Publications by authors named "Tudor G Jovin"
Background: Trials of endovascular therapy for basilar artery occlusion, including vertebral occlusion extending into the basilar artery, have shown inconsistent results. We aimed to pool data to estimate safety and efficacy and to explore the benefit across pre-specified subgroups through individual patient data meta-analysis.
Methods: VERITAS was a systematic review and meta-analysis that pooled patient-level data from trials that recruited patients with vertebrobasilar ischaemic stroke who were randomly assigned to treatment with either endovascular therapy or standard medical treatment alone.
The long-term effects of ischemic stroke on cognition and mental health are not reflected in traditional outcome metrics, like the modified Rankin Scale (mRS) for functional independence. Consequently, this may lead to mismatches in perceptions of overall recovery, despite otherwise qualifying as having good functional outcomes (mRS 0-2). In our multicenter, multinational analysis, we aim to describe the prevalence of, and factors associated with, patient-reported cognitive impairment despite achieving good functional outcomes.
View Article and Find Full Text PDFBackground: The EXCELLENT registry aimed to evaluate the effectiveness of the EMBOTRAP Revascularization Device in an all-comer population in a real-world setting, with a focus on the composition of retrieved clots.
Methods: EXCELLENT is a prospective, global registry of patients with acute ischemic stroke treated with EMBOTRAP as the first-line mechanical thrombectomy device conducted at 34 sites (25 sites contributing clot) from September 2018 to March 2021, utilizing core imaging and central histology laboratories blinded to clinical data, independent 90-day modified Rankin Scale assessment and Clinical Events Committee.
Results: After screening 3799 patients, a total of 997 subjects (mean age, 70.
Article Synopsis
- A study evaluated the safety and efficacy of endovascular thrombectomy in patients with acute large-vessel occlusion and tandem lesions, focusing on those with low (0-5) and high (6-10) Alberta Stroke Program Early Computed Tomography Scores (ASPECTS).
- The analysis included 691 patients, revealing that those with low ASPECTS had significantly lower odds of achieving a favorable functional outcome (mRS 0-2) and higher odds of suffering symptomatic intracranial hemorrhage compared to those with high ASPECTS.
- The researchers concluded that endovascular thrombectomy may lead to poorer functional recovery in patients with tandem lesions and low ASPECTS, particularly in the
Background: In large vessel occlusion (LVO) stroke patients transferred to a comprehensive stroke center for thrombectomy, spontaneous reperfusion may occur during transport, and anecdotally more frequently in patients transferred via helicopter than by ground. This pattern has been more often observed in conjunction with tenecteplase (TNK) treatment prior to helicopter transport. We aim to explore the "chopperlysis" effect-how helicopter transport, particularly with thrombolytics, may affect reperfusion and clinical outcomes.
View Article and Find Full Text PDFArticle 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.
While imaging has traditionally played a fundamental role in the selection of patients undergoing endovascular thrombectomy, recent thrombectomy trials involving patients with large ischemic strokes demonstrated a consistent benefit of endovascular thrombectomy across all imaging strata, suggesting that reperfusion benefit may exist independent of current imaging constructs. Although these findings attest to the uniformly beneficial effects of reperfusion, they also shed doubt on the accuracy and utility of our imaging modalities in defining reversible versus irreversible ischemia and challenge the premise of imaging-based selection. We aimed to review the histopathologic studies and clinical trials that have shaped our understanding of current imaging constructs aiming to outline the existing imaging-neuropathological gap that may be far wider than previously perceived.
View Article and Find Full Text PDFBackground: 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: Clinicians need simple and highly predictive prognostic scores to assist practical decision-making. We aimed to develop a simple outcome prediction score applied 24 hours after anterior circulation acute ischemic stroke treatment with endovascular thrombectomy and validate it in patients treated both with and without endovascular thrombectomy.
Methods: Using the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration data set (n=1764), patients in the endovascular thrombectomy arm were divided randomly into a derivation cohort (n=430) and a validation cohort (n=441).
Background: Robust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice.
Methods: The pooled Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) angiography dataset was analyzed by a centralized, independent imaging core blinded to other clinical data.
Article Synopsis
- - The study investigates the effects of acute carotid artery stenting (CAS) on functional outcomes in patients with acute stroke and tandem lesions (TLs) undergoing endovascular therapy (EVT), suggesting that CAS leads to better outcomes.
