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Gerschenfeld G, Turc G, Obadia M, Chausson N, Consoli A, Olindo S, Caroff J, Marnat G, Blanc R, Ben Hassen W, Seners P, Guillon B, Wiener E, Bourcier R, Yger M, Cho TH, Checkouri T, Gory B, Smadja D, Sibon I, Richard S, Piotin M, Eker OF, Pico F, Lapergue B, Alamowitch S. Functional Outcome and Hemorrhage Rates After Bridging Therapy With Tenecteplase or Alteplase in Patients With Large Ischemic Core. Neurology 2024; 103:e209398. [PMID: 38862134 DOI: 10.1212/wnl.0000000000209398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES IV tenecteplase is an alternative to alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) ischemic stroke. Little data are available on its use in patients with large ischemic core. We aimed to compare the efficacy and safety of both thrombolytics in this population. METHODS We conducted a retrospective analysis of patients with anterior circulation LVO strokes and diffusion-weighed imaging Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≤5 treated with tenecteplase or alteplase before MT from the TETRIS (tenecteplase) and ETIS (alteplase) French multicenter registries. Primary outcome was reduced disability at 3 months (ordinal analysis of the modified Rankin scale [mRS]). Safety outcomes were 3-month mortality, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage (sICH). We used propensity score overlap weighting to reduce baseline differences between treatment groups. RESULTS We analyzed 647 patients (tenecteplase: n = 194; alteplase: n = 453; inclusion period 2015-2022). Median (interquartile range) age was 71 (57-81) years, with NIH Stroke Scale score 19 (16-22), DWI-ASPECTS 4 (3-5), and last seen well-to-IV thrombolysis and puncture times 165 minutes (130-226) and 260 minutes (203-349), respectively. After MT, the successful reperfusion rate was 83.1%. After propensity score overlap weighting, all baseline variables were well balanced between both treatment groups. Compared with patients treated with alteplase, patients treated with tenecteplase had better 3-month mRS (common odds ratio [OR] for reduced disability: 1.37, 1.01-1.87, p = 0.046) and lower 3-month mortality (OR 0.52, 0.33-0.81, p < 0.01). There were no significant differences between thrombolytics for PH (OR 0.84, 0.55-1.30, p = 0.44) and sICH incidence (OR 0.70, 0.42-1.18, p = 0.18). DISCUSSION Our data are encouraging regarding the efficacy and reassuring regarding the safety of tenecteplase compared with that of alteplase in bridging therapy for patients with LVO strokes and a large ischemic core in routine clinical care. These results support its consideration as an alternative to alteplase in bridging therapy for patients with large ischemic cores. TRIALS REGISTRATION INFORMATION NCT03776877 (ETIS registry) and NCT05534360 (TETRIS registry). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with anterior circulation LVO stroke and DWI-ASPECTS ≤5 treated with tenecteplase vs alteplase before MT experienced better functional outcomes and lower mortality at 3 months.
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Affiliation(s)
- Gaspard Gerschenfeld
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Guillaume Turc
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Michael Obadia
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Nicolas Chausson
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Arturo Consoli
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Stephane Olindo
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Jildaz Caroff
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Gaultier Marnat
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Raphael Blanc
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Wagih Ben Hassen
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Pierre Seners
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Benoit Guillon
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Emmanuel Wiener
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Romain Bourcier
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Marion Yger
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Tae-Hee Cho
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Thomas Checkouri
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Benjamin Gory
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Didier Smadja
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Igor Sibon
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Sebastien Richard
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Michel Piotin
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Omer F Eker
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Fernando Pico
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Bertrand Lapergue
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
| | - Sonia Alamowitch
- From the AP-HP (G.G., M.Y., T.C., S.A.), Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université; STARE Team (G.G., M.Y., T.C., S.A.), iCRIN, Institut du Cerveau et de la Moelle épinière, ICM; Institut de Psychiatrie et Neurosciences de Paris (G.G., G.T., N.C., P.S., M.Y., D.S., S.A.), U1266, INSERM, Paris; Neurologie (G.T.), GHU Paris Psychiatrie et Neurosciences; Université Paris Cité (G.T.), FHU Neurovasc; Neurologie (O.M., P.S.), Fondation Rothschild, Paris; Neurologie (N.C., D.S.), Hôpital Sud-Francilien, Corbeil-Essonnes; Neuroradiologie (A.C.), Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes; Neurologie (S.O., I.S.), CHU de Bordeaux; AP-HP (J.C.), Neuroradiologie Interventionnelle, Hôpital Bicêtre, Université Paris-Saclay, Kremlin-Bicêtre; Neuroradiologie (G.M.), CHU de Bordeaux; Neuroradiologie (R. Blanc, M.P.), Fondation Rothschild; Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et Neurosciences; Neurologie (B. Guillon), CHU de Nantes; Neurologie (E.W., F.P.), Centre Hospitalier de Versailles, Le Chesnay; Neuroradiologie (R. Bourcier), CHU de Nantes; Neurologie (T.-H.C.), Hospices Civils de Lyon; Neuroradiologie (B. Gory), and Neurologie (S.R.), CHRU de Nancy; Neuroradiologie (O.F.E.), Hospices Civils de Lyon; and Neurologie (B.L.), Hôpital Foch, Suresnes, France
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Ravipati S, Amjad A, Zulfiqar K, Biju H, Hassan W, Jafri HM, Husnain A, Tahir I, Aslam M, Afzal S, Ehsan M, Cheema HA, Ayyan M, Rehman WU, Dani SS. Endovascular thrombectomy for acute ischemic stroke with a large infarct area: an updated systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis 2024:107818. [PMID: 38871260 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Since the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone. METHODS We searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs). RESULTS Our meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69). CONCLUSION Endovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.
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Affiliation(s)
- Shivani Ravipati
- Department of Medicine, Dr.Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, India.
| | - Ayesha Amjad
- Department of Medicine, Sargodha Medical College, Pakistan.
| | - Komal Zulfiqar
- Department of Medicine, Allama Iqbal Medical College, Pakistan.
| | - Hannah Biju
- Department of Medicine, Kristu Jayanti College, India.
| | - Wajeeh Hassan
- Department of Medicine, Allama Iqbal Medical College, Pakistan.
| | | | - Ali Husnain
- Department of Radiology, Northwestern University, U.S.A.
| | - Ibrahim Tahir
- Department of Medicine, Sheikh Khalifa Bin Zayed Al Nahyan Medical and College, Pakistan.
| | - Muaaz Aslam
- Department of Medicine, Sheikh Khalifa Bin Zayed Al Nahyan Medical and College, Pakistan.
| | - Sharib Afzal
- Department of Medicine, Ziauddin University, Pakistan.
| | - Muhammad Ehsan
- Department of Medicine, King Edward Medical University, Pakistan.
| | | | - Muhammad Ayyan
- Department of Medicine, King Edward Medical University, Pakistan.
| | - Wajeeh Ur Rehman
- Department of Medicine, United Health Services, Johnson City, New York.
| | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, MA.
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Han N, Zhang X, Zhang Y, Liu Y, Ma H, Ge H, Wang Y, Li S, Yan X, Li T, Wu Y, Ma J, Shi W, Zhang G, Tian Y, Chang M. Endovascular thrombectomy versus medical management on outcomes with infarct volumes more than 70 mL. Ann Clin Transl Neurol 2024. [PMID: 38858521 DOI: 10.1002/acn3.52124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Endovascular thrombectomy (EVT) in patients with large infarct volume remains controversial. The aim of this study is to compare clinical outcomes between EVT and medical management in acute large vessel occlusion with infarct volumes larger than 70 mL on diffusion-weighted magnetic resonance imaging (DWI). METHODS A prospective observational cohort study was conducted, including patients with anterior cerebral circulation occlusion due to ischemic stroke with infarct volumes larger than 70 mL within 24 h of onset between July 2018 and June 2023. Eligible patients were divided into two groups: the EVT group and the medical management (non-EVT) group. The main outcomes were functional independence and mortality at 90 days. To assess clinical endpoints, we selected variables including age, NIHSS score, infarct volume, and occlusion location for 1:1 propensity score (PS) matching and PS adjustment using inverse probability of treatment weighting (IPTW). RESULTS Among the 131 identified patients (mean [SD] age, 69.9 [13.7] years; 58 female), the median infarct volume was 123.6 mL. Of these patients, 75 (57.3%) underwent EVT. After PS adjustment, EVT was not associated with functional independence (10.9% vs. 10.9%; p = 1.000) or mortality (43.5% vs. 47.8%; p = 0.675). Additionally, after PS adjustment using IPTW, EVT was also not associated with a functional independence (15.8% vs. 13.7%; p = 0.767) or mortality (46.8% vs. 44.0%; p = 0.762). CONCLUSION This study provides real-world evidence regarding infarct volumes larger than 70 mL, indicating that EVT does not provide benefits compared to medical management alone when considering age, NIHSS score, infarct volume, and occlusion location.
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Affiliation(s)
- Nannan Han
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xiaobo Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Yu Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Yu Liu
- School of Information Science and Technology, Northwest University, Xi'an, China
| | - Haojun Ma
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Hanming Ge
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanfei Wang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Shilin Li
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xudong Yan
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Tengfei Li
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yulun Wu
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Juan Ma
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Wenzhen Shi
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, The Affiliated Hospital of Northwest University, Xi'an, China
- Clinical Medical Research Center, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Gejuan Zhang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Ye Tian
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, The Affiliated Hospital of Northwest University, Xi'an, China
- Clinical Medical Research Center, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Mingze Chang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an, China
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4
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Sarraj A, Pujara DK, Campbell BC. Current State of Evidence for Neuroimaging Paradigms in Management of Acute Ischemic Stroke. Ann Neurol 2024; 95:1017-1034. [PMID: 38606939 DOI: 10.1002/ana.26925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
Stroke is the chief differential diagnosis in patient presenting to the emergency room with abrupt onset focal neurological deficits. Neuroimaging, including non-contrast computed tomography (CT), magnetic resonance imaging (MRI), vascular and perfusion imaging, is a cornerstone in the diagnosis and treatment decision-making. This review examines the current state of evidence behind the different imaging paradigms for acute ischemic stroke diagnosis and treatment, including current recommendations from the guidelines. Non-contrast CT brain, or in some centers MRI, can help differentiate ischemic stroke and intracerebral hemorrhage (ICH), a pivotal juncture in stroke diagnosis and treatment algorithm, especially for early window thrombolytics. Advanced imaging such as MRI or perfusion imaging can also assist making a diagnosis of ischemic stroke versus mimics such as migraine, Todd's paresis, or functional disorders. Identification of medium-large vessel occlusions with CT or MR angiography triggers consideration of endovascular thrombectomy (EVT), with additional perfusion imaging help identify salvageable brain tissue in patients who are likely to benefit from reperfusion therapies, particularly in the ≥6 h window. We also review recent advances in neuroimaging and ongoing trials in key therapeutic areas and their imaging selection criteria to inform the readers on potential future transitions into use of neuroimaging for stroke diagnosis and treatment decision making. ANN NEUROL 2024;95:1017-1034.
