Yasir Durrani, Jakob V. E. Gerstl, Danielle Murphy, Ashley Harris, Imane Saali, Toby Gropen, Shashank Shekhar, Ari D. Kappel, Nirav J. Patel, Rose Du, Rodolfo E. Alcedo Guardia, Juan C. Vicenty‐Padilla, Adam A. Dmytriw, Vitor Mendes Pereira, Saef Izzy, Allauddin Khan, Mohammed A. Aziz‐Sultan, David S. Liebeskind, Jason M. Davies, Adnan H. Siddiqui, Edoardo Gaude, Joshua D. Bernstock
Large‐vessel occlusion (LVO) ischemic stroke is responsible for significant morbidity and mortality. We have previously described a novel tool for acute LVO detection that combines blood‐based biomarkers (glial fibrillary acidic protein and d ‐dimer) with stroke severity scales to achieve high accuracy. Accordingly, the present study sought to prospectively validate cutoff values that we had previously established for biomarkers and scales. The TIME (Testing for Identification Markers of Stroke) trial was designed as a prospective observational diagnostic accuracy study. All ambulance‐identified stroke code activations <18 hours from symptom onset were recruited at Brandon Regional Hospital (Brandon, FL) between May 2021 and August 2022. Previously determined cutoff concentrations of plasma glial fibrillary acidic protein (213 pg/mL) and d ‐dimer (600 ng/mL) were used in combination with prehospital stroke scales to detect LVO. We compared rates of LVO detection against a reference standard using computed tomography/magnetic resonance angiography. A total of 382 patients with suspected stroke were recruited. The final cohort was composed of 323 patients with suspected stroke with the following distribution: LVO ischemic stroke (n = 29, 9%), non‐LVO ischemic stroke (n = 48, 15%), hemorrhagic stroke (n = 13, 4%), transient ischemic attack (n = 12, 3.9%), and stroke mimics (n = 220, 68.1%). Combining blood‐based biomarkers (glial fibrillary acidic protein and d ‐dimer) with the scale field assessment stroke triage for emergency destination yielded the best performance for LVO detection, with specificity of 94% and sensitivity of 71%. Performance was found to be higher in a subanalysis focusing on patients presenting <6 hours from symptom onset, with 93% specificity and 81% sensitivity. Critically, application of the biomarker and stroke scale algorithms ruled out all patients with hemorrhage. The present work prospectively validated the potential utility of previously defined glial fibrillary acidic protein and d ‐dimer cutoff levels (ie, 213 pg/mL and 600 ng/mL, respectively), demonstrating their value for discrimination of LVO stroke from differential diagnoses during code stroke workups. (ClinicalTrials.gov number, NCT04292600.)
{"title":"Prospective Validation of Glial Fibrillary Acidic Protein,\u0000 d\u0000 ‐Dimer, and Clinical Scales for Acute Large‐Vessel Occlusion Ischemic Stroke Detection","authors":"Yasir Durrani, Jakob V. E. Gerstl, Danielle Murphy, Ashley Harris, Imane Saali, Toby Gropen, Shashank Shekhar, Ari D. Kappel, Nirav J. Patel, Rose Du, Rodolfo E. Alcedo Guardia, Juan C. Vicenty‐Padilla, Adam A. Dmytriw, Vitor Mendes Pereira, Saef Izzy, Allauddin Khan, Mohammed A. Aziz‐Sultan, David S. Liebeskind, Jason M. Davies, Adnan H. Siddiqui, Edoardo Gaude, Joshua D. Bernstock","doi":"10.1161/svin.123.001304","DOIUrl":"https://doi.org/10.1161/svin.123.001304","url":null,"abstract":"\u0000 \u0000 \u0000 Large‐vessel occlusion (LVO) ischemic stroke is responsible for significant morbidity and mortality. We have previously described a novel tool for acute LVO detection that combines blood‐based biomarkers (glial fibrillary acidic protein and\u0000 d\u0000 ‐dimer) with stroke severity scales to achieve high accuracy. Accordingly, the present study sought to prospectively validate cutoff values that we had previously established for biomarkers and scales.