karim, R., Smail, R.C., Gauhar, S., Elmamoun, S., Malani, S., Pralhad Kelavkar, S., Hiden, J., Ferdinand, P., Sanyal, R., Varquez, R., Smith, B., Okechukwu, C., Fox, E., Collins, E., Courtney, K., Tauro, S., Patterson, C., McShane, D., Roberts, G., McIImoyle, J., McGuire, K., Fearon, P., Gordon, P., Isaacs, K., Lucas, K., Smith, L., Dews, L., Bates, M., Lawrence, S., Heeley, S., Patel, V., Chin, Y.M., Sims, D., Littleton, E., Khaira, J., Nadar, K., Kieliszkowska, A., Sari, B., Domingos Belo, C., Smith, E., Manolo, E.Y., Aeron-Thomas, J., Doheny, M., Garcia Pardo, M., Recaman, M., Tibajia, M.C., Aissa, M., Mah, Y., Yu, T., Meenakshisundaram, S., Heller, S., Alsukhni, R., Williams, O., Farag, M., Benger, M., Engineer, A., Bayhonan, S., Conway, S., Bhalla, A., Nouvakis, D., Theochari, E., Boyle, F., Teo, J., King-Robson, J., Law, K.Y., Sztriha, L., McGovern, A., Day, D., Mitchell-Douglas, J., Francis, J., Iqbal, A., Punjabivaryani, P., Anonuevo Reyes, J., Anonuevo Reyes, M., Pauls, M., Buch, A., Hedstrom, A., Hutchinson, C., Kirkland, C., Newham, J., Wilkes, G., Fleming, L., Fleck, N., Franca, A., Chwal, B., Oldoni, C., Mantovani, G., Noll, G., Zanella, L., Soma, M., Secchi, T., Borelli, W., Rimoli, B.P., da Cunha Silva, G.H., Machado Galvao Mondin, L.A., Barbosa Cerantola, R., Imthon, A.K., Esaki, A.S., Camilo, M., Vincenzi, O.C., ds Cruz, R.R., Morillos, M.B., Riccioppa Rodrigues, G.G., Santos Ferreira, K., Pazini, A.M., Pena Pereira, M.A., de Albuquerque, A.L.A., Massote Fontanini, C.E., Matinez Rubio, C.F., dos Santos, D.T., Dias, F.A., Alves, F.F.A., Milani, C., Pegorer Santos, B., Winckler, F., De Souza, J.T., Bonome, L.A.M., Cury Silva, V.A., Teodoro, R.S., Modolo, G.P., Ferreira, N.C., Barbosa dos Santos, D.F., dos Santos Moreira, J.C., Cruz Guedes de Morais, A.B., Vieira, J., Mendes, G., de Queiroz, J.P., Coutts, Shelagh B, Ankolekar, Sandeep, Appireddy, Ramana, Arenillas, Juan F, Assis, Zarina, Bailey, Peter, Barber, Philip A, Bazan, Rodrigo, Buck, Brian H, Butcher, Ken S, Camden, Marie-Christine, Campbell, Bruce C V, Casaubon, Leanne K, Catanese, Luciana, Chatterjee, Kausik, Choi, Philip M C, Clarke, Brian, Dowlatshahi, Dar, Ferrari, Julia, Field, Thalia S, Ganesh, Aravind, Ghia, Darshan, Goyal, Mayank, Greisenegger, Stefan, Halse, Omid, Horn, Mackenzie, Hunter, Gary, Imoukhuede, Oje, Kelly, Peter J, Kennedy, James, Kleinig, Timothy J, Krishnan, Kailash, Lima, Fabricio, Mandzia, Jennifer L, Marko, Martha, Martins, Sheila O, Medvedev, George, Menon, Bijoy K, Mishra, Sachin M, Molina, Carlos, Moussaddy, Aimen, Muir, Keith W, Parsons, Mark W, Penn, Andrew M W, Pille, Arthur, Pontes-Neto, Octávio M, Roffe, Christine, Serena, Joaquin, Simister, Robert, Singh, Nishita, Spratt, Neil, Strbian, Daniel, Tham, Carol H, Wiggam, M Ivan, Williams, David J, Willmot, Mark R, Wu, Teddy, Yu, Amy Y X, Zachariah, George, Zafar, Atif, Zerna, Charlotte, and Hill, Michael D
Published: 2024
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4. Aneurysmal Versus 'Benign' Perimesencephalic Subarachnoid Hemorrhage

Author: Anas Alrohimi, Mark A. Davison, Abhi Pandhi, Mohammad A. Abdulrazzak, Daniel Wadden, Mark Bain, Nina Moore, M. Shazam Hussain, and Gabor Toth
Subjects: aneurysm, digital subtraction angiography, hydrocephalus, perimesencephalic subarachnoid hemorrhage, vasospasm, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background The rate of underlying ruptured aneurysms, complications, and their relevance to outcomes in “benign” perimesencephalic subarachnoid hemorrhage are not well known and underreported. Methods Retrospective analysis of patients with perimesencephalic subarachnoid hemorrhage from a large tertiary care center (2007–2022). Results Eighty‐one patients were included with mean age of 55.5 ± 10.3 years. An underlying ruptured aneurysm was diagnosed in 5 patients (6.2%); 3 (60%) had negative computed tomography angiography and they were detected only in digital subtraction angiography (2 on initial digital subtraction angiography and 1 on follow‐up digital subtraction angiography). The most common complication was vasospasm in 25/81 patients (31%), and the majority 21/25 (84%) were asymptomatic. Symptomatic vasospasm occurred at a significantly higher rate among patients with underlying aneurysm (40% versus 2.6%; P = 0.01). Hydrocephalus occurred in 10% of patients, all within 1 day, but at a higher rate in the aneurysmal group (40% versus 8%; P = 0.07). A total of 88% of patients had modified Rankin scale score 0–2 at discharge, but at a significantly higher rate in nonaneurysmal patients (91% versus 40%; P = 0.01). An underlying aneurysm, hydrocephalus, and symptomatic vasospasm were associated with poor functional status (odds ratio [OR] = 14.7 [2.1–104]; P = 0.007, OR = 22.6 [4.2–123.5]; P
Published: 2024
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5. Early and late basilar artery thrombectomy time window outcomes

Author: Adam T. Mierzwa, Rahul Rao, Sami Al Kasab, Ashley Nelson, Santiago Ortega-Gutierrez, Juan Vivanco-Suarez, Mudassir Farooqui, Ashutosh P. Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh N. Nguyen, Piers Klein, Mohamad Abdalkader, Hisham Salahuddin, Aditya Pandey, Zachary Wilseck, Sravanthi Koduri, Nirav Vora, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Syed Zaidi, and Mouhammad Jumaa
Subjects: stroke, basilar artery, thrombectomy, large-vessel occlusion, time window, Neurology. Diseases of the nervous system, RC346-429
Abstract: ImportanceStroke-to-recanalization time is a strong predictor of outcomes in anterior circulation large-vessel occlusion (LVO). The authors aimed to evaluate functional outcomes in early (
Published: 2024
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6. Using co-creation focus groups to customise a remote multidomain programme designed to increase dementia literacy

Author: Aravind Ganesh, Teresa Liu-Ambrose, Natalie Phillips, Kenneth Rockwood, Edeltraut Kröger, Nathan Herrmann, Guangyong Zou, Paul Mick, Serge Gauthier, Walter Wittich, Marie-Céline Lorenzini, Danielle Laurin, Gillian Einstein, Jennifer Bethell, Eric Smith, Karen Messer, Caroline Duchaine, Andrew Hamilton, Heather Keller, Barry Greenberg, Lesley Miller, Susan Marzolini, Robin Hsiung, Jennifer Campos, Jennifer Walker, Catherine Hughes, Nicole Gervais, Andrew Centen, Louis Bherer, Brigitte Gilbert, Amanda Wagner, Katherine Siminovitch, Laura Middleton, Carol Thomas, Andrew Lim, Nicole Anderson, Quincy Almeida, Ron Postuma, Nadia Gosselin, Howard Feldman, Alan Evans, Howard Chertkow, Nellie Kamkar, Manuel Montero-Odasso, Mark Speechley, Bill McIlroy, Richard Camicioli, Roger Marple, Raed Joundi, Chris McGibbon, Linda Yetman, Bryn Robinson, Sylvie Belleville, Haakon Nygaard, Danielle Alcock, Sarah Banks, Paul Brewster, Senny Chan, Marc Cuesta, Samir Das, Carol Evans, Guylaine Ferland, Scott Hofer, Inbal Itzhak, Diane Jacobs, Jody-Lynn Lupo, Zia Mohades, Carolyn Revta, Julie Robillard, Penny Slack, Kayla Regan, Gabrielle Aubin, Asma Fadhlaoui, Nicole D Anderson, Nouha Ben Gaied, Joyla Furlano, Pamela Jarrett, Michael Borrie, January Durant, Tatiana Herold, Yanina Sarquis-Adamson, Penelope Slack, Amal Trigui, Shahnaz Winer, Fatim Ajwani, Anas Alrohimi, Gabrielle Aubin Geneviève Arsenault-Lapierre, Maude Bouchard, Mark Boulos, Jacqueline Burt, Asif Javed Butt, Julie Carrier, Alison Chasteen, Rachel A. Crockett, Danielle D’Amico, Véronique Daneault, Thanh Dang-Vu, Alex Desautels, Caroline Desrosiers, Shirley Dumassais, Emily Dwosh, Margaret Fahnestok, Ryan Stanley Falck, Alexandra Fiocco, Christine Gagnon, Jean-François Gagnon, Liisa Galea, Catherine-Alexandra Grégoire, Stephanie Huang, Inbal Itzak, Elizaveta Klekovkina, Kim Lasnier-Le Quang, Dominique Lorrain, Kaljani Mahalingam, Sarantia Samantha Maltezos, Brooklyn Mankasingh, Samira Mehrabi, Tatiyana Mollayeva, Annabelle Moore, Aline Moussard, Reanne Mundadan, Kelly Murphy, Leigh-Anne M. Noltie, JB Orange, Emilie Parolin, Kathy Pichora-Fuller, Lori Piquette, Jason Plaks, Avery Pratt, Maria Natasha Rajah, Helli Raptis, Anne Julien-Rocheleau, Marie Y. Savundranayagam, Kylie Sullivan, Munira Sultana, Fatima Tangkhpanya, Talar Tcherkezian, Anne-Julie Tessier, Lynn Valeyry Verty, Stephanie Yamin, Anthonio Zadra, Rolando Acosta, Camille Beaudoin, Charlie Henri-Bellamare, Jessica Callegaro, Milad Heshmati, Pierre Pac Soo, Krista Lanctot, Joanne McLaurin, Paul Territo, Donald Weaver, Cheryl Wellington, Rida Abou-Haidar, Sarah Best, Korbin Blue, Isabella Celotto, Lauren Cole, Roger Dixon, Hiroko Dodge, Nada Elhayek, Thalia Field, Jason Haassenstab, Josée Hachee, Lisa Madlesnky, Lauren Moniz, Hanin Omar, Chris Pauley, Jenna Sands Ève Samson, Andrew Sexton, Sheetal Shajan, Sachie Sharma, Mariam Sidrak, Julia Truemner, François Boutin, Yves Boutot, Lise Daigle, Nita Goldband, Elaine Harris, Janet Finkelstein, Kateri Marchand, and Lloyd Schneider
Subjects: Medicine
Abstract: Objectives To adapt the content and functionalities of Brain Health PRO, a web-based multidomain program designed to increase dementia literacy, to the context and needs of users, providers and community organisations across Québec, Canada.Design Five consecutive qualitative co-creation focus group sessions 30–90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention.Setting Virtual meetings.Participants A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies.Data analysis Session recordings were summarised through both qualitative description and thematic analysis.Results The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of Brain Health PRO.Conclusions Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.
Published: 2023
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7. Abstract Number ‐ 49: Risk of HT with Early DOACs after Acute Ischemic Stroke: A Pooled Analysis

