Publications by authors named "Bruce Campbell"

Rationale: The benefit of tenecteplase in the treatment of large vessel occlusion (LVO) patients presenting within 24 hours of symptom onset remains unclear.

Aim: To assess the effectiveness and safety of tenecteplase, compared to standard of care, in patients presenting within the first 24 hours of symptom onset with a LVO and target mismatch on perfusion CT.

Methods And Design: The "Extending the time window for Tenecteplase by Effective Reperfusion of peNumbrAL tissue in patients with Large Vessel Occlusion" (ETERNAL-LVO) trial is a prospective, randomized, open-label, blinded endpoint, phase 3, parallel-group, superiority trial with covariate-adjusted 1:1 randomization, and adaptive sample size re-estimation.

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  • 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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  • Tranexamic acid, an antifibrinolytic agent, was tested in a study on patients with intracerebral hemorrhage who had ongoing bleeding (spot signs) to assess its effect on hematoma growth when administered within 4.5 hours of onset.
  • A systematic review and meta-analysis were conducted, evaluating randomized trials comparing tranexamic acid to a placebo, specifically including 162 participants with follow-up imaging.
  • Results showed that tranexamic acid treatment did not significantly reduce hematoma growth compared to placebo, with a slightly lower growth rate in the treatment group, but overall outcomes suggested continued monitoring and assessment of safety was needed.
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  • 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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  • Endovascular thrombectomy (EVT) is shown to be cost-effective for patients with extensive ischemic injury, providing better health outcomes and lower societal costs compared to standard care among various populations, including those in the US, Australia, and Spain.
  • The analysis utilized a Markov model to assess outcomes based on quality-adjusted life years (QALYs) and found significant cost savings, with reductions of $23,409 in the US, $10,691 in Australia, and $30,036 in Spain.
  • EVT remains cost-effective across different age groups and severity levels of strokes, indicating a need to adapt healthcare systems to increase thrombectomy access for patients with larger strokes.
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We have enjoyed getting to know Beatie Wolfe after finding her work to be compelling for its consistent ability to use art and communication to build bridges between different societal worlds. Beatie is a multimedia artist who started her career reimagining the ceremonial experiences of analog music formats, creating a new series of retro-future designs for the digital age, and now perfects an artistic process, which melds art and science and other disciplines to create stunning multifaceted installations that draw huge enthusiastic audiences when displayed in public.

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Background: Six randomized trials have not detected a difference between intravenous alteplase plus endovascular thrombectomy and endovascular thrombectomy alone in stroke. Tenecteplase, a recombinant human tenecteplase tissue-type plasminogen activator, is a genetically modified variant of alteplase. It is unclear whether the outcomes are different if alteplase is replaced with tenecteplase.

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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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Inclusion of adaptive design features in a clinical trial provides preplanned flexibility to dynamically modify a trial during its conduct while preserving validity and integrity. Adaptive trials are needed to accelerate the conduct of more efficient, informative, and ethical clinical research in the field of neurology. Stroke is a natural candidate for adoption of these innovative approaches to trial design.

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  • The no-reflow phenomenon may lead to poor patient outcomes after thrombectomy, with various imaging definitions leading to inconsistent prevalence rates.
  • An analysis of 131 patients showed significant variability in no-reflow prevalence (0.8-22.1%) and poor agreement between different imaging definitions regarding patient outcomes.
  • The definition based on >15% cerebral blood volume or flow asymmetry was most effective in predicting poor clinical outcomes 90 days post-treatment.
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Purpose: For nearly half of patients who undergo Endovascular Thrombectomy following ischemic stroke, successful recanalisation does not guarantee a good outcome. Understanding the underlying tissue changes in the infarct tissue with the help of biomarkers specific to ischemic stroke could offer valuable insights for better treatment and patient management decisions. Using quantitative susceptibility mapping (QSM) MRI to measure cerebral iron concentration, this study aims to track the progression of iron within the infarct lesion after successful reperfusion.

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As a self-professed AI artist, Nina Rajcic presented an opportunity for us to explore a curiosity regarding how AI artists have been developing a process during an AI boon brought on by transformer and generative AI tools. Although her journey has been one of pursuing text as a creative output, the nature of transformers and diffusion suggested relevance to graphical outputs. The following interview did not disappoint in that pursuit.

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Background: The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender.

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Thrombolytic therapies for acute ischemic stroke are widely available but only result in recanalization early enough, to be therapeutically useful, in 10% to 30% of cases. This large gap in treatment effectiveness could be filled by novel therapies that can increase the effectiveness of thrombus clearance without significantly increasing the risk of harm. This focused update will describe the current state of emerging adjuvant treatments for acute ischemic stroke reperfusion.

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A decade on from the first positive thrombectomy trials, hyperacute therapies for ischemic stroke continue to rapidly advance. Effective treatments remain limited to reperfusion, although several cytoprotective approaches continue to be investigated. Intravenous fibrinolytics are now demonstrated to be beneficial up to 24 h in patients selected using perfusion imaging, but their role in patients with non-disabling symptoms appears very limited.

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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.

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