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 The TIME (Testing for Identification Markers of Stroke) trial was designed as a prospective observational diagnostic accuracy study. All ambulance‐identified stroke code activations <18 hours from symptom onset were recruited at Brandon Regional Hospital (Brandon, FL) between May 2021 and August 2022. Previously determined cutoff concentrations of plasma glial fibrillary acidic protein (213 pg/mL) and\u0000 d\u0000 ‐dimer (600 ng/mL) were used in combination with prehospital stroke scales to detect LVO. We compared rates of LVO detection against a reference standard using computed tomography/magnetic resonance angiography.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 A total of 382 patients with suspected stroke were recruited. The final cohort was composed of 323 patients with suspected stroke with the following distribution: LVO ischemic stroke (n = 29, 9%), non‐LVO ischemic stroke (n = 48, 15%), hemorrhagic stroke (n = 13, 4%), transient ischemic attack (n = 12, 3.9%), and stroke mimics (n = 220, 68.1%). Combining blood‐based biomarkers (glial fibrillary acidic protein and\u0000 d\u0000 ‐dimer) with the scale field assessment stroke triage for emergency destination yielded the best performance for LVO detection, with specificity of 94% and sensitivity of 71%. Performance was found to be higher in a subanalysis focusing on patients presenting <6 hours from symptom onset, with 93% specificity and 81% sensitivity. Critically, application of the biomarker and stroke scale algorithms ruled out all patients with hemorrhage.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 The present work prospectively validated the potential utility of previously defined glial fibrillary acidic protein and\u0000 d\u0000 ‐dimer cutoff levels (ie, 213 pg/mL and 600 ng/mL, respectively), demonstrating their value for discrimination of LVO stroke from differential diagnoses during code stroke workups. (ClinicalTrials.gov number, NCT04292600.)\u0000 \u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"35 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manisha Koneru, Clint A. Badger, Fabio Settecase, Joey D English, Jaehyun Kim, Rajkamal S. Khangura, Warren T. Kim, Adam A. Dmytriw, M. Bhattacharyya, Jane Khalife, Pratit D. Patel, Ajith J. Thomas, Tudor G. Jovin, Daniel A. Tonetti, Hamza A. Shaikh
Early clinical experience with the Tenzing 7 delivery catheter (T7, Route 92 Medical, San Mateo, CA, USA) demonstrates high success rates for intracranial delivery of large bore aspiration catheters. Its soft, flexible, tapered tip mitigates the “ledge effect” that may cause resistance when navigating neurovascular devices through tortuous internal carotid arteries (ICAs) or other arterial branch origin variants. This study aims to characterize T7 performance across ICAs with varying tortuosities. A retrospective analysis was performed of prospectively collected data from patients with acute ischemic stroke treated with aspiration thrombectomy using T7 between January 2020 and July 2022 at 3 stroke centers. The ICA tortuosity index (TI) was derived from the ratio of actual to straight length measurements from anterior‐posterior and lateral projections during digital subtraction angiography. T7 success is defined as delivering the aspiration catheter to the face of the occlusion. Regression analysis between TI and T7 success was performed. Correlations were calculated between TI, ICA grading, puncture‐to‐reperfusion time, number of passes, and final modified Treatment in Cerebral Infarction score. Significance was P ≤ $ le $ 0.05. Of 107 patients meeting inclusion, median age was 69 (interquartile range 60–81) years, and most occlusions were in the M1 segment (73/107; 68.2%). T7 rate of success was 95.3% (102/107), and there was no association between TI and T7 technical success ( P = 0.23). Greater TIs and cavernous ICA tortuosity grades were not correlated with worse intraprocedural outcomes ( P >0.24). In our multicenter experience, T7 performed well even in highly tortuous extracranial vasculature. Successful aspiration catheter delivery and intraprocedural performance were consistent irrespective of ICA tortuosity. Our findings support the use of T7 in aspiration endovascular thrombectomy for acute stroke for patients with tortuous extracranial vasculature.