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Affiliation(s)
- Amrou Sarraj
- University Hospital Cleveland Medical Center-Case Western Reserve University, Neurology, Cleveland, Ohio, USA
| | - Deep K Pujara
- University Hospital Cleveland Medical Center-Case Western Reserve University, Neurology, Cleveland, Ohio, USA
| | - Bruce Cv Campbell
- The Royal Melbourne Hospital-The Florey Institute for Neuroscience and Mental Health, Medicine and Neurology, Parkville, Australia
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5
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Sun D, Nguyen TN, Pan Y, Wang M, Abdalkader M, Masoud HE, Ma A, Tong X, Ma G, Sun X, Song L, Ma N, Gao F, Mo D, Miao Z, Huo X. Unsuccessful Recanalization versus Medical Management of Patients with Large Ischemic Core : Analysis of the ANGEL-ASPECT Randomized Trial. Clin Neuroradiol 2024; 34:441-450. [PMID: 38319347 DOI: 10.1007/s00062-024-01384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The outcomes of patients with large ischemic core who fail to recanalize with endovascular therapy (EVT) compared to medical management (MM) are uncertain. The objective was to evaluate the clinical and safety outcomes of patients who underwent EVT in patients with large ischemic core and unsuccessful recanalization. METHODS This was a post hoc analysis of the ANGEL-ASPECT randomized trial. Unsuccessful recanalization was defined as patients who underwent EVT with eTICI 0-2a. The primary endpoint was 90-day very poor outcome (mRS 5-6). Multivariable logistic regression was conducted controlling for ASPECTS, occlusion location, intravenous thrombolysis, and time to treatment. RESULTS Of 455 patients 225 were treated with MM. Of 230 treated with EVT, 43 (19%) patients had unsuccessful recanalization. There was no difference in 90-day very poor outcomes (39.5% vs. 40%, aOR 0.93, 95% confidence interval, CI 0.47-1.85, p = 0.95), sICH (7.0% vs. 2.7%, aOR 2.81, 95% CI 0.6-13.29, p = 0.19), or mortality (30% vs. 20%, aOR 1.65, 95% CI 0.89-3.06, p = 0.11) between the unsuccessful EVT and MM groups, respectively. There were higher rates of ICH (55.8% vs. 17.3%, p < 0.001), infarct core volume growth (142.7 ml vs. 90.5 ml, β = 47.77, 95% CI 20.97-74.57 ml, p < 0.001), and decompressive craniectomy (18.6% vs. 3.6%, p < 0.001) in the unsuccessful EVT versus MM groups. CONCLUSION In a randomized trial of patients with large ischemic core undergoing EVT with unsuccessful recanalization, there was no difference in very poor outcomes, sICH or death versus medically managed patients. In the unsuccessful EVT group, there were higher rates of any ICH, volume of infarct core growth, and decompressive craniectomy.
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Affiliation(s)
- Dapeng Sun
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Yuesong Pan
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Mohamad Abdalkader
- Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Hesham E Masoud
- Neurology, SUNY Upstate Medical University Hospital, Syracuse, NY, USA
| | - Alice Ma
- Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Gaoting Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Ligang Song
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China.
| | - Xiaochuan Huo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China.
- Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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6
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Morsi RZ, Elfil M, Ghaith HS, Aladawi M, Elmashad A, Kothari S, Desai H, Ghozy S, Prabhakaran S, Amuluru K, Gandhi CD, Kass-Hout T, Al-Mufti F. Endovascular thrombectomy for large ischemic strokes: An updated living systematic review and meta-analysis of randomized clinical trials. J Neurol Sci 2024; 460:123003. [PMID: 38640579 DOI: 10.1016/j.jns.2024.123003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Recent studies indicate endovascular thrombectomy (EVT) as a safe, effective treatment for acute ischemic stroke (AIS) with large ischemic regions. Our study updates an ongoing living systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of EVT to medical management only. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing EVT to medical management in AIS patients with large ischemic areas. Using fixed-effect models, we conducted a meta-analysis to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management. We evaluated bias risk with the Cochrane tool and graded the certainty of evidence using the GRADE approach. RESULTS Of 1363 new citations, we included six RCTs with a total of 1876 patients. We found low-certainty evidence of improved functional independence (risk difference [RD] 29.9%, 95% CI 17.2% to 46.9%), increase in sICH (RD 2.6%, 95% CI 0.3% to 6.4%), and a non-significant decrease in mortality (RD -1.8%, 95% CI -3.9% to 0.6%) for AIS patients with large infarcts who underwent EVT compared to medical management only. CONCLUSION Our revised meta-analysis suggests low-certainty evidence that there is improved functional independence, a non-significant decrease in mortality, and an increase in sICH among AIS patients with large infarcts who undergo EVT compared to those receiving medical management alone. SYSTEMATIC REVIEW PROTOCOL REGISTRATION PROSPERO (CRD42023398742).
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Affiliation(s)
- Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Ahmed Elmashad
- Department of Neurology, University of Connecticut, Farmington, CT, USA
| | - Sachin Kothari
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Harsh Desai
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Krishna Amuluru
- Goodman Campbell Brain and Spine, Carmel, IN, USA; Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA.
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
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7
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Broocks G, Fiehler J, Meyer L. Discrepancy Between Ischemic Changes Observed on Non-Enhanced Computed Tomography and Perfusion Imaging: Implications for Decision-Making in Treatment. J Stroke 2024; 26:339-341. [PMID: 38836283 PMCID: PMC11164595 DOI: 10.5853/jos.2023.03909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Sui Y, Chen W, Chen C, Chang Y, Bivard A, Wang P, Geng Y, Parsons M, Lin L. CTP-Defined Large Core Is a Better Predictor of Poor Outcome for Endovascular Treatment Than ASPECTS-Defined Large Core. Stroke 2024; 55:1227-1234. [PMID: 38488357 DOI: 10.1161/strokeaha.123.045091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/31/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Recent trials confirmed the effectiveness of endovascular therapy in patients with large ischemic cores. Yet the optimal neuroimaging modalities to define large core remains unclear. We tried to address this question by comparing the functional outcomes in patients receiving thrombectomy selected by either noncontrast computed tomography Alberta Stroke Program Early Computed Tomography Score (ASPECTS) or computed tomography perfusion (CTP). METHODS This study retrospectively selected patients enrolled in the International Stroke Perfusion Registry between August 2011 and April 2022. Patients with acute stroke with large vessel occlusion in anterior circulation treated with endovascular therapy were included. All received both CTP and noncontrast computed tomography. The primary outcome was defined as poor functional outcome represented by a modified Rankin Scale score of 5 to 6 at 3 months. Large cores were defined in terms of either (1) noncontrast computed tomography ASPECTS ≤5 or (2) core volume ≥70 mL on CTP. RESULTS A total of 1115 patients were included in the analysis, of which 90 patients had ASPECTS ≤5 (8.1%) and 97 patients CTP core ≥70 mL (8.7%). A fair agreement between ASPECTS and CTP with a κ value of 0.31 (0.21-0.40) was found. Compared with patients with neither CTP nor ASPECTS large cores, those with only ASPECTS-defined large cores (ie, ASPECTS ≤5; n=56) did not have a higher adjusted odds of poor outcome (29%; odds ratio, 1.84 [0.91-3.73]; P=0.089). However, patients with CTP large core but not ASPECTS-defined large core (n=63) had a higher adjusted odds of poor outcome (60%; odds ratio, 3.91 [2.01-7.60]; P<0.001). In time-stratified subgroup analysis (>6 versus ≤6 hours), ASPECTS showed no discriminative difference between ≤5 and >5 in poor outcome for patients receiving endovascular therapy within 6 hours. CONCLUSIONS CTP core ≥70 mL-defined large cores are more predictive of poor outcome than ASPECTS ≤5-defined core in endovascular therapy patients, particularly within 6 hours after stroke onset.
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Affiliation(s)
- Yi Sui
- Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College Affiliated Brain Hospital, Shenyang Clinical Research Center for Neurological Diseases, China (Y.S.)
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China (Y.S.)
| | - Wenhuo Chen
- Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.)
| | - Chushuang Chen
- Faculty of Health, University of Newcastle, Australia (C.C., M.P., L.L.)
| | - Yanting Chang
- School of Public Health, China Medical University, Shenyang, China (Y.C.)
| | - Andrew Bivard
- Melbourne Brain Centre, University of Melbourne, Australia (A.B.)
| | - Peng Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China (P.W., Y.G.)
| | - Yu Geng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China (P.W., Y.G.)
| | - Mark Parsons
- Faculty of Health, University of Newcastle, Australia (C.C., M.P., L.L.)
- South Western Clinical School, University of New South Wales, Sydney, Australia (M.P., L.L.)
| | - Longting Lin
- Faculty of Health, University of Newcastle, Australia (C.C., M.P., L.L.)
- South Western Clinical School, University of New South Wales, Sydney, Australia (M.P., L.L.)
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9
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Geraghty JR, Testai FD. Advances in neurovascular research: Scientific highlights from the 15th world stroke congress. J Stroke Cerebrovasc Dis 2024; 33:107617. [PMID: 38307467 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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10
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Zeng H, Zhu Q. Application of imaging modalities for endovascular thrombectomy of large core infarcts in clinical practice. Front Neurol 2024; 15:1272890. [PMID: 38665995 PMCID: PMC11043533 DOI: 10.3389/fneur.2024.1272890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Four randomized controlled trials of large infarct core volume (LICV) included three imaging modalities: non-contrast CT (NCCT)-Alberta Stroke Program Early CT Score (ASPECTS), diffusion-weighted imaging (DWI)-ASPECTS, and NCCT-ASPECTS combined with CTP (CT perfusion). However, there is no clear consensus on the optimal imaging modality for endovascular thrombectomy (EVT) trials of large core infarcts. The variety and complexity of imaging modalities make it difficult to apply them in clinical practice. By familiarizing ourselves with these imaging modalities, we can better apply them in the clinic and correctly screen patients with large core infarcts in the anterior circulation who can benefit from EVT therapy.
