Article
Clinical Neurology
Manon Kappelhof, Manon L. Tolhuisen, Kilian M. Treurniet, Bruna G. Dutra, Heitor Alves, Guang Zhang, Scott Brown, Keith W. Muir, Antoni Davalos, Yvo B. W. E. M. Roos, Jeffrey L. Saver, Andrew M. Demchuk, Tudor G. Jovin, Serge Bracard, Bruce C. Campbell, Aad van der Lugt, Francis Guillemin, Philip White, Michael D. Hill, Diederik W. J. Dippel, Peter J. Mitchell, Mayank Goyal, Henk A. Marquering, Charles B. L. M. Majoie
Summary: This study found that increased thrombus perviousness was associated with improved functional outcomes in patients with acute ischemic stroke. While control arm patients showed better outcomes with increased perviousness, there was no significant association in the EVT arm. Mortality and follow-up infarct volume decreased with higher thrombus attenuation increase in the overall population.
Review
Hematology
Maxime Gauberti, Sara Martinez de Lizarrondo, Denis Vivien
Summary: Twenty-five years ago, intravenous thrombolysis has transformed the care for patients with acute ischemic stroke, and recent clinical trials have shown the benefits of mechanical thrombectomy. However, new strategies targeting tPA-resistant thrombi, such as tenecteplase, and experimental models targeting DNA and von Willebrand factor show promising results for improving stroke outcomes. Further research and trials are needed to enhance the effectiveness of thrombolysis in ischemic stroke patients.
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
(2021)
Article
Clinical Neurology
Fouzi Bala, Ilaria Casetta, Stefania Nannoni, Darragh Herlihy, Mayank Goyal, Enrico Fainardi, Patrik Michel, John Thornton, Sarah Power, Valentina Saia, Aidan Hegarty, Giovanni Pracucci, Andrew Demchuk, Salvatore Mangiafico, Karl Boyle, Michael D. Hill, Danilo Toni, Sean Murphy, Ayoola Ademola, Beom Joon Kim, Bijoy K. Menon, Mohammed A. Almekhlafi
Summary: Sex-related differences in outcomes were investigated in late-presenting stroke patients treated with endovascular treatment. The study found that sex did not influence functional outcomes, but men had worse outcomes with advancing age in terms of mortality and symptomatic intracranial hemorrhage.
Article
Clinical Neurology
Karim Mahawish, John Gommans, Timothy Kleinig, Bhavesh Lallu, Alicia Tyson, Annemarei Ranta
Summary: The switch from alteplase to tenecteplase for stroke thrombolysis was successfully implemented with stakeholder endorsement. Patients treated with tenecteplase showed better clinical outcomes, shorter door-to-needle time, and similar complication rates compared to alteplase.
Review
Clinical Neurology
Fana Alemseged, Thanh N. Nguyen, Francisco Mont' Alverne, Xinfeng Liu, Wouter J. Schonewille, Raul G. Nogueira
Summary: Basilar artery occlusion is a devastating neurological condition with high risks of disability and death. Despite the lack of randomized controlled trials, recent studies have shown that endovascular therapy (EVT) is beneficial for basilar artery occlusion within 24 hours of onset. These studies emphasized the importance of consecutive recruitment, fast enrollment, and minimizing cross-over to demonstrate the efficacy of EVT. This topical review examines and contextualizes the current evidence on EVT for basilar artery occlusion.
Article
Medicine, General & Internal
Waranya Rattanavipapong, Thanaboon Worakijthamrongchai, Budsadee Soboon, Vilawan Luankongsomchit, Mananchaya Kongmuangpuk, Wanrudee Isaranuwatchai, Yot Teerawattananon, Yongchai Nilanont
Summary: EVT has been shown to be cost-effective in treating AIS patients in Thailand, both for those eligible for intravenous alteplase and those who are not.
Review
Clinical Neurology
Aristeidis H. Katsanos, Guillaume Turc, Marios Psychogios, Johannes Kaesmacher, Lina Palaiodimou, Maria Ioanna Stefanou, George Magoufis, Ashkan Shoamanesh, Marios Themistocleous, Simona Sacco, Jens Fiehler, Jan Gralla, Daniel Strbian, Andrei Alexandrov, Urs Fischer, Georgios Tsivgoulis
Summary: This study compared the efficacy of direct endovascular treatment and bridging therapy for patients with acute large vessel occlusion. The results showed no significant differences in functional outcomes between the two treatment groups, but patients receiving direct endovascular treatment had a lower likelihood of successful recanalization compared to those receiving bridging therapy.
