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2. Tenecteplase versus alteplase for thrombolysis in patients selected by use of perfusion imaging within 4·5 h of onset of ischaemic stroke (TASTE): a multicentre, randomised, controlled, phase 3 non-inferiority trial

Author

Phan, Timmy, Selmes, Christine, Lees, Kennedy, Kaste, Markku, MacIsaac, Rachael, Wellings, Tom, Loiselle, Andre, Pepper, Elizabeth, Miteff, Ferdi, Krishnamurthy, Venkatesh, Ang, Timothy, Alanati, Khaled, Gangadharan, Shyam, Zareie, Hossein, Starling, Rita, Dunkerton, Sophie, He, Jiacheng, Datta, Raka, Royan, Angela, Kerr, Erin, Kaauwai, Lara, Belevski, Linda, Ormond, Sally, Johnson, Annalese, Evans, Malcolm, Lachapelle, Nicole, Ombelet, Fouke, Bladin, Chris, Dewey, Helen, Wong, Joseph, Park, Peter, Cody, Ross, Tan, Peter, Callaly, Edward, Senanayake, Channa, Thomas, Grace, Liu, Jennifer, Busch, Tessa, Stuart, Narelle, Chung, Malcohm, Yassi, Nawaf, Valente, Michael, Sharobeam, Angelos, Cooley, Regan, Zhao, Henry, Alemseged, Fana, Williams, Cameron, Ng, Jo Lyn, Balabanski, Anna, dos Santos, Angela, Williamson, John, Pavlin-Premrl, Davor, Beharry, James, Ma, Margaret, Park, Ashley, Yan, Bernard, Hand, Peter, Jackson, David, McDonald, Amy, Fisicchia, Laura, Parsons, Nicola, Olenko, Liudmyla, Johns, Hannah, Guha, Prodipta, Rokaha, Birendra, Dhimal, Niruta, Harvey, Jackson, Cagi, Lavenia, Chia, Nicholas, Goh, Rudy, Palanikumar, Log, El-Masri, Shaddy, Mahadevan, Joshua, Kuranawai, Craig, Waters, Michael, Vallat, Wilson, Cheong, Eddie, Drew, Roy, Cordato, Dennis, McDougall, Alan, Cappelen-Smith, Cecilia, Venkat, Abhay, Edwards, Leon, Blair, Christopher, Thomas, James, Helou, Jacob, Green, Daniel, Nguyen, Tram, Pham, Timmy, Khan, Jasmeen, Miller, Megan, Loubiere, Laurence, Buck, Brian, Butcher, Ken, Fairall, Paige, Butt, Asif, Kalashyan, Hayrapet, Nomani, Ali, Lloret, Mar, Mishra, Sachin, Thirunavukkarasu, Sibi, Sivakumar, Leka, D'Souza, Atlantic, Tsai, Chon-Haw, Tseng, Billy, Tai, Iris, Chiang, I-Husan, Kuan, Angela, Tsai, Vivian, Hsu, Alice, Hsu, Sammi, Alchin, Deborah, Sanjuan, Estela, Fink, John, Wilson, Duncan, Mason, Deborah, Berry-Norohna, Alexander, Winders, Joel, Eagle, Jane, Green, Rosemary, Bremner, Kathleen, Celestino, Sherisse, Lee, Jiunn-Tay, Chou, Chung-Hsing, Tsai, Chia-Kuang, Sung, Yueh-Feng, Tsai, Chia-Lin, Lin, Yu-Kai, Kao, Hung-Wen, Vuong, Jason, Thirugnanachandran, Tharani, Hervet, Marie Veronic, Simmons, Karen, Sabet, Arman, Bailey, Peter, Urbi, Berzenn, Kurakose, Sumole, Martinez-Majander, Nicolas, Räty, Silja, Tiainen, Marjaana, Sibolt, Gerli, Ivanoff, Terhi, Sanz, Ana Calleja, García, Elisa Cortijo, De Lera Alfonso, Mercedes C., Araque, Maria Ester Ramos, Gómez, Alicia Sierra, Peñacoba, Gonzalo Valle, Vicente, Beatriz Gómez, Muñoz, Javier Reyes, Muñoz Rubio, Pedro Luis, Shah, Darshan, Harrison, Emma, Bendall, Carol, Subramanian, Ganesh, Jeng, Jiann-Shing, Tang, Sung-Chun, Tsai, Li-Kai, Yeh, Shin-Joe, Chen, Chih-Hao, Chung, Tai-Chun, Wong, Andrew, Muller, Claire, Skinner, Genevieve, Gunathilagan, Gunaratnam, Natarajan, Indira, Coutts, Shelagh, Menon, Bijoy, Kenney, Carol, Clarke, Brian, Ghatala, Rita, Mudd, Paul, Chen, Chih-Hung, Lemmens, Robin, Demeestere, Jelle, Mahant, Neil, Sun, Mu-Chien, Parsons, Mark W, Yogendrakumar, Vignan, Churilov, Leonid, Garcia-Esperon, Carlos, Campbell, Bruce C V, Russell, Michelle L, Sharma, Gagan, Chen, Chushuang, Lin, Longting, Chew, Beng Lim, Ng, Felix C, Deepak, Akshay, Choi, Philip M C, Kleinig, Timothy J, Cordato, Dennis J, Wu, Teddy Y, Fink, John N, Ma, Henry, Phan, Thanh G, Markus, Hugh S, Molina, Carlos A, Strbian, Daniel, Meretoja, Atte, Arenillas, Juan F, Buck, Brian H, Devlin, Michael J, Brown, Helen, Butcher, Ken S, O'Brien, Billy, Wijeratne, Tissa, Bivard, Andrew, Grimley, Rohan S, Agarwal, Smriti, Munshi, Sunil K, Donnan, Geoffrey A, Davis, Stephen M, Miteff, Ferdinand, Spratt, Neil J, and Levi, Christopher R