{"title":"Tenzing 7 Delivery Catheter Performance Across Tortuosity Indices","authors":"Manisha Koneru, Clint A. Badger, Fabio Settecase, Joey D English, Jaehyun Kim, Rajkamal S. Khangura, Warren T. Kim, Adam A. Dmytriw, M. Bhattacharyya, Jane Khalife, Pratit D. Patel, Ajith J. Thomas, Tudor G. Jovin, Daniel A. Tonetti, Hamza A. Shaikh","doi":"10.1161/svin.124.001351","DOIUrl":"https://doi.org/10.1161/svin.124.001351","url":null,"abstract":"\u0000 \u0000 Early clinical experience with the Tenzing 7 delivery catheter (T7, Route 92 Medical, San Mateo, CA, USA) demonstrates high success rates for intracranial delivery of large bore aspiration catheters. Its soft, flexible, tapered tip mitigates the “ledge effect” that may cause resistance when navigating neurovascular devices through tortuous internal carotid arteries (ICAs) or other arterial branch origin variants. This study aims to characterize T7 performance across ICAs with varying tortuosities.\u0000 \u0000 \u0000 \u0000 \u0000 A retrospective analysis was performed of prospectively collected data from patients with acute ischemic stroke treated with aspiration thrombectomy using T7 between January 2020 and July 2022 at 3 stroke centers. The ICA tortuosity index (TI) was derived from the ratio of actual to straight length measurements from anterior‐posterior and lateral projections during digital subtraction angiography. T7 success is defined as delivering the aspiration catheter to the face of the occlusion. Regression analysis between TI and T7 success was performed. Correlations were calculated between TI, ICA grading, puncture‐to‐reperfusion time, number of passes, and final modified Treatment in Cerebral Infarction score. Significance was\u0000 P\u0000 \u0000 \u0000 ≤\u0000 $ le $\u0000 \u0000 \u0000 0.05.\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 Of 107 patients meeting inclusion, median age was 69 (interquartile range 60–81) years, and most occlusions were in the M1 segment (73/107; 68.2%). T7 rate of success was 95.3% (102/107), and there was no association between TI and T7 technical success (\u0000 P\u0000 = 0.23). Greater TIs and cavernous ICA tortuosity grades were not correlated with worse intraprocedural outcomes (\u0000 P\u0000 >0.24).\u0000 \u0000 \u0000 \u0000 \u0000 In our multicenter experience, T7 performed well even in highly tortuous extracranial vasculature. Successful aspiration catheter delivery and intraprocedural performance were consistent irrespective of ICA tortuosity. Our findings support the use of T7 in aspiration endovascular thrombectomy for acute stroke for patients with tortuous extracranial vasculature.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"54 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James M. Hillis, Bernardo C. Bizzo, Isabella Newbury‐Chaet, Sarah F. Mercaldo, John Chin, Ankita Ghatak, Madeleine A. Halle, Eric L'Italien, Ashley L. MacDonald, Alex S. Schultz, Karen Buch, John Conklin, Stuart Pomerantz, Sandra Rincon, Keith J. Dreyer, William A. Mehan
Intracranial hemorrhage is a critical finding on computed tomography (CT) of the head. This study compared the accuracy of an artificial intelligence (AI) model (Annalise Enterprise CTB Triage Trauma) to consensus neuroradiologist interpretations in detecting 4 hemorrhage subtypes: acute subdural/epidural hematoma, acute subarachnoid hemorrhage, intra‐axial hemorrhage, and intraventricular hemorrhage. A retrospective stand‐alone performance assessment was conducted on data sets of cases of noncontrast CT of the head acquired between 2016 and 2022 at 5 hospitals in the United States for each hemorrhage subtype. The cases were obtained from patients aged ≥18 years. The positive cases were selected on the basis of the original clinical reports using natural language processing and manual confirmation. The negative cases were selected by taking the next negative case acquired from the same CT scanner after positive cases. Each case was interpreted independently by up to 3 neuroradiologists to establish consensus interpretations. Each case was then interpreted by the AI model for the presence of the relevant hemorrhage subtype. The neuroradiologists were provided with the entire CT study. The AI model separately received thin (≤1.5 mm) and thick (>1.5 and ≤5 mm) axial series as available. The 4 cohorts included 571 cases of acute subdural/epidural hematoma, 310 cases of acute subarachnoid hemorrhage, 926 cases of intra‐axial hemorrhage, and 199 cases of intraventricular hemorrhage. The AI model identified acute subdural/epidural hematoma with area under the curve of 0.973 (95% CI, 0.958–0.984) on thin series and 0.942 (95% CI, 0.921–0.959) on thick series; acute subarachnoid hemorrhage with area under the curve 0.993 (95% CI, 0.984–0.998) on thin series and 0.966 (95% CI, 0.945–0.983) on thick series; intraaxial hemorrhage with area under the curve of 0.969 (95% CI, 0.956–0.980) on thin series and 0.966 (95% CI, 0.953–0.976) on thick series; and intraventricular hemorrhage with area under the curve of 0.987 (95% CI, 0.969–0.997) on thin series and 0.983 (95% CI, 0.968–0.994) on thick series. Each finding had at least 1 operating point with sensitivity and specificity >80%. The assessed AI model accurately identified intracranial hemorrhage subtypes in this CT data set. Its use could assist the clinical workflow, especially through enabling triage of abnormal CTs.