Review
Clinical Neurology
William K. Diprose, Michael T. M. Wang, Kaustubha Ghate, Stefan Brew, James R. Caldwell, Ben Mcguinness, P. Alan Barber
Summary: The meta-analysis concluded that adjunctive IAT with EVT does not show significant differences in terms of safety and efficacy compared to EVT alone, although there is a trend towards higher functional independence with EVT + IAT treatment.
Article
Neuroimaging
Leon A. Rinkel, Kilian Maurizio Treurniet, Manon Kappelhof, Natalie E. LeCouffe, Agnetha A. E. Bruggeman, Daan Nieboer, Wim H. van Zwam, Maarten Uyttenboogaart, Diederik W. J. Dippel, Bart J. Emmer, Yvo B. W. E. M. Roos, Charles B. L. M. Majoie, J. M. Coutinho
Summary: The study aimed to investigate the impact of time metrics on the treatment effect of intravenous alteplase (IVT) prior to endovascular treatment (EVT) on functional outcome. The results showed that the effect of IVT on functional outcome was not influenced by the time intervals for onset-to-randomization, onset-to-IV-needle, door-to-groin, or needle-to-groin.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2022)
Article
Clinical Neurology
Seung-Jae Lee, Tae-Kyeong Lee, Bum-Tae Kim, Dong-Seong Shin
Summary: Thrombus migration (TM) occurs in about 19.5% of patients undergoing thrombectomy, with intravenous thrombolysis (IVT) and female sex being associated with TM. TM is also associated with better functional outcomes in patients, regardless of the angiographic outcomes.
WORLD NEUROSURGERY
(2021)
Review
Clinical Neurology
William K. Diprose, Michael T. M. Wang, Kaustubha Ghate, Stefan Brew, James R. Caldwell, Ben McGuinness, P. Alan Barber
Summary: Based on a systematic review and meta-analysis, adjunct intra-arterial thrombolysis (IAT) as a supplement to endovascular thrombectomy (EVT) appears to be safe and potentially effective in ischemic stroke patients.
Article
Clinical Neurology
Youngran Kim, Anjail Sharrief, Min Ji Kwak, Swapnil Khose, Rania Abdelkhaleq, Sergio Salazar-Marioni, Guo-Qiang Zhang, Sunil A. Sheth
Summary: This study examines the equity in access to and utilization of endovascular therapy (EVT) across racial and ethnic groups. The findings indicate that Black patients have lower rates of EVT compared to White patients, despite similar admissions to EVT-performing hospitals and comprehensive stroke centers.
Article
Cardiac & Cardiovascular Systems
Sanne J. den Hartog, Osama Zaidat, Bob Roozenbeek, Adriaan C. G. M. van Es, Agnetha A. E. Bruggeman, Bart J. Emmer, Charles B. L. M. Majoie, Wim H. van Zwam, Ido R. van den Wijngaard, Pieter Jan van Doormaal, Hester F. Lingsma, James F. Burke, Diederik W. J. Dippel
Summary: The study found that first-pass reperfusion is associated with favorable outcomes in stroke treatment, independently of patient characteristics. Compared with multiple-pass reperfusion, first-pass reperfusion has better results.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2021)
Article
Cardiac & Cardiovascular Systems
Sanne J. den Hartog, Hester F. Lingsma, Pieter-Jan van Doormaal, Jeannette Hofmeijer, Lonneke S. F. Yo, Charles B. L. M. Majoie, Diederik W. J. Dippel, Aad van der Lugt, Bob Roozenbeek
Summary: This study aimed to evaluate the variation in door-to-reperfusion time between and within Dutch intervention hospitals and analyze the contribution of different time intervals to this variation. The study found that there is variation in door-to-reperfusion time between hospitals and even more within hospitals. It also highlighted the importance of reducing variation between patients within a hospital and specifically focusing on CTA-to-groin time and groin-to-reperfusion time to improve stroke care quality.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Clinical Neurology
Preeti Malik, Urvish K. Patel, Surabhi Kaul, Ramit Singla, Tapan Kavi, Kogulavadanan Arumaithurai, Vishal B. Jani
Summary: Pediatric stroke is a debilitating disease with various risk factors. Early identification of high-risk patients is important for preventive strategies. The use of intravenous tissue plasminogen activator and endovascular thrombectomy in pediatric stroke patients is associated with increased risk of mortality and hemorrhagic conversion. Further clinical studies are needed to evaluate the appropriate candidates for these treatments based on risk: benefit ratio.