- - Conducted across 16 stroke centers, the research included 570 patients and found that those who underwent CAS had higher rates of successful reperfusion and favorable functional outcomes compared to those who did not.
- - The analysis indicates that successful reperfusion significantly predicts better functional outcomes, while also showing that it partially mediates the relationship between acute CAS and improved outcomes in stroke patients.
Background: As stroke endovascular thrombectomy (EVT) treatment indications expand, understanding population-based EVT eligibility becomes critical for resource planning. We aimed to project current and future population-based EVT eligibility in the United States.
Methods: We conducted a post hoc analysis of the physician-adjudicated GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study; 2015 epoch), a population-based, cross sectional, observational study of stroke incidence, treatment, and outcomes across a 5-county region.
Article Synopsis
- Tandem lesions involve stenosis or occlusion of the cervical internal carotid artery, often due to atherosclerosis or dissection, combined with a large vessel occlusion; this study compares patient outcomes based on the cause of ICA lesions.
- The study analyzed data from 526 patients treated endovascularly between 2015 and 2020, focusing on 90-day functional independence and various secondary outcomes, using matching methods for analysis.
- Results showed no differences in 90-day independence, but patients with dissection had lower successful recanalization rates and higher distal emboli incidents compared to those with atherosclerosis.
Objective: We aimed to assess the impact of time to endovascular thrombectomy (EVT) on clinical outcomes in the DAWN trial, while also exploring the potential effect modification of mode of stroke onset on this relationship.
Methods: The association between every 1-h treatment delay with 90-day functional independence (modified Rankin Scale [mRS] score 0-2), symptomatic intracranial hemorrhage, and 90-day mortality was explored in the overall population and in three modes of onset subgroups (wake-up vs. witnessed vs.
Article Synopsis
- The study investigated the impact of endovascular therapy (EVT) on cognitive outcomes following a large vessel occlusion stroke, using data from the ESCAPE trial.
- Cognitive assessments were performed 90 days post-stroke and included various tests to evaluate memory and cognitive function, with results indicating that EVT significantly improved cognitive outcomes across all tests.
- Findings showed that EVT was associated with better cognitive performance (higher odds ratios for favorable outcomes), and both final infarct volume and cognitive function had notable correlations, suggesting that both factors influence recovery.
Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.
Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).
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
- * A retrospective analysis of trauma patients from 2020 to 2022 identified a small number of cerebral stroke cases, out of which 10 met the criteria for further evaluation, mostly admitted after falls.
- * The AI program successfully detected 83.3% of large vessel occlusions within an hour of patient arrival without misidentifying any non-occlusions, suggesting potential benefits for timely stroke treatment in trauma settings and a need for further research on its effectiveness.
Subarachnoid hemorrhage (SAH) accounts for 5% of stroke, with women having a decreased inflammatory response compared to men; however, this mechanism has yet to be identified. One hurdle in SAH research is the lack of human brain models. Studies in murine models are helpful, but human models should be used in conjunction for improved translatability.
View Article and Find Full Text PDFBackground: Ischemic stroke lesion volume at follow-up is an important surrogate outcome for acute stroke trials. We aimed to assess which differences in 48-hour lesion volume translate into meaningful clinical differences.
Methods: We used pooled data from 7 trials investigating the efficacy of endovascular treatment for anterior circulation large vessel occlusion in acute ischemic stroke.
Background: Endovascular therapy (EVT) stands as an established and effective intervention for acute ischemic stroke in patients harboring tandem lesions (TLs). However, the optimal anesthetic strategy for EVT in TL patients remains unclear. This study aims to evaluate the impact of distinct anesthetic techniques on outcomes in acute ischemic stroke patients presenting with TLs.
View Article and Find Full Text PDFImportance: While the understanding of inflammation in the pathogenesis of many neurological diseases is now accepted, this special commentary addresses the need to study chronic inflammation in the propagation of cognitive Fog, Asthenia, and Depression Related to Inflammation which we name Brain FADE syndrome. Patients with Brain FADE syndrome fall in the void between neurology and psychiatry because the depression, fatigue, and fog seen in these patients are not idiopathic, but instead due to organic, inflammation involved in neurological disease initiation.
Observations: A review of randomized clinical trials in stroke, multiple sclerosis, Parkinson's disease, COVID, traumatic brain injury, and Alzheimer's disease reveal a paucity of studies with any component of Brain FADE syndrome as a primary endpoint.
Background: Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection.
Observations: A patient presented with acute aphasia and right-arm weakness.