Publications by authors named "Alexandre Poppe"
Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis, pregnancy complications, and other nonthrombotic manifestations in the presence of antiphospholipid antibodies. Neurovascular complications, including ischemic stroke, cerebral venous thrombosis and cognitive impairment, pose significant challenges in management.
Objective: To comprehensively review relevant and updated clinical aspects of neurovascular manifestations of APS.
Background: In the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke), treatment with nerinetide was associated with a smaller infarct volume among patients who did not receive intravenous alteplase. We assessed the effect of nerinetide on the surrogate imaging outcome of final infarct volume in patients who did not receive intravenous alteplase and explored predictors of outcome and modifiers of nerinetide's effect on infarct volume.
Methods: ESCAPE-NA1 was a multicenter, randomized trial in which patients with acute stroke with a baseline Alberta Stroke Program Early CT Score >4, undergoing endovascular thrombectomy, were randomized to receive intravenous nerinetide or placebo.
Article Synopsis
- Carotid plaques may play a significant role in causing ischemic strokes, and this study evaluated their characteristics in relation to strokes that occur on either side of the affected carotid artery.
- Researchers analyzed data from the ESCAPE-NA1 trial, focusing on patients with embolic stroke of undetermined source (ESUS) who underwent thrombectomy, and looked for "vulnerable carotid plaques" using various imaging criteria.
- The findings revealed that vulnerable plaques, characterized by surface irregularity and significant stenosis, were significantly more common in the carotid arteries on the same side as the stroke, highlighting the importance of monitoring these plaques for better stroke risk assessment.
Purpose: The modified Rankin Scale (mRS) at 90 days is the primary outcome in most acute stroke studies, but the long follow-up period has disadvantages. The National Institutes of Health Stroke Scale (NIHSS) at 24 h shows a strong, but imperfect, association with 90-day mRS. This study examines the association between 24-hour NIHSS and 90-day mRS and reasons for discrepancies.
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- The study assessed how the quality of reperfusion affects clinical and radiological outcomes in patients from the ESCAPE NA1 trial.
- Researchers analyzed different reperfusion patterns using the expanded Treatment in Cerebral Infarction (eTICI) Scale to compare patient outcomes, including rates of good or excellent clinical recovery, symptomatic hemorrhage, and death.
- Results showed that higher reperfusion grades were linked to better clinical outcomes and lower mortality rates, regardless of how many attempts were needed to achieve them, or the speed of reperfusion.
Introduction: Obtaining informed consent for research from patients in medical emergencies remains a challenge, particularly in acute stroke care as treatment must be administered quickly and patients often arrive in the hospital in a state of incapacitation. Adaptations to standard consenting approaches-such as the use of surrogate consent or deferral of consent-have significant limitations. This feasibility study aims to test a new consenting approach in acute stroke care that we call advance consent.
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- Cervical artery dissection (CeAD) is a leading cause of ischemic strokes in young adults, and this study explored the effects of intravenous thrombolysis (IVT) on patients with CeAD and stroke symptoms.
- Analyzed data from the STOP-CAD study, it found that IVT significantly improved functional independence after 90 days in patients without increasing the risk of symptomatic intracranial hemorrhage.
- The results suggest that IVT is a beneficial treatment for eligible patients with CeAD, aligning with current medical guidelines on its use.
Article Synopsis
- The study examines the safety and effectiveness of intravenous tenecteplase compared to alteplase in treating patients with acute ischemic strokes in the posterior circulation.
- A post-hoc analysis of over 1,500 patients found no significant differences in outcomes between the two treatments in terms of recovery, symptomatic intracerebral hemorrhage, and mortality.
- Both medications showed similar rates of successful reperfusion and recanalization, suggesting that tenecteplase can be as effective as alteplase for this type of stroke without increased risks.
Introduction: In stroke patients with acute large vessel occlusion, endovascular therapy (EVT) may be performed with or without sedation. Our aim is to describe self-reported intraprocedural comfort in patients undergoing EVT depending on sedation type.
Methods: We performed a prospective observational single-center study of patients undergoing EVT.
Background: Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.
Methods: We analyzed data from Optimizing Patient Treatment in Major Ischemic Stroke With EVT, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients with large vessel occlusion transferred for EVT and those directly admitted to an EVT-capable center.
Safety of acute internal carotid artery stenting during endovascular thrombectomy in patients with acute ischemic stroke: a retrospective analysis of the OPTIMISE registry.
J Neurointerv Surg
June 2024
Background: The optimal management of tandem carotid lesions during endovascular thrombectomy (EVT) remains uncertain. The safety and efficacy of acute carotid artery stenting (aCAS) are debated, including safety concerns such as procedural complications and symptomatic intracerebral hemorrhage (sICH). We aimed to assess aCAS safety among EVT-treated patients using a large Canadian registry.
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- The study investigates the differences between cerebral amyloid angiopathy-related inflammation (CAA-RI) and biopsy-positive primary angiitis of the CNS (BP-PACNS), focusing on their clinical and radiologic presentations as well as relapse rates.