Published
2024
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7. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials

Author

Zi, Wenjie, Nogueira, Raul, Yang, Qingwu, Liu, Jianmin, Yang, Pengfei, Zhang, Yongwei, Yan, Bernard, Mitchell, Peter, Miao, Zhong Rong, Majoie, Charles B., Roos, Yvo B., Suzuki, Kentaro, Kimura, Kazumi, Matsumaru, Yuji, Fischer, Urs, Gralla, Jan, Cavalcante, Fabiano W., Kappelhof, Manon, Treurniet, Kilian M., Kaesmacher, Johannes, Zhang, Lei, Bush, Steven, Nieboer, Daan, Lingsma, Hester F., Rothwell, Peter, Saver, Jeffrey, Fiehler, Jens, Li, Fengli, Huang, Jiacheng, Song, Jiaxing, Hong, Bo, Chen, Wenhuo, Peng, Ya, Han, Hongxing, Zhang, Liyong, Li, Zifu, Xing, Pengfei, Shen, Hongjian, Zhang, Ping, Zhang, Xiaoxi, Davis, Stephen, Nguyen, Huy-Thang, Donnan, Geoffrey, Huo, Xiaochuan, Nan, Guangxian, Bivard, Andrew, Ma, Henry, Vu, Dang Lu, Campbell, Bruce, Rinkel, Leon A., Emmer, Bart J., Coutinho, Jonathan M., LeCouffe, Natalie E., Dippel, Diederik W., van der Lugt, Aad, van Zwam, Wim H., van Oostenbrugge, Robert J., Uyttenboogaart, Maarten, Costalat, Vincent, Lycklama, Geert, Hofmeijer, Jeannette, van Norden, Anouk, Otsuka, Toshiaki, Takeuchi, Masataka, Morimoto, Masafumi, Kanazawa, Ryuzaburo, Takayama, Yohei, Kamiya, Yuki, Shigeta, Keigo, Okubo, Seiji, Hayakawa, Mikito, Strbian, Daniel, Eker, Omer, Cognard, Christophe, Meinel, Thomas, Dobrocky, Tomas, Jung, Simon, Piechowiak, Eike, Marnat, Gaultier, Sibon, Igor, Bourcier, Romain, de Gaalon, Solene, Papagiannaki, Chrysanthi, Lefebvre, Margaux, Majoie, Charles B, Cavalcante, Fabiano, Treurniet, Kilian M, Miao, Zhongrong, Rinkel, Leon A, Wang, Shouchun, Coutinho, Jonathan M, Emmer, Bart J, LeCouffe, Natalie E, Lingsma, Hester F, Nogueira, Raul G, and Roos, Yvo B

Published
2023
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10. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