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Affiliation(s)
| | - Qingfeng Zhu
- Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan, China
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11
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Rex N, Oueidat K, Ospel J, McDonough R, Rinkel L, Baird GL, Collins S, Jindal G, Alvin MD, Boxerman J, Barber P, Jayaraman M, Smith W, Amirault-Capuano A, Hill M, Goyal M, McTaggart R. Modeling diffusion-weighted imaging lesion expansion between 2 and 24 h after endovascular thrombectomy in acute ischemic stroke. Neuroradiology 2024; 66:621-629. [PMID: 38277008 DOI: 10.1007/s00234-024-03294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) lesion expansion after endovascular thrombectomy (EVT) is not well characterized. We used serial diffusion-weighted magnetic resonance imaging (MRI) to measure lesion expansion between 2 and 24 h after EVT. METHODS In this single-center observational analysis of patients with acute ischemic stroke due to large vessel occlusion, DWI was performed post-EVT (< 2 h after closure) and 24-h later. DWI lesion expansion was evaluated using multivariate generalized linear mixed modeling with various clinical moderators. RESULTS We included 151 patients, of which 133 (88%) had DWI lesion expansion, defined as a positive change in lesion volume between 2 and 24 h. In an unadjusted analysis, median baseline DWI lesion volume immediately post-EVT was 15.0 mL (IQR: 6.6-36.8) and median DWI lesion volume 24 h post-EVT was 20.8 mL (IQR: 9.4-66.6), representing a median change of 6.1 mL (IQR: 1.5-17.7), or a 39% increase. There were no significant associations among univariable models of lesion expansion. Adjusted models of DWI lesion expansion demonstrated that relative lesion expansion (defined as final/initial DWI lesion volume) was consistent across eTICI scores (0-2a, 0.52%; 2b, 0.49%; 2c-3, 0.42%, p = 0.69). For every 1 mL increase in lesion volume, there was 2% odds of an increase in 90-day mRS (OR: 1.021, 95%CI [1.009, 1.034], p < 0.001). CONCLUSION We observed substantial lesion expansion post-EVT whereby relative lesion expansion was consistent across eTICI categories, and greater absolute lesion expansion was associated with worse clinical outcome. Our findings suggest that alternate endpoints for cerebroprotectant trials may be feasible.
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Affiliation(s)
- Nathaniel Rex
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Karim Oueidat
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Johanna Ospel
- Department of Radiology, University of Calgary, Calgary, Canada
| | | | - Leon Rinkel
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Grayson L Baird
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Scott Collins
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Gaurav Jindal
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Matthew D Alvin
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Phil Barber
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Mahesh Jayaraman
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Wendy Smith
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Amanda Amirault-Capuano
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA
| | - Michael Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Ryan McTaggart
- Department of Diagnostic Imaging, Brown University, 593 Eddy Street Providence, Providence, RI, 02903, USA.
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12
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Rilianto B, Kurniawan RG, Rajab NM, Prasetyo BT. Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning. Neuropsychiatr Dis Treat 2024; 20:621-630. [PMID: 38528854 PMCID: PMC10962920 DOI: 10.2147/ndt.s453629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
High rates of morbidity and mortality indicate that stroke is a major health concern. Unfortunately, the management of ischemic stroke is hindered by several obstacles, particularly in developing countries such as Indonesia, where the burden of morbidity and mortality remains high. In this literature review, we intend to conduct a thorough investigation and analysis of the obstacles to stroke thrombectomy in developing countries, with a focus on Indonesia. Even though numerous studies and recent advances in thrombectomy techniques have been developed, many centers around the world continue to struggle to implement them. The majority of these institutions are located in developing nations like Indonesia. It faces numerous obstacles, including a lack of public awareness, infrastructure, human resources, and financial difficulties. The absence of early education and large-scale campaigns contributes to the dearth of public awareness. Inadequate imaging facilities, prehospital and referral systems, as well as disparities in healthcare expenditure and accessibility, contribute to the absence of infrastructure. Inadequate numbers of neurointerventionists, neurologists, and neurosurgeons, as well as a disparate distribution of these professionals, contribute to human resource issues. Inadequate national insurance coverage, high import tariffs on medical devices, and the high cost of healthcare have a negative impact on the financial situation. We provide related strategies regarding the current situation in Indonesia based on the recent evidence and comparison with developed countries. Academic institutions, medical associations, and government agencies must collaborate to overcome these challenges.
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Affiliation(s)
- Beny Rilianto
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Ricky Gusanto Kurniawan
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Nurfadilah M Rajab
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
| | - Bambang Tri Prasetyo
- Neurointervention Division, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia
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13
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Chen M, Joshi KC, Kolb B, Sitton CW, Pujara DK, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain SM, Churilov L, Blackburn S, Sundararajan S, Hu YC, Herial N, Arenillas JF, Tsai JP, Budzik RF, Hicks W, Kozak O, Yan B, Cordato D, Manning NW, Parsons M, Hanel RA, Aghaebrahim A, Wu T, Cardona Portela P, Gandhi CD, Al-Mufti F, Perez de la Ossa N, Schaafsma J, Blasco J, Sangha N, Warach S, Kleinig TJ, Johns H, Shaker F, Abdulrazzak MA, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Al-Shaibi FK, Samaniego EA, Nguyen TN, Fifi JT, Tjoumakaris SI, Jabbour P, Mendes Pereira V, Lansberg MG, Sila C, Bambakidis NC, Davis S, Wechsler L, Albers GW, Grotta JC, Ribo M, Hassan AE, Campbell B, Hill MD, Sarraj A. Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial. J Neurointerv Surg 2024:jnis-2023-021219. [PMID: 38471760 DOI: 10.1136/jnis-2023-021219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. METHODS SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was examined. RESULTS Of 351 included patients, 194 (55%) and 189 (54%) demonstrated intracranial and intracerebral hemorrhage, respectively, with a higher incidence in EVT (134 (75%) and 130 (73%)) versus medical management (MM) (60 (35%) and 59 (34%), both P<0.001). Hemorrhagic infarction type 1 (HBC=1a) and type 2 (HBC=1b) accounted for 93% of all hemorrhages. Parenchymal hematoma (PH) type 1 (HBC=1c) and type 2 (HBC=2) were observed in 1 (0.6%) EVT-treated and 4 (2.2%) MM patients. Symptomatic ICH (sICH) (SITS-MOST definition) was seen in 0.6% EVT patients and 1.2% MM patients. No trend for ICH with core volumes (P=0.10) or Alberta Stroke Program Early CT Score (ASPECTS) (P=0.74) was observed. Among EVT patients, the presence of any ICH did not worsen clinical outcome (modified Rankin Scale (mRS) at 90 days: 4 (3-6) vs 4 (3-6); adjusted generalized OR 1.00, 95% CI 0.68 to 1.47, P>0.99) or modify EVT treatment effect (Pinteraction=0.77). CONCLUSIONS ICH was present in 75% of the EVT population, but PH or sICH were infrequent. The presence of any ICH did not worsen functional outcomes or modify EVT treatment effect at 90-day follow-up. The high rate of hemorrhages overall still represents an opportunity for adjunctive therapies in EVT patients with a large ischemic core.
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Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C Joshi
- Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bradley Kolb
- Rush University Medical Center, Chicago, Illinois, USA
| | - Clark W Sitton
- Diagnostic & Interventional Imaging, UT Houston, Houston, Texas, USA
| | | | - Michael G Abraham
- Neurology and Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Santiago Ortega-Gutierrez
- Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott E Kasner
- Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shazam M Hussain
- Cleveland Clinic Stroke Program, Cleveland Clinic, Cleveland Heights, Ohio, USA
| | | | - Spiros Blackburn
- Neurosurgery, University of Texas Medical School at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA
| | | | - Yin C Hu
- Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Nabeel Herial
- Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Juan F Arenillas
- Stroke Unit, Neurology Department, Stroke Unit. Neurology Department. Universitary Hospital, Valladolid (Spain), Valladolid, Spain
| | - Jenny P Tsai
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - William Hicks
- OhioHealth Neurological Physicians, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Osman Kozak
- Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Abington Memorial Hospital, Abington, Pennsylvania, USA
| | - Bernard Yan
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Manning
- Institute of Neurosciences, UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
- Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Mark Parsons
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Amin Aghaebrahim
- Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Teddy Wu
- Neurology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | | | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Joanna Schaafsma
- Medicine - Div. Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Navdeep Sangha
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Steven Warach
- University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Timothy J Kleinig
- Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hannah Johns
- University of Melbourne, Parkville, Victoria, Australia
| | - Faris Shaker
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Abhishek Ray
- Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
| | - Jeffery Sunshine
- Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA
| | - Amanda Opaskar
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kelsey R Duncan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Wei Xiong
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Edgar A Samaniego
- Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Maarten G Lansberg
- Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA
| | - Cathy Sila
- Neurological Institute, University Hospitals- Case Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine
| | - Nicholas C Bambakidis
- Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Stephen Davis
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lawrence Wechsler
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Gregory W Albers
- Neurology & Neurological Sciences, Stanford University, Stanford, California, USA
| | - James C Grotta
- Neurology, Memorial Hermann Hospital/UT Houston, Houston, Texas, USA
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Bruce Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Amrou Sarraj
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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14
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Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Churilov L, Johns H, Sitton CW, Yogendrakumar V, Ng FC, Pujara DK, Blackburn S, Sundararajan S, Hu YC, Herial NA, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Cheung A, Hanel RA, Aghaebrahim AN, Wu TY, Portela PC, Gandhi CD, Al-Mufti F, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Kleinig TJ, Shaker F, Al Shaibi F, Toth G, Abdulrazzak MA, Sharma G, Ray A, Sunshine J, Opaskar A, Duncan KR, Xiong W, Samaniego EA, Maali L, Lechtenberg CG, Renú A, Vora N, Nguyen T, Fifi JT, Tjoumakaris SI, Jabbour P, Tsivgoulis G, Pereira VM, Lansberg MG, DeGeorgia M, Sila CA, Bambakidis N, Hill MD, Davis SM, Wechsler L, Grotta JC, Ribo M, Albers GW, Campbell BC. Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles. JAMA 2024; 331:750-763. [PMID: 38324414 PMCID: PMC10851143 DOI: 10.1001/jama.2024.0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Importance Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain. Objective To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect. Design, Setting, and Participants An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022. Intervention EVT vs MM. Main Outcomes and Measures Primary outcome was functional outcome-90-day mRS score (0, no symptoms, to 6, death) assessed by adjusted generalized OR (aGenOR; values >1 represent more favorable outcomes). Benefit of EVT vs MM was assessed across levels of ischemic injury defined by noncontrast CT using ASPECTS score and by the volume of brain with severely reduced blood flow on CT perfusion or restricted diffusion on MRI. Results Among 352 patients randomized, 336 were analyzed (median age, 67 years; 139 [41.4%] female); of these, 168 (50%) were randomized to EVT, and 2 additional crossover MM patients received EVT. In an ordinal analysis of mRS at 90 days, EVT improved functional outcomes compared with MM within ASPECTS categories of 3 (aGenOR, 1.71 [95% CI, 1.04-2.81]), 4 (aGenOR, 2.01 [95% CI, 1.19-3.40]), and 5 (aGenOR, 1.85 [95% CI, 1.22-2.79]). Across strata for CT perfusion/MRI ischemic core volumes, aGenOR for EVT vs MM was 1.63 (95% CI, 1.23-2.16) for volumes ≥70 mL, 1.41 (95% CI, 0.99-2.02) for ≥100 mL, and 1.47 (95% CI, 0.84-2.56) for ≥150 mL. In the EVT group, outcomes worsened as ASPECTS decreased (aGenOR, 0.91 [95% CI, 0.82-1.00] per 1-point decrease) and as CT perfusion/MRI ischemic core volume increased (aGenOR, 0.92 [95% CI, 0.89-0.95] per 10-mL increase). No heterogeneity of EVT treatment effect was observed with or without mismatch, although few patients without mismatch were enrolled. Conclusion and Relevance In this exploratory analysis of a randomized clinical trial of patients with extensive ischemic stroke, EVT improved clinical outcomes across a wide spectrum of infarct volumes, although enrollment of patients with minimal penumbra volume was low. In EVT-treated patients, clinical outcomes worsened as presenting ischemic injury estimates increased. Trial Registration ClinicalTrials.gov Identifier: NCT03876457.
