Publications by authors named "Kelsey R Duncan"
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.*
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.
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.
Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well: The SELECT Late Study.
JAMA Neurol
February 2023
Importance: The role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well.
Objective: To evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well.
Design, Setting, And Participants: This retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand.
Gait deficits are often persistent after stroke, and current rehabilitation methods do not restore normal gait for everyone. Targeted methods of focused gait therapy that meet the individual needs of each stroke survivor are needed. Our objective was to develop and test a combination protocol of simultaneous brain stimulation and focused stance phase training for people with chronic stroke (>6 months).
View Article and Find Full Text PDFBackground: Multiple studies have reported higher rates of glioma in areas with higher socioeconomic status (SES) but to the authors' knowledge have not stratified by other factors, including race/ethnicity or urban versus rural location.
Methods: The authors identified the average annual age-adjusted incidence rates and calculated hazard ratios for death for gliomas of various subtypes, stratified by a county-level index for SES, race/ethnicity, US region, and rural versus urban status.
Results: Rates of glioma were highest in counties with higher SES (rate ratio, 1.