INTERNATIONAL JOURNAL OF STROKE
(2021)
Article
Clinical Neurology
Raed A. Joundi, James A. King, Jillian Stang, Dana Nicol, Michael D. Hill, Moira K. Kapral, Eric E. Smith, Amy Y. X. Yu
Summary: This study validates the effectiveness of the Passive Surveillance Stroke Severity (PaSSV) Indicator using administrative datasets and clinical registries. The results suggest that PaSSV improves model discrimination for case fatality and home time outcomes in acute stroke patients.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Neuroimaging
Nishita Singh, Jessalyn K. Holodinsky, Nima Kashani, Rosalie McDonough, Fouzi Bala, MacKenzie Horn, Jillian Stang, Andrew M. Demchuk, Michael D. Hill, Mohammed A. Almekhlafi
Summary: This study aimed to predict the 90 day home time in stroke patients with a low baseline ASPECTS using random forest regression modeling. The results showed that patients with low ASPECTS who underwent EVT achieved comparable outcomes when selected based on demographic and clinical profiles similar to higher ASPECTS patients.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Clinical Neurology
Jessalyn K. Holodinsky, Patrice Lindsay, Amy Y. X. Yu, Aravind Ganesh, Raed A. Joundi, Michael D. Hill
Summary: This study used administrative data to estimate the number of stroke events resulting in hospital or emergency department presentation across Canada in the 2017-18 fiscal year. The findings indicate that a stroke event resulting in hospital or emergency department presentation occurs every 5 minutes in Canada.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Clinical Neurology
Bruce C. V. Campbell, Michael D. Hill, Thanh N. Nguyen, Joseph P. Broderick
Article
Clinical Neurology
Johanna M. Ospel, Wolfgang G. Kunz, Rosalie McDonough, Wim van Zwam, Floor Pinckaers, Jeffrey L. Saver, Michael D. Hill, Andrew M. Demchuk, Tudor G. Jovin, Peter Mitchell, Bruce C. Campbell, Phil White, Keith Muir, Hamza Achit, Serge Bracard, Scott Brown, Mayank Goyal
Summary: This study aimed to investigate the clinical and economic benefit of endovascular treatment (EVT) in stroke patients with mild preexisting symptoms/disability. The results showed that EVT, in addition to best medical management, was a superior treatment strategy, resulting in cost savings and improved quality of life.
Review
Clinical Neurology
Lily W. Zhou, Amy Y. X. Yu, Long Ngo, Michael D. Hill, Thalia S. Field
Summary: This study examined the incidence of cerebral venous thrombosis (CVT) in British Columbia, Canada, and found that it has increased over time. The literature on CVT incidence showed significant heterogeneity and possible publication bias.
Article
Clinical Neurology
K. Zhu, F. Bala, J. Zhang, F. Benali, P. Cimflova, B. J. Kim, R. McDonough, N. Singh, M. D. Hill, M. Goyal, A. Demchuk, B. K. Menon, W. Qiu
Summary: This article aims to develop an automated approach to quantify thrombus on NCCT and CTA in patients with stroke. The deep learning model obtained reliable results in both internal and external datasets.
AMERICAN JOURNAL OF NEURORADIOLOGY
(2023)
Article
Clinical Neurology
Ubong Udoh, Brian Dewar, Stuart Nicholls, Mark Fedyk, Robert Fahed, Jeff Perry, Michael D. Hill, Bijoy Menon, Richard H. Swartz, Alexandre Y. Poppe, Sophia Gocan, Jamie Brehaut, Katie Dainty, Victoria Shepherd, Dar Dowlatshahi, Michel Shamy
Summary: Advance consent is a potential solution to the challenge of obtaining informed consent for acute stroke trials. Canadian stroke clinic physicians expressed comfort and willingness in obtaining advance consent, with minimal disruption to clinic workflow. These findings support further investigation of advance consent for acute stroke trials.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Review
Clinical Neurology
Ayoola Ademola, Lehana Thabane, Joel Adekanye, Ayooluwanimi Okikiolu, Samuel Babatunde, Mohammed A. Almekhlafi, Bijoy K. Menon, Michael D. Hill, Kevin A. Hildebrand, Tolulope T. Sajobi
Summary: This study evaluated the credibility of subgroup analyses in stroke trials and found that the quality of subgroup analysis reporting remains poor, indicating a need for improved training and guidance.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Article
Clinical Neurology
Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh
Summary: This study compared the ability of NCCT and MR imaging to assess brain atrophy in patients with acute ischemic stroke. The results showed that NCCT had a weaker ability to assess cortical atrophy and a stronger ability to assess subcortical atrophy.