- It included 104 patients with CAA-RI and 52 with BP-PACNS, revealing that CAA-RI tends to show more white matter lesions and hemorrhagic features, while BP-PACNS is associated more with headaches and motor deficits.
- The results indicate significant differences in features between the two conditions, suggesting that they may require different diagnostic approaches and could have varying outcomes in terms of recurrence.
Article Synopsis
- The study investigates how the timing of endovascular thrombectomy (EVT) affects the quality of life reported by patients who have experienced an ischemic stroke.
- Using data from an international clinical trial, it evaluates the relationship between the time from hospital arrival to treatment and self-reported health outcomes 90 days post-stroke.
- Findings indicate that quicker EVT may lead to better patient-reported quality of life, but further analysis is necessary to fully understand the implications of timing on symptoms across various health domains.
Background: Early ischemic change and collateral extent are colinear with ischemic core volume (ICV). We investigated the relationship between a combined score using the Alberta Stroke Program Early Computed Tomography Score and multiphase computed tomography angiography (mCTA) collateral extent, named mCTA-ACE score, on functional outcomes in endovascular therapy-treated patients.
Methods: We performed a post hoc analysis of a subset of endovascular therapy-treated patients from the Alteplase Compared to Tenecteplase trial which was conducted between December 2019 and January 2022 at 22 centers across Canada.
Article Synopsis
- The study investigated the impact of endovascular therapy (EVT) on cognitive outcomes following a large vessel occlusion stroke, using data from the ESCAPE trial.
- Cognitive assessments were performed 90 days post-stroke and included various tests to evaluate memory and cognitive function, with results indicating that EVT significantly improved cognitive outcomes across all tests.
- Findings showed that EVT was associated with better cognitive performance (higher odds ratios for favorable outcomes), and both final infarct volume and cognitive function had notable correlations, suggesting that both factors influence recovery.
Article Synopsis
- * The study analyzed data from the ESCAPE-NA1 trial, involving 408 patients, and found that 35% experienced hemorrhagic transformation, mostly classified as hemorrhagic infarction or parenchymal hematoma.
- * Larger volumes of low relative cerebral blood flow (CBF) were associated with an increased risk of parenchymal hematoma, suggesting that CBF metrics could help assess the risk of complications following treatment.
Background: To assess the association of qualitative and quantitative infarct characteristics and 3 cognitive outcome tests, namely the Montreal Cognitive Assessment (MOCA) for mild cognitive impairment, the Boston Naming Test for visual confrontation naming, and the Sunnybrook Neglect Assessment Procedure for neglect, in large vessel occlusion stroke.
Methods: Secondary observational cohort study using data from the randomized-controlled ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke), in which patients with large vessel occlusion undergoing endovascular treatment were randomized to receive either intravenous Nerinetide or placebo. MOCA, Sunnybrook Neglect Assessment Procedure, and 15-item Boston Naming Test were obtained at 90 days.
Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study.
J Neurointerv Surg
March 2024
Background: Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.
Objective: T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.
Methods: We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases.
Background: Spontaneous acute intracerebral hemorrhage (ICH) is associated with greater stroke-related disability and mortality. Hematoma expansion (HME), an important treatment target in acute ICH, is time-dependent, with a greater probability of hematoma growth occurring <3 hours from ICH onset.
Summary: Promising treatment options to reduce HME include early intensive blood pressure (BP) reduction and the administration of hemostatic or anticoagulant reversal agents, yet large phase III clinical trials have so far failed to show overwhelming benefit for these interventions in acute ICH.
Background: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation.
Methods: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma.
Article Synopsis
- In the AcT trial, researchers examined how effective and safe intravenous tenecteplase is compared to alteplase for treating patients with minor ischaemic strokes, specifically those with low NIHSS scores (≤5).
- The study included 378 patients, showing that 51.8% of those treated with tenecteplase achieved good functional outcomes compared to 47.5% with alteplase, but the differences in outcomes were not statistically significant.
- Safety results indicated no major differences between the two treatments in terms of severe complications like symptomatic intracranial hemorrhage or mortality within 90 days.
Background: Recent evidence from thrombolysis trials indicates the noninferiority of intravenous tenecteplase to intravenous alteplase with respect to good functional outcomes in patients with acute stroke. We examined whether the health-related quality of life (HRQOL) of patients with acute stroke differs by the type of thrombolysis treatment received. In addition, we examined the association between the modified Rankin Scale score 0 to 1 and HRQOL and patient-reported return to prebaseline stroke functioning at 90 days.
View Article and Find Full Text PDFOral anticoagulation (OAC) prevents stroke in atrial fibrillation, yet a residual stroke risk remains. In this single-center retrospective analysis of acute ischemic stroke patients despite OAC, suboptimal OAC treatment is common (30%: inappropriate dosing (17%); patient non-adherence (13%)). Other causes of stroke included OAC interruption (14.
View Article and Find Full Text PDFBackground: Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase).
Methods: AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.