{"title":"Evaluation of an Artificial Intelligence Model for Identification of Intracranial Hemorrhage Subtypes on Computed Tomography of the Head","authors":"James M. Hillis, Bernardo C. Bizzo, Isabella Newbury‐Chaet, Sarah F. Mercaldo, John Chin, Ankita Ghatak, Madeleine A. Halle, Eric L'Italien, Ashley L. MacDonald, Alex S. Schultz, Karen Buch, John Conklin, Stuart Pomerantz, Sandra Rincon, Keith J. Dreyer, William A. Mehan","doi":"10.1161/svin.123.001223","DOIUrl":"https://doi.org/10.1161/svin.123.001223","url":null,"abstract":"\u0000 \u0000 Intracranial hemorrhage is a critical finding on computed tomography (CT) of the head. This study compared the accuracy of an artificial intelligence (AI) model (Annalise Enterprise CTB Triage Trauma) to consensus neuroradiologist interpretations in detecting 4 hemorrhage subtypes: acute subdural/epidural hematoma, acute subarachnoid hemorrhage, intra‐axial hemorrhage, and intraventricular hemorrhage.\u0000 \u0000 \u0000 \u0000 A retrospective stand‐alone performance assessment was conducted on data sets of cases of noncontrast CT of the head acquired between 2016 and 2022 at 5 hospitals in the United States for each hemorrhage subtype. The cases were obtained from patients aged ≥18 years. The positive cases were selected on the basis of the original clinical reports using natural language processing and manual confirmation. The negative cases were selected by taking the next negative case acquired from the same CT scanner after positive cases. Each case was interpreted independently by up to 3 neuroradiologists to establish consensus interpretations. Each case was then interpreted by the AI model for the presence of the relevant hemorrhage subtype. The neuroradiologists were provided with the entire CT study. The AI model separately received thin (≤1.5 mm) and thick (>1.5 and ≤5 mm) axial series as available.\u0000 \u0000 \u0000 \u0000 The 4 cohorts included 571 cases of acute subdural/epidural hematoma, 310 cases of acute subarachnoid hemorrhage, 926 cases of intra‐axial hemorrhage, and 199 cases of intraventricular hemorrhage. The AI model identified acute subdural/epidural hematoma with area under the curve of 0.973 (95% CI, 0.958–0.984) on thin series and 0.942 (95% CI, 0.921–0.959) on thick series; acute subarachnoid hemorrhage with area under the curve 0.993 (95% CI, 0.984–0.998) on thin series and 0.966 (95% CI, 0.945–0.983) on thick series; intraaxial hemorrhage with area under the curve of 0.969 (95% CI, 0.956–0.980) on thin series and 0.966 (95% CI, 0.953–0.976) on thick series; and intraventricular hemorrhage with area under the curve of 0.987 (95% CI, 0.969–0.997) on thin series and 0.983 (95% CI, 0.968–0.994) on thick series. Each finding had at least 1 operating point with sensitivity and specificity >80%.\u0000 \u0000 \u0000 \u0000 The assessed AI model accurately identified intracranial hemorrhage subtypes in this CT data set. Its use could assist the clinical workflow, especially through enabling triage of abnormal CTs.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"21 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yasmin N. Aziz, Pablo Harker, Felipe Ayala, Laura M C Ades, Vaibhav Vagal, Pooja Khatri
Limited evidence is available for the treatment of acute symptomatic subocclusive lesions in ischemic stroke. We sought to identify current treatment patterns of stroke teams at academic health centers. We conducted an email survey of the National Institutes of Health StrokeNet regional coordinating centers (RCCs). Each RCC principal investigator was asked to nominate a local stroke interventionalist, or a neurologist if the RCC principal investigator was an interventionalist, most aligned with the typical practice pattern of the RCC's lead hospital, to receive a survey. The survey consisted of a clinical vignette and displayed a subocclusive lesion in the left middle cerebral artery on computed tomography angiogram followed by subsequent scenarios, revising only 1 historical, clinical, or radiographic variable at a time. Participants were asked to select initial management for each scenario. Results were reviewed and analyzed by stroke‐trained physicians. Responses were received from 42 (77.8%) of 54 surveyed individuals, representing 25 (92.6%) of 27 RCCs nationwide, including 25 (59.5%) interventionalists. The majority (76.2%) of respondents treated the patient in the primary clinical vignette with mechanical thrombectomy. Among all 6 clinical scenarios, respondents chose mechanical thrombectomy with or without medical management as first‐line treatment for 4 (67%) vignettes. Exceptions were low National Institutes of Health Stroke Scale score and known ipsilateral stenosis, where respondents chose medical management as first‐line treatment. Despite limited evidence to support mechanical thrombectomy versus other treatment strategies, the majority of StrokeNet RCC respondents would use mechanical thrombectomy with or without medical therapy to treat acute ischemic stroke due to intracranial subocclusive lesions.