Author

Parson, M, Valente, M, Chen, A, Sharobeam, A, Edwards, L, Blair, C, Christensen, L, Ægidius, K, Pihl, T, Fassel-Larsen, C, Wassvik, L, Folke, M, Rosenbaum, S, Gharehbagh, S S, Hansen, A, Preisler, N, Antsov, K, Mallene, S, Lill, M, Herodes, M, Vibo, R, Rakitin, A, Saarinen, J, Tiainen, M, Tumpula, O, Noppari, T, Raty, S, Sibolt, G, Nieminen, J, Niederhauser, J, Haritoncenko, I, Puustinen, J, Haula, T-M, Sipilä, J, Viesulaite, B, Taroza, S, Rastenyte, D, Matijosaitis, V, Vilionskis, A, Masiliunas, R, Ekkert, A, Chmeliauskas, P, Lukosaitis, V, Reichenbach, A, Moss, T T, Nilsen, H Y, Hammer-Berntzen, R, Nordby, L M, Weiby, T A, Nordengen, K, Ihle-Hansen, H, Stankiewiecz, M, Grotle, O, Nes, M, Thiemann, K, Særvold, I M, Fraas, M, Størdahl, S, Horn, J W, Hildrum, H, Myrstad, C, Tobro, H, Tunvold, J-A, Jacobsen, O, Aamodt, N, Baisa, H, Malmberg, V N, Rohweder, G, Ellekjær, H, Ildstad, F, Egstad, E, Helleberg, B H, Berg, H H, Jørgensen, J, Tronvik, E, Shirzadi, M, Solhoff, R, Van Lessen, R, Vatne, A, Forselv, K, Frøyshov, H, Fjeldstad, M S, Tangen, L, Matapour, S, Kindberg, K, Johannessen, C, Rist, M, Mathisen, I, Nyrnes, T, Haavik, A, Toverud, G, Aakvik, K, Larsson, M, Ytrehus, K, Ingebrigtsen, S, Stokmo, T, Helander, C, Larsen, I C, Solberg, T O, Seljeseth, Y M, Maini, S, Bersås, I, Mathé, J, Rooth, E, Laska, A-C, Rudberg, A-S, Esbjörnsson, M, Andler, F, Ericsson, A, Wickberg, O, Karlsson, J-E, Redfors, P, Jood, K, Buchwald, F, Mansson, K, Gråhamn, O, Sjölin, K, Lindvall, E, Cidh, Å, Tolf, A, Fasth, O, Hedström, B, Fladt, J, Dittrich, T D, Kriemler, L, Hannon, N, Amis, E, Finlay, S, Mitchell-Douglas, J, McGee, J, Davies, R, Johnson, V, Nair, A, Robinson, M, Greig, J, Halse, O, Wilding, P, Mashate, S, Chatterjee, K, Martin, M, Leason, S, Roberts, J, Dutta, D, Ward, D, Rayessa, R, Clarkson, E, Teo, J, Ho, C, Conway, S, Aissa, M, Papavasileiou, V, Fry, S, Waugh, D, Britton, J, Hassan, A, Manning, L, Khan, S, Asaipillai, A, Fornolles, C, Tate, M L, Chenna, S, Anjum, T, Karunatilake, D, Foot, J, VanPelt, L, Shetty, A, Wilkes, G, Buck, A, Jackson, B, Fleming, L, Carpenter, M, Jackson, L, Needle, A, Zahoor, T, Duraisami, T, Northcott, K, Kubie, J, Bowring, A, Keenan, S, Mackle, D, England, T, Rushton, B, Hedstrom, A, Amlani, S, Evans, R, Muddegowda, G, Remegoso, A, Ferdinand, P, Varquez, R, Davis, M, Elkin, E, Seal, R, Fawcett, M, Gradwell, C, Travers, C, Atkinson, B, Woodward, S, Giraldo, L, Byers, J, Cheripelli, B, Lee, S, Marigold, R, Smith, S, Zhang, L, Ghatala, R, Sim, C H, Ghani, U, Yates, K, Obarey, S, Willmot, M, Ahlquist, K, Bates, M, Rashed, K, Board, S, Andsberg, G, Sundayi, S, Garside, M, Macleod, M-J, Manoj, A, Hopper, O, Cederin, B, Toomsoo, T, Gross-Paju, K, Tapiola, T, Kestutis, J, Amthor, K-F, Heermann, B, Ottesen, V, Melum, T A, Kurz, M, Parsons, M, Roaldsen, Melinda B, Eltoft, Agnethe, Wilsgaard, Tom, Christensen, Hanne, Engelter, Stefan T, Indredavik, Bent, Jatužis, Dalius, Karelis, Guntis, Kõrv, Janika, Lundström, Erik, Petersson, Jesper, Putaala, Jukka, Søyland, Mary-Helen, Tveiten, Arnstein, Bivard, Andrew, Johnsen, Stein Harald, Mazya, Michael V, Werring, David J, Wu, Teddy Y, De Marchis, Gian Marco, Robinson, Thompson G, and Mathiesen, Ellisiv B

Published
2023
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14. Endovascular thrombectomy versus standard bridging thrombolytic with endovascular thrombectomy within 4·5 h of stroke onset: an open-label, blinded-endpoint, randomised non-inferiority trial