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Affiliation(s)
- Amrou Sarraj
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | - Michael Chen
- Rush University Medical Center, Chicago, Illinois
| | - Leonid Churilov
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah Johns
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | - Vignan Yogendrakumar
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Felix C. Ng
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Deep K. Pujara
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Sophia Sundararajan
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Yin C. Hu
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Nabeel A. Herial
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Juan F. Arenillas
- Hospital Clínico Universitario Valladolid—University of Valladolid, Valladolid, Spain
| | | | | | | | - Osman Kozak
- Abington Jefferson Health, Abington, Pennsylvania
| | - Bernard Yan
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Andrew Cheung
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | - Teddy Y. Wu
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | - Fawaz Al-Mufti
- Westchester Medical Center, New York Medical College, Valhalla
| | | | | | | | | | - Steven Warach
- Dell Medical School at The University of Texas at Austin–Ascension Texas, Austin
| | | | - Faris Shaker
- McGovern Medical School at UTHealth, Houston, Texas
| | - Faisal Al Shaibi
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | | | - Gagan Sharma
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Abhishek Ray
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Sunshine
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Amanda Opaskar
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Kelsey R. Duncan
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Wei Xiong
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Laith Maali
- University of Kansas Medical Center, Kansas City
| | | | - Arturo Renú
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nirav Vora
- Riverside Methodist Hospital, OhioHealth, Columbus
| | | | | | | | - Pascal Jabbour
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Georgios Tsivgoulis
- Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Michael DeGeorgia
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Cathy A. Sila
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | - Nicholas Bambakidis
- University Hospital Cleveland Medical Center—Case Western Reserve University, Cleveland, Ohio
| | | | - Stephen M. Davis
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Marc Ribo
- Hospital Vall d’Hebrón, Barcelona, Spain
| | | | - Bruce C. Campbell
- The Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia
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15
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Klapproth S, Meyer L, Kniep H, Bechstein M, Kyselyova A, Hanning U, Schön G, Rimmele L, Fiehler J, Broocks G. Effect of short- versus long-term serum glucose levels on early ischemic water homeostasis and functional outcome in patients with large vessel occlusion stroke. Eur J Neurol 2024; 31:e16166. [PMID: 38015448 DOI: 10.1111/ene.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE In ischemic stroke, the impact of short- versus long-term blood glucose level (BGL) on early lesion pathophysiology and functional outcome has not been assessed. The purpose of this study was to directly compare the effect of long-term blood glucose (glycated hemoglobin [HbA1c]) versus serum BGL on early edema formation and functional outcome. METHODS Anterior circulation ischemic stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) on admission were analyzed. Endpoints were early ischemic cerebral edema, measured by quantitative net water uptake (NWU) on initial CT and functional independence at Day 90. RESULTS A total of 345 patients were included. Patients with functional independence had significantly lower baseline NWU (3.1% vs. 8.3%; p < 0.001) and lower BGL (113 vs. 123 mg/dL; p < 0.001) than those without functional independence, while HbA1c levels did not differ significantly (5.7% vs. 5.8%; p = 0.15). A significant association was found for NWU and BGL (ß = 0.02, 95% confidence interval [CI] 0.006-0.03; p = 0.002), but not for HbA1c and NWU (ß = -0.16, 95% CI -0.53-0.21; p = 0.39). Mediation analysis showed that 67% of the effect of BGL on functional outcome was mediated by early edema formation. CONCLUSION Aggravated early edema and worse functional outcome was associated with elevated short-term serum BGL, but not with HbA1c levels. Hence, the link between short-term BGL and early edema development might be used as a target for adjuvant therapy in patients with ischemic stroke.
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Affiliation(s)
- Susan Klapproth
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Al-Mufti F, Marden FA, Burkhardt JK, Raper D, Schirmer CM, Baker A, Chen PR, Bulsara KR, Narsinh KH, Amans MR, Cooper J, Yaghi S, Al-Kawaz M, Hetts SW. Endovascular therapy for anterior circulation emergent large vessel occlusion stroke in patients with large ischemic cores: a report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2024:jnis-2023-021444. [PMID: 38395601 DOI: 10.1136/jnis-2023-021444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Early clinical trials validating endovascular therapy (EVT) for emergent large vessel occlusion (ELVO) ischemic stroke in the anterior circulation initially focused on patients with small or absent completed infarctions (ischemic cores) to maximize the probability of detecting a clinically meaningful and statistically significant benefit of EVT. Subsequently, real-world experience suggested that patients with large core ischemic strokes (LCS) at presentation may also benefit from EVT. Several large, retrospective, and prospective randomized clinical trials have recently been published that further validate this approach. These guidelines aim to provide an update for endovascular treatment of LCS. METHODS A structured literature review of LCS studies available since 2019 and grading the strength and quality of the evidence was performed. Recommendations were made based on these new data by consensus of the authors, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The management of ELVO strokes with large ischemic cores continues to evolve. The expert panel agreed on several recommendations: Recommendation 1: In patients with anterior circulation ELVO who present within 24 hours of last known normal with large infarct core (70-149 mL or ASPECTS 3-5) and meet other criteria of RESCUE-Japan LIMIT, SELECT2, ANGEL-ASPECT, TESLA, TENSION, or LASTE trials, thrombectomy is indicated (Class I, Level A). Recommendations 2-7 flow directly from recommendation 1. Recommendation 2: EVT in patients with LCS aged 18-85 years is beneficial (Class I, Level A). Recommendation 3: EVT in patients with LCS >85 years of age may be beneficial (Class I, Level B-R). Recommendation 4: Patients with LCS and NIHSS score 6-30 benefit from EVT in LCS (Class I, Level A). Recommendation 5: Patients with LCS and NIHSS score <6 and >30 may benefit from EVT in LCS (Class IIa, Level A). Recommendation 6: Patients with LCS and low baseline mRS (0-1) benefit from EVT (Class I, Level A). Recommendation 7: Patients with LCS and time of last known well 0-24 hours benefit from EVT (Class I, Level A). Recommendation 8: It is recommended that patients with ELVO LCS who also meet the criteria for on-label or guideline-directed use of IV thrombolysis receive IV thrombolysis, irrespective of whether endovascular treatments are being considered (Class I, Level B-NR). CONCLUSIONS The indications for endovascular treatment of ELVO strokes continue to expand and now include patients with large ischemic cores on presentation. Further prospective randomized studies, including follow-up to assess the population-based efficacy of treating patients with LCS, are warranted.
