Publications by authors named "Strbian D"
Background: Whether bridging thrombolysis with tenecteplase is beneficial compared with thrombectomy alone in patients who had a stroke with large-vessel occlusion remains unclear.
Methods: This is a causal inference study of observational data from the trials SWIFT DIRECT and EXTEND-IA TNK Parts 1 and 2 applying target trial emulation. We compared patients receiving thrombectomy alone to patients receiving tenecteplase 0.
Background: Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.
Aim: Our aim was to determine the key challenges for MT implementation and access worldwide.
Methods: We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network, and as invited by co-authors between December 2022 and March 2023.
Article Synopsis
- 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.
Introduction: After severe ischemic stroke (IS), circulating levels of symmetric dimethylarginine (SDMA) increase. We investigated the early dynamics of SDMA in stroke to potentially aid with prehospital identification of severe IS from hemorrhagic stroke (HS).
Methods: We performed targeted mass spectrometry (MS) measurements of SDMA in two sequential acute plasma samples (early and secondary) of 50 IS patients with LVO and 49 HS patients.
Background: Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.
View Article and Find Full Text PDFBackground And Purpose: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance.
Methods: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke.
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 PDFBackground: Hemorrhagic transformation (HT) and cerebral edema (CED) are both major complications following ischemic stroke, but few studies have evaluated their overlap. We evaluated the frequency and predictors of CED/HT overlap and whether their co-occurrence impacts functional outcome more than each in isolation.
Methods: 892 stroke patients enrolled in a prospective study had follow-up CT imaging evaluated for HT and CED; the latter was quantified using the ratio of hemispheric CSF volumes (with hemispheric CSF ratio < 0.
Article Synopsis
- The European Stroke Organisation (ESO) developed guidelines for managing basilar artery occlusion (BAO) due to its poor outcomes, despite being a small percentage of strokes.
- The guidelines were created using the GRADE methodology and involved a systematic literature review based on 10 clinical questions identified as critical (PICO).
- The findings suggest using intravenous thrombolysis (IVT) within 24 hours for BAO patients, combined with endovascular treatments for better outcomes, but results varied depending on factors like treatment location and initial stroke severity.
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
- The study compared the effectiveness of intravenous tenecteplase and alteplase in treating ischaemic stroke patients identified as having salvageable brain tissue using perfusion imaging, focusing on whether tenecteplase is at least as effective (non-inferior) to alteplase in terms of patient outcomes after 3 months.
- Conducted across 35 hospitals in eight countries, the trial enrolled 680 patients aged 18 and older, who were randomly assigned to receive either tenecteplase or alteplase, with the primary outcome being the rate of patients without disability measured through the modified Rankin Scale.
- The trial was halted early due to positive results
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.
Article Synopsis
- The study investigates whether the size of a brain infarct influences the effectiveness and safety of initiating direct oral anticoagulants (DOACs) soon after an ischemic stroke in patients with atrial fibrillation.
- This was a post hoc analysis of the ELAN trial, involving nearly 2,000 participants from over 100 sites worldwide, comparing early DOAC initiation within 48 hours versus late initiation according to the severity of the stroke.
- The main outcome measured was serious complications (like recurrent strokes or bleeding) within 30 days, with findings suggesting minimal difference in outcomes between early and late DOAC initiation for minor strokes specifically.
Background: Individuals with minor ischaemic stroke and intracranial occlusion are at increased risk of poor outcomes. Intravenous thrombolysis with tenecteplase might improve outcomes in this population. We aimed to test the superiority of intravenous tenecteplase over non-thrombolytic standard of care in patients with minor ischaemic stroke and intracranial occlusion or focal perfusion abnormality.
View Article and Find Full Text PDFBackground: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone.
Methods: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone.
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.
Background: Whether hemorrhagic transformation (HT) modifies the treatment effect of early compared with late initiation of direct oral anticoagulation in people with ischemic stroke and atrial fibrillation is unknown.
Methods: This is a post hoc analysis of the ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation). The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, major extracranial bleeding, systemic embolism, or vascular death within 30 days.
The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1%-2% of all strokes, it has very poor natural outcome.
View Article and Find Full Text PDFBackground: Studies comparing bridging intravenous thrombolysis (IVT) with direct endovascular therapy (EVT) in patients with acute ischemic stroke who present late are limited. We aimed to compare the clinical outcomes and safety of bridging IVT in patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent EVT 6 to 24 hours after time last known well.
Methods: We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022.
Background And Objectives: There is uncertainty whether patients with large vessel occlusion (LVO) presenting in the late 6-hour to 24-hour time window can be selected for endovascular therapy (EVT) by noncontrast CT (NCCT) and CT angiography (CTA) for LVO detection. We evaluated the clinical outcomes of patients selected for EVT by NCCT compared with those medically managed in the extended time window.
Methods: This multinational cohort study was conducted at 66 sites across 10 countries.
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.
Background: The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood.
Objective: Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH.
Methods: Analysis of pooled data from multicenter ICH registries.