{"title":"First‐Line Treatment of Symptomatic Subocclusive Large‐Vessel Stroke: Results of a Nationwide StrokeNet Survey","authors":"Yasmin N. Aziz, Pablo Harker, Felipe Ayala, Laura M C Ades, Vaibhav Vagal, Pooja Khatri","doi":"10.1161/svin.124.001367","DOIUrl":"https://doi.org/10.1161/svin.124.001367","url":null,"abstract":"\u0000 \u0000 Limited evidence is available for the treatment of acute symptomatic subocclusive lesions in ischemic stroke. We sought to identify current treatment patterns of stroke teams at academic health centers.\u0000 \u0000 \u0000 \u0000 We conducted an email survey of the National Institutes of Health StrokeNet regional coordinating centers (RCCs). Each RCC principal investigator was asked to nominate a local stroke interventionalist, or a neurologist if the RCC principal investigator was an interventionalist, most aligned with the typical practice pattern of the RCC's lead hospital, to receive a survey. The survey consisted of a clinical vignette and displayed a subocclusive lesion in the left middle cerebral artery on computed tomography angiogram followed by subsequent scenarios, revising only 1 historical, clinical, or radiographic variable at a time. Participants were asked to select initial management for each scenario. Results were reviewed and analyzed by stroke‐trained physicians.\u0000 \u0000 \u0000 \u0000 Responses were received from 42 (77.8%) of 54 surveyed individuals, representing 25 (92.6%) of 27 RCCs nationwide, including 25 (59.5%) interventionalists. The majority (76.2%) of respondents treated the patient in the primary clinical vignette with mechanical thrombectomy. Among all 6 clinical scenarios, respondents chose mechanical thrombectomy with or without medical management as first‐line treatment for 4 (67%) vignettes. Exceptions were low National Institutes of Health Stroke Scale score and known ipsilateral stenosis, where respondents chose medical management as first‐line treatment.\u0000 \u0000 \u0000 \u0000 Despite limited evidence to support mechanical thrombectomy versus other treatment strategies, the majority of StrokeNet RCC respondents would use mechanical thrombectomy with or without medical therapy to treat acute ischemic stroke due to intracranial subocclusive lesions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"52 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140973937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariana Andere, Jasmin Dao, Amy A. Gelfand, R. Morshed, Alexandra C. Ross, Amanda E. Wagstaff, H. Fullerton, C. Fox
Comorbid conditions may result in symptoms that mimic stroke in children with moyamoya arteriopathy. Health care usage for stroke mimics is not well characterized. Consecutive children (aged <18 years) with moyamoya syndrome or disease treated at a single center (2007–2021) were identified from a registry. Data including documentation of headache, anxiety, and functional neurologic disorders were retrospectively abstracted using standardized forms. Encounters were attributed to the comorbid condition when (1) related symptoms led to the visit; (2) the condition was documented as the visit diagnosis; and (3) in the absence of stroke, transient ischemic attack, or seizure. We identified 32 children (63% female) with symptomatic moyamoya arteriopathy diagnosed via imaging at a median age of 7.5 years (range, 0.7–17) years, all treated with revascularization surgery. During follow‐up (median, 6.7 years after diagnosis [interquartile range, 4.0–8.3]), 81% of patients reported headache, 53% reported anxiety, 19% reported panic attacks, and 6% developed a functional neurologic disorder. Both patients with functional neurologic disorder also had migraines and anxiety. In 10 patients (31% of the cohort), a stroke mimic led to 33 emergency department encounters and 9 hospital admissions; 9 received head imaging (magnetic resonance imaging, computed tomography, or computed tomographic angiography) as part of the workup. Headaches, anxiety, and functional neurologic disorders may mimic stroke symptoms in children with moyamoya arteriopathy, leading to significant health care usage. While providers should remain vigilant for stroke, early recognition of stroke mimics should promote interventions to address comorbid conditions.
