Publications by authors named "Bala Fouzi"
Background And Purpose: Successful and complete reperfusion should be the aim of every endovascular thrombectomy (EVT) procedure. However, the effect of time delays on successful reperfusion in late window stroke patients presenting 6-to-24 h from onset has not been investigated.
Materials And Methods: We pooled individual patient-level data from seven trials and registries for anterior circulation stroke patients treated with EVT between 6 and 24 h from onset.
Article Synopsis
- Non-stenotic carotid plaques, identified as having less than 50% stenosis, are considered a potential factor in ischemic strokes, particularly in patients with low-risk neurological events.
- The study analyzed data from 334 patients who experienced minor neurological symptoms and underwent CT angiography and MRI, finding that nearly 46% had these non-stenotic plaques, with a notable prevalence among those showing DWI-positive ischemia.
- The results indicated that non-stenotic plaques are more common on the side of DWI-positive lesions, suggesting a significant association between these plaques and the risk of ischemic events, as patients with non-stenotic plaques had a 40% higher risk for DWI-positive ischemia.
Background: About 25% of patients with acute ischemic stroke have lacunar infarct on follow-up imaging. In this secondary analysis from the AcT (Alteplase Compared With Tenecteplase) trial, we assessed if there is variation in safety or efficacy of intravenous thrombolysis by infarct type in patients with no visible occlusion. We also determined if this effect differed between tenecteplase and alteplase.
View Article and Find Full Text PDFBackground: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion presents significant clinical benefits over mTICI 2b/2c, necessitating strategies to reduce both ENT and EDT.
View Article and Find Full Text PDFArticle Synopsis
- A study compared the effectiveness of IV tenecteplase and IV alteplase in patients undergoing thrombectomy for acute ischemic stroke, using data from the AcT trial.
- It analyzed the outcomes of different endovascular thrombectomy strategies (stent retriever vs. aspiration) and how they interacted with the type of thrombolysis used.
- Results indicated that while there was no overall difference in efficacy, tenecteplase was associated with better outcomes when paired with aspiration as the first-line strategy.
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.
Article Synopsis
- Transcranial Doppler (TCD) ultrasound shows potential for quickly diagnosing large vessel occlusion (LVO) in patients with suspected acute ischemic stroke (AIS).
- A systematic review analyzed 170 studies, narrowing down to 7 that included 2260 patients, with findings showing TCD-derived biomarkers have high accuracy (85.9% to 99.2%) for diagnosing LVO.
- TCD appears effective and cost-efficient for improving stroke management, despite some limitations in data acquisition from certain patients.
Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.
Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.
Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial.
Background: Carotid web (CaW) is a risk factor for ischemic stroke, mainly in young patients with stroke of undetermined etiology. Its detection is challenging, especially among non-experienced physicians.
Methods: We included patients with CaW from six international trials and registries of patients with acute ischemic stroke.
Article Synopsis
- 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.
Background: The Carotid web (CaW) is a cause of stroke, particularly in younger individuals. However, the frequency and the radiological features of the web's morphology associated with stroke risk are uncertain. We determined the CaW radiological features on computed tomography (CT) angiography associated with ipsilateral stroke.
View Article and Find Full Text PDFBackground 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.
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.
Background: We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window.
Methods: Individual patients' data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed.
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 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.
Importance: Age is a leading predictor of poor outcomes after brain injuries like stroke. The extent to which age is associated with preexisting burdens of brain changes, visible on neuroimaging but rarely considered in acute decision-making or trials, is unknown.
Objectives: To explore the mediation of age on functional outcome by neuroimaging markers of frailty (hereinafter neuroimaging frailty) in patients with acute ischemic stroke receiving endovascular thrombectomy (EVT).
Article Synopsis
- Flow diverter embolization is an accepted treatment for intracranial aneurysms, and this study specifically looks at the safety and effectiveness of the Surpass Evolve device in this context.
- Between May 2019 and June 2022, 116 patients with either ruptured or unruptured aneurysms were treated and monitored for complications and aneurysm occlusion rates at 3 and 6 months post-treatment.
- Results showed a high occlusion rate (75.6% at 3 months and 80.4% at 6 months) with few complications, concluding that the Surpass Evolve is a reliable option for treating intracranial aneurysms.
Article Synopsis
- Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) were analyzed for their effectiveness in patients with pre-stroke dementia or cognitive impairment, a group often excluded from clinical trials.
- A systematic review and meta-analysis included nine studies, showing no significant differences in 90-day outcomes, mortality, or intracranial hemorrhage between those with and without pre-stroke dementia receiving IVT.
- The findings suggest that while IVT and EVT have no major safety concerns for these patients, pre-stroke cognitive impairment may lead to poorer 90-day outcomes specifically with EVT.
Background: The AcT (Alteplase Compared to Tenecteplase) randomized controlled trial showed that tenecteplase is noninferior to alteplase in treating patients with acute ischemic stroke within 4.5 hours of symptom onset. The effect of time to treatment on clinical outcomes with alteplase is well known; however, the nature of this relationship is yet to be described with tenecteplase.
View Article and Find Full Text PDFBackground: Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15-20% of acute stroke with large vessel occlusion.
Aims: We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.
Background: Emerging data suggest that direct oral anticoagulants may be a suitable choice for anticoagulation for cerebral venous thrombosis (CVT). However, conducting high-quality trials in CVT is challenging as it is a rare disease with low rates of adverse outcomes such as major bleeding and functional dependence. To facilitate the design of future CVT trials, SECRET (Study of Rivaroxaban for Cerebral Venous Thrombosis) assessed (1) the feasibility of recruitment, (2) the safety of rivaroxaban compared with standard-of-care anticoagulation, and (3) patient-centered functional outcomes.
View Article and Find Full Text PDFBackground And Purpose: Brain atrophy is an important surrogate for brain reserve, the capacity of the brain to cope with acquired injuries such as acute stroke. It is unclear how well atrophy measurements on MR imaging can be reproduced using NCCT imaging. We aimed to compare pragmatic atrophy measures on NCCT with MR imaging in patients with acute ischemic stroke.
View Article and Find Full Text PDFBackground And Objectives: Brain frailty may impair the ability of acute stroke patients to cope with the injury, irrespective of their chronologic age, resulting in impaired recovery. We aim to investigate the impact of brain atrophy on functional outcome assessed at different time points after endovascular thrombectomy (EVT).
Methods: In this retrospective post hoc analysis of the ESCAPE-NA1 trial, we analyzed CT imaging data for cortical atrophy by using the GCA scale, including region-specific scales, and subcortical atrophy by using the intercaudate distance to inner table width (CC/IT) ratio.