Author

Desmond, Patricia, Yassi, Nawaf, Zhao, Henry, Williams, Cameron, Alemseged, Fana, Ng, Felix C, Yogendrakumar, Vignan, Bailey, Peter, De Villiers, Laetitia, Phan, Thanh, Thirugnanachandran, Tharani, Chong, Winston, Asadi, Hamed, Slater, Lee Anne, Manning, Nathan, Wenderoth, Jason, McDougall, Alan, Cappelen-Smith, Cecilia, Whitley, Justin, Edwards, Leon, Esperon, Carlos Garcia, Spratt, Neil, Pepper, Elizabeth, Levi, Chris, Faulder, Ken, Harrington, Timothy, Krause, Martin, Waters, Michael, Fink, John, Ma, Gaoting, Shen, Xiangpeng, Song, Xiangkong, Gao, Yonglei, Guangxian, Nam, Guo, Zaiyu, Zhang, Heliang, Han, Hongxing, Wang, Hao, Liao, Geng, Zhang, Zhenyu, Li, Chaomao, Yang, Zhi, Cai, Chuwei, Huang, Chuming, Hong, Yifan, Mitchell, Peter J, Yan, Bernard, Churilov, Leonid, Dowling, Richard J, Bush, Steven J, Bivard, Andrew, Huo, Xiao Chuan, Wang, Guoqing, Zhang, Shi Yong, Ton, Mai Duy, Cordato, Dennis J, Kleinig, Timothy J, Ma, Henry, Chandra, Ronil V, Brown, Helen, Campbell, Bruce C V, Cheung, Andrew K, Steinfort, Brendan, Scroop, Rebecca, Redmond, Kendal, Miteff, Ferdinand, Liu, Yan, Duc, Dang Phuc, Rice, Hal, Parsons, Mark W, Wu, Teddy Y, Nguyen, Huy-Thang, Donnan, Geoffrey A, Miao, Zhong Rong, and Davis, Stephen M

Published
2022
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15. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial

Author

Bivard, Andrew, Zhao, Henry, Churilov, Leonid, Campbell, Bruce C V, Coote, Skye, Yassi, Nawaf, Yan, Bernard, Valente, Michael, Sharobeam, Angelos, Balabanski, Anna H, Dos Santos, Angela, Ng, Jo Lyn, Yogendrakumar, Vignan, Ng, Felix, Langenberg, Francesca, Easton, Damien, Warwick, Alex, Mackey, Elizabeth, MacDonald, Amy, Sharma, Gagan, Stephenson, Michael, Smith, Karen, Anderson, David, Choi, Philip, Thijs, Vincent, Ma, Henry, Cloud, Geoffrey C, Wijeratne, Tissa, Olenko, Liudmyla, Italiano, Dominic, Davis, Stephen M, Donnan, Geoffrey A, and Parsons, Mark W

Published
2022
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16. Collateral assessment on magnetic resonance imaging/angiography up to 30 hours after stroke onset.

Author

Tomari, Shinya, Lillicrap, Thomas, Garcia-Esperon, Carlos, Tomari Kashida, Yumi, Bivard, Andrew, Lin, Longting, Levi, Christopher R., and Spratt, Neil J.

Subjects
POSTERIOR cerebral artery, STROKE patients, MAGNETIC resonance imaging, PERFUSION imaging, CEREBRAL arteries, STROKE
Abstract

Purpose: We aimed to validate hyperintense vessel sign (HVS) on FLAIR imaging or posterior cerebral artery (PCA) laterality on MR angiography beyond 4.5 hours after stroke onset. Materials and methods: Data from acute ischemic stroke patients with internal carotid or middle cerebral artery occlusion who underwent CT perfusion imaging at baseline, follow-up MR perfusion imaging and angiography within 30 hours after stroke, without effective recanalization on follow-up imaging, were analysed retrospectively. Patients were separately classified as high or low HVS (>5 or ≤5 slices of HVS), and PCA laterality positive or negative group. We compared core and penumbra volumes at follow-up imaging and neurological outcomes between high or low HVS group, and between PCA laterality positive or negative group. Results: Of 49 patients analyzed, four patients with artifacts were excluded and 45 were classified into high (n = 23) or low (n = 22) HVS group. High group had a smaller core volume (median 32 ml versus 109 ml, p = 0.004), larger penumbra volume at follow-up (68 ml versus 0 ml, p = 0.001), and better outcomes (modified Rankin Scale at three months, 3 versus 5, p = 0.03). For PCA laterality analysis, 1 patient with previously occluded PCA was excluded and 48 patients were classified as positive (n = 22) or negative (n = 26). Positive group had larger core volume (116 ml versus 37 ml), and no significant differences in penumbral volumes or outcomes. Conclusion: Prominent HVS in later time was associated with small core volume, persistent penumbra volume and favorable outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Implementation of an optimised tele-medicine platform for stroke in South Australia improves patient care.