{"title":"Stroke Mimics in Children With Moyamoya Arteriopathy","authors":"Ariana Andere, Jasmin Dao, Amy A. Gelfand, R. Morshed, Alexandra C. Ross, Amanda E. Wagstaff, H. Fullerton, C. Fox","doi":"10.1161/svin.123.001152","DOIUrl":"https://doi.org/10.1161/svin.123.001152","url":null,"abstract":"\u0000 \u0000 Comorbid conditions may result in symptoms that mimic stroke in children with moyamoya arteriopathy. Health care usage for stroke mimics is not well characterized.\u0000 \u0000 \u0000 \u0000 Consecutive children (aged <18 years) with moyamoya syndrome or disease treated at a single center (2007–2021) were identified from a registry. Data including documentation of headache, anxiety, and functional neurologic disorders were retrospectively abstracted using standardized forms. Encounters were attributed to the comorbid condition when (1) related symptoms led to the visit; (2) the condition was documented as the visit diagnosis; and (3) in the absence of stroke, transient ischemic attack, or seizure.\u0000 \u0000 \u0000 \u0000 We identified 32 children (63% female) with symptomatic moyamoya arteriopathy diagnosed via imaging at a median age of 7.5 years (range, 0.7–17) years, all treated with revascularization surgery. During follow‐up (median, 6.7 years after diagnosis [interquartile range, 4.0–8.3]), 81% of patients reported headache, 53% reported anxiety, 19% reported panic attacks, and 6% developed a functional neurologic disorder. Both patients with functional neurologic disorder also had migraines and anxiety. In 10 patients (31% of the cohort), a stroke mimic led to 33 emergency department encounters and 9 hospital admissions; 9 received head imaging (magnetic resonance imaging, computed tomography, or computed tomographic angiography) as part of the workup.\u0000 \u0000 \u0000 \u0000 Headaches, anxiety, and functional neurologic disorders may mimic stroke symptoms in children with moyamoya arteriopathy, leading to significant health care usage. While providers should remain vigilant for stroke, early recognition of stroke mimics should promote interventions to address comorbid conditions.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"63 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xia Meng, Shuya Li, Hongguo Dai, Guozhi Lu, Weiwei Wang, Fengyuan Che, Yu Geng, Minghui Sun, Xiyan Li, Yongjun Wang
Tenecteplase, a bioengineered variant of alteplase, is a new alternative thrombolytic agent. The ORIGINAL study aims to evaluate the efficacy and safety of tenecteplase versus standard care in Chinese patients with acute ischemic stroke within 4.5 hours of symptom onset. This is a multicenter phase III study that employs a randomized (1:1), active‐controlled, parallel‐group, prospective, open‐label, blinded–end point design. Adult participants (aged ≥18 years) with acute ischemic stroke who are eligible for intravenous thrombolysis within 4.5 hours of symptom onset according to current guideline recommendations are recruited from ≈55 neurology clinics/stroke centers throughout China. The primary objective of the ORIGINAL study is to demonstrate the noninferiority of tenecteplase (0.25 mg/kg) to alteplase (0.9 mg/kg) on the basis of the proportion of patients who achieve a modified Rankin Scale score of 0 or 1 on day 90, that is, a favorable functional outcome. The prespecified noninferiority risk ratio margin is 0.937. Secondary end points include other functional outcomes and the following safety end points: adjudicated symptomatic intracerebral hemorrhage (up to 36 hours after the end of study drug administration) based on the European Cooperative Acute Stroke Study III definition; all‐cause death within 90 days; and the proportion of patients with a modified Rankin Scale score of 5 or 6 on day 90. It is anticipated that the results of this study will contribute to the growing body of evidence for the noninferiority of tenecteplase to alteplase given within 4.5 hours of acute ischemic stroke symptom onset and support a new indication for tenecteplase in China. NCT04915729 ( https://clinicaltrials.gov/study/NCT04915729 )