Author: Anas Alrohimi, David Z Rose, Scott Burgin, Swetha Renati, Hilker Corbin, Wei Deng, Guilherme H Oliveira, Theresa M Beckie, Arthur J Labovitz, Michael G Fradley, Nhi Tran, Laura C Gioia, Mahesh Kate, Kelvin Ng, Dar Dowlatshahi, Thalia S Field, Shelagh B Coutts, Muzzafar Siddiqui, Michael D Hill, Jodi Miller, Glen Jickling, Ashfaq Shuaib, Brian Buck, Mike Sharma, and Ken S Butcher
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction The risk of hemorrhagic transformation (HT) in the early phase of acute ischemic stroke (AIS) remains unknown, leading to potential unnecessary delays in initiation of anticoagulation for secondary stroke prevention. We sought to assess the rate of HT associated withdirect oral anticoagulant (DOAC) initiation within and beyond 48 hours after AIS, using a pooled analysis of available published data. Methods A pooled analysis of 6 studies (4 prospective observational blinded outcome studies and2 randomized trials) of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted. The primary endpoint was incident radiographic HT on follow‐up imaging. Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, mortality within the study period, and follow‐up modified Rankin Scale score.The results were reported as odds ratio (OR) andhazard ratio (HR)with 95% confidence interval (CI). Results We evaluated 509 patients; median infarct volume was1.5 (0.1‐7.8) ml, andmedian National Institutes of Health Stroke Scale was2 (0‐3).Incident radiographic HT was seen on follow‐up scan in 34 (6.8%) patients.DOAC initiation within 48 hours from index event was not associated with incident HT (adjusted OR 0.67, [0.30 – 1.50]P = 0.32).No patients developed symptomatic HT.Conversely, 31 (6.1%) patients developedrecurrent ischemic events, 64% of which occurred within 14 days.Initiating a DOAC within 48 hours of onset was associated with a trend towards lower rates of recurrent ischemic events, but this was not statistically significant (HR 0.42, [0.17 – 1.008]P = 0.052). In contrast to HT,recurrent ischemic events were associated with poor functional outcomes (OR = 6.8, [2.84 – 16.24], p< 0.001). Conclusions Initiation of DOAC within 48 hours after stroke was not associated with decreased risk of recurrent ischemic events, or increasedincident risk of HT. Both recurrent ischemic events and incident HT occurred at similar rates.Unlike HT, however, recurrent ischemic events were associated with poor outcomes.
Published: 2023
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8. Abstract Number ‐ 200: Aneurysmal versus 'Benign' Perimesencephalic Subarachnoid Hemorrhage

Author: Anas Alrohimi, Abhi Pandhi, Mohammad A Abdulrazzak, Mark Bain, Nina Moore, Shazam Hussain, Daniel Wadden, and Gabor Toth
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction Perimesencephalic subarachnoid hemorrhage (PMSAH) is characterized by bleeding centered in the basal cisterns anterior to the midbrain and pons without intraparenchymal or overt intraventricular extension. The term “benign” is often attached, because typically no source of bleeding is identified on high‐resolution vascular imaging, and recovery if often uncomplicated. Rarely, however, PMSAH can be secondary to ruptured vertebrobasilar aneurysms, and outcomes of these patients is underreported. Methods Retrospective analysis of patients with PMSAH to determine the rate of underlying ruptured aneurysm or vascular abnormality, associated complications, and outcomes. Age, sex, vascular risk factors, presenting symptoms, Hunt and Hess grade, modified Fisher grade, rate of underlying ruptured aneurysm, vasospasm, re‐bleed, hydrocephalus, and modified Rankin scale (mRS) were collected. Primary outcome was good functional status at discharge (mRS 0–2), reported as odds ratio (OR) with 95% confidence interval (CI). Results A total of 74 patients with PMSAH between 2007 and 2022 were identified. Mean age was 55.5± 10 years, and 60% were male. Hypertension and smoking were reported in 57% and 35% of patients, respectively. The most common presenting symptom was thunderclap headache in 89% of patients. Median (IQR) ofHunt and Hess grade was 2 (1‐2), and modified Fisher grade was 3 (1‐3). An underlying ruptured aneurysm was found in 3 patients (4%); two of which were in the vertebrobasilar system and one in the posterior communicating artery. Most common complications in this cohort was vasospasm in 28%, followed by hydrocephalus in 11%. Among patients with aneurysmal bleed, vasospasm and hydrocephalus occurred in 66% of patients each, compared to 8.5% and 27%, respectively in patients with non‐aneurysmal PMSAH. Re‐bleeding occurred only in one patient (1.3%); which occurred in a patient with non‐aneurysmal source of hemorrhage. A total of 88% of patients in our cohort had a favorable functional outcome (mRS 0–2) at discharge. An underlying ruptured aneurysm and acute hydrocephalus were associated with poor functional status(OR = 18.3, [1.5–228], P < 0.024), and OR = 25.8, [4.5–149], P < 0.001), respectively. However, vasospasm was noted to be asymptomatic in most cases (90%) and was not associated with unfavorable outcomes (OR = 0.75, [0.14–3.9], P < 0.73). Conclusions “Benign” PMSAH pattern was associated with a ruptured aneurysm in 4% of patients in our cohort.An underlying aneurysm and acute hydrocephalus were associated with poor outcomes. However, vasospasm was incidental and was not associated with unfavorable outcomes in patients with PMSAH.
Published: 2023
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9. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