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Affiliation(s)
- Fawaz Al-Mufti
- Departments of Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Franklin A Marden
- Interventional Neuroradiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Raper
- Departments of Neurological Surgery, Radiology, and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
| | - Amanda Baker
- Departments of Radiology, Biomedical Imaging, and Neurological Surgery, UCSF, San Francisco, California, USA
| | - Peng Roc Chen
- Neurosurgery, The University of Texas Health Science Center at Houston Vivian L Smith Department of Neurosurgery, Houston, Texas, USA
| | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Kazim H Narsinh
- Departments of Radiology, Biomedical Imaging, and Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Matthew Robert Amans
- Departments of Radiology, Biomedical Imaging, and Neurological Surgery, UCSF, San Francisco, California, USA
| | - Jared Cooper
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
- Department of Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mais Al-Kawaz
- Departments of Neurology, Neurosurgery, and Radiology, University of Kentucky, Lexington, Kentucky, USA
- Mount Sinai Health System, New York, New York, USA
| | - Steven W Hetts
- Radiology, Biomedical Imaging, and Neurological Surgery, UCSF, San Francisco, California, USA
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17
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Liu Q, Fang J, Jiang X, Duan T, Luo Y, Gao L, Dong S, Ma M, Zhou M, He L. Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores. Neurol Sci 2024; 45:663-670. [PMID: 37700175 DOI: 10.1007/s10072-023-06995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Understanding the benefits and risks of endovascular therapy (EVT) is crucial for elderly patients with large ischemic cores, as the combination of advanced age and extensive brain infarction may negatively impact clinical outcomes. METHODS The study retrospectively analyzed clinical outcomes for elderly stroke patients (age ≥ 70) with large ischemic cores (Alberta Stroke Program Early CT Score [ASPECTS] < 6 or ischemic cores ≥ 70 ml) in the anterior circulation using data from our prospective database between June 2018 and January 2022. The effectiveness and risks of EVT in those patients were investigated, with the primary outcome being fair outcome (modified Rankin Scale, mRS ≤ 3). RESULTS Among 182 elderly patients with large ischemic core volume (120 in the EVT group and 62 in the non-EVT group), 20.9% (38/182, 22.5% in the EVT group vs. 17.7% in the non-EVT group) achieved a fair outcome. Meanwhile, 49.5% (90/182, 45.8% in the EVT group vs. 56.5% in the non-EVT group) of them died at 3 months. The benefits of EVT numerically exceeded non-EVT treatment for those aged ≤ ~ 85 years or with a mismatch volume ≥ ~ 50 ml. However, after adjustment, EVT was associated with an increased risk of symptomatic intracranial hemorrhage (aOR 4.24, 95%CI 1.262-14.247). CONCLUSIONS This study highlights the clinical challenges faced by elderly patients with large infarctions, resulting in poor outcomes at 3 months. EVT may still provide some benefits in this population, but it also carries an increased risk of intracranial hemorrhage.
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Affiliation(s)
- Qian Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ting Duan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yaxi Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijie Gao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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18
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Geraghty JR, Testai FD. WITHDRAWN: Advances in Neurovascular Research: Scientific Highlights from the 15 th World Stroke Congress. J Stroke Cerebrovasc Dis 2024:107614. [PMID: 38301748 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.107614. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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19
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Lim GZ, Lai JY, Seet CYH, Tham CH, Venketasubramanian N, Tan BYQ, Jing M, Yeo JYP, Myint MZ, Sia CH, Teoh HL, Sharma VK, Chan BPL, Yang C, Makmur A, Ong SJ, Yeo LLL. Revolutionizing the Management of Large-Core Ischaemic Strokes: Decoding the Success of Endovascular Therapy in the Recent Stroke Trials. J Cardiovasc Dev Dis 2023; 10:499. [PMID: 38132666 PMCID: PMC10743836 DOI: 10.3390/jcdd10120499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Endovascular therapy (EVT) has revolutionized the management of acute ischaemic strokes with large vessel occlusion, with emerging evidence suggesting its benefit also in large infarct core volume strokes. In the last two years, four randomised controlled trials have been published on this topic-RESCUE-Japan LIMIT, ANGEL-ASPECT, SELECT2 and TENSION, with overall results showing that EVT improves functional and neurological outcomes compared to medical management alone. This review aims to summarise the recent evidence presented by these four trials and highlight some of the limitations in our current understanding of this topic.
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Affiliation(s)
- Gareth Zigui Lim
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Jonathan Yexian Lai
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Christopher Ying Hao Seet
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Carol Huilian Tham
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Joshua Yee Peng Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - May Zin Myint
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Cardiology, National University Heart Center, Singapore 119228, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Vijay Kumar Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Bernard Poon Lap Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Cunli Yang
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
| | - Andrew Makmur
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
| | - Shao Jin Ong
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119228, Singapore (V.K.S.); (B.P.L.C.)
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
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20
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Fainardi E, Busto G, Morotti A. Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties. Eur J Radiol Open 2023; 11:100524. [PMID: 37771657 PMCID: PMC10523426 DOI: 10.1016/j.ejro.2023.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
The purpose of this is study was to review pearls and pitfalls of advanced imaging, such as computed tomography perfusion and diffusion-weighed imaging and perfusion-weighted imaging in the selection of acute ischemic stroke (AIS) patients suitable for endovascular treatment (EVT) in the late time window (6-24 h from symptom onset). Advanced imaging can quantify infarct core and ischemic penumbra using specific threshold values and provides optimal selection parameters, collectively called target mismatch. More precisely, target mismatch criteria consist of core volume and/or penumbra volume and mismatch ratio (the ratio between total hypoperfusion and core volumes) with precise cut-off values. The parameters of target mismatch are automatically calculated with dedicated software packages that allow a quick and standardized interpretation of advanced imaging. However, this approach has several limitations leading to a misclassification of core and penumbra volumes. In fact, automatic software platforms are affected by technical artifacts and are not interchangeable due to a remarkable vendor-dependent variability, resulting in different estimate of target mismatch parameters. In addition, advanced imaging is not completely accurate in detecting infarct core, that can be under- or overestimated. Finally, the selection of candidates for EVT remains currently suboptimal due to the high rates of futile reperfusion and overselection caused by the use of very stringent inclusion criteria. For these reasons, some investigators recently proposed to replace advanced with conventional imaging in the selection for EVT, after the demonstration that non-contrast CT ASPECTS and computed tomography angiography collateral evaluation are not inferior to advanced images in predicting outcome in AIS patients treated with EVT. However, other authors confirmed that CTP and PWI/DWI postprocessed images are superior to conventional imaging in establishing the eligibility of patients for EVT. Therefore, the routine application of automatic assessment of advanced imaging remains a matter of debate. Recent findings suggest that the combination of conventional and advanced imaging might improving our selection criteria.
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Affiliation(s)
- Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Andrea Morotti
- Department of Neurological and Vision Sciences, Neurology Unit, ASST Spedali Civili, Brescia, Italy
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21
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Maxin AJ, Gulek BG, Chae J, Winston G, Weisbeek P, McGrath LB, Levitt MR. A smartphone pupillometry tool for detection of acute large vessel occlusion. J Stroke Cerebrovasc Dis 2023; 32:107430. [PMID: 37857150 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES Pupillary light reflex (PLR) parameters can be used as quantitative biomarkers of neurological function. Since digital infrared pupillometry is expensive, we sought to examine alterations in PLR parameters using a smartphone quantitative pupillometry platform in subjects with acute ischemic stroke (AIS). MATERIALS AND METHODS Patients were enrolled if they presented to the emergency department as a stroke code activation and had evidence of a large vessel occlusion (LVO) on computed tomography angiography. Controls were enrolled from hospital staff. A smartphone pupillometer was used in AIS patients with LVO pre-mechanical thrombectomy, immediately post-thrombectomy, and at 24 h post-thrombectomy. Clinical and demographic data were collected, along with the proprietary Neurological Pupil index (NPi) score from the NPi-200 digital infrared pupillometer. PLR parameters were compared using mean differences. The absolute and non-absolute inter-eye difference in each parameter for each subject were also analyzed by measuring 1 - (R:L) to determine alteration in the equilibrium between subject pupils. The NPi was analyzed for mean differences between cohorts. RESULTS Healthy controls (n = 132) and AIS patients (n = 31) were enrolled. Significant differences were observed in PLR parameters for healthy subjects when compared to pre-thrombectomy subjects in both mean and absolute inter-eye differences after post hoc Bonferroni correction. The proprietary NPi score was not significantly different for all groups and comparisons. CONCLUSIONS Significant alterations in the PLR were observed in AIS patients with LVO before thrombectomy, indicating the potential use of smartphone pupillometry for detection of LVO.
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Affiliation(s)
- Anthony J Maxin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; School of Medicine, Creighton University, Omaha, NE, USA
| | - Bernice G Gulek
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - John Chae
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Graham Winston
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Lynn B McGrath
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Department of Radiology, University of Washington, Seattle, WA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Stroke & Applied Neuroscience Center, University of Washington, Seattle, WA, USA.
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22
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Abdollahifard S, Taherifard E, Sadeghi A, Kiadeh PRH, Yousefi O, Mowla A. Endovascular therapy for acute stroke with a large infarct core: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107427. [PMID: 37925765 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE In this meta-analysis, we aimed to investigate the efficacy and safety of endovascular treatment (EVT) for acute ischemic stroke (AIS) patients with large core infarct. METHODS Three online databases of Web of Science, PubMed and Scopus were systematically searched. Original studies which evaluated AIS participants with large core infarction who underwent EVT were included. R statistical software was used for statistical analyses. Effect sizes were presented with odds ratios (ORs) with their 95% confidence intervals (CIs). The effect sizes were pooled using random effects modeling. RESULTS Including 47 studies and 15,173 patients, this meta-analysis showed that compared with medical management (MM), EVT was significantly associated with decreased odds of mortality (0.67, 95% CI: 0.51-0.87) and increased odds of favorable outcomes, including a modified Rankin Scale of 0-3 (2.36, 95% CI: 1.69-3.291) and of 0-2 (3.54, 95% CI: 1.96-6.4) in 90 days and remarkable improvement in National Institutes of Health Stroke Scale within 48 h after the procedure (3.6, 95% CI:1.32-9.79). Besides, there was a higher chance of intracranial hemorrhage (ICH) development (1.88, 95% CI: 1.32-2.68) but not symptomatic ICH (1.34, 95% CI: 0.78-2.31) in those who underwent EVT. CONCLUSION Our study suggests that EVT might be an effective and relatively safe treatment option for the treatment of AIS patients with large vessel occlusion who have large core infarcts, although more large-scale trials are needed to consolidate the results and to make inclusion criteria and the patient selection process clearer.
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Affiliation(s)
| | - Erfan Taherifard
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Omid Yousefi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), 1200 North State St., Suite 3300, Los Angeles, CA 90033, USA.