Author

Kurunawai, Craig, Chushuang Chen, Willcour, Matthew, Tan, Aaron, Mahadevan, Joshua, Waters, Michael, Harvey, Jackson, Van Eunen, Joanne, Dixon, Karen, Piantedosi, Bianca, Bivard, Andrew, Parsons, Mark William, Davis, Stephen M., Donnan, Geoffrey Alan, Jannes, Jim, and Kleinig, Timothy

Subjects
STROKE, NEUROLOGISTS, TELEMEDICINE, PATIENT care, RURAL hospitals, STROKE patients
Abstract

Background: Patients with a large vessel occlusion require a transfer from a primary stroke centre to access thrombectomy, often over significant distances in regional areas. We sought to optimise stroke care access in the regional South Australian Tele-Strokeservice (SATS) to improve patient access to thrombectomy. Methods: We undertook a 24-month interventional historically controlled cohort study comparing acute stroke care metrics in the SATS. This consisted of a 12-month control period and a 12-month intervention monitoring period. The study intervention considered of an education package provided to the regional hospitals, a stroke neurologist roster to receive consultations and the intervention of a centralised tele-stroke system to provide treatment advice and organise patient transfers where needed. The SATS services 61 rural hospitals in South Australia, and Alice Springs in the Northern Territory. Suspected acute stroke patients presenting to the participating regional hospitals in SATS network where a telehealth consultation took place. Results: Over the study period, there were 919 patient referrals, with 449 consultations in the pre-intervention phase and 470 in the post-intervention phase. Demographic features in both epochs were similar. The post-intervention phase was associated with shorter door-to-scan time (35 min, IQR: 18,70; vs. 49 min, IQR:25,102, p < 0.0001), faster door-to-thrombolysis time (58 min, IQR: 39,91, vs.83 min, IQR: 55,100, p = 0.0324) and a higher portion of patients treated with thrombectomy (54, 11.5% vs. 26, 5.8%, p = 0.002). Conclusion: An optimised implementation of a streamlined telehealth platform with ongoing education and feedback to referring sites was associated with improved stroke workflow metrics and higher thrombectomy rates. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Whole Blood Viscosity and Cerebral Blood Flow in Acute Ischemic Stroke.

Author

Gyawali, Prajwal, Lillicrap, Thomas P., Esperon, Carlos G., Bhattarai, Aseem, Bivard, Andrew, and Spratt, Neil

Subjects
CEREBRAL circulation, ISCHEMIC stroke, BLOOD viscosity, BLOOD flow, DISEASE risk factors
Abstract

Existing effective treatments for ischemic stroke restore blood supply to the ischemic region using thrombolysis or mechanical removal of clot. However, it is increasingly recognized that successful removal of occlusive thrombus from the large artery—recanalization, may not always be accompanied by successful restoration of blood flow to the downstream tissues—reperfusion. Ultimately, brain tissue survival depends on cerebral perfusion, and a functioning microcirculation. Because capillary diameter is often equal to or smaller than an erythrocyte, microcirculation is largely dependent on erythrocyte rheological (hemorheological) factors such as whole blood viscosity (WBV). Several studies in the past have demonstrated elevated WBV in stroke compared with healthy controls. Also, elevated WBV has shown to be an independent risk factor for stroke. Elevated WBV leads to endothelial dysfunction, decreases nitric oxide-dependent flow-mediated vasodilation, and promotes hemostatic alterations/thrombosis, all leading to microcirculation sludging. Compromised microcirculation further leads to decreased cerebral perfusion. Hence, modulating WBV through pharmacological agents might be beneficial to improve cerebral perfusion in stroke. This review discusses the effect of elevated WBV on endothelial function, hemostatic alterations, and thrombosis leading to reduced cerebral perfusion in stroke. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Automatic segmentation of hemorrhagic transformation on follow-up non-contrast CT after acute ischemic stroke.