Author: Srivastava, Abhilekh, Aljammaz, Ahmed M, Akindotun, Akintomide Femi, Jin, Albert Y, Fraser, Alexander, Khaw, Alexander V, Lemnaru, Alexandru, Southwell, Alisia, Ramji, Alnar, Alvarado-Bolaños, Alonso, Mouminah, Amr, Lahlouh, Amro B, Yu, Amy Y, Alrohimi, Anas, Lavoie, Andre, Rogge, Andrea, Micieli, Andrew, Nguyen, Andrew Linh, Callaghan-Brown, Angelique, Florendo-Cumbermack, Anita, Wadhwa, Ankur, Beaudoin, Ann-Marie, Cayley, Anne, Liddy, Anne Marie, Trivedi, Anurag, Katsanos, Aristeidis H, Shuaib, Ashfaq, Butt, Asif Javed, Bereznyakova, Olena, Beauchamp, Beth, Mahlitz, Breane, Graham, Brett R, Dewar, Brian, Buck, Brian H, Durafourt, Bryce A, Holtby, Caitlin, Jackson-Tarlton, Caitlin S, Bockus, Caitlyn, Stephenson, Caroline, Galloway, Camille, Odier, Céline, Deacon, Charles, Zerna, Charlotte, Vekhande, Chetan C, Bocti, Christian, Stapf, Christian, Hawkes, Christine, Stables, Christine Anne, Bogiatzi, Chrysi, Rodriguez, Claudia, Candale-Radu, Claudia, Murphy, Colleen, Casserly, Courtney Sarah, Fok, Daniel, Boasquevisque, Danielle de Sa, Wile, Daryl, Volders, David, Sahlas, Demetrios J, Shand, Elaine, Cora, Elena Adela, Battista, Eliane Di, Stewart, Eileen, Junk, Emily, Harrison, Emma L, Frenette, Eric, Teleg, Ericka, Abdellah, Eslam, Ghrooda, Esseddeeg, Akthar, Farhana, Evoy, François, Klein, Gary M, Maclean, Genoveva, Jickling, Glen C, Hawthorne, Glenda, Boyd, Gordon, Walker, Gregory, Saposnik, Gustavo, Lau, H Lee, Badr, Hanan E, Toma, Hassanain, Kalashyan, Hayrapet, Marion-Moffet, Hugo, Grant, Ian, Fatakdawala, Idris, Beaulieu-Boire, Isabelle, Williams, Janice, Brar, Jaskiran, Rivest, Jean, Wang, Jeffrey Z, Dawe, Jessica, Stang, Jillian, Day, Joanne, Miller, Jodi, Gorman, Johnathon, Hopyan, Julia Jasmine, Lee, Julian, Kromm, Julie, Foster, Kaitlyn, Ratnayake, Kanchana, Perera, Kanjana S, Murray, Karina Villaluna, Ryckborst, Karla, Lin, Katie, Sage, Kayla, Sivakuma, Keithan, MacDonald, Kelly A, Ng, Kelvin Kuan, Merchant, Ketki, Khan, Khurshid, Ghavami, Kimia, Johnston, Kyra, Mai, Lauren M, White, Leah, Barratt, Lee, Longpre, Linda, Crellin, Lisa, Peeling, Lissa, Piquette, Lori, Lomax, Lysa Boissé, Sadeghi, Mahsa, Kamra, Maneesha, Lavoie-April, Manuel, Moores, Margaret, Bullrich, Maria Bres, McClelland, Marie, Salluzzi, Marina, Wilcox, Mark, Boulos, Mark I, Marko, Martha, Boyko, Matthew, Lantagne-Hurtubise, Maude, AlHamid, May Adel, Shawawrah, Mays, Kelly, Michael E, Thorne, Michael W D, Shamy, Michel, Bussiere, Miguel, Dominc Tse, Ming Yin, Benguzzi, Mowad, Sharma, Mukul, Horton, Myles, Newcommon, Nancy, Simon, Nandy-Shelwine, Parks, Natalie E, Sultan, Nazeem, Markovic, Nevena, Daneault, Nicole, Ishaque, Noman, Fairall, Paige, Kostyrko, Pawel B, Stys, Peter K, Teal, Philip, Couillard, Philippe, King-Azote, Princess, Collier, Quentin, Epp, Rachel, Nair, Radhika, Joundi, Raed A, Jassal, Rajive, Schneider, Raphael, Hosseini, Reza, Bouchard, Rosalie, Whelan, Ruth, Cooley, S Regan, Sujanthan, Sajeevan, Mansoor, Salman, Yip, Samuel, Wasyliw, Sanchea, Taylor, Sean W., Friedman, Sebastian, Mann, Sharan, Maley, Sharleen Weese, Chiasson, Sherry, Hu, Sherry Xueying, Althubait, Shorog, Himed, Shuhira, Chen, Shuo, Bal, Simerpreet S, Page, Stacey A, Beck, Stacey D, Woodroffe, Stephanie, Reiter, Stephanie D, Gaal, Stephen van, Peters, Steven Ray, Darvesh, Sultan, Save, Supriya, Alcock, Susan, Piercey, Susannah, Adam, Suzie, Gosselin, Sylvie, Fitzpatrick, Tess, Perron, Thomas-Louis, Stewart, Tim, Benstead, Timothy J, Naidoo, Vishaya, Wahab, Wasan Abd, Oczkowski, Wiesław, Kingston, William, Leduc, William, To, William T H, Yu, Yeyao Joe, Liu, Zhongyu A, Aljundi, Ziad Ezzat, Menon, Bijoy K, Singh, Nishita, Deschaintre, Yan, Almekhlafi, Mohammed A, Coutts, Shelagh B, Thirunavukkarasu, Sibi, Khosravani, Houman, Appireddy, Ramana, Moreau, Francois, Gubitz, Gord, Tkach, Aleksander, Catanese, Luciana, Dowlatshahi, Dar, Medvedev, George, Mandzia, Jennifer, Pikula, Aleksandra, Shankar, Jai, Williams, Heather, Field, Thalia S, Manosalva, Alejandro, Siddiqui, Muzaffar, Zafar, Atif, Imoukhuede, Oje, Hunter, Gary, Demchuk, Andrew M, Mishra, Sachin, Gioia, Laura C, Jalini, Shirin, Cayer, Caroline, Phillips, Stephen, Elamin, Elsadig, Shoamanesh, Ashkan, Subramaniam, Suresh, Kate, Mahesh, Jacquin, Gregory, Camden, Marie-Christine, Benali, Faysal, Alhabli, Ibrahim, Bala, Fouzi, Horn, MacKenzie, Stotts, Grant, Hill, Michael D, Gladstone, David J, Poppe, Alexandre, Sehgal, Arshia, Zhang, Qiao, Lethebe, Brendan Cord, Doram, Craig, Ademola, Ayoola, Kenney, Carol, Sajobi, Tolulope T, and Swartz, Richard H
Published: 2022
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10. Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry.

Author: Mierzwa, Adam T, Nelson, Ashley, Kasab, Sami Al, Ortega Gutierrez, Santiago, Vivanco-Suarez, Juan, Farooqui, Mudassir, Jadhav, Ashutosh P, Desai, Shashvat, Toth, Gabor, Alrohimi, Anas, Nguyen, Thanh N, Klein, Piers, Abdalkader, Mohamad, Salahuddin, Hisham, Pandey, Aditya, Wilseck, Zachary, Koduri, Sravanthi, Vora, Niraj, Aladamat, Nameer, and Gharaibeh, Khaled
Published: 2024
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11. Early apixaban therapy after ischemic stroke in patients with atrial fibrillation

Author: Alrohimi, Anas, Buck, Brian, Jickling, Glen, Shuaib, Ashfaq, Thirunavukkarasu, Sibi, and Butcher, Ken S.
Published: 2021
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12. Stroke mimics: incidence, aetiology, clinical features and treatment

Author: Brian H. Buck, Naveed Akhtar, Anas Alrohimi, Khurshid Khan, and Ashfaq Shuaib
Subjects: Stroke, mimics, MRI, recurrence, TIA, Medicine
Abstract: AbstractMimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.
Published: 2021
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13. Understanding Physician and Patient Preferences for Thrombolysis in Ischemic Stroke Eligible for Endovascular Thrombectomy

Author: Nishita Singh, Nima Kashani, Aravind Ganesh, Carol Kenney, David Ben‐Israel, Raed Joundi, Aristeidis H. Katsanos, Anas Alrohimi, Fouzi Bala, Michel Shamy, Aleksander Tkach, Richard H. Swartz, Brian H. Buck, Andrew M. Demchuk, Michael D. Hill, Kednapa Thavorn, Tolulope Sajobi, Mohammed Almekhlafi, Dar Dowlatshahi, and Bijoy K. Menon
Subjects: acute ischemic stroke, bridging therapy, direct endovascular therapy, focus group, mixed methods study, survey, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background In light of evidence from recent trials that endovascular thrombectomy (EVT) alone may potentially be noninferior to combined treatment, that is, with intravenous thrombolysis (IVT) with alteplase and EVT, we sought to understand physician and patient preferences around this issue. Methods We conducted a 2‐stage mixed methods study that included a structured, international, web‐based cross‐sectional survey among stroke physicians, and a focus group involving stroke survivors and caregivers. Demographic information was collected from all participants. The survey offered multiple choice questions and options to respond via free text which was analyzed quantitatively. The focus group was conducted online and analyzed qualitatively using a grounded theory approach. Results A total of 225 physicians (67% men) from 44 countries completed the survey. Most participants (70%) were between 31 and 50 years of age. Survey results showed that in current practice, 90% respondents would offer IVT to patients with large vessel occlusion stroke eligible for both IVT and EVT. When asked if their practice would change in light of recent trials, 63% responded no. When asked about the appropriate timing for IVT in the setting of large vessel occlusion stroke with EVT availability, 56% preferred to administer IVT immediately, 21% were willing to defer the decision for 30 minutes from groin puncture, and 8% were willing to defer for 60 minutes from groin puncture to assess if reperfusion was achieved with EVT. A total of 61% participants would choose to use tenecteplase over alteplase as the preferred drug for IVT if both drugs are backed by evidence. The focus group identified a need to better understand patient characteristics that may benefit from EVT‐only or combined strategies. The focus group also identified the need for more data to inform physician decision making. Conclusions Most physicians surveyed prefer IVT before EVT in patients with acute ischemic stroke attributable to large vessel occlusion, although there was some uncertainty around this issue. The need for further studies, including data on IVT with tenecteplase and among various patient subgroups to inform decision making, was apparent from both the survey and the patient focus group.
Published: 2022
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14. Aneurysmal Versus “Benign” Perimesencephalic Subarachnoid Hemorrhage

Author: Alrohimi, Anas, primary, Davison, Mark A., additional, Pandhi, Abhi, additional, Abdulrazzak, Mohammad A., additional, Wadden, Daniel, additional, Bain, Mark, additional, Moore, Nina, additional, Hussain, M. Shazam, additional, and Toth, Gabor, additional
Published: 2024
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15. Abstract WP183: Intracranial Atherosclerotic Disease in Acute Basilar Artery Occlusion

Author: Mierzwa, Adam T, primary, Al Kasab, Sami, additional, Nelson, Ashley, additional, Ortega, Santiago, additional, Vivanco-Suarez, Juan, additional, Farooqui, Mudassir, additional, Jadhav, Ashutosh P, additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh, additional, Klein, Piers, additional, AbdalKader, Mohamad, additional, Pandey, Aditya, additional, Koduri, Sravanthi, additional, Vora, Shivangi, additional, Aladamat, Nameer, additional, Gharaibeh, Khaled, additional, Afreen, Ehad, additional, Zaidi, Syed, additional, and Jumaa, Mouhammad A, additional
Published: 2024
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16. Early and late basilar artery thrombectomy time window outcomes

Author: Mierzwa, Adam T., primary, Rao, Rahul, additional, Al Kasab, Sami, additional, Nelson, Ashley, additional, Ortega-Gutierrez, Santiago, additional, Vivanco-Suarez, Juan, additional, Farooqui, Mudassir, additional, Jadhav, Ashutosh P., additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh N., additional, Klein, Piers, additional, Abdalkader, Mohamad, additional, Salahuddin, Hisham, additional, Pandey, Aditya, additional, Wilseck, Zachary, additional, Koduri, Sravanthi, additional, Vora, Nirav, additional, Aladamat, Nameer, additional, Gharaibeh, Khaled, additional, Afreen, Ehad, additional, Zaidi, Syed, additional, and Jumaa, Mouhammad, additional
Published: 2024
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17. Treatment outcomes for ARUBA-eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry with the ARUBA trial

Author: Alrohimi, Anas, primary, Achey, Rebecca L, additional, Thompson, Nicolas, additional, Abdalla, Ramez N, additional, Patterson, Thomas, additional, Moazeni, Yasaman, additional, Rasmussen, Peter A, additional, Toth, Gabor, additional, Bain, Mark D, additional, Ansari, Sameer A, additional, Hussain, Shazam M, additional, and Moore, Nina Z, additional
Published: 2024
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18. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial

