Publications by authors named "Bernard Yan"

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.*
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Article Synopsis
  • Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
  • In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
  • Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
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  • The study investigates how repeat imaging for stroke patients being transferred to comprehensive stroke centers (CSCs) affects the timing of endovascular thrombectomy (EVT) and identifies factors that can predict changes in brain infarct size during transport.
  • Researchers analyzed data from patients with large vessel occlusion who underwent CT perfusion imaging at both primary and comprehensive stroke centers, focusing on changes in imaging parameters and clinical factors.
  • Results showed that growth in the perfusion core during transport was rare and primarily linked to lower initial ASPECTS scores, suggesting that initial favorable imaging may indicate whether repeat imaging is needed upon arrival at the CSC.
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Article Synopsis
  • - The study focuses on the safety and effectiveness of using intra-arterial (IA) tenecteplase in patients with large vessel occlusion (LVO) stroke who have already undergone successful reperfusion, as many still face dependency or death after three months.
  • - Conducted as a multicenter, open-label, and prospective randomized controlled trial, it aims to enroll up to 256 patients who will be split evenly between receiving IA tenecteplase and best medical management post-reperfusion.
  • - The main goal is to improve outcomes at 90 days measured by the modified Rankin Scale, while monitoring for safety through potential complications like intracranial hemorrhage.
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Importance: Recently, 6 randomized clinical trials-RESCUE-Japan-LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core Trial), ANGEL-ASPECT (Trial of Endovascular Therapy for Acute Ischemic Stroke With Large Infarct), SELECT2 (Trial of Endovascular Thrombectomy for Large Ischemic Strokes), TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke), TENSION (Endovascular Thrombectomy for Acute Ischemic Stroke With Established Large Infarct), and LASTE (Large Stroke Therapy Evaluation)-have concluded their investigations on the efficacy and safety of endovascular thrombectomy (EVT) for the treatment of patients with ischemic stroke, anterior-circulation large vessel occlusions, and large areas of ischemic changes defined as an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 5 or less. Overall, the results appeared to be positive, with 5 of the 6 trials meeting their primary efficacy end point, and 1 trial that was a near miss. However, questions remain regarding how these trial results should be interpreted and incorporated into routine clinical practice.

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Background: The optimal treatment for patients with acute large vessel occlusion (LVO) secondary to intracranial atherosclerotic disease (ICAD) is unclear. Adjunctive rescue therapy with balloon angioplasty or stenting may be necessary to ensure vessel patency. We aimed to compare the safety and clinical outcomes of adjunctive rescue therapy vs lone thrombectomy for ICAD-related-LVO.

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Article Synopsis
  • The study investigated whether intravenous tranexamic acid can reduce haematoma growth in patients experiencing an acute intracerebral hemorrhage when administered within 2 hours of onset, compared to a placebo.
  • Conducted as a double-blind, randomized phase 2 trial across multiple countries, the research included 201 eligible participants who were assigned to receive either tranexamic acid or saline as a placebo.
  • The primary outcome measured was haematoma growth assessed through CT scans at 24 hours, alongside safety endpoints including mortality and thromboembolic events at specified intervals.
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Background And Objectives: Early treatment with intravenous alteplase increases the probability of lytic-induced reperfusion in large vessel occlusion (LVO) patients. The relationship of tenecteplase-induced reperfusion and the timing of thrombolytic administration has not been explored. In this study, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates and assessed their relationship to the time of thrombolytic administration.

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Article 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.
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Background: Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.

Methods: SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand.

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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.

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Article Synopsis
  • This study investigates whether the effectiveness of intravenous thrombolysis (IVT) combined with thrombectomy for treating acute ischemic stroke decreases as time from symptom onset increases.
  • It involves a comprehensive analysis of data from six clinical trials, focusing on patients with anterior circulation large-vessel occlusions who arrived at treatment centers between January 2017 and July 2021.
  • Results indicate a statistically significant relationship between the timing of IVT administration and treatment outcomes, suggesting that the benefit of combining IVT with thrombectomy may be time-dependent.
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Background: A proportion of large vessel occlusion strokes demonstrate early recanalization, obviating the initial intention to proceed to endovascular thrombectomy. Neurological improvement is a possible surrogate marker for reperfusion. We aimed to determine the optimal threshold of neurological improvement, as defined by the National Institutes of Health Stroke Scale (NIHSS), which best associates with early recanalization.

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Approximately one-third of acute ischemic strokes with an identifiable vessel occlusion are caused by medium vessel occlusion (MeVO), that is, nonlarge vessel occlusions that are potentially amenable to endovascular treatment (EVT). Management of patients with MeVO is challenging in many ways: detecting MeVOs can be challenging, particularly for inexperienced physicians, and in busy clinical routine, MeVOs, therefore, remain sometimes undiagnosed. While the clinical course of MeVO stroke with medical management, including intravenous thrombolysis, is by no means, benign, it is more favorable compared with large vessel occlusion.

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Article Synopsis
  • - The study aimed to determine the cost-effectiveness of endovascular thrombectomy (EVT) for patients with M2 occlusions compared to those who did not receive EVT, using real-world data and clinical trial findings.
  • - Researchers matched 83 patients (42 EVT and 41 non-EVT) based on baseline characteristics and developed a Markov model to assess long-term outcomes, revealing greater quality-adjusted life years (QALY) but higher costs associated with EVT treatment.
  • - The results showed that EVT was more beneficial in terms of QALY (5.48 vs 5.24) but also more expensive (A$133,457 vs A$126,127), leading to an incremental cost-effect
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Article Synopsis
  • This text discusses a study evaluating whether endovascular treatment alone is as effective as using both intravenous thrombolysis and endovascular treatment in patients with acute ischemic stroke.
  • The study was conducted through a systematic review and meta-analysis of randomized controlled trials, focusing on patients' outcomes measured by their 90-day modified Rankin Scale scores.
  • A total of six studies, involving over 2300 participants, were analyzed to determine the non-inferiority of endovascular treatment alone compared to the combination of treatments.
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Background: Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care.

Methods: Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation.

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Intracranial atherosclerotic disease (ICAD) is one of the most common causes of acute ischemic stroke worldwide. Patients with acute large vessel occlusion due to underlying ICAD (ICAD-LVO) often do not achieve successful recanalization when undergoing mechanical thrombectomy (MT) alone, requiring rescue treatment, including intra-arterial thrombolysis, balloon angioplasty, and stenting. Therefore, early detection of ICAD-LVO before the procedure is important to enable physicians to select the optimal treatment strategy for ICAD-LVO to improve clinical outcomes.

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Introduction: Tissue at risk, as estimated by CT perfusion utilizing Tmax+6, correlates with final infarct volume (FIV) in acute ischaemic stroke (AIS) without reperfusion. Tmax thresholds are derived from Western ethnic populations but not from ethnic Asian populations. We aimed to investigate the influence of ethnicity on Tmax thresholds.

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Background: First pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related strokes have different clot composition compared with non-AF strokes, which may impact thrombectomy reperfusion results. We compared FPE rates in AF and non-AF stroke patients to evaluate if AF-related strokes had higher FPE rates.

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Background: Following reperfusion treatment in ischemic stroke, computed tomography (CT) imaging at 24 h is widely used to assess radiological outcomes. Even without visible hyperattenuation, occult angiographic contrast may persist in the brain and confound Hounsfield unit-based imaging metrics, such as net water uptake (NWU).

Aims: We aimed to assess the presence and factors associated with retained contrast post-thrombectomy on 24-h imaging using dual-energy CT (DECT), and its impact on the accuracy of NWU as a measure of cerebral edema.

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