Author

Jiacheng Sun, Werdiger, Freda, Blair, Christopher, Chushuang Chen, Qing Yang, Bivard, Andrew, Longting Lin, and Parsons, Mark

Subjects
ISCHEMIC stroke, STROKE patients, ENDOVASCULAR surgery, STROKE
Abstract

Background: Hemorrhagic transformation (HT) following reperfusion therapies is a serious complication for patients with acute ischemic stroke. Segmentation and quantification of hemorrhage provides critical insights into patients' condition and aids in prognosis. This study aims to automatically segment hemorrhagic regions on follow-up non-contrast head CT (NCCT) for stroke patients treated with endovascular thrombectomy (EVT). Methods: Patient data were collected from 10 stroke centers across two countries. We propose a semi-automated approach with adaptive thresholding methods, eliminating the need for extensive training data and reducing computational demands. We used Dice Similarity Coefficient (DSC) and Lin's Concordance Correlation Coefficient (Lin's CCC) to evaluate the performance of the algorithm. Results: A total of 51 patients were included, with 28 Type 2 hemorrhagic infarction (HI2) cases and 23 parenchymal hematoma (PH) cases. The algorithm achieved a mean DSC of 0.66 ± 0.17. Notably, performance was superior for PH cases (mean DSC of 0.73 ± 0.14) compared to HI2 cases (mean DSC of 0.61 ± 0.18). Lin's CCC was 0.88 (95% CI 0.79-0.93), indicating a strong agreement between the algorithm's results and the ground truth. In addition, the algorithm demonstrated excellent processing time, with an average of 2.7 s for each patient case. Conclusion: To our knowledge, this is the first study to perform automated segmentation of post-treatment hemorrhage for acute stroke patients and evaluate the performance based on the radiological severity of HT. This rapid and effective tool has the potential to assist with predicting prognosis in stroke patients with HT after EVT. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials: Consensus Recommendations and Further Research Priorities.

Author

Warach, Steven, Luby, Marie, Albers, Gregory, Bammer, Roland, Bivard, Andrew, Campbell, Bruce, Derdeyn, Colin, Heit, Jeremy, Khatri, Pooja, Lansberg, Maarten, Liebeskind, David, Majoie, Charles, Marks, Michael, Menon, Bijoy, Muir, Keith, Parsons, Mark, Vagal, Achala, Yoo, Albert, Alexandrov, Andrei, Baron, Jean-Claude, Fiorella, David, Furlan, Anthony, Puig, Josep, Schellinger, Peter, and Wintermark, Max

Subjects
angiography, clinical trial, ischemia, reperfusion, stroke, Clinical Trials as Topic, Consensus, Education, Endovascular Procedures, Humans, Neuroimaging, Stroke, Thrombolytic Therapy
Abstract

BACKGROUND AND PURPOSE: The Stroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology, and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5 to 6, 2015 in Washington, DC. The purpose of this roadmap was to focus on the role of imaging in future research and clinical trials. METHODS: This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the US Food and Drug Administration to discuss STIR priorities in the light of an unprecedented series of positive acute stroke endovascular therapy clinical trials. RESULTS: The imaging session summarized and compared the imaging components of the recent positive endovascular trials and proposed opportunities for pooled analyses. The imaging workshop developed consensus recommendations for optimal imaging methods for the acquisition and analysis of core, mismatch, and collaterals across multiple modalities, and also a standardized approach for measuring the final infarct volume in prospective clinical trials. CONCLUSIONS: Recent positive acute stroke endovascular clinical trials have demonstrated the added value of neurovascular imaging. The optimal imaging profile for endovascular treatment includes large vessel occlusion, smaller core, good collaterals, and large penumbra. However, equivalent definitions for the imaging profile parameters across modalities are needed, and a standardization effort is warranted, potentially leveraging the pooled data resulting from the recent positive endovascular trials.

Published
2016

29. Cost-Effectiveness of Endovascular Thrombectomy in M2 Occlusion Stroke: Real-World Experience Versus Clinical Trials

Author

Gao, Lan, primary, Tan, Elise, additional, Chen, Chushuang, additional, Kleinig, Timothy, additional, Yan, Bernard, additional, Cheung, Andrew, additional, Levi, Chris, additional, Garcia-Esperon, Carlos, additional, Cordato, Dennis, additional, Blair, Chris, additional, Lin, Longting, additional, Parsons, Mark, additional, and Bivard, Andrew, additional

Published
2023
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35. "Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective.

Author

Postol, Nicola, Barton, Julia, Wakely, Luke, Bivard, Andrew, Spratt, Neil J., and Marquez, Jodie

Subjects
LEG physiology, ROBOTIC exoskeletons, NEUROLOGICAL disorders, FOCUS groups, HEALTH services accessibility, WORK, MOTIVATION (Psychology), MEDICAL care costs, BEHAVIOR, ROBOTICS, QUALITATIVE research, MARKETING, COMPARATIVE studies, PSYCHOSOCIAL factors, EXPERIENTIAL learning, QUESTIONNAIRES, COMMUNICATION, DESCRIPTIVE statistics, TECHNOLOGY, CONTENT analysis, THEMATIC analysis, PHYSICAL therapists, PHYSICAL therapists' attitudes, MEDICAL logic
Abstract

Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation. Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed. Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements – experiences and perspectives of use, and mechanical elements – the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?" Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery. Further innovation of design features, marketing, and cost are needed to enhance ongoing development and integration. Routine clinical implementation of lower limb exoskeletons is unlikely at this time in Australia and New Zealand. Therapists do expect lower limb exoskeletons to have an ongoing role in future rehabilitation. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Novel artificial intelligence-based hypodensity detection tool improves clinician identification of hypodensity on non-contrast computed tomography in stroke patients.