AMERICAN JOURNAL OF NEURORADIOLOGY
(2023)
Article
Clinical Neurology
Rena Seeger, Ubong Udoh, Brian Dewar, Stuart Nicholls, Mark Fedyk, Robert Fahed, Jeff Perry, Michael D. Hill, Bijoy Menon, Richard H. Swartz, Alexandre Y. Poppe, Sophia Gocan, Jamie Brehaut, Katie Dainty, Victoria Shepherd, Dar Dowlatshahi, Michel Shamy
Summary: This survey explores the acceptability of advance consent among Canadian Research Ethics Board (REB) chairs who review acute stroke trials. The majority of respondents expressed comfort approving studies that adopt advance consent, but no clear preference for advance consent over deferral of consent emerged. Concerns were raised about broad rather than trial-specific advance consent. These findings shed light on the acceptability of advance consent to Canadian ethics regulators.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Clinical Neurology
Miranda Wan, Patrice Lindsay, Amy Y. X. Yu, Michael D. Hill, Jessalyn K. Holodinsky
Summary: We provide an updated estimate of adult stroke event rates by age group, sex, and stroke type using Canadian administrative data. Overall, our findings show that there are similar stroke event rates between women and men, with slight differences in stroke event rate at various ages by sex and stroke type. These emerging patterns warrant attention in future studies. Our findings emphasize the importance of continuous surveillance to monitor the epidemiology of stroke in Canada.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Endocrinology & Metabolism
Alexander D. Rebchuk, Michael D. Hill, Mayank Goyal, Andrew Demchuk, Shelagh B. Coutts, Negar Asdaghi, Dar Dowlatshahi, Jessalyn K. Holodinsky, Enrico Fainardi, Jai Shankar, Mohamed Najm, Marta Rubiera, Alexander Khaw, Wu Qiu, Bijoy K. Menon, Thalia S. Field
Summary: Women, especially postmenopausal women, have worse outcomes after acute ischemic stroke. One possible reason for this is the decrease in the vasculoprotective effects of estrogen in older women. This study investigated the effects of sex and age on neuroradiological predictors of recanalization in acute ischemic stroke patients. The results showed that there was no association between sex and radiological predictors of recanalization.
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
(2023)
Article
Neuroimaging
Nathaniel Rex, Johanna M. Ospel, Scott B. Brown, Rosalie McDonough, Nima Kashani, Michael D. Hill, Diederik W. J. Dippel, Bruce Campbell, Keith W. Muir, Andrew M. Demchuk, Serge Bracard, Francis Guillemin, Tudor G. Jovin, Peter J. Mitchell, Phil White, Charles B. L. M. Majoie, Jeffrey L. Saver, Mayank Goyal
Summary: This study compared the functional outcomes of patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) who underwent endovascular treatment (EVT) with poor reperfusion, with those who received best medical management only. The results showed that patients with poor reperfusion after EVT had worse functional outcomes compared to those who only received medical management.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Clinical Neurology
Joseph P. Broderick, Gisele Sampaio Silva, Magdy Selim, Scott E. Kasner, Yasmin Aziz, Jocelyn Sutherland, Edward C. Jauch, Opeolu M. Adeoye, Michael D. Hill, Eva A. Mistry, Patrick D. Lyden, J. Mocco, Elaine M. Smith, Macarena Hernandez-Jimenez, Emir Deljkich, Hooman Kamel
Summary: The STAIR meeting discussed opportunities for improving enrollment in acute stroke trials, focusing on issues such as emergency consent, eligibility criteria, investigator availability, and trial execution.
