Publications by authors named "Piers Klein"
Background: Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.
View Article and Find Full Text PDFBackground: Growing evidence suggests that direct oral anticoagulants (DOACs) may be suitable for cerebral venous thrombosis (CVT). The optimal strategy regarding lead-in parenteral anticoagulation (PA) prior to DOAC is unknown.
Methods: In this post hoc analysis of the retrospective ACTION-CVT study, we compared patients treated with DOACs as part of routine care: those given "very early" DOAC (no PA), "early" (<5 days PA) and "delayed" (5-21 days PA).
Article Synopsis
- A significant portion of patients (1 in 10) experience epilepsy after having cerebral venous thrombosis (CVT), but it's challenging to predict who will be affected.* -
- Researchers created the DIAS3 prognostic score using clinical data from over 1,100 patients to assess the likelihood of developing post-CVT epilepsy based on six clinical variables.* -
- The study found a range of predicted risks for post-CVT epilepsy within one and three years, with successful validation of the score confirming its effectiveness in estimating individual risk.*
Article Synopsis
- Cervical artery dissection (CeAD) is a leading cause of ischemic strokes in young adults, and this study explored the effects of intravenous thrombolysis (IVT) on patients with CeAD and stroke symptoms.
- Analyzed data from the STOP-CAD study, it found that IVT significantly improved functional independence after 90 days in patients without increasing the risk of symptomatic intracranial hemorrhage.
- The results suggest that IVT is a beneficial treatment for eligible patients with CeAD, aligning with current medical guidelines on its use.
Venous sinus diverticulum in patients with pulsatile tinnitus: An acquired lesion.
Interv Neuroradiol
September 2024
Background: The etiopathogenesis of venous sinus diverticulum is controversial. Conflicting evidence has been published suggesting that venous sinus diverticulum is either a congenital or acquired lesion.
Methods: This is a case report of a single individual followed for 17 years within a single healthcare system.
Article Synopsis
- Medium vessel occlusion (MeVO) strokes, especially in the M2 segment of the middle cerebral artery, are a significant challenge in stroke management, necessitating effective prediction of patient outcomes after mechanical thrombectomy (MT).
- This study analyzed data from the MAD-MT registry to evaluate the relationship between follow-up infarct volume (FIV) and 90-day functional outcomes, using the modified Rankin Scale (mRS) as a measurement.
- Results showed that FIV is a strong predictor of outcomes, with specific volume thresholds indicating favorable prognosis; notably, an FIV of ≤15 ml had the best predictive capability, outperforming traditional recanalization scores.
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.
View Article and Find Full Text PDFArticle Synopsis
- * Data from 670 patients revealed that while IVT may improve some outcomes, such as higher chances of achieving a modified Rankin Scale score of 0-2 in univariable analysis, this benefit was not consistently observed in more rigorous multivariable analyses.
- * Overall, the findings suggest that adjunctive IVT may not significantly enhance clinical outcomes or safety compared to MT alone for this patient population.
Article Synopsis
- Age is often a factor in predicting outcomes for patients with large vessel occlusions treated with mechanical thrombectomy, but there’s limited research on outcomes for octo/nonagenarians compared to younger patients, specifically for acute basilar artery occlusions.
- A study using data from the PC-SEARCH Thrombectomy Registry analyzed 444 cases, dividing patients into two age groups: those over 80 and those 80 or younger.
- Results showed that while fewer older patients achieved favorable outcomes at 90 days post-treatment, the differences were not statistically significant after adjusting for other health factors, suggesting that octo/nonagenarians can have comparable functional recovery to younger patients when treated with thrombectomy.
Article Synopsis
- Researchers developed a 9-point score to predict positive outcomes for patients undergoing endovascular therapy (EVT) in late-presenting strokes (6-24 hours after last known well), based on a multinational study involving over 3,200 patients.
- The score takes into account factors like age, early CT changes, and stroke severity, with higher scores indicating a better chance of functional recovery at 90 days compared to those receiving only medical management.
- Validation of the score showed it is a useful tool for estimating EVT outcomes, particularly benefiting patients with lower to midrange scores in terms of good functional results and independence.