Author

Dos Santos, Angela, Visser, Milanka, Longting Lin, Bivard, Andrew, Churilov, Leonid, and Parsons, Mark William

Subjects
ARTIFICIAL intelligence, COMPUTED tomography, STROKE patients, ISCHEMIC stroke, MEDICAL personnel
Abstract

Introduction: In acute stroke, identifying early changes (parenchymal hypodensity) on non-contrast CT (NCCT) can be challenging. We aimed to identify whether the accuracy of clinicians in detecting acute hypodensity in ischaemic stroke patients on a non-contrast CT is improved with the use of an Artificial Intelligence (AI) based, automated hypodensity detection algorithm (HDT) using MRI-DWI as the gold standard. Methods: The study employed a case-crossover within-clinician design, where 32 clinicians were tasked with identifying hypodensity lesions on NCCT scans for five a priori selected patient cases, before and after viewing the AI-based HDT. The DICE similarity coefficient (DICE score) was the primary measure of accuracy. Statistical analysis compared DICE scores with and without AI-based HDT using mixed-effects linear regression, with individual NCCT scans and clinicians as nested random effects. Results: The AI-based HDT had a mean DICE score of 0.62 for detecting hypodensity across all NCCT scans. Clinicians' overall mean DICE score was 0.33 (SD 0.31) before AI-based HDT implementation and 0.40 (SD 0.27) after implementation. AI-based HDT use was associated with an increase of 0.07 (95% CI: 0.02-0.11, p = 0.003) in DICE score accounting for individual scan and clinician effects. For scans with small lesions, clinicians achieved a mean increase in DICE score of 0.08 (95% CI: 0.02, 0.13, p = 0.004) following AI-based HDT use. In a subgroup of 15 trainees, DICE score improved with AI-based HDT implementation [mean difference in DICE 0.09 (95% CI: 0.03, 0.14, p = 0.004)]. Discussion: AI-based automated hypodensity detection has potential to enhance clinician accuracy of detecting hypodensity in acute stroke diagnosis, especially for smaller lesions, and notably for less experienced clinicians. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials

Author

Majoie, Charles B, primary, Cavalcante, Fabiano, additional, Gralla, Jan, additional, Yang, Pengfei, additional, Kaesmacher, Johannes, additional, Treurniet, Kilian M, additional, Kappelhof, Manon, additional, Yan, Bernard, additional, Suzuki, Kentaro, additional, Zhang, Yongwei, additional, Li, Fengli, additional, Morimoto, Masafumi, additional, Zhang, Lei, additional, Miao, Zhongrong, additional, Rinkel, Leon A, additional, Huang, Jiacheng, additional, Otsuka, Toshiaki, additional, Wang, Shouchun, additional, Davis, Stephen, additional, Cognard, Christophe, additional, Hong, Bo, additional, Coutinho, Jonathan M, additional, Song, Jiaxing, additional, Chen, Wenhuo, additional, Emmer, Bart J, additional, Eker, Omer, additional, Zhang, Liyong, additional, Dobrocky, Tomas, additional, Nguyen, Huy-Thang, additional, Bush, Steven, additional, Peng, Ya, additional, LeCouffe, Natalie E, additional, Takeuchi, Masataka, additional, Han, Hongxing, additional, Matsumaru, Yuji, additional, Strbian, Daniel, additional, Lingsma, Hester F, additional, Nieboer, Daan, additional, Yang, Qingwu, additional, Meinel, Thomas, additional, Mitchell, Peter, additional, Kimura, Kazumi, additional, Zi, Wenjie, additional, Nogueira, Raul G, additional, Liu, Jianmin, additional, Roos, Yvo B, additional, Fischer, Urs, additional, Nogueira, Raul, additional, Miao, Zhong Rong, additional, Majoie, Charles B., additional, Roos, Yvo B., additional, Cavalcante, Fabiano W., additional, Treurniet, Kilian M., additional, Lingsma, Hester F., additional, Rothwell, Peter, additional, Saver, Jeffrey, additional, Fiehler, Jens, additional, Li, Zifu, additional, Xing, Pengfei, additional, Shen, Hongjian, additional, Zhang, Ping, additional, Zhang, Xiaoxi, additional, Donnan, Geoffrey, additional, Huo, Xiaochuan, additional, Nan, Guangxian, additional, Bivard, Andrew, additional, Ma, Henry, additional, Vu, Dang Lu, additional, Campbell, Bruce, additional, Rinkel, Leon A., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, LeCouffe, Natalie E., additional, Dippel, Diederik W., additional, van der Lugt, Aad, additional, van Zwam, Wim H., additional, van Oostenbrugge, Robert J., additional, Uyttenboogaart, Maarten, additional, Costalat, Vincent, additional, Lycklama, Geert, additional, Hofmeijer, Jeannette, additional, van Norden, Anouk, additional, Kanazawa, Ryuzaburo, additional, Takayama, Yohei, additional, Kamiya, Yuki, additional, Shigeta, Keigo, additional, Okubo, Seiji, additional, Hayakawa, Mikito, additional, Jung, Simon, additional, Piechowiak, Eike, additional, Marnat, Gaultier, additional, Sibon, Igor, additional, Bourcier, Romain, additional, de Gaalon, Solene, additional, Papagiannaki, Chrysanthi, additional, and Lefebvre, Margaux, additional