Author: Coutts, Shelagh B, Ankolekar, Sandeep, Appireddy, Ramana, Arenillas, Juan F, Assis, Zarina, Bailey, Peter, Barber, Philip A, Bazan, Rodrigo, Buck, Brian H, Butcher, Ken S, Camden, Marie-Christine, Campbell, Bruce C V, Casaubon, Leanne K, Catanese, Luciana, Chatterjee, Kausik, Choi, Philip M C, Clarke, Brian, Dowlatshahi, Dar, Ferrari, Julia, Field, Thalia S, Ganesh, Aravind, Ghia, Darshan, Goyal, Mayank, Greisenegger, Stefan, Halse, Omid, Horn, Mackenzie, Hunter, Gary, Imoukhuede, Oje, Kelly, Peter J, Kennedy, James, Kenney, Carol, Kleinig, Timothy J, Krishnan, Kailash, Lima, Fabricio, Mandzia, Jennifer L, Marko, Martha, Martins, Sheila O, Medvedev, George, Menon, Bijoy K, Mishra, Sachin M, Molina, Carlos, Moussaddy, Aimen, Muir, Keith W, Parsons, Mark W, Penn, Andrew M W, Pille, Arthur, Pontes-Neto, Octávio M, Roffe, Christine, Serena, Joaquin, Simister, Robert, Singh, Nishita, Spratt, Neil, Strbian, Daniel, Tham, Carol H, Wiggam, M Ivan, Williams, David J, Willmot, Mark R, Wu, Teddy, Yu, Amy Y X, Zachariah, George, Zafar, Atif, Zerna, Charlotte, Hill, Michael D, Salluzzi, Marina, Blenkin, Nicole, Dueck, Ashley, Doram, Craig, Zhang, Qiao, Kenney, Carol, Ryckborst, Karla, Bohn, Shelly, Collier, Quentin, Taylor, Frances, Lethebe, B. Cord, Jambula, Anitha, Sage, Kayla, Toussaint, Lana, Save, Supryia, Lee, Jaclyn, Laham, N, Sultan, A.A., Deepak, A., Sitaram, A., Demchuk, Andrew M., Lockey, A., Micielli, A., Wadhwa, A., Arabambi, B., Graham, B., Bogiatzi, Chrysi, Doshi, Darshan, Chakraborty, D., Kim, Diana, Vasquez, D, Singh, D, Tse, Dominic, Harrison, E., Smith, E.E., Teleg, E., Klourfeld, E., Klein, G., Sebastian, I.A., Evans, J, Hegedus, J, Kromm, J, Lin, K, Ignacio, K, Ghavami, Kimia, Ismail, M., Moores, M., Panzini, M.A., Boyko, M., Almekhlafi, M.A., Newcommon, Nancy, Maraj, N., Imoukhuede, O., Volny, O., Stys, Peter, Couillard, Phillipe, Ojha, P., Eswaradass, P., Joundi, Raed, Singh, R., Asuncion, R.M., Muir, R.T., Dey, S., Mansoor, S., Wasyliw, S., Nagendra, S., Hu, Sherry, Althubait, S., Chen, S., Bal, S., Van Gaal, Stephen, Peters, Steven, Ray, Sucharita, Chaturvedi, S., Subramaniam, Suresh, Fu, Vivian, Villaluna, K., Maclean, G., King-Azote, P., Ma, C., Plecash, A., Murphy, C., Gorman, J., Wilson, L., Zhou, L., Benevente, O., Teal, P., Yip, S., Mann, S., Dewar, B., Demetroff, M., Shamloul, R., Beardshaw, R., Roberts, S., Blaquiere, D., Stotts, G., Shamy, M., Bereznyakova, O., Fahed, R., Alesefir, W., Lavoie, Suzy, Hache, A., Collard, K, Mackey, A., Gosselin-Lefebvre, S., Verreault, S., Beauchamp, B., Lambourn, L., Khaw, A., Mai, L., Sposato, L., Bres Bullrich, M., Azarpazhooh, R., Fridman, S., Kapoor, A., Southwell, A., Bardi, E., Fatakdawala, I., Kamra, M, Lopes, K., Popel, N., Norouzi, V., Liu, A., Liddy, A.M., Ghoari, B., Hawkes, C., Enriquez, C.A., Gladstone, D.J., Manosalva Alzate, H.A., Khosravani, H., Hopyan, J.J., Sivakumar, K., Son, M., Boulos, M.I., Hamind, M.A., Swartz, R.H., Murphy, R., Reiter, S., Fitzpatrick, T., Bhandari, V., Good, J., Penn, M., Naylor, M., Frost, S., Cayley, A., Akthar, F., Williams, J., Kalman, L., Crellin, L., Wiegner, R., Singh, R.S., Stewart, T., To, W., Singh, S., Pikula, A., Jaigobin, C., Carpani, F., Silver, F., Janssen, H., Schaafsma, J., del Campo, M., Alskaini, M., Rajendram, P., Fairall, P., Granfield, B., Crawford, D., Jabs, J., White, L., Sivakumar, L., Piquette, L., Nguyen, T., Nomani, A., Wagner, A., Alrohimi, A., Butt, A., D'Souza, A., Gajurel, B., Vekhande, C., Kamble, H., Kalashyan, H., Lloret, M., Benguzzi, M., Arsalan, N., Ishaque, N., Ashayeriahmadabad, R., Samiento, R., Hosseini, S., Kazi, S., Das, S., Sugumar, T., Selchen, D., Kostyrko, P., Muccilli, A., Saposnik, A.G., Vandervelde, C., Ratnayake, K., McMillan, S., Katsanos, A., Shoamanesh, A., Sahlas, D.J., Naidoo, V., Todorov, V., Toma, H., Brar, J., Lee, J., Horton, M., Chen, S., Shand, E., Weatherby, S., Jin, A., Durafourt, B., Jalini, S., Gardner, A., Tyson, C., Junk, E., Foster, K., Bolt, K., Sylvain, N., Maley, S., Urroz, L., Peeling, L., Kelly, M., Whelan, R., Cooley, R., Teitelbaum, J., Boutayeb, A., Moore, A., Cole, E., Waxman, L., Ben-Amor, N., Sanchez, R., Khalil, S., Nehme, A., Legault, C., Tampieri, D., Ehrensperger, E., Vieira, L., Cortes, M., Angle, M., Hannouche, M., Badawy, M., Werner, K., Wieszmuellner, S., Langer, A., Gisold, A., Zach, H., Rommer, P., Macher, S., Blechinger, S., Marik, W., Series, W., Baumgartinger, M., Krebs, S., Koski, J., Eirola, S., Ivanoff, T., Erakanto, A., Kupari, L., Sibolt, G., Panula, J., Tomppo, L., Tiainen, M., Ahlstrom, M., Martinez Majander, N., Suomalainen, O., Raty, S., Levi, C., Kerr, E., Allen, J., Kaauwai, L.P., Belevski, L., Russell, M., Ormond, S., Chew, A., Loiselle, A., Royan, A., Hughes, B., Garcia Esperon, C., Pepper, E., Miteff, F., He, J., Lycett, M., Min, M., Murray, N., Pavey, N., Starling de Barros, R., Gangadharan, S., Dunkerton, S., Waller, S., Canento Sanchez, T., Wellings, T., Edmonds, G., Whittaker, K.A., Ewing, M., Lee, P., Singkang, R., McDonald, A., Dos Santos, A., Shin, C., Jackson, D., Tsoleridis, J., Fisicchia, L., Parsons, N., Shenoy, N., Smith, S., Sharobeam, A., Balabanski, A., Park, A., Williams, C., Pavlin-Premri, D., Rodrigues, E., Alemseged, F., Ng, F., Zhao, H., Beharry, J., Ng, J.L., Williamson, J., Wong, J.Z.W., Li, K., Kwan, M.K., Valente, M., Yassi, N., Cooley, R., Yogendrakumar, V., McNamara, B., Buchanan, C., McCarthy, C., Thomas, G., Stephens, K., Chung, M., Chung, M.F., Tang, M., Busch, T., Frost, T., Lee, R., Stuart, N., Pachani, N., Menon, A., Borojevic, B., Linton, C.M., Garcia, G., Callaly, E.P., Dewey, H., Liu, J., Chen, J., Wong, J., Nowak, K., To, K., Lizak, N.S., Bhalala, O., Park, P., Tan, P., Martins, R., Cody, R., Forbes, R., Chen, S.K., Ooi, S., Tu, S., Dang, Y.L., Ling, Z., Cranefield, J., Drew, R., Tan, A., Kurunawai, C., Harvey, J., Mahadevan, J.J., Cagi, L., Palanikumar, L., Chia, L.N., Goh, R., El-Masri, S., Urbi, B., Rapier, C., Berrill, H., McEvoy, H., Dunning, R., Kuriakose, S., Chad, T., Sapaen, V., Sabet, A., Shah, D., Yeow, D., Lilley, K., Ward, K., Mozhy Mahizhnan, M., Tan, M., Lynch, C., Coveney, S., Tobin, K., McCabe, J., Marnane, M., Murphy, S., Large, M., Moynihan, B., Boyle, K., Sanjuan, E., Sanchis, M., Boned, S., Pancorbo, O., Sala, V., Garcia, L., Garcia-Tornel, A., Juega, J., Pagola, J., Santana, K., Requena, M., Muchada, M., Olive, M., Lozano, P.J., Rubiera, M., Deck, M., Rodriguez, N., Gomez, B., Reyes Munoz, F.J., Gomez, A.S., Sanz, A.C., Garcia, E.C., Penacoba, G., Ramos, M.E., de Lera Alfonso, M., Feliu, A, Pardo, L., Ramirez, P., Murillo, A., Lopez Dominguez, D., Rodriguez, J., Terceno Izaga, M., Reina, M., Viturro, S.B., Bojaryn, U., Vera Monge, V.A., Silva Blas, Y., R Siew, R., Agustin, S J, Seet, C., Tianming, T., d'Emden, A., Murray, A., Welch, A., Hatherley, K., Day, N., Smith, W., MacRae, E., Mitchell, E.S., Mahmood, A., Elliot, J., Neilson, S., Biswas, V., Brown, C., Lewis, A., Ashton, A., Werring, D., Perry, R., Muhammad, R., Lee, Y.C., Black, A., Robinson, A., Williams, A., Banaras, A., Cahoy, C., Raingold, G., Marinescu, M., Atang, N., Bason, N., Francia, N., Obarey, S., Feerick, S., Joseph, J., Schulz, U., Irons, R., Benjamin, J., Quinn, L., Jhoots, M., Teal, R., Ford, G., Harston, G., Bains, H., Gbinigie, I., Mathieson, P., Irons, R., Sim, C.H., Hayter, E., Kennedy, K., Binnie, L., Priestley, N., Williams, R., Ghatala, R., Stratton, S., Blight, A., Zhang, L., Davies, A., Duffy, H., Roberts, J., Homer, J., Roberts, K., Dodd, K., Cawley, K., Martin, M., Leason, S., Cotgreave, S., Taylor, T., Nallasivan, A., Haider, S., Chakraborty, T., Webster, T., Gil, A., Martin, B., Joseph, B., Cabrera, C., Jose, D., Man, J., Aquino, J., Sebastian, S., Osterdahl, M., Kwan, M., Matthew, M., Ike, N., Bello, P., Wilding, P., Fuentes, R., Shah, R., Mashate, S., Patel, T., Nwanguma, U., Dave, V., Haber, A., Lee, A., O'Sullivan, A., Drumm, B., Dawson, A.C., Matar, T., Biswas, V., Roberts, D., Taylor, E., Rounis, E., El-Masry, A., O'Hare, C., Kalladka, D., Jamil, S., Auger, S., Raha, O., Evans, M., Vonberg, F., Kalam, S., Ali Sheikh, A., Jenkins, I.H., George, J., Kwan, J., Blagojevic, J., Saeed, M., Haji-Coll, M., Tsuda, M., Sayed, M., Winterkron, N., Thanbirajah, N., Vittay, O., Karim, R., Smail, R.C., Gauhar, S., Elmamoun, S., Malani, S., Pralhad Kelavkar, S., Hiden, J., Ferdinand, P., Sanyal, R., Varquez, R., Smith, B., Okechukwu, C., Fox, E., Collins, E., Courtney, K., Tauro, S., Patterson, C., McShane, D., Kerr, E., Roberts, G., McIImoyle, J., McGuire, K., Fearon, P., Gordon, P., Isaacs, K., Lucas, K., Smith, L., Dews, L., Bates, M., Lawrence, S., Heeley, S., Patel, V., Chin, Y.M., Sims, D., Littleton, E., Khaira, J., Nadar, K., Kieliszkowska, A., Sari, B., Domingos Belo, C., Smith, E., Manolo, E.Y., Aeron-Thomas, J., Doheny, M., Garcia Pardo, M., Recaman, M., Tibajia, M.C., Aissa, M., Mah, Y., Yu, T., Patel, V., Meenakshisundaram, S., Heller, S., Alsukhni, R., Williams, O., Farag, M., Benger, M., Engineer, A., Aissa, M., Bayhonan, S., Conway, S., Bhalla, A., Nouvakis, D., Theochari, E., Boyle, F., Teo, J., King-Robson, J., Law, K.Y., Sztriha, L., Ismail, M., McGovern, A., Day, D., Mitchell-Douglas, J., Francis, J., Iqbal, A., Punjabivaryani, P., Anonuevo Reyes, J., Anonuevo Reyes, M., Pauls, M., Buch, A., Hedstrom, A., Hutchinson, C., Kirkland, C., Newham, J., Wilkes, G., Fleming, L., Fleck, N., Franca, A., Chwal, B., Oldoni, C., Mantovani, G., Noll, G., Zanella, L., Soma, M., Secchi, T., Borelli, W., Rimoli, B.P., da Cunha Silva, G.H., Machado Galvao Mondin, L.A., Barbosa Cerantola, R., Imthon, A.K., Esaki, A.S., Camilo, M., Vincenzi, O.C., ds Cruz, R.R., Morillos, M.B., Riccioppa Rodrigues, G.G., Santos Ferreira, K., Pazini, A.M., Pena Pereira, M.A., de Albuquerque, A.L.A., Massote Fontanini, C.E., Matinez Rubio, C.F., dos Santos, D.T., Dias, F.A., Alves, F.F.A., Milani, C., Pegorer Santos, B., Winckler, F., De Souza, J.T., Bonome, L.A.M., Cury Silva, V.A., Teodoro, R.S., Modolo, G.P., Ferreira, N.C., Barbosa dos Santos, D.F., dos Santos Moreira, J.C., Cruz Guedes de Morais, A.B., Vieira, J., Mendes, G., and de Queiroz, J.P.
Abstract: Individuals with minor ischaemic stroke and intracranial occlusion are at increased risk of poor outcomes. Intravenous thrombolysis with tenecteplase might improve outcomes in this population. We aimed to test the superiority of intravenous tenecteplase over non-thrombolytic standard of care in patients with minor ischaemic stroke and intracranial occlusion or focal perfusion abnormality.
Published: 2024
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19. Protocol for LASER: A Randomized Evaluation and an Associated Registry of Early Anticoagulation With Edoxaban After Ischemic Stroke in Patients With Atrial Fibrillation

