33 results match your criteria: "FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University[Affiliation]"
Is Dexmedetomidine Safe for Procedural Sedation During Mechanical Thrombectomy for Acute Stroke Secondary to Large Vessel Occlusion?
Neurology
December 2024
From the VHC Health (Z.N.), Arlington, VA; and Neuroendovascular Division (D.R.Y.), Departments of Neurology and Neurosurgery, M. Miller School of Medicine, University of Miami, FL.
Article Synopsis
- Mechanical thrombectomy (MT) access for acute ischemic stroke varies greatly across countries, prompting the need for a scoring system to evaluate and improve treatment accessibility worldwide.
- A systematic review and a modified Delphi method were used to identify key attributes affecting MT access, culminating in a final score of 0-36 based on 12 consensus attributes selected by international experts.
- The MT access score serves as a pioneering tool to identify barriers to MT access, aiming to enhance stroke care and outcomes globally by guiding public health interventions.
Mediation Analysis of Acute Carotid Stenting in Tandem Lesions: Effect on Functional Outcome in a Multicenter Registry.
Neurology
August 2024
From the Departments of Neurology (A.R.C., M.G.-C., M.F., D.Q.-O., Y.L., J.V.-S., M.D., S.O.-G.), Neurosurgery (S.O.-G.), and Radiology (S.O.-G.), University of Iowa Hospitals and Clinics, Iowa City; Neuroscience, Clinical Effectiveness, and Public Health Research Group (A.R.C.), Universidad Cientifica del Sur, Lima, Peru; Department of Neurology (N.H.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (M.R.), Hospital Vall d'Hebron, Barcelona, Spain; Department of Neurology (A.E.H.), Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, TX; Department of Neurology (M.A.J.), ProMedica Toledo Hospital, OH; Department of Neurology (A.A.D.), University of New Mexico Health Science Center, Albuquerque; Department of Neurology (M.G.A.), University of Kansas Medical Center, Kansas City; Department of Neurosurgery (J.T.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology and Brain Repair (W.R.G., M.M.), University of South Florida, Tampa; Department of Neurology (A.M.M., D.R.Y.), University of Miami Miller School of Medicine, FL; Cooper Neurological Institute (J.E.S., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Neurology (T.N.N.), Boston Medical Center, MA; Department of Neurology (S.S.), UT Health McGovern Medical School, Houston; Texas Stroke Institute (A.J.Y.), Dallas-Fort Worth, TX; Department of Neurology (G.L.), Saint Louis University, MO; Asia Pacific Comprehensive Stroke Institute (N.J.), Pomona Valley Hospital Medical Center, CA.
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.
Cervical Dissection in Patients With Tandem Lesions Is Associated With Distal Embolism and Lower Recanalization Success.
Stroke
July 2024
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
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.
Mechanical Thrombectomy Workshops Improve Procedural Knowledge and Skills Among Neurointerventional Teams in Low- to Middle-Income Countries.
Stroke
July 2024
Department of Neurology, University of Miami Miller School of Medicine, FL (D.R.Y., G.L.G.P.).
Article Synopsis
- A study was conducted to address the disparity in access to mechanical thrombectomy (MT) in low- to middle-income countries by organizing team-based workshops aimed at improving knowledge and skills related to MT for stroke treatment.
- The workshops, held in Jamaica and the Dominican Republic, included didactic and hands-on training for neurointerventional teams, resulting in significant improvements in test scores and practical skills in managing strokes due to large vessel occlusion.
- Feedback from participants indicated high satisfaction rates, with a majority believing that the training would positively impact their clinical practice.
The Stroke Treatment Academic Industry Roundtable XII included a workshop to discuss the most promising approaches to improve outcome from acute stroke. The workshop brought together representatives from academia, industry, and government representatives. The discussion examined approaches in 4 epochs: pre-reperfusion, reperfusion, post-reperfusion, and access to acute stroke interventions.
View Article and Find Full Text PDFSafety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions.
Stroke
October 2023
Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City (S.O.-G.).