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23
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Bendszus M, Fiehler J, Subtil F, Bonekamp S, Aamodt AH, Fuentes B, Gizewski ER, Hill MD, Krajina A, Pierot L, Simonsen CZ, Zeleňák K, Blauenfeldt RA, Cheng B, Denis A, Deutschmann H, Dorn F, Flottmann F, Gellißen S, Gerber JC, Goyal M, Haring J, Herweh C, Hopf-Jensen S, Hua VT, Jensen M, Kastrup A, Keil CF, Klepanec A, Kurča E, Mikkelsen R, Möhlenbruch M, Müller-Hülsbeck S, Münnich N, Pagano P, Papanagiotou P, Petzold GC, Pham M, Puetz V, Raupach J, Reimann G, Ringleb PA, Schell M, Schlemm E, Schönenberger S, Tennøe B, Ulfert C, Vališ K, Vítková E, Vollherbst DF, Wick W, Thomalla G. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402:1753-1763. [PMID: 37837989 DOI: 10.1016/s0140-6736(23)02032-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice. METHODS In a prospective multicentre, open-label, randomised trial, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and a large established infarct indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 were randomly assigned using a central, web-based system (using a 1:1 ratio) to receive either endovascular thrombectomy with medical treatment or medical treatment (ie, standard of care) alone up to 12 h from stroke onset. The study was conducted in 40 hospitals in Europe and one site in Canada. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days, assessed by investigators masked to treatment assignment. The primary analysis was done in the intention-to-treat population. Safety endpoints included mortality and rates of symptomatic intracranial haemorrhage and were analysed in the safety population, which included all patients based on the treatment they received. This trial is registered with ClinicalTrials.gov, NCT03094715. FINDINGS From July 17, 2018, to Feb 21, 2023, 253 patients were randomly assigned, with 125 patients assigned to endovascular thrombectomy and 128 to medical treatment alone. The trial was stopped early for efficacy after the first pre-planned interim analysis. At 90 days, endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2·58 [95% CI 1·60-4·15]; p=0·0001) and with lower mortality (hazard ratio 0·67 [95% CI 0·46-0·98]; p=0·038). Symptomatic intracranial haemorrhage occurred in seven (6%) patients with thrombectomy and in six (5%) with medical treatment alone. INTERPRETATION Endovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection. FUNDING EU Horizon 2020.
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Affiliation(s)
- Martin Bendszus
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; eppdata GmbH, Hamburg, Germany
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Susanne Bonekamp
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-La Paz University Hospital-Universidad Autonoma de Madrid, Madrid, Spain
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Antonin Krajina
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Angélique Denis
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Franziska Dorn
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Fabian Flottmann
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Christian Herweh
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Silke Hopf-Jensen
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Vi Tuan Hua
- Department of Neurology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Kastrup
- Klinik für Neurologie, Klinikum Bremen Mitte, Bremen, Germany
| | - Christiane Fee Keil
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stefan Müller-Hülsbeck
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Nico Münnich
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | - Paolo Pagano
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Panagiotis Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen Mitte, Bremen, Germany; Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabor C Petzold
- Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mirko Pham
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volker Puetz
- Department of Neurology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Jan Raupach
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Gernot Reimann
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | | | - Maximilian Schell
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bjørn Tennøe
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Christian Ulfert
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kateřina Vališ
- St Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Vítková
- Department of Neurology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | | | - Wolfgang Wick
- Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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24
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Wei W, Zhang J, Xie S, Fan D, Chen Y, Zhong C, Chen L, Zhang Y, Shi S. Endovascular therapy versus medical management for acute ischemic stroke with large infarct core: Systematic review and meta-analysis of randomized controlled trials. Clin Neurol Neurosurg 2023; 234:108007. [PMID: 37797364 DOI: 10.1016/j.clineuro.2023.108007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of endovascular therapy (EVT) versus best medical management (BMM) in patients with acute ischemic stroke (AIS) with large infarct core. METHODS We searched Pubmed, Embase and Cochrane Central Register of Controlled Trials for published randomized clinical trials (RCTs) from inception to February 18, 2023. We defined patients with large core infarcts as having an Alberta Stroke Program early computed tomography score (ASPECTS) of 3-5. The primary outcome was functional independence, defined as a score of 0-2 on the modified Rankin scale (mRS) at 90 days. Secondary outcome was independent ambulation defined as mRS 0-3 at 90 days. Safety outcomes were mortality at 90 days, symptomatic intracranial hemorrhage (sICH) and any intracranial hemorrhage (ICH). RESULTS The overall treatment effect was more favourable to EVT group. EVT was significantly correlated with improvement of functional independence at 90 days (mRS 0-2) (RR = 2.40; 95 % CI, 1.82-3.16; P < 0.01; I2 = 0 %) and independent ambulation (mRS 0-3) (RR = 1,78; 95 % CI, 1.28-2.48; P < 0.01; I2 = 58 %) at 90 days. 90-day mortality was not significantly different between the two groups(RR = 0.95; 95 % CI, 0.78-1.16; P > 0.05; I2 = 0 %). The risk of sICH and any ICH was higher in EVT group than in BMM group. CONCLUSION Compared with BMM, EVT may improve functional outcomes in patients with ASPECTS 3-5, despite being associated with an increased risk of sICH and any ICH.
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Affiliation(s)
- Wenqian Wei
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Jian Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Shuyu Xie
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Dongmei Fan
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Yiyun Chen
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Chongxu Zhong
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Liufei Chen
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China
| | - Yueling Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China.
| | - Shengliang Shi
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi 530007, China.
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25
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Migdady I, Johnson-Black PH, Leslie-Mazwi T, Malhotra R. Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke. J Clin Med 2023; 12:6641. [PMID: 37892779 PMCID: PMC10607145 DOI: 10.3390/jcm12206641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core infarcts, even when large volumes of salvageable brain tissue were present, due to the high risk of hemorrhagic transformation and reperfusion injury. However, recent retrospective and prospective studies have shown improved outcomes with endovascular thrombectomy, and several clinical trials were recently published to evaluate the efficacy of endovascular management of patients presenting with large-core infarcts. With or without thrombectomy, patients with large-core infarcts remain at high risk of in-hospital complications such as hemorrhagic transformation, malignant cerebral edema, seizures, and others. Expert neurocritical care management is necessary to optimize blood pressure control, mitigate secondary brain injury, manage cerebral edema and elevated intracranial pressure, and implement various neuroprotective measures. Herein, we present an overview of the current and emerging evidence pertaining to endovascular treatment for large-core infarcts, recent advances in neurocritical care strategies, and their impact on optimizing patient outcomes.
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Affiliation(s)
- Ibrahim Migdady
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Phoebe H. Johnson-Black
- Department of Neurosurgery, Division of Neurocritical Care, UCLA David Geffen School of Medicine, Ronald Reagan Medical Center, Los Angeles, CA 90095, USA;
| | | | - Rishi Malhotra
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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Ren Z, Wangqin R, Demiraj F, Li W, Mokin M, Wang A, Miao Z, Wang Y, Burgin WS. Derivation and validation of a predictive scale to expedite endovascular intervention for acute stroke patients with an intervenable vessel occlusion. J Neurointerv Surg 2023:jnis-2023-020871. [PMID: 37734930 DOI: 10.1136/jnis-2023-020871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early endovascular intervention team mobilization may reduce reperfusion times and improve clinical outcomes for patients with acute ischemic stroke (AIS) with a possible intervenable vessel occlusion (IVO). In an emergency department or mobile stroke unit, incorporating rapidly available non-contrast CT (NCCT) information with examination findings may improve the accuracy of arterial occlusion prediction scales. For this purpose, we developed a rapid and straightforward IVO predictive instrument-the T3AM2PA1 scale. METHODS The T3AM2PA1 scale was retrospectively derived from our 'Get with the Guidelines' database. We included all patients with acute stroke alert between January 2017 and August 2018 with a National Institutes of Health Stroke Scale (NIHSS) score between 5 and 25 inclusive. Different pre-intervention variables were collected, including itemized NIHSS and NCCT information. The T3AM2PA1 scale was also compared with other commonly used scales and was validated in a separate sequential retrospective cohort of patients with a full range of NIHSS scores. RESULTS 574 eligible patients from 2115 acute stroke alerts were identified. The scale was established with five items (CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparesis, gaze deviation, and language disturbance), with a total score of 9. To minimize unnecessary angiography, a cut-off of ≥5 for IVO detection yielded a sensitivity of 52%, a specificity of 90%, and a positive predictive value of 76%. CONCLUSIONS The T3AM2PA1 scale accurately predicts the presence of clinical IVO in patients with AIS. Adopting the T3AM2PA1 scale could reduce revascularization times, improve treatment outcomes, and potentially reduce disability.
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Affiliation(s)
- Zeguang Ren
- Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Runqi Wangqin
- Duke Clinical Research Institute, Duke Univeristy Medical Center, Durham, North Carolina, USA
| | - Francis Demiraj
- Department of Neurology, FAU Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Weizhe Li
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Maxim Mokin
- Department of Neurosurgery and Neurology, University of South Florida, Tampa, Florida, USA
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - W Scott Burgin
- Department of Neurology, University of South Florida, Tampa, Florida, USA
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27
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Abuelazm M, Ahmad U, Abu Suilik H, Seri A, Mahmoud A, Abdelazeem B. Endovascular Thrombectomy for Acute Stroke with a Large Ischemic Core: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Neuroradiol 2023; 33:625-634. [PMID: 37233795 PMCID: PMC10450014 DOI: 10.1007/s00062-023-01306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Endovascular thrombectomy (ET) efficacy and safety in stroke with a large ischemic core is still inconclusive as this population has been underrepresented in ET randomized controlled trials (RCTs). METHODS We conducted a systematic review and meta-analysis synthesizing RCTs, which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through February 18th, 2023. Our primary outcome was neurological disability measured by the modified Rankin scale (mRS). Dichotomous outcomes were pooled using risk ratio (RR) along with confidence interval (CI) using Revman V. 5.4 software. RESULTS Three RCTs with a total of 1010 patients were included in our analysis. ET significantly increased the rates of functional independence (mRS ≤ 2) (RR: 2.54 with 95% CI [1.85, 3.48]), independent ambulation (mRS ≤ 3) (RR: 1.78 with 95% CI [1.28, 2.48]), and early neurological improvement (RR: 2.46 with 95% CI [1.60, 3.79]). However, there was no difference between endovascular thrombectomy and medical care in excellent neurological recovery (mRS ≤ 1) (RR: 1.35 with 95% CI [0.88, 2.08]). Also, ET significantly reduced the rate of poor neurological recovery (mRS 4-6) (RR: 0.79 with 95% CI [0.72, 0.86]). However, endovascular thrombectomy was associated with more incidence of any intracranial hemorrhage (RR: 2.40 with 95% CI [1.90, 3.01] [0.72, 0.86]). CONCLUSION ET combined with medical care was associated with better functional outcomes compared with medical care alone. However, ET was associated with a higher rate of intracranial hemorrhage. This can support extending ET indication in the management of stroke with a large ischemic core.