Author: Anas Alrohimi, Glen Jickling, Thomas Jeerakathil, Ashfaq Shuaib, Khurshid Khan, Mahesh Kate, Michael D. Hill, Brian Buck, and Ken Butcher
Subjects: atrial fibrillation, ischemic stroke, hemorrhagic transformation, edoxaban, randomized clinical trial, Neurology. Diseases of the nervous system, RC346-429
Abstract: Background: The optimal timing of anticoagulation after stroke in patients with atrial fibrillation (AF) is unknown.Aim and Hypothesis: Our primary aim is to demonstrate the safety of edoxaban initiation within 5 days of AF related stroke. Our secondary aim is to determine predictors of hemorrhagic transformation (HT) after AF related stroke. We hypothesize that the rate of radiological HT will not be increased in patients starting edoxaban within 5 days of AF related stroke, relative to those in whom initiation is delayed. We hypothesize that the risk of HT in patients treated with edoxaban can be predicted using RNA expressed in leukocytes at time of stroke.Methods and Design: LASER (Lixiana Acute Stroke Evaluation Registry) is a randomized controlled trial with an associated registry (clinicaltrials.gov NCT03494530). One hundred and fifty patients with ischemic stroke and AF will undergo baseline Computed Tomography (CT) scan and will be randomized 2:1 within 5 days of symptom onset to early (≤5 days, n = 100) or delayed (6–14 days, n = 50) edoxaban initiation. Participants will undergo clinical assessment and repeat CT at 7 days and clinical assessment at 90 days.Study Outcomes: The primary outcome is the rate of incident radiological HT. Secondary outcomes include symptomatic HT, recurrent ischemic stroke, recurrent sub-clinical infarcts on follow up CT, systemic hemorrhagic complication rate, National Institute of Health Stroke Scale and modified Rankin Scale at day 7 and 90, mortality within 90 days, quality of life assessments at day 90, and predictors of HT, including RNA expression by 6 pre-selected candidate genes.Discussion: Event rates for both HT and recurrent ischemic events, in patients treated with early vs. delayed edoxaban initiation are unknown. The primary study endpoint of LASER is an objective performance criterion relevant to clinical decision making in patients with AF related stroke. This study will provide data required for a definitive safety/efficacy study sample size power calculation.
Published: 2021
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20. Thrombolysis in Stroke Mimics: Comprehensive Stroke Centers vs Telestroke Sites

Author: Radhika Nair, Khurshid Khan, Jillian M. Stang, Mary-Lou Halabi, Erik Youngson, Anas Alrohimi, and Ashfaq Shuaib
Subjects: Neurology, Neurology (clinical), General Medicine
Abstract: Background: Hyperacute treatment of acute stroke may lead to thrombolysis in stroke mimics (SM). Our aim was to determine the frequency of thrombolysis in SM in primary stroke centers (PSC) dependent on telestroke versus comprehensive stroke centers (CSC). Method: Retrospective review of prospectively collected data from the Quality improvement and Clinical Research (QuICR) registry, the Discharge Abstract Database (DAD), and The National Ambulatory Care Reporting System (NACRS) of consecutive patients treated with intravenous thrombolysis for acute ischemic stroke in Alberta (Canada) from April 2016 to March 2021. Result: A total of 2471 patients who received thrombolysis were included. Linking the QuICR registry to DAD 169 (6.83%) patients were identified as SM; however, on our review of the records, only 112 (4.53%) were actual SM. SMs were younger with a mean age of 61.66 (±16.15) vs 71.08 (±14.55) in stroke. National Institute of Health Stroke Scale was higher in stroke with a median (IQR) of 10 (5–17) vs 7 (5–10) in SM. Only one patient (0.89 %) in SM groups had a small parenchymal hemorrhage versus 155 (6.57%) stroke patients had a parenchymal hemorrhage. There was no death among patients of thrombolysed SM during hospitalization versus 276 (11.69%) in stroke. There was no significant difference in the rate of SM among thrombolysed patients between PSC 27 (5.36%) versus CSC 85 (4.3%) (P = 0.312). The most responsible diagnosis of SM was migraine/migraine equivalent, functional disorder, seizure, and delirium. Conclusion: The diagnosis of SM may not always be correct when the information is extracted from databases. The rate of thrombolysis in SM via telestroke is similar to treatment in person at CSC.
Published: 2022

21. E-265 Aneurysmal versus ‘benign’ perimesencephalic subarachnoid hemorrhage

Author: Alrohimi, A, primary, Davison, M, additional, Pandhi, A, additional, Abdulrazzak, A, additional, Bain, M, additional, Moore, N, additional, Wadden, D, additional, Tsai, J, additional, Rasmussen, P, additional, Hussain, M, additional, and Toth, G, additional
Published: 2023
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22. E-173 Thrombectomy passes and clinical outcomes in patients with stroke intervention beyond 24 hours

Author: Pandhi, A, primary, Alrohimi, A, additional, Abdulrazzak, M, additional, Bain, M, additional, Moore, N, additional, Hussain, M, additional, Wadden, D, additional, Bullen, J, additional, and Toth, G, additional
Published: 2023
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23. E-257 Flow diversion of the ophthalmic aneurysms, outcomes in relation to the ophthalmic artery origin

Author: Abdulrazzak, M, primary, Alrohimi, A, additional, Pandhi, A, additional, Patterson, T, additional, Moore, N, additional, Tsai, J, additional, Bain, M, additional, Hussain, M, additional, Masaryk, T, additional, Rassmusen, P, additional, and Toth, G, additional
Published: 2023
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24. LB-008 Treatment outcomes for ARUBA eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry to the ARUBA trial

Author: Alrohimi, A, primary, Achey, R, additional, Abdalla, R, additional, Patterson, T, additional, Moazeni, Y, additional, Rasmussen, P, additional, Toth, G, additional, Bain, M, additional, Ansari, S, additional, Hussain, S, additional, and Moore, N, additional
Published: 2023
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25. Timing of Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation

Author: Anas Alrohimi, Glen Jickling, Brian Buck, and Ken S. Butcher
Subjects: Neurology, Neurology (clinical), General Medicine
Abstract: Patients with atrial fibrillation (AF) and ischemic stroke are at high risk for stroke recurrence. Early anticoagulation may reduce the risk of recurrent events but is usually avoided due to the risk of hemorrhagic transformation (HT). Current guidelines are based on empiric expert opinion. The assumed risk of HT is based on historical data from an older generation of anticoagulants. The direct oral anticoagulants (DOACs) have demonstrated lower risk of intracranial hemorrhage compared to older anticoagulants. However, the optimal timing of DOAC initiation after AF-related ischemic stroke has remained an area of clinical equipoise, as the pivotal phase III trials did not include patients in the early period after ischemic stroke. Multiple prospective studies and a few smaller randomized controlled trials evaluating the safety and efficacy of early versus delayed DOAC initiation have been completed. These studies have reported promising results of early DOAC initiation after acute ischemic stroke. However, a standardized documentation of HT rates on follow-up imaging with objective assessment criteria is missing from most of these studies. Larger randomized trials of early versus delayed DOAC are ongoing. A literature review was performed using keywords and Medical Subject Headings in MEDLINE/PubMed and Google Scholar databases. For each relevant paper, the bibliography was scrutinized for other relevant articles and journals. In this article, we review the risk of recurrent ischemic stroke and HT in patients with AF, pathophysiology, classification, predictors, natural history, and outcomes of HT and discuss the studies of early anticoagulation after AF-related ischemic stroke.
Published: 2022

26. Acute Basilar Artery Occlusion Thrombectomy Performed in Early (<6 hours) and Late Time Window (>6 hours) from the PC-SEARCH Registry (S24.002)

Author: Aladamat, Nameer, primary, Mierzwa, Adam, additional, Zaidi, Syed, additional, Gharaibeh, Khaled, additional, Afreen, Ehad, additional, Al Kasab, Sami, additional, Nelson, Ashley, additional, Farooqui, Mudassir, additional, Suarez, Juan Vivanco, additional, Jadhav, Ashutosh, additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh, additional, Piers, Klein, additional, Abdalkader, Mohamad, additional, Pandey, Aditya, additional, Koduri, Sravanthi, additional, Vora, Nirav, additional, Vora, Shivangi, additional, Jumaa, Mouhammad, additional, and Gutierrez, Santiago Ortega, additional
Published: 2023
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27. Predictors of good outcome in Acute stroke due to basilar artery occlusion from the PC-SEARCH Registry (S24.005)

Author: Mierzwa, Adam, primary, Zaidi, Syed, additional, Aladamat, Nameer, additional, Gharaibeh, Khaled, additional, Afreen, Ehad, additional, Al Kasab, Sami, additional, Nelson, Ashley, additional, Gutierrez, Santiago Ortega, additional, Suarez, Juan Vivanco, additional, Farooqui, Mudassir, additional, Jadhav, Ashutosh, additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh, additional, Piers, Klein, additional, Abdalkader, Mohamad, additional, Salahuddin, Hisham, additional, Pandey, Aditya, additional, Koduri, Sravanthi, additional, vora, Nirav, additional, and Jumaa, Mouhammad, additional
Published: 2023
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28. Intra-Arterial Thrombolysis Associated with Symptomatic Intracranial Hemorrhage in Acute Basilar Artery Thrombectomy, PC-SEARCH Registry Analysis (P8-5.008)

Author: Mierzwa, Adam, primary, Zaidi, Syed, additional, Gharaibeh, Khaled, additional, Aladamat, Nameer, additional, Afreen, Ehad, additional, Al Kasab, Sami, additional, Nelson, Ashley, additional, Gutierrez, Santiago Ortega, additional, Farooqui, Mudassir, additional, Vivanco-Suarez, Juan, additional, Jadhav, Ashutosh, additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh, additional, Piers, Klein, additional, Abdalkader, Mohamad, additional, Pandey, Aditya, additional, Koduri, Sravanthi, additional, Vora, Shivangi, additional, Vora, Nirav, additional, and Jumaa, Mouhammad, additional
Published: 2023
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29. Safety Profile of Rescue Stenting Following Thrombectomy for Acute Basilar Artery Occlusion – PC SEARCH Registry Analysis (P7-5.002)

Author: Afreen, Ehad, primary, Mierzwa, Adam, additional, Zaidi, Syed, additional, Aladamat, Nameer, additional, Gharaibeh, Khaled, additional, Nelson, Ashley, additional, Gutierrez, Santiago Ortega, additional, Farooqui, Mudassir, additional, Vivanco-Suarez, Juan, additional, Jadhav, Ashutosh, additional, Desai, Shashvat, additional, Toth, Gabor, additional, Alrohimi, Anas, additional, Nguyen, Thanh, additional, Piers, Klein, additional, Abdalkader, Mohamad, additional, Pandey, Aditya, additional, Koduri, Sravanthi, additional, Vora, Shivangi, additional, Vora, Nirav, additional, Jumaa, Mouhammad, additional, and Al Kasab, Sami, additional
Published: 2023
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30. Mechanical thrombectomy for acute large vessel occlusion stroke beyond 24 h

Author: Pandhi, Abhi, primary, Chandra, Rahul, additional, Abdulrazzak, Mohammad A., additional, Alrohimi, Anas, additional, Mahapatra, Ashutosh, additional, Bain, Mark, additional, Moore, Nina, additional, Hussain, M. Shazam, additional, Bullen, Jennifer, additional, and Toth, Gabor, additional
Published: 2023
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31. Risk of Hemorrhagic Transformation with Early Use of Direct Oral Anticoagulants after Acute Ischemic Stroke: A Pooled Analysis of Prospective Studies and Randomized Trials

Author: Alrohimi, Anas, primary, Rose, David Z., additional, Burgin, William Scott, additional, Renati, Swetha, additional, Hilker, Nicholas, additional, Deng, Wei, additional, Oliveira, Guilherme, additional, Beckie, Theresa, additional, Labovitz, Arthur J, additional, Fradley, Michael G, additional, Tran, Nhi, additional, Gioia, Laura, additional, Kate, Mahesh, additional, Ng, Kuan H, additional, Dowlatshahi, Dar, additional, Field, Thalia Shoshana, additional, Coutts, Shelagh B, additional, Siddiqui, Muzzafar, additional, Hill, Michael D, additional, Miller, Jodi, additional, Jickling, Glen C, additional, Shuaib, Ashfaq, additional, Buck, Brian, additional, Sharma, Mukul, additional, and Butcher, Kenneth, additional
Published: 2023
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32. Abstract Number ‐ 49: Risk of HT with Early DOACs after Acute Ischemic Stroke: A Pooled Analysis

Author: Alrohimi, Anas, primary, Rose, David Z, additional, Burgin, Scott, additional, Renati, Swetha, additional, Corbin, Hilker, additional, Deng, Wei, additional, Oliveira, Guilherme H, additional, Beckie, Theresa M, additional, Labovitz, Arthur J, additional, Fradley, Michael G, additional, Tran, Nhi, additional, Gioia, Laura C, additional, Kate, Mahesh, additional, Ng, Kelvin, additional, Dowlatshahi, Dar, additional, Field, Thalia S, additional, Coutts, Shelagh B, additional, Siddiqui, Muzzafar, additional, Hill, Michael D, additional, Miller, Jodi, additional, Jickling, Glen, additional, Shuaib, Ashfaq, additional, Buck, Brian, additional, Sharma, Mike, additional, and Butcher, Ken S, additional
Published: 2023
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33. Abstract Number ‐ 200: Aneurysmal versus “Benign” Perimesencephalic Subarachnoid Hemorrhage

Author: Alrohimi, Anas, primary, Pandhi, Abhi, additional, Abdulrazzak, Mohammad A, additional, Bain, Mark, additional, Moore, Nina, additional, Hussain, Shazam, additional, Wadden, Daniel, additional, and Toth, Gabor, additional
Published: 2023
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34. Acute Basilar Artery Occlusion Thrombectomy Performed in Early (<6 hours) and Late Time Window (>6 hours) from the PC-SEARCH Registry (S24.002)

Author: Nameer Aladamat, Adam Mierzwa, Syed Zaidi, Khaled Gharaibeh, Ehad Afreen, Sami Al Kasab, Ashley Nelson, Mudassir Farooqui, Juan Vivanco Suarez, Ashutosh Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh Nguyen, Klein Piers, Mohamad Abdalkader, Aditya Pandey, Sravanthi Koduri, Nirav Vora, Shivangi Vora, Mouhammad Jumaa, and Santiago Ortega Gutierrez
Published: 2023

35. Safety Profile of Rescue Stenting Following Thrombectomy for Acute Basilar Artery Occlusion – PC SEARCH Registry Analysis (P7-5.002)

Author: Ehad Afreen, Adam Mierzwa, Syed Zaidi, Nameer Aladamat, Khaled Gharaibeh, Ashley Nelson, Santiago Ortega Gutierrez, Mudassir Farooqui, Juan Vivanco-Suarez, Ashutosh Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh Nguyen, Klein Piers, Mohamad Abdalkader, Aditya Pandey, Sravanthi Koduri, Shivangi Vora, Nirav Vora, Mouhammad Jumaa, and Sami Al Kasab
Published: 2023

36. Predictors of good outcome in Acute stroke due to basilar artery occlusion from the PC-SEARCH Registry (S24.005)

Author: Adam Mierzwa, Syed Zaidi, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Sami Al Kasab, Ashley Nelson, Santiago Ortega Gutierrez, Juan Vivanco Suarez, Mudassir Farooqui, Ashutosh Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh Nguyen, Klein Piers, Mohamad Abdalkader, Hisham Salahuddin, Aditya Pandey, Sravanthi Koduri, Nirav vora, and Mouhammad Jumaa
Published: 2023

37. Intravenous Thrombolysis (IV tPA) Prior to Basilar Artery Thrombectomy, Analysis of the PCSEARCH Registry (S24.010)

Author: Ehad Afreen, Adam Mierzwa, Syed Zaidi, Khaled Gharaibeh, Nameer Aladamat, Sami Al Kasab, Ashley Nelson, Santiago Ortega Gutierrez, Mudassir Farooqui, Juan Vivanco-Suarez, Ashutosh Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh Nguyen, Piers Klein, Mohamad Abdalkader, Aditya Pandey, Sravanthi Koduri, Shivangi Vora, Nirav Vora, Mouhammad Jumaa, and Hisham Salahuddin
Published: 2023

38. Intra-Arterial Thrombolysis Associated with Symptomatic Intracranial Hemorrhage in Acute Basilar Artery Thrombectomy, PC-SEARCH Registry Analysis (P8-5.008)

Author: Adam Mierzwa, Syed Zaidi, Khaled Gharaibeh, Nameer Aladamat, Ehad Afreen, Sami Al Kasab, Ashley Nelson, Santiago Ortega Gutierrez, Mudassir Farooqui, Juan Vivanco-Suarez, Ashutosh Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh Nguyen, Klein Piers, Mohamad Abdalkader, Aditya Pandey, Sravanthi Koduri, Shivangi Vora, Nirav Vora, and Mouhammad Jumaa
Published: 2023

39. Comparing Functional Outcomes and Safety Profiles of First-Line Aspiration Thrombectomy Versus Stentriever for Acute Basilar Artery Occlusion: Propensity Analysis of the PC-SEARCH Thrombectomy Registry.