Background: We aimed to describe the safety and efficacy of mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for patients with tandem lesions and whether using intraprocedural antiplatelet therapy influences MT's safety with IVT treatment.
Methods: This is a subanalysis of a pooled, multicenter cohort of patients with acute anterior circulation tandem lesions treated with MT from 16 stroke centers between January 2015 and December 2020. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2.
Global, Regional, and National Economic Consequences of Stroke.
Stroke
September 2023
Department of Neurosurgery, Brigham and Women's Hospital (J.V.E.G., S.E.B., A.G.Y., P.L., R.L., S.G., A.D.K., N.J.P., M.A.A.-S., R.D., T.R.S., J.D.B.), Harvard Medical School, MA.
Background: An understanding of global, regional, and national macroeconomic losses caused by stroke is important for allocation of clinical and research resources. The authors investigated the macroeconomic consequences of stroke disease burden in the year 2019 in 173 countries.
Methods: Disability-adjusted life year data for overall stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) were collected from the GBD study (Global Burden of Disease) 2019 database.
Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale.
Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021.
Impact of Time to Treatment on Endovascular Thrombectomy Outcomes in the Early Versus Late Treatment Time Windows.
Stroke
March 2023
Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., K.W., H.G., A.A., C.M.G., H.Y., N.B.S., C.D., G.G.P., S.K., N.K., E.M.-L., D.R.Y., T.R., R.L.S., J.G.R.).
Background: The impact of time to treatment on outcomes of endovascular thrombectomy (EVT) especially in patients presenting after 6 hours from symptom onset is not well characterized. We studied the differences in characteristics and treatment timelines of EVT-treated patients participating in the Florida Stroke Registry and aimed to characterize the extent to which time impacts EVT outcomes in the early and late time windows.
Methods: Prospectively collected data from Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry from January 2010 to April 2020 were reviewed.
Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions.
Neurology
November 2021
From the Departments of Neurology (V.S., L.G., D.R.Y.) and Neurosurgery (V.S., D.R.Y.), Jackson Memorial Hospital and University of Miami Miller School of Medicine, FL.
Purpose Of The Review: To provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.
Recent Findings: Randomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.
Background And Purpose: Collaterals govern the pace and severity of cerebral ischemia, distinguishing fast or slow progressors and corresponding therapeutic opportunities. The fate of sustained collateral perfusion or collateral failure is poorly characterized. We evaluated the nature and impact of collaterals on outcomes in the late time window DAWN trial (Diffusion-Weighted Imaging or Computed Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo).
View Article and Find Full Text PDFEffect of Hispanic Status in Mechanical Thrombectomy Outcomes After Ischemic Stroke: Insights From STAR.
Stroke
November 2021
Department of Neurosurgery, University of Miami, FL (J.D.B., S.H.C., E.M.L., E.C.P., D.R.Y., R.M.S.).
Background And Purpose: Epidemiological studies have shown racial and ethnic minorities to have higher stroke risk and worse outcomes than non-Hispanic Whites. In this cohort study, we analyzed the STAR (Stroke Thrombectomy and Aneurysm Registry) database, a multi-institutional database of patients who underwent mechanical thrombectomy for acute large vessel occlusion stroke to determine the relationship between mechanical thrombectomy outcomes and race.
Methods: Patients who underwent mechanical thrombectomy between January 2017 and May 2020 were analyzed.
Serial ASPECTS in the DAWN Trial: Infarct Evolution and Clinical Impact.
Stroke
October 2021
University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.).
Background And Purpose: The impact of baseline ischemia on Alberta Stroke Program Early CT Score (ASPECTS) and evolution over 24 hours may be distinct in late thrombectomy. We analyzed predictors of serial ASPECTS and clinical outcomes in the DAWN trial (Diffusion-Weighted Imaging or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo).
Methods: The DAWN Imaging Core Laboratory independently scored ASPECTS at baseline and 24 hours.
Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry.
Stroke
July 2021
Advanced Neuroscience Network/Tenet South Florida, Boynton Beach (N.H.M.-K.).
Background And Purpose: This study investigates clinical outcomes after mechanical thrombectomy in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0 to 5.