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Affiliation(s)
| | | | | | - Amith Seri
- Department of Internal Medicine, McLaren Health Care, Flint, MI, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
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28
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Li Q, Abdalkader M, Siegler JE, Yaghi S, Sarraj A, Campbell BCV, Yoo AJ, Zaidat OO, Kaesmacher J, Pujara D, Nogueira RG, Saver JL, Li L, Han Q, Dai Y, Sang H, Yang Q, Nguyen TN, Qiu Z. Mechanical Thrombectomy for Large Ischemic Stroke: A Systematic Review and Meta-analysis. Neurology 2023; 101:e922-e932. [PMID: 37277200 PMCID: PMC10501098 DOI: 10.1212/wnl.0000000000207536] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is growing evidence for endovascular thrombectomy (EVT) in patients with large ischemic core infarct and large vessel occlusion (LVO). The objective of this study was to compare the efficacy and safety of EVT vs medical management (MM) using a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). METHODS We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0-3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42023396232). RESULTS A total of 5,395 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded by review of the title, abstract, and full text. Finally, 3 RCTs and 10 cohort studies met the inclusion criteria. The RCT analysis showed that EVT improved the 90-day functional outcomes of patients with large ischemic core with high-quality evidence, including independent ambulation (mRS 0-3: RR 1.78, 95% CI 1.28-2.48, p < 0.001) and functional independence (mRS 0-2: RR 2.59, 95% CI 1.89-3.57, p < 0.001), but without significantly increasing the risk of symptomatic intracranial hemorrhage (sICH: RR 1.83, 95% CI 0.95-3.55, p = 0.07) or early mortality (RR 0.95, 95% CI 0.78-1.16, p = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH. DISCUSSION This systematic review and meta-analysis indicates that in patients with LVO stroke with a large ischemic core, EVT was associated with improved functional outcomes over MM without increasing sICH risk. The results of ongoing RCTs may provide further insight in this patient population.
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Affiliation(s)
- Qi Li
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Mohamad Abdalkader
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - James E Siegler
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Shadi Yaghi
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Amrou Sarraj
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Bruce C V Campbell
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Albert J Yoo
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Osama O Zaidat
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Johannes Kaesmacher
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Deep Pujara
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Raul G Nogueira
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Jeffrey L Saver
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Lei Li
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Qin Han
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA.
| | - Yi Dai
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Hongfei Sang
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Qingwu Yang
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
| | - Thanh N Nguyen
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA.
| | - Zhongming Qiu
- From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA.
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Feyen L, Kniep H, Blockhaus C, Weinzierl M, Katoh M, Haage P, Rohde S, Münnich N. Thrombectomy in ischemic stroke patients with alberta stroke program early computed tomography score 4-5 and 0-3: Factors associated with favorable outcome. J Stroke Cerebrovasc Dis 2023; 32:107104. [PMID: 37156088 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/04/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy. MATERIAL AND METHODS All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanalization was defined as Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Multivariable logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome. RESULTS 621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neurological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanalization (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome. CONCLUSION Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable outcome in patients with low ASPECTS.
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Germany, Heusnerstraße 40, 42283, Wuppertal.
| | - Helge Kniep
- Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Christian Blockhaus
- Heart Centre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, Witten 58448, Germany
| | - Martin Weinzierl
- Department of Neurosurgery, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany
| | - Patrick Haage
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Stefan Rohde
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany; German Society of Interventional Radiology and Minimal Invasive Therapy, German Society of Interventional Radiology and Minimal Invasive Therapy (DeGIR) and German Society of Neuroradiology (DGNR), Ernst Reuter Platz 10, Berlin 10587, Germany
| | - Nico Münnich
- University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany
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Han N, Zhang X, Zhang Y, Liu Y, Zhang Y, Ma H, Ge H, Li S, Zhang X, Yan X, Li T, Gao B, Du C, Ji X, Shi W, Tian Y, Chang M. Nomogram to predict unfavorable outcome of endovascular thrombectomy for large ischemic core. Ann Clin Transl Neurol 2023; 10:1353-1364. [PMID: 37329177 PMCID: PMC10424651 DOI: 10.1002/acn3.51826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/30/2023] [Accepted: 05/27/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE The prognosis for patients presenting with a large ischemic core (LIC) following endovascular thrombectomy is relatively poor. This study aimed to construct and validate a nomogram for predicting 3-month unfavorable outcome in patients with anterior circulation occlusion-related LIC who underwent endovascular thrombectomy. METHODS A retrospective training cohort and a prospective validation cohort of patients with a large ischemic core were studied. The diffusion weighted imaging related radiomic features and pre-thrombectomy clinical features were collected. After the selection of relevant features, a nomogram predicting modified Rankin Scale score of 3-6 as an unfavorable outcome was established. The discriminatory value of the nomogram was evaluated with a receiver operating characteristic curve. RESULTS A total of 140 patients (mean age 66.3 ± 13.4 years, 35% female) were included in this study, consisting of a training cohort (n = 95) and a validation cohort (n = 45). The percentage of patients with an mRS scores of 0-2 was 30%, 0-3 was 40.7%, and 32.9% were dead. Age, National Institute of Health Stroke Scale (NIHSS) score, and two radiomic features, Maximum2DDiameterColumn and Maximum2DDiameterSlice, were identified as factors associated with unfavorable outcome in the nomogram. The nomogram demonstrated an area under the curve of 0.892 (95% confidence interval [CI], 0.812-0.947) in the training dataset and 0.872 (95% CI, 0.739-0.953) in the validation dataset. INTERPRETATION This nomogram, which includes age, NIHSS score, Maximum2DDiameterColumn, and Maximum2DDiameterSlice, may predict the risk of unfavorable outcome in patients with LIC caused by anterior circulation occlusion.
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Affiliation(s)
- Nannan Han
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Xiaobo Zhang
- The College of Life SciencesNorthwest UniversityXi'anChina
| | - Yu Zhang
- The College of Life SciencesNorthwest UniversityXi'anChina
| | - Yu Liu
- School of Information Science and TechnologyNorthwest UniversityXi'anChina
| | - Yongqin Zhang
- School of Information Science and TechnologyNorthwest UniversityXi'anChina
| | - Haojun Ma
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Hanming Ge
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Shilin Li
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Xiao Zhang
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
- Clinical Medical Research CenterThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Xudong Yan
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Tengfei Li
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Bin Gao
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Chengxue Du
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Xinchao Ji
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Wenzhen Shi
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
- Clinical Medical Research CenterThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Ye Tian
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
- Clinical Medical Research CenterThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
| | - Mingze Chang
- Department of NeurologyThe Affiliated Hospital of Northwest University, Xi'an No.3 HospitalXi'anChina
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Dumas V, Martin K, Giraud C, Prigent J, Bloch W, Soualmi K, Herpe G, Boucebci S, Neau JP, Guillevin R, Velasco S. Functional outcome in low-ASPECTS (0-5) acute ischemic stroke treated with mechanical thrombectomy: impact of laterality explored in a single-center study. Front Neurol 2023; 14:1205256. [PMID: 37470004 PMCID: PMC10353876 DOI: 10.3389/fneur.2023.1205256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Background There is no consensus regarding the influence of infarct laterality in patients with acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT), particularly in low-ASPECT (0-5) patients who were excluded from the initial MT studies and that participated in dedicated randomized-controlled trials that do not consider the side of the occlusion. We aimed to evaluate the role of infarct laterality on the clinical outcome in low-ASPECT AIS patients treated with MT. Material and methods We retrospectively analyzed our institutional stroke database in our Thrombectomy-Capable Stroke Center (TCSC), including patient characteristics, procedural variables, and outcomes, between January 2015 and January 2022. Patients with acute intracranial ICA and/or proximal MCA occlusions with ASPECT ≤ 5 either on CT or MRI were included and divided into 2 groups according to the location of ischemia. The primary endpoint was a good clinical outcome at 90 days (modified Rankin Scale (mRS) score of 0-3). Results Between January 2015 and November 2021, 817 MT were performed, of which 82 were low-ASPECT (10.0%): 41 left-sided and 41 right-sided strokes. The rates of good clinical outcome were 30.8% (12/41) for the left-sided group and 43.6% (17/41) for the right-sided group, with a p-value of 0.349. The morality rate showed no significant difference between the two groups: 39.0% (16/41) in the right stroke group and 36.6% (15/41) in the left stroke group. Conclusion The clinical outcome was not significantly influenced by stroke laterality. The results of this single-center retrospective study indicate either a lack of strength or equal value in performing mechanical thrombectomy regardless of stroke laterality.
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Affiliation(s)
- Victor Dumas
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Killian Martin
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Clément Giraud
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
| | - Julia Prigent
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - William Bloch
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Karim Soualmi
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Guillaume Herpe
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Samy Boucebci
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Jean Philippe Neau
- Department of Neurology, Poitiers University Medical Center, Poitiers, France
| | - Rémy Guillevin
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
| | - Stéphane Velasco
- Department of Radiology, Poitiers University Medical Center, Poitiers, France
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Lin S, Li Y, Lei C, Zhou X, Zhu X, Yang X, Chen C. Differences in risk factors and outcome after acute stroke in patients with tandem occlusion and those with isolated intracranial occlusion after endovascular treatment. Neurosurg Rev 2023; 46:103. [PMID: 37140688 DOI: 10.1007/s10143-023-02013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/04/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study aimed to compare the clinical features, treatment, and clinical outcome of patients with tandem occlusion and isolated intracranial occlusion through endovascular treatment (EVT). METHODS Patients with acute cerebral infarction who received EVT in two stroke centers were retrospectively included. According to MRI or CTA results, the patients were divided into tandem occlusion group or isolated intracranial occlusion group. The baseline data, etiological classification, treatment, post-stroke complications, image features, and clinical outcome were compared. Multivariate logistic regression analysis was used to evaluate the related factors affecting the prognosis of patients with EVT. RESULTS Among 161 patients with acute cerebral infarction, there were 33 cases (20.5%) in the tandem occlusion group and 128 cases (79.5%) in the isolated intracranial occlusion group. Compared with isolated intracranial occlusion, the patients with tandem occlusion had higher rates of large artery atherosclerosis (P = 0.028), symptomatic intracerebral hemorrhage (sICH) (P = 0.023), bilateral infarction (P = 0.042), and longer time for endovascular procedure (P = 0.026). There was no significant statistical difference in 90-day mRS score between the two groups (P = 0.060). Multivariate logistic regression identified the following independent predictors of poor functional outcome: older age, high fasting blood glucose, infarction area > 1/3, and hemorrhagic transformation. CONCLUSIONS Compared with isolated intracranial occlusion, there was not a worse prognosis among patients with tandem occlusion who received EVT.