Author: Mierzwa, Adam T., Al Kasab, Sami, Nelson, Ashley, Ortega Gutierrez, Santiago, Vivanco-Suarez, Juan, Farooqui, Mudassir, Jadhav, Ashutosh P., Desai, Shashvat, Toth, Gabor, Alrohimi, Anas, Thanh N. Nguyen, Klein, Piers, Abdalkader, Mohamad, Salahuddin, Hisham, Pandey, Aditya, Koduri, Sravanthi, Vora, Niraj, Aladamat, Nameer, Gharaibeh, Khaled, and Afreen, Ehad
Published: 2023
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40. Abstract TP145: Mechanical Thrombectomy Beyond 24 Hours

Author: Pandhi, Abhi, primary, Chandra, Rahul, additional, Abdulrazzak, Mohammad, additional, Alrohimi, Anas, additional, Bain, Mark, additional, Moore, Nina, additional, Hussain, Muhammad, additional, Wadden, Daniel, additional, Bullen, Jennifer, additional, and Toth, Gabor, additional
Published: 2023
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41. Thrombolysis in Stroke Mimics: Comprehensive Stroke Centers vs Telestroke Sites

Author: Nair, Radhika, primary, Khan, Khurshid, additional, Stang, Jillian M., additional, Halabi, Mary-Lou, additional, Youngson, Erik, additional, Alrohimi, Anas, additional, and Shuaib, Ashfaq, additional
Published: 2022
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42. Timing of anticoagulation after acute ischemic stroke in patients with atrial fibrillation

Author: Alrohimi, Anas M
Abstract: Patients with atrial fibrillation (AF) and ischemic stroke are at high risk for stroke recurrence. Early anticoagulation may reduce the risk of recurrent events but is usually avoided due to the risk of hemorrhagic transformation (HT). The risk of HT is based on historical data from an older generation of anticoagulants. Recently, four direct oral anticoagulants (DOACs) have demonstrated a lower risk of intracranial hemorrhagic complications compared to older anticoagulants. However, in the pivotal phase III DOAC trials, AF patients were excluded within 7-30 days of an acute ischemic stroke (or up to 6 months for severe/disabling strokes). In patients with AF-related ischemic stroke, we aimed 1) To assess the safety of early DOAC initiation, 2) To identify clinical, imaging and RNA transcript predictors of HT, and 3) To determine the current practices on the timing of DOAC initiation. Chapter 1 reviews the risk of recurrent ischemic stroke and HT in patients with AF, pathophysiology, classification, predictors, natural history and outcomes of HT, and discusses the studies of early anticoagulation after AF-related ischemic stroke. Chapter 2 is a prospective study of patients with AF treated with dabigatran within 14 days of transient ischemic attack (TIA)/ minor ischemic stroke. Our results demonstrated that early dabigatran treatment did not precipitate symptomatic HT after minor stroke, and recurrent ischemic stroke as an outcome may be more common and important than HT. Chapter 3 is a prospective study of patients with AF treated with apixaban within 14 days of TIA/ ischemic stroke regardless of the size and severity. We found that early apixaban treatment did not precipitate symptomatic HT after stroke. All HT identified on neuroimaging were asymptomatic. Recurrent ischemic events were clinically symptomatic. Chapter 4 is a design for a randomized controlled trial (RCT) with an associated registry, which has actually begun at University of Alberta Hospital. A sample size of 150 patients with AF-related ischemic stroke is planned to be randomized 2:1 within five days of symptom onset to early (≤5 days, n=100) or delayed (6-14 days, n=50) edoxaban initiation. By conducting this RCT, we aimed to demonstrate the safety of edoxaban initiation within five days of AF-related stroke, and establish clinical, imaging and RNA transcript predictors of HT. Chapter 5 is an international electronic survey with practice-related demographic and clinical questions related to the timing of DOAC initiation. Our results showed that decisions related to the timing of DOAC initiation varied globally and the variability in clinical practice will continue until RCTs are completed. Chapter 6 is a pooled analysis of six studies of DOAC initiation within 14 days of ischemic stroke. Our analysis revealed that DOAC initiation within 48 hours after ischemic stroke was not associated with increased incident HT risk and that recurrent ischemic events were common and associated with poor outcomes. Chapter 7 is an interim analysis of the RCT that is described in chapter 4. We demonstrated that initiating edoxaban within five days of ischemic stroke onset was not associated with an increased risk of symptomatic or incident radiographic HT. By using clinical and systematic brain imaging data at baseline and following DOAC initiation, this thesis demonstrates that early DOAC initiation after ischemic stroke is not associated with an increased risk of HT. Baseline asymptomatic HT is associated with larger infarct volumes, and DOAC initiation does not appear to increase the risk of symptomatic HT. Incident radiographic HT on follow-up imaging could represent the natural history in the evolution of the infarct and does not appear to independently influence the functional outcomes. This may suggest that incident radiographic HT may be a useful objective performance criterion if systematic serial post-randomization imaging is included in the design. Finally, this thesis reveals that recurrent ischemic events are common, clinically symptomatic, and appear to affect functional outcomes. This observation suggests that recurrent ischemic stroke will be the more common clinical outcomes of interest in the RCTs; however, risk of symptomatic HT remains an important consideration as even a slight increase in frequency may outweigh any benefits of early anticoagulation. This thesis supports the need for further trials of DOAC timing after AF-related stroke, and our data might be useful for designing and calculating sample size requirements for future trials.
Published: 2023
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43. E-223 Atypical delayed mechanical thrombectomy for calcified cardiac emboli

Author: A Pandhi, A Alrohimi, A Mahapatra, A Russman, and G Toth
Published: 2022

44. Thrombolysis in Stroke Mimics: Comprehensive Stroke Centers vs Telestroke Sites

Author: Nair, Radhika, Khan, Khurshid, Stang, Jillian M., Halabi, Mary-Lou, Youngson, Erik, Alrohimi, Anas, and Shuaib, Ashfaq
Abstract: ABSTRACT:Background:Hyperacute treatment of acute stroke may lead to thrombolysis in stroke mimics (SM). Our aim was to determine the frequency of thrombolysis in SM in primary stroke centers (PSC) dependent on telestroke versus comprehensive stroke centers (CSC).Method:Retrospective review of prospectively collected data from the Quality improvement and Clinical Research (QuICR) registry, the Discharge Abstract Database (DAD), and The National Ambulatory Care Reporting System (NACRS) of consecutive patients treated with intravenous thrombolysis for acute ischemic stroke in Alberta (Canada) from April 2016 to March 2021.Result:A total of 2471 patients who received thrombolysis were included. Linking the QuICR registry to DAD 169 (6.83%) patients were identified as SM; however, on our review of the records, only 112 (4.53%) were actual SM. SMs were younger with a mean age of 61.66 (±16.15) vs 71.08 (±14.55) in stroke. National Institute of Health Stroke Scale was higher in stroke with a median (IQR) of 10 (5–17) vs 7 (5–10) in SM. Only one patient (0.89 %) in SM groups had a small parenchymal hemorrhage versus 155 (6.57%) stroke patients had a parenchymal hemorrhage. There was no death among patients of thrombolysed SM during hospitalization versus 276 (11.69%) in stroke. There was no significant difference in the rate of SM among thrombolysed patients between PSC 27 (5.36%) versus CSC 85 (4.3%) (P= 0.312). The most responsible diagnosis of SM was migraine/migraine equivalent, functional disorder, seizure, and delirium.Conclusion:The diagnosis of SM may not always be correct when the information is extracted from databases. The rate of thrombolysis in SM via telestroke is similar to treatment in person at CSC.
Published: 2023
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45. Stroke mimics: incidence, aetiology, clinical features and treatment

Author: Ashfaq Shuaib, Brian Buck, Khurshid Khan, Anas Alrohimi, and Naveed Akhtar
Subjects: Pediatrics, medicine.medical_specialty, recurrence, Review Article, 030204 cardiovascular system & hematology, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Suspected stroke, Stroke, mimics, business.industry, Incidence (epidemiology), Incidence, TIA, Stroke mimics, General Medicine, medicine.disease, Magnetic Resonance Imaging, Neurology, Etiology, business, Tomography, X-Ray Computed, MRI
Abstract: Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.
Published: 2021

46. E-223 Atypical delayed mechanical thrombectomy for calcified cardiac emboli

Author: Pandhi, A, primary, Alrohimi, A, additional, Mahapatra, A, additional, Russman, A, additional, and Toth, G, additional
Published: 2022
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47. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