Methods: We included data from the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) from patients who underwent mechanical thrombectomy within 8 hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), functional independence (modified Rankin Scale score 0-2), 90-day mortality, and symptomatic intracranial hemorrhage at 24 hours.
Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion: A Multicenter Experience.
Stroke
June 2021
Department of Neurology, Henry Ford Hospital, Detroit, MI (G.A.M., H.A.N., L.S., D.M., A.B.C.).
Background And Purpose: Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO.
Methods: This is a retrospective multicenter cohort of patients who underwent rMT at 6 tertiary institutions in the United States between March 2016 and March 2020.
Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions.
Neurology
July 2020
From the Departments of Neurology, Neurosurgery & Epidemiology (E.C.L.), University of Iowa, Iowa City, IA; Cerebrovascular Center (A.N.R.), Cleveland Clinic, OH; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (D.L.B.), University of Michigan, Ann Arbor, MI; Department of Neurology (C.D.B.), Wake Forest School of Medicine, Winston-Salem, NC; Stroke Unit (V.C.), University of Perugia, Italy; Department of Neurology (A.C.), Hospital Clinic, Barcelona, Spain; Department of Neurology (C.J.C., D.L.T.), University of Washington, Seattle, WA; Department of Neurology (S.C.-F.), Texas Tech University, El Paso, TX; Departments of Neurology & Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurological Sciences (P.F.), University of Nebraska, Omaha, NE; Department of Neurology & Neurosurgery (M.T.F.), Vanderbilt University, Nashville, TN; Department of Neurology (L.B.G.), University of Kentucky, Lexington, KY; Department of Neurology (N.R.G.), McGovern Medical School at UTHealth, Houston, TX; Department of Health Management and Policy (B.K.), University of Iowa, Iowa City, IA; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Adult Health & Gerontology Nursing (S.L.), Rush University, Chicago, IL; Department of Neurology (D.S.L.), UCLA; Department of Neurology (J.J.M.), University of Utah, Salt Lake City, UT; Neurocritical Care, OhioHealth Riverside Methodist Hospital (A.M.M.), Columbus, OH; Department of Neurology (J.G.R.), University of Miami, FL; Department of Neurology (N.S.), University Southern California, Los Angeles, CA; Department of Neurology (L.H.S.), Yale School of Medicine, New Haven, CT; Department of Neurology (B.S.), University of Massachusetts, Worcester, MA; Department of Neurology (A.N.S.), University of Florida, Gainesville, FL; Department of Neurology (W.S.), UCSF; Department of Neurology (D.Z.W.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology & Neurosurgery (D.R.Y.), University of Miami, FL; and Department of Neurology (B.B.W.), University of Virginia, Charlottesville, VA.
The coronavirus 2019 (COVID-19) pandemic requires drastic changes in allocation of resources, which can affect the delivery of stroke care, and many providers are seeking guidance. As caregivers, we are guided by 3 distinct principles that will occasionally conflict during the pandemic: (1) we must ensure the best care for those stricken with COVID-19, (2) we must provide excellent care and advocacy for patients with cerebrovascular disease and their families, and (3) we must advocate for the safety of health care personnel managing patients with stroke, with particular attention to those most vulnerable, including trainees. This descriptive review by a diverse group of experts in stroke care aims to provide advice by specifically addressing the potential impact of this pandemic on (1) the quality of the stroke care delivered, (2) ethical considerations in stroke care, (3) safety and logistic issues for providers of patients with stroke, and (4) stroke research.
View Article and Find Full Text PDFMechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement From the Society of Vascular and Interventional Neurology.
Stroke
June 2020
Department of Neurology, UCLA Comprehensive Stroke Center, CA (D.S.L.).
Impact of Periprocedural and Technical Factors and Patient Characteristics on Revascularization and Outcome in the DAWN Trial.
Stroke
January 2020
Cooper University Hospital, Neurological Institute, Camden, NJ (T.G.J.).
Article Synopsis
- The study examines the effectiveness of mechanical thrombectomy in acute ischemic stroke patients who received treatment 6 to 24 hours after symptoms began, focusing on factors that influence recovery.