Published
2023
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44. Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically

Author

Wang, Peng, Chen, Wenhuo, Chen, Chushuang, Bivard, Andrew, Yu, Geng, Parsons, Mark W., and Lin, Longting

Subjects
Neurology (clinical), Research Article
Abstract

Background and ObjectivesThe best management of patients with mild stroke and large vessel occlusion (LVO) remains unclear. This study aimed to identify perfusion imaging predictors of poor functional outcome in such patients.MethodsThis cohort study retrospectively selected patients enrolled in the International Stroke Perfusion Imaging Registry between August 2011 and April 2022. The registry enrolled patients with acute ischemic stroke and with baseline CT perfusion scanned within 24 hours of stroke onset. This study identified patients with mild symptoms, defined by an NIH Stroke Scale score of ≤5. Patients with LVO of anterior circulation were selected. This study further selected patients who received medical management and excluded patients who received endovascular treatment. The primary outcome was poor functional outcome defined as a modified Rankin Scale of 3–6 at 3 months. Perfusion lesion was defined by delay time > 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome.ResultsA total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL,p< 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01–1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01–1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion p< 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31–1.78]).DiscussionA perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.

Published
2022

46. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST) : a multicentre, open-label, randomised controlled trial

Author

Roaldsen, Melinda B, Eltoft, Agnethe, Wilsgaard, Tom, Christensen, Hanne, Engelter, Stefan T, Indredavik, Bent, Jatužis, Dalius, Karelis, Guntis, Kõrv, Janika, Lundström, Erik, Petersson, Jesper, Putaala, Jukka, Søyland, Mary-Helen, Tveiten, Arnstein, Bivard, Andrew, Johnsen, Stein Harald, Mazya, Michael V, Werring, David J, Wu, Teddy Y, De Marchis, Gian Marco, Robinson, Thompson G, Mathiesen, Ellisiv B, Roaldsen, Melinda B, Eltoft, Agnethe, Wilsgaard, Tom, Christensen, Hanne, Engelter, Stefan T, Indredavik, Bent, Jatužis, Dalius, Karelis, Guntis, Kõrv, Janika, Lundström, Erik, Petersson, Jesper, Putaala, Jukka, Søyland, Mary-Helen, Tveiten, Arnstein, Bivard, Andrew, Johnsen, Stein Harald, Mazya, Michael V, Werring, David J, Wu, Teddy Y, De Marchis, Gian Marco, Robinson, Thompson G, and Mathiesen, Ellisiv B

Abstract

Background: Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. Methods: TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). Findings: From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants w

Published
2023
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49. Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke.

Author

Longting Lin, Blair, Christopher, Fu, James, Cordato, Dennis, Cappelen-Smith, Cecilia, Cheung, Andrew, Manning, Nathan W., Wenderoth, Jason, Chushuang Chen, Bivard, Andrew, Butcher, Kenneth, Kleinig, Timothy J., Choi, Philip, Levi, Christopher R., and Parsons, Mark

Subjects
MORTALITY prevention, CONFIDENCE intervals, FUNCTIONAL status, ANTICOAGULANTS, ATRIAL fibrillation, THROMBOLYTIC therapy, RETROSPECTIVE studies, ACQUISITION of data, TREATMENT effectiveness, STROKE patients, THROMBECTOMY, MEDICAL records, DESCRIPTIVE statistics, ENDOVASCULAR surgery, ODDS ratio
Abstract

Background Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports. Methods In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status: anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3). Results Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%). Conclusions Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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