Publications by authors named "Amanda Opaskar"
Background: Several social and biological factors are shown to differentially affect stroke outcomes between men and women. We evaluated whether clinical outcomes and endovascular thrombectomy (EVT) treatment effects differed between the sexes in patients presenting with large ischemic stroke.
Methods: The SELECT2 trial (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) was a randomized controlled trial assessing the efficacy and safety of EVT in patients with large strokes across the United States, Canada, Europe, Australia, and New Zealand between October 2019 and September 2022.
Article Synopsis
- This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
- Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
- About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.
View Article and Find Full Text PDFArticle Synopsis
- Researchers looked at how bleeding in the brain (intracerebral hemorrhage or ICH) affects people who had a specific treatment for severe strokes called endovascular thrombectomy (EVT).
- Out of the 351 patients studied, many experienced bleeding, especially those who had EVT, but serious types of bleeding were rare.
- In the end, having some bleeding didn’t make the patients’ health outcomes worse, and there may be new treatments that could help those with bleeding issues in similar cases.
Article Synopsis
- Patients with large ischemic core strokes often have poor outcomes and are rarely transferred for endovascular thrombectomy (EVT), leading to a need for better understanding of treatment effects in different patient groups.
- The study analyzed data from the SELECT2 trial, focusing on adults with acute ischemic strokes due to specific artery occlusions, comparing those who were directly treated at EVT centers with those who were transferred.
- Results indicated that EVT improved functional outcomes in both transfer and non-transfer patients, suggesting that EVT can benefit patients regardless of transfer delays, although the median ASPECTS score showed a decline during transfers.
Importance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain.
Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect.
Design, Setting, And Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022.
Article Synopsis
- Reperfusion therapy significantly benefits ischemic stroke patients by reducing infarct growth and cerebral edema, which may be key to improving clinical outcomes.* -
- A study involving 542 patients found that successful reperfusion was linked to decreased infarct growth and midline shift, highlighting their role as mediators in treatment effectiveness.* -
- Although successful reperfusion initially correlated with better functional outcomes, this link diminished when accounting for infarct growth and midline shift, indicating these factors greatly influence treatment success.*
Objective: Endovascular mechanical thrombectomy is safe and effective for the treatment of acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). Still, despite high rates of procedural success, it is routine practice to uniformly admit postthrombectomy patients to an intensive care unit (ICU) for postoperative observation. Predictors of ICU criteria and care requirements in the postmechanical thrombectomy ischemic stroke patient population are lacking.
View Article and Find Full Text PDFStroke in pregnancy is rare and has a wide range of etiologies and implications on stroke management that differ from nonpregnant individuals. The highest risk of stroke is during the third trimester and puerperium period, where hypertensive disorders of pregnancy occur; however, stroke can occur at any point during pregnancy. In this chapter, we will provide an overview of the epidemiology of stroke in pregnancy and then review the specific etiologies of ischemic and hemorrhagic stroke as they relate to pregnant women.
View Article and Find Full Text PDFBackground Following cryptogenic stroke, guidelines recommend cardiac monitoring for occult atrial fibrillation (AF). We aimed to evaluate predictors of AF during long-term implantable cardiac monitoring. Methods and Results We studied 293 consecutive patients who underwent implantable cardiac monitor implant (Medtronic LINQ) following hospitalization for cryptogenic stroke at the University of Rochester Medical Center from January 2013 to September 2018.
View Article and Find Full Text PDFBackground: As medical schools strive to improve the learning environment, it is important to understand medical students' perceptions of mistreatment. The purpose of this study was to explore student interpretations of previously reported mistreatment incidents to better understand how they conceptualise the interactions.
Methods: Medical students were presented with case scenarios of previously reported instances of mistreatment and asked to indicate their agreement as to whether the scenarios demonstrated mistreatment, using a five-point Likert scale (1, strongly disagree; 5, strongly agree).