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Affiliation(s)
- Shihan Lin
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
| | - Yongyu Li
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
| | - Chunyan Lei
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China.
| | - Xinlian Zhou
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
| | - Xiaoyan Zhu
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
| | - Xinglong Yang
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
| | - Chun Chen
- Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China
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Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Blackburn S, Sitton CW, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Wallace AN, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Cardona-Portela P, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Elijovich L, Tekle W, Samaniego EA, Maali L, Abdulrazzak MA, Psychogios MN, Shuaib A, Pujara DK, Shaker F, Johns H, Sharma G, Yogendrakumar V, Ng FC, Rahbar MH, Cai C, Lavori P, Hamilton S, Nguyen T, Fifi JT, Davis S, Wechsler L, Pereira VM, Lansberg MG, Hill MD, Grotta JC, Ribo M, Campbell BC, Albers GW. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med 2023; 388:1259-1271. [PMID: 36762865 DOI: 10.1056/nejmoa2214403] [Citation(s) in RCA: 220] [Impact Index Per Article: 220.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations. METHODS We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome. RESULTS The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P<0.001). A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional independence (relative risk, 2.97; 95% CI, 1.60 to 5.51). Mortality was similar in the two groups. In the thrombectomy group, arterial access-site complications occurred in 5 patients, dissection in 10, cerebral-vessel perforation in 7, and transient vasospasm in 11. Symptomatic intracranial hemorrhage occurred in 1 patient in the thrombectomy group and in 2 in the medical-care group. CONCLUSIONS Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.).
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Affiliation(s)
- Amrou Sarraj
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ameer E Hassan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael G Abraham
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Santiago Ortega-Gutierrez
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Scott E Kasner
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - M Shazam Hussain
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael Chen
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Spiros Blackburn
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Clark W Sitton
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Leonid Churilov
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Sophia Sundararajan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Yin C Hu
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Nabeel A Herial
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Pascal Jabbour
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Daniel Gibson
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Adam N Wallace
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Juan F Arenillas
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Jenny P Tsai
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ronald F Budzik
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - William J Hicks
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Osman Kozak
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Bernard Yan
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Dennis J Cordato
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Nathan W Manning
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Mark W Parsons
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ricardo A Hanel
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Amin N Aghaebrahim
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Teddy Y Wu
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Pere Cardona-Portela
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Natalia Pérez de la Ossa
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Joanna D Schaafsma
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Jordi Blasco
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Navdeep Sangha
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Steven Warach
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Chirag D Gandhi
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Timothy J Kleinig
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Daniel Sahlein
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Lucas Elijovich
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Wondwossen Tekle
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Edgar A Samaniego
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Laith Maali
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - M Ammar Abdulrazzak
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Marios N Psychogios
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Ashfaq Shuaib
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Deep K Pujara
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Faris Shaker
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Hannah Johns
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Gagan Sharma
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Vignan Yogendrakumar
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Felix C Ng
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Mohammad H Rahbar
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Chunyan Cai
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Philip Lavori
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Scott Hamilton
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Thanh Nguyen
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Johanna T Fifi
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Stephen Davis
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Lawrence Wechsler
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Vitor M Pereira
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Maarten G Lansberg
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Michael D Hill
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - James C Grotta
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Marc Ribo
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Bruce C Campbell
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
| | - Gregory W Albers
- From the Departments of Neurology (A. Sarraj, S.S., D.K.P.) and Neurosurgery (Y.C.H.), University Hospitals Cleveland Medical Center-Case Western Reserve University, and the Cerebrovascular Center, Cleveland Clinic (M.S.H., J.P.T., M.A.A.), Cleveland, and the Departments of Neurointerventional Radiology (R.F.B.) and Neurology (W.J.H.), OhioHealth-Riverside Methodist Hospital, Columbus - all in Ohio; the Neuroscience Institute, Valley Baptist Medical Center, Harlingen (A.E.H., W.T.), the Departments of Neurosurgery (S.B., F.S.), Diagnostic and Interventional Imaging (C.W.S.), and Internal Medicine (M.H.R., C.C.), McGovern Medical School at UTHealth, and the Mobile Stroke Unit, Memorial Hermann Hospital (J.C.G.), Houston, and the Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin (S.W.) - all in Texas; the Department of Neurology, University of Kansas Medical Center, Kansas City (M.G.A., L.M.); the Departments of Neurosurgery and Radiology (S.O.-G.) and Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City; the Division of Vascular Neurology, University of Pennsylvania (S.E.K.), the Department of Neurosurgery, Thomas Jefferson University Hospital (N.A.H., P.J.), and the Department of Neurology, Hospital of the University of Pennsylvania (L.W.), Philadelphia, and Neurovascular Associates of Abington, Jefferson Health, Abington (O.K.) - all in Pennsylvania; the Department of Neurosurgery, Rush University Medical Center, Chicago (M.C.); Melbourne Medical School, University of Melbourne (L.C., H.J.), the Melbourne Brain Centre, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne (B.Y., G.S., V.Y., F.C.N., S.D., B.C.C.), and the Florey Institute of Neuroscience and Mental Health (L.C., B.C.C.), Parkville, VIC, the Departments of Neurology (D.J.C., M.W.P.) and Neurosurgery (N.W.M.), Liverpool Hospital, and the Department of Neurology, University of New South Wales (M.W.P.), Liverpool, and the Neurology Service, Royal Adelaide Hospital, Adelaide, SA (T.J.K.) - all in Australia; the Department of Neurosurgery, Ascension Columbia St. Mary's Hospital, Milwaukee (D.G., A.N.W.); the Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid (J.F.A.), the Department of Neurology, Bellvitge University Hospital (P.C.-P.), the Department of Interventional Radiology, Hospital Clínic de Barcelona (J.B.), and the Department of Neurology, Hospital Vall d'Hebrón (M.R.), Barcelona, and the Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (N.P.O.) - all in Spain; Neurosurgery, Corewell Health, Grand Rapids, MI (J.P.T.); Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, FL (R.A.H., A.N.A.); the Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (T.Y.W.); the Divisions of Internal Medicine and Neurology, Toronto Western Hospital (J.D.S.), and the Division of Neurology, St. Michael's Hospital (V.M.P.), Toronto, the Divisions of Internal Medicine and Neurology, University of Alberta, Edmonton (A. Shuaib), and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB (M.D.H.) - all in Canada; Neurological Services, Kaiser Permanente Southern California, Los Angeles (N.S.), the Departments of Biomedical Data Science (P.L.) and Neurology (M.G.L., G.W.A.), Stanford University, Stanford, and MAPS Public Benefit Corporation, San Jose (S.H.) - all in California; the Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla (C.D.G.), and the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (J.T.F.) - both in New York; Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, IN (D.S.); Neurology, Semmes Murphey Clinic, Memphis, TN (L.E.); Neuroradiology, University Hospital Basel, Basel, Switzerland (M.N.P.); and the Neurology Department, Boston Medical Center, Boston (T.N.)
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Huo X, Ma G, Tong X, Zhang X, Pan Y, Nguyen TN, Yuan G, Han H, Chen W, Wei M, Zhang J, Zhou Z, Yao X, Wang G, Song W, Cai X, Nan G, Li D, Wang AYC, Ling W, Cai C, Wen C, Wang E, Zhang L, Jiang C, Liu Y, Liao G, Chen X, Li T, Liu S, Li J, Gao F, Ma N, Mo D, Song L, Sun X, Li X, Deng Y, Luo G, Lv M, He H, Liu A, Zhang J, Mu S, Liu L, Jing J, Nie X, Ding Z, Du W, Zhao X, Yang P, Liu L, Wang Y, Liebeskind DS, Pereira VM, Ren Z, Wang Y, Miao Z. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med 2023; 388:1272-1283. [PMID: 36762852 DOI: 10.1056/nejmoa2213379] [Citation(s) in RCA: 224] [Impact Index Per Article: 224.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The role of endovascular therapy for acute stroke with a large infarction has not been extensively studied in differing populations. METHODS We conducted a multicenter, prospective, open-label, randomized trial in China involving patients with acute large-vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower values indicating larger infarction) or an infarct-core volume of 70 to 100 ml. Patients were randomly assigned in a 1:1 ratio within 24 hours from the time they were last known to be well to undergo endovascular therapy and receive medical management or to receive medical management alone. The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability), and the primary objective was to determine whether a shift in the distribution of the scores on the modified Rankin scale at 90 days had occurred between the two groups. Secondary outcomes included scores of 0 to 2 and 0 to 3 on the modified Rankin scale. The primary safety outcome was symptomatic intracranial hemorrhage within 48 hours after randomization. RESULTS A total of 456 patients were enrolled; 231 were assigned to the endovascular-therapy group and 225 to the medical-management group. Approximately 28% of the patients in both groups received intravenous thrombolysis. The trial was stopped early owing to the efficacy of endovascular therapy after the second interim analysis. At 90 days, a shift in the distribution of scores on the modified Rankin scale toward better outcomes was observed in favor of endovascular therapy over medical management alone (generalized odds ratio, 1.37; 95% confidence interval, 1.11 to 1.69; P = 0.004). Symptomatic intracranial hemorrhage occurred in 14 of 230 patients (6.1%) in the endovascular-therapy group and in 6 of 225 patients (2.7%) in the medical-management group; any intracranial hemorrhage occurred in 113 (49.1%) and 39 (17.3%), respectively. Results for the secondary outcomes generally supported those of the primary analysis. CONCLUSIONS In a trial conducted in China, patients with large cerebral infarctions had better outcomes with endovascular therapy administered within 24 hours than with medical management alone but had more intracranial hemorrhages. (Funded by Covidien Healthcare International Trading [Shanghai] and others; ANGEL-ASPECT ClinicalTrials.gov number, NCT04551664.).
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Affiliation(s)
- Xiaochuan Huo
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Gaoting Ma
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xu Tong
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xuelei