Author: Menon, Bijoy K, primary, Buck, Brian H, additional, Singh, Nishita, additional, Deschaintre, Yan, additional, Almekhlafi, Mohammed A, additional, Coutts, Shelagh B, additional, Thirunavukkarasu, Sibi, additional, Khosravani, Houman, additional, Appireddy, Ramana, additional, Moreau, Francois, additional, Gubitz, Gord, additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, Jai, additional, Williams, Heather, additional, Field, Thalia S, additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhuede, Oje, additional, Hunter, Gary, additional, Demchuk, Andrew M, additional, Mishra, Sachin, additional, Gioia, Laura C, additional, Jalini, Shirin, additional, Cayer, Caroline, additional, Phillips, Stephen, additional, Elamin, Elsadig, additional, Shoamanesh, Ashkan, additional, Subramaniam, Suresh, additional, Kate, Mahesh, additional, Jacquin, Gregory, additional, Camden, Marie-Christine, additional, Benali, Faysal, additional, Alhabli, Ibrahim, additional, Bala, Fouzi, additional, Horn, MacKenzie, additional, Stotts, Grant, additional, Hill, Michael D, additional, Gladstone, David J, additional, Poppe, Alexandre, additional, Sehgal, Arshia, additional, Zhang, Qiao, additional, Lethebe, Brendan Cord, additional, Doram, Craig, additional, Ademola, Ayoola, additional, Shamy, Michel, additional, Kenney, Carol, additional, Sajobi, Tolulope T, additional, Swartz, Richard H, additional, Srivastava, Abhilekh, additional, Aljammaz, Ahmed M, additional, Akindotun, Akintomide Femi, additional, Jin, Albert Y, additional, Fraser, Alexander, additional, Khaw, Alexander V, additional, Lemnaru, Alexandru, additional, Southwell, Alisia, additional, Ramji, Alnar, additional, Alvarado-Bolaños, Alonso, additional, Mouminah, Amr, additional, Lahlouh, Amro B, additional, Yu, Amy Y, additional, Alrohimi, Anas, additional, Lavoie, Andre, additional, Rogge, Andrea, additional, Micieli, Andrew, additional, Nguyen, Andrew Linh, additional, Callaghan-Brown, Angelique, additional, Florendo-Cumbermack, Anita, additional, Wadhwa, Ankur, additional, Beaudoin, Ann-Marie, additional, Cayley, Anne, additional, Liddy, Anne Marie, additional, Trivedi, Anurag, additional, Katsanos, Aristeidis H, additional, Shuaib, Ashfaq, additional, Butt, Asif Javed, additional, Bereznyakova, Olena, additional, Beauchamp, Beth, additional, Mahlitz, Breane, additional, Graham, Brett R, additional, Dewar, Brian, additional, Durafourt, Bryce A, additional, Holtby, Caitlin, additional, Jackson-Tarlton, Caitlin S, additional, Bockus, Caitlyn, additional, Stephenson, Caroline, additional, Galloway, Camille, additional, Odier, Céline, additional, Deacon, Charles, additional, Zerna, Charlotte, additional, Vekhande, Chetan C, additional, Bocti, Christian, additional, Stapf, Christian, additional, Hawkes, Christine, additional, Stables, Christine Anne, additional, Bogiatzi, Chrysi, additional, Rodriguez, Claudia, additional, Candale-Radu, Claudia, additional, Murphy, Colleen, additional, Casserly, Courtney Sarah, additional, Fok, Daniel, additional, Boasquevisque, Danielle de Sa, additional, Wile, Daryl, additional, Volders, David, additional, Sahlas, Demetrios J, additional, Shand, Elaine, additional, Cora, Elena Adela, additional, Battista, Eliane Di, additional, Stewart, Eileen, additional, Junk, Emily, additional, Harrison, Emma L, additional, Frenette, Eric, additional, Teleg, Ericka, additional, Abdellah, Eslam, additional, Ghrooda, Esseddeeg, additional, Akthar, Farhana, additional, Evoy, François, additional, Klein, Gary M, additional, Maclean, Genoveva, additional, Jickling, Glen C, additional, Hawthorne, Glenda, additional, Boyd, Gordon, additional, Walker, Gregory, additional, Saposnik, Gustavo, additional, Lau, H Lee, additional, Badr, Hanan E, additional, Toma, Hassanain, additional, Kalashyan, Hayrapet, additional, Marion-Moffet, Hugo, additional, Grant, Ian, additional, Fatakdawala, Idris, additional, Beaulieu-Boire, Isabelle, additional, Williams, Janice, additional, Brar, Jaskiran, additional, Rivest, Jean, additional, Wang, Jeffrey Z, additional, Dawe, Jessica, additional, Stang, Jillian, additional, Day, Joanne, additional, Miller, Jodi, additional, Gorman, Johnathon, additional, Hopyan, Julia Jasmine, additional, Lee, Julian, additional, Kromm, Julie, additional, Foster, Kaitlyn, additional, Ratnayake, Kanchana, additional, Perera, Kanjana S, additional, Murray, Karina Villaluna, additional, Ryckborst, Karla, additional, Lin, Katie, additional, Sage, Kayla, additional, Sivakuma, Keithan, additional, MacDonald, Kelly A, additional, Ng, Kelvin Kuan, additional, Merchant, Ketki, additional, Khan, Khurshid, additional, Ghavami, Kimia, additional, Johnston, Kyra, additional, Mai, Lauren M, additional, White, Leah, additional, Barratt, Lee, additional, Longpre, Linda, additional, Crellin, Lisa, additional, Peeling, Lissa, additional, Piquette, Lori, additional, Lomax, Lysa Boissé, additional, Sadeghi, Mahsa, additional, Kamra, Maneesha, additional, Lavoie-April, Manuel, additional, Moores, Margaret, additional, Bullrich, Maria Bres, additional, McClelland, Marie, additional, Salluzzi, Marina, additional, Wilcox, Mark, additional, Boulos, Mark I, additional, Marko, Martha, additional, Boyko, Matthew, additional, Lantagne-Hurtubise, Maude, additional, AlHamid, May Adel, additional, Shawawrah, Mays, additional, Kelly, Michael E, additional, Thorne, Michael W D, additional, Bussiere, Miguel, additional, Dominc Tse, Ming Yin, additional, Benguzzi, Mowad, additional, Sharma, Mukul, additional, Horton, Myles, additional, Newcommon, Nancy, additional, Simon, Nandy-Shelwine, additional, Parks, Natalie E, additional, Sultan, Nazeem, additional, Markovic, Nevena, additional, Daneault, Nicole, additional, Ishaque, Noman, additional, Fairall, Paige, additional, Kostyrko, Pawel B, additional, Stys, Peter K, additional, Teal, Philip, additional, Couillard, Philippe, additional, King-Azote, Princess, additional, Collier, Quentin, additional, Epp, Rachel, additional, Nair, Radhika, additional, Joundi, Raed A, additional, Jassal, Rajive, additional, Schneider, Raphael, additional, Hosseini, Reza, additional, Bouchard, Rosalie, additional, Whelan, Ruth, additional, Cooley, S Regan, additional, Sujanthan, Sajeevan, additional, Mansoor, Salman, additional, Yip,, Samuel, additional, Wasyliw, Sanchea, additional, Taylor, Sean W., additional, Friedman, Sebastian, additional, Mann, Sharan, additional, Maley, Sharleen Weese, additional, Chiasson, Sherry, additional, Hu, Sherry Xueying, additional, Althubait, Shorog, additional, Himed, Shuhira, additional, Chen, Shuo, additional, Bal, Simerpreet S, additional, Page, Stacey A, additional, Beck, Stacey D, additional, Woodroffe, Stephanie, additional, Reiter, Stephanie D, additional, Gaal, Stephen van, additional, Peters, Steven Ray, additional, Darvesh, Sultan, additional, Save, Supriya, additional, Alcock, Susan, additional, Piercey, Susannah, additional, Adam, Suzie, additional, Gosselin, Sylvie, additional, Fitzpatrick, Tess, additional, Perron, Thomas-Louis, additional, Stewart, Tim, additional, Benstead, Timothy J, additional, Naidoo, Vishaya, additional, Wahab, Wasan Abd, additional, Oczkowski, Wiesław, additional, Kingston, William, additional, Leduc, William, additional, To, William T H, additional, Yu, Yeyao Joe, additional, Liu, Zhongyu A, additional, and Aljundi, Ziad Ezzat, additional
Published: 2022
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48. Timing of Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation

Author: Alrohimi, Anas, primary, Jickling, Glen, additional, Buck, Brian, additional, and Butcher, Ken S., additional
Published: 2022
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49. Mechanical thrombectomy for acute large vessel occlusion stroke beyond 24 h

Author: Abhi Pandhi, Rahul Chandra, Mohammad A. Abdulrazzak, Anas Alrohimi, Ashutosh Mahapatra, Mark Bain, Nina Moore, M. Shazam Hussain, Jennifer Bullen, and Gabor Toth
Subjects: Neurology, Neurology (clinical)
Published: 2023

50. Risk of hemorrhagic transformation with early use of direct oral anticoagulants after acute ischemic stroke: A pooled analysis of prospective studies and randomized trials

Author: Anas Alrohimi, David Z Rose, W Scott Burgin, Swetha Renati, Nicholas Corbin Hilker, Wei Deng, Guilherme H Oliveira, Theresa M Beckie, Arthur J Labovitz, Michael G Fradley, Nhi Tran, Laura C Gioia, Mahesh Kate, Kelvin Ng, Dar Dowlatshahi, Thalia S Field, Shelagh B Coutts, Muzzafar Siddiqui, Michael D Hill, Jodi Miller, Glen Jickling, Ashfaq Shuaib, Brian Buck, Mike Sharma, and Ken S Butcher
Subjects: Neurology
Abstract: Introduction: Precise risk of hemorrhagic transformation (HT) in acute ischemic stroke (AIS) remains unknown, leading to delays in anticoagulation initiation for secondary stroke prevention. We sought to assess the rate of HT associated with direct oral anticoagulant (DOAC) initiation within and beyond 48 h post-AIS. Methods: A pooled analysis of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted with six studies (four prospective open label treatment, blinded outcome studies and two randomized trials; NCT02295826 and NCT02283294). The primary endpoint was incident radiographic HT on follow-up imaging (days 7–30). Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, study period mortality, and follow-up modified Rankin Scale score. The results were reported as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). Results: We evaluated 509 patients; median infarct volume was 1.5 (0.1–7.8) ml, and median National Institutes of Health Stroke Scale was 2 (0–3). Incident radiographic HT was seen on follow-up scan in 34 (6.8%) patients. DOAC initiation within 48 h from index event was not associated with incident HT (adjusted OR 0.67, [0.30–1.50] P = 0.32). No patients developed symptomatic HT. Conversely, 31 (6.1%) patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating a DOAC within 48 h of onset was associated with similar recurrent ischemic event rates compared with those in which treatment was delayed (HR: 0.42, [0.17–1.008] P = 0.052). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR = 6.8, [2.84–16.24], p Conclusions: In this pooled analysis, initiation of DOAC within 48 h post-stroke was not associated with increased incident risk of HT, and none developed symptomatic HT. The analysis was underpowered to determine the effect of early DOAC use upon recurrent ischemic events.
Published: 2023

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