{"title":"Tenecteplase Versus Alteplase in Acute Ischemic Stroke in Chinese Patients: Protocol for the ORIGINAL Study","authors":"Xia Meng, Shuya Li, Hongguo Dai, Guozhi Lu, Weiwei Wang, Fengyuan Che, Yu Geng, Minghui Sun, Xiyan Li, Yongjun Wang","doi":"10.1161/svin.124.001363","DOIUrl":"https://doi.org/10.1161/svin.124.001363","url":null,"abstract":"\u0000 \u0000 Tenecteplase, a bioengineered variant of alteplase, is a new alternative thrombolytic agent. The ORIGINAL study aims to evaluate the efficacy and safety of tenecteplase versus standard care in Chinese patients with acute ischemic stroke within 4.5 hours of symptom onset.\u0000 \u0000 \u0000 \u0000 This is a multicenter phase III study that employs a randomized (1:1), active‐controlled, parallel‐group, prospective, open‐label, blinded–end point design. Adult participants (aged ≥18 years) with acute ischemic stroke who are eligible for intravenous thrombolysis within 4.5 hours of symptom onset according to current guideline recommendations are recruited from ≈55 neurology clinics/stroke centers throughout China.\u0000 \u0000 \u0000 \u0000 The primary objective of the ORIGINAL study is to demonstrate the noninferiority of tenecteplase (0.25 mg/kg) to alteplase (0.9 mg/kg) on the basis of the proportion of patients who achieve a modified Rankin Scale score of 0 or 1 on day 90, that is, a favorable functional outcome. The prespecified noninferiority risk ratio margin is 0.937. Secondary end points include other functional outcomes and the following safety end points: adjudicated symptomatic intracerebral hemorrhage (up to 36 hours after the end of study drug administration) based on the European Cooperative Acute Stroke Study III definition; all‐cause death within 90 days; and the proportion of patients with a modified Rankin Scale score of 5 or 6 on day 90.\u0000 \u0000 \u0000 \u0000 It is anticipated that the results of this study will contribute to the growing body of evidence for the noninferiority of tenecteplase to alteplase given within 4.5 hours of acute ischemic stroke symptom onset and support a new indication for tenecteplase in China.\u0000 \u0000 \u0000 \u0000 \u0000 NCT04915729 (\u0000 https://clinicaltrials.gov/study/NCT04915729\u0000 )\u0000 \u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"106 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Vos, Rick J. van Tuijl, Liselore A Mensing, Maud E. H. Ophelders, Mireille R. E. Velthuis, N. Zuithoff, G. Rinkel, Hugo J. Kuijf, J. Zwanenburg, I. van der Schaaf, B. Velthuis, Y. Ruigrok
Hemodynamic stress is linked to the development of intracranial aneurysms (IAs) and may be influenced by anatomic variation of intracranial arteries. We assessed diameters and bifurcation angles of intracranial arteries forming the circle of Willis in a cohort of individuals screened for the presence of IAs. Individuals with and without IAs identified at screening with magnetic resonance angiography were compared. Diameters and bifurcation angles of the following arteries were measured using semiautomatic methods: A1 and A2 segments of the anterior cerebral artery, M1 and M2 segments of the middle cerebral artery, P1 segments of the posterior cerebral artery, posterior communicating artery (Pcom), internal carotid artery, vertebral artery, and basilar artery. We employed univariate general linear models to assess group differences. This included subgroup comparisons between individuals with IAs at specific locations and matched controls, and comparisons on group level between individuals with and without IAs, corrected for age and sex. In 94 of the 1049 individuals (9.0%) included, IAs were detected. Individuals with middle cerebral artery IAs had wider ipsilateral M2–M2 bifurcation angles compared with controls (121±25° versus 97±19°; P <0.01). Individuals with anterior communicating artery IAs showed smaller angles for the A1–A2 bifurcation (106±16° versus 120±17°; P = 0.02), while those with Pcom IAs had wider Pcom–C7 bifurcation angles (147±14° versus 127±17°; P = 0.02) and smaller diameters below the ipsilateral internal carotid artery top (2.86±0.36 mm versus 3.10±0.33 mm; P = 0.03) compared with controls. We found associations between wider M2–M2 bifurcation angles or narrower A1–A2 bifurcation angles and IA presence, consistent with prior literature. Moreover, we uncovered previously unexplored associations, including wider Pcom–C7 bifurcation angles and smaller internal carotid artery diameters in individuals with Pcom IAs. Future research should explore the potential of these markers in predicting IAs in at‐risk populations during follow‐up screenings.