Article Synopsis
- Mechanical thrombectomy is the standard treatment for large vessel occlusions, but there's limited evidence for its effectiveness in treating distal and medium vessel occlusions, particularly for patients with low stroke scale scores (≤6).
- A study analyzed data from 41 academic centers, comparing outcomes of low versus higher stroke scale score patients who underwent thrombectomy, revealing high successful reperfusion rates in both groups.
- Results showed that patients with lower stroke scale scores experienced better functional outcomes and lower mortality rates, but the treatment's effectiveness compared to intravenous thrombolysis (IVT) is still uncertain.
Background And Objectives: Intracranial atherosclerotic disease (ICAD) large vessel occlusion (LVO) is responsible for up to 30% of LVO. In this study, we aimed to determine the likelihood of favorable functional outcomes (modified Rankin Scale 0-3) in acute ICAD-LVO basilar occlusion compared with embolic basilar occlusion.
Methods: This is an analysis of the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intraprocedural Predictors for Mechanical Thrombectomy Registry in which patients with acute basilar artery occlusions from 8 comprehensive stroke centers were included from 2015 to 2021.
Article Synopsis
- The study investigates the effectiveness of two anesthesia methods—general anesthesia (GA) and conscious sedation (non-GA)—for patients undergoing endovascular treatment for isolated posterior cerebral artery (PCA) occlusion stroke.
- Researchers analyzed data from the PLATO study focusing on patient outcomes such as the modified Rankin Scale scores after 90 days, as well as successful reperfusion rates and safety measures like intracranial hemorrhage.
- Results show that while both anesthesia methods had similar functional outcomes and safety profiles, GA was associated with significantly higher rates of successful reperfusion during treatment.
Article Synopsis
- Posterior cerebral artery occlusion (PCAo) can lead to long-term disabilities, and this study compares the effectiveness of endovascular thrombectomy (EVT), both with and without intravenous thrombolysis (IVT), against IVT alone for treating PCAo.
- The study analyzed data from 724 patients treated within 24 hours of PCAo onset, measuring outcomes like functional independence and early neurological improvement over a three-month period.
- Results indicated that EVT did not improve overall functional outcomes compared to IVT alone; however, it increased the likelihood of early improvement, but also raised risks of symptomatic intracranial hemorrhage and mortality.
Background And Purpose: We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods: In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days.
Background: Approximately 30% of patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion have pre-stroke modified Rankin Scale (mRS) scores ≥2. We aimed to investigate the safety and outcomes of endovascular treatment (EVT) in patients with AIS with moderate pre-stroke disability (mRS score 3) in an extended time frame (ie, 6-24 hours from the last time known well).
Methods: Data were collected from five centers in Europe and the USA from January 2018 to January 2023 and included 180 patients who underwent EVT in an extended time frame.
Article Synopsis
- Endovascular treatment (EVT) is commonly used for proximal vessel occlusion strokes, but its effectiveness for distal medium vessel occlusions is uncertain; this study compares EVT with medical management (MM) for those occlusions.
- A retrospective analysis of 321 patients showed no significant differences between EVT and MM in terms of overall disability, good and excellent outcomes, or 90-day mortality.
- The study concluded that both treatment methods had similar safety profiles, with no notable differences in rates of symptomatic intracranial hemorrhage or mortality.
Article Synopsis
- A study was conducted to investigate the effects of different anesthesia types (general vs. non-general) during endovascular treatment for strokes caused by distal medium vessel occlusions (DMVO).
- Researchers analyzed data from multiple centers and focused on outcomes like disability after 90 days, successful blood vessel reperfusion, and rates of complications.
- Results showed no significant differences between the two anesthesia groups regarding disability, successful treatment, or safety measures, suggesting that anesthesia type may not impact clinical outcomes in DMVO strokes.
Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings.
Patients And Methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022.
Article Synopsis
- The study investigates the effectiveness of endovascular treatment (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion (iPCAO) during acute ischemic strokes, lacking prior randomized trial evidence.
- Results show that EVT leads to better functional outcomes for patients with more severe stroke symptoms (NIHSS >6), but not for those with milder symptoms (NIHSS ≤6).
- Additionally, while EVT improves outcomes, it is also linked to a higher occurrence of symptomatic intracranial hemorrhages, regardless of initial stroke severity.