- It analyzes data from the DAWN trial, looking at various procedural factors like anesthesia type and thrombectomy device usage to see their impact on patient outcomes.
- Results indicated that while a high percentage achieved substantial blood flow recovery, factors such as needing three or more device passes and high baseline stroke severity were linked to lower chances of independent recovery after three months.
Benefit of Endovascular Thrombectomy by Mode of Onset: Secondary Analysis of the DAWN Trial.
Stroke
November 2019
Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, NJ (T.G.J.).
Background and Purpose- It is unknown whether the benefit of thrombectomy in late presenting acute stroke patients with imaging evidence of clinical-infarct mismatch is different in patients presenting with wake-up stroke compared with those presenting with witnessed onset or unwitnessed onset. Methods- Prespecified secondary analysis was performed from DAWN (Diffusion Weighted Imaging [DWI] or Computerized Tomography Perfusion [CTP] Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention), a multicenter, prospective, randomized clinical trial with blinded end point assessment comparing thrombectomy with the Trevo device against standard medical therapy in patients with acute stroke and clinical-infarct mismatch presenting 6 to 24 hour after the time last seen well. For the purposes of this study, the primary outcome was the proportion of modified Rankin Scale score 0 to 2 at 90 days.
View Article and Find Full Text PDFNoncontrast Computed Tomography Alberta Stroke Program Early CT Score May Modify Intra-Arterial Treatment Effect in DAWN.
Stroke
September 2019
The Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA (D.C.H., R.G.N.).
Background and Purpose- It is unknown whether noncontrast computed tomography (NCCT) can identify patients who will benefit from intra-arterial treatment (IAT) in the extended time window. We sought to characterize baseline Alberta Stroke Program Early CT Score (ASPECTS) in DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) and to assess whether ASPECTS modified IAT effect. Methods- Core lab adjudicated ASPECTS scores were analyzed.
View Article and Find Full Text PDFPatterns and Outcomes of Endovascular Therapy in Mild Stroke.
Stroke
August 2019
From the Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., D.R.Y., K.W., H.E.G., C.M.G., E.M.-L., S.K., C.D., S.A.O., T.R., R.L.S., J.G.R.).
Background and Purpose- We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods- From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Stroke Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (National Institutes of Health Stroke Scale [NIHSS] ≤5) or moderate/severe (NIHSS>5) categories.
View Article and Find Full Text PDFImpact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry.
Stroke
March 2019
University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.).
Background and Purpose- Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods- STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy.
View Article and Find Full Text PDFEmergent Management of Tandem Lesions in Acute Ischemic Stroke.
Stroke
February 2019
From the Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.).
Background and Purpose- Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the extracranial lesion requires acute stenting remains unclear. Our aim was to investigate differences in clinical and procedural outcomes related to stenting extracranial lesions in a registry of patients undergoing thrombectomy for acute stroke. Methods- Data were analyzed from the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)-a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device.
View Article and Find Full Text PDFTime From Imaging to Endovascular Reperfusion Predicts Outcome in Acute Stroke.
Stroke
April 2018
From the Department of Neurology (J.P.T., M.M., S.C., S. Kemp, S. Kim, N.M., C.F., M.S., G.W.A., M.G.L.) and Department of Radiology (R.B., G.Z., M.P.M.), Stanford University, CA; Department of Neurology, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology, University of Tennessee College of Medicine, Memphis (T.G.D.); Department of Radiology, Saint Luke's Health System, Kansas City, MO (N.A.); and Department of Neurology, University of Miami, FL (D.R.Y.).
Background And Purpose: This study aims to describe the relationship between computed tomographic (CT) perfusion (CTP)-to-reperfusion time and clinical and radiological outcomes, in a cohort of patients who achieve successful reperfusion for acute ischemic stroke.
Methods: We included data from the CRISP (Computed Tomographic Perfusion to Predict Response in Ischemic Stroke Project) in which all patients underwent a baseline CTP scan before endovascular therapy. Patients were included if they had a mismatch on their baseline CTP scan and achieved successful endovascular reperfusion.