{"title":"Anatomical Markers Associated With the Presence of Intracranial Aneurysms in Individuals Screened for Aneurysms","authors":"I. Vos, Rick J. van Tuijl, Liselore A Mensing, Maud E. H. Ophelders, Mireille R. E. Velthuis, N. Zuithoff, G. Rinkel, Hugo J. Kuijf, J. Zwanenburg, I. van der Schaaf, B. Velthuis, Y. Ruigrok","doi":"10.1161/svin.124.001299","DOIUrl":"https://doi.org/10.1161/svin.124.001299","url":null,"abstract":"\u0000 \u0000 Hemodynamic stress is linked to the development of intracranial aneurysms (IAs) and may be influenced by anatomic variation of intracranial arteries. We assessed diameters and bifurcation angles of intracranial arteries forming the circle of Willis in a cohort of individuals screened for the presence of IAs.\u0000 \u0000 \u0000 \u0000 Individuals with and without IAs identified at screening with magnetic resonance angiography were compared. Diameters and bifurcation angles of the following arteries were measured using semiautomatic methods: A1 and A2 segments of the anterior cerebral artery, M1 and M2 segments of the middle cerebral artery, P1 segments of the posterior cerebral artery, posterior communicating artery (Pcom), internal carotid artery, vertebral artery, and basilar artery. We employed univariate general linear models to assess group differences. This included subgroup comparisons between individuals with IAs at specific locations and matched controls, and comparisons on group level between individuals with and without IAs, corrected for age and sex.\u0000 \u0000 \u0000 \u0000 \u0000 In 94 of the 1049 individuals (9.0%) included, IAs were detected. Individuals with middle cerebral artery IAs had wider ipsilateral M2–M2 bifurcation angles compared with controls (121±25° versus 97±19°;\u0000 P\u0000 <0.01). Individuals with anterior communicating artery IAs showed smaller angles for the A1–A2 bifurcation (106±16° versus 120±17°;\u0000 P\u0000 = 0.02), while those with Pcom IAs had wider Pcom–C7 bifurcation angles (147±14° versus 127±17°;\u0000 P\u0000 = 0.02) and smaller diameters below the ipsilateral internal carotid artery top (2.86±0.36 mm versus 3.10±0.33 mm;\u0000 P\u0000 = 0.03) compared with controls.\u0000 \u0000 \u0000 \u0000 \u0000 We found associations between wider M2–M2 bifurcation angles or narrower A1–A2 bifurcation angles and IA presence, consistent with prior literature. Moreover, we uncovered previously unexplored associations, including wider Pcom–C7 bifurcation angles and smaller internal carotid artery diameters in individuals with Pcom IAs. Future research should explore the potential of these markers in predicting IAs in at‐risk populations during follow‐up screenings.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"91 S8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How Low Do We Go? NIHSS in Anterior Circulation Thrombectomy Decision‐Making","authors":"Therese Dunne, Karan Patel, James E Siegler","doi":"10.1161/svin.123.001212","DOIUrl":"https://doi.org/10.1161/svin.123.001212","url":null,"abstract":"","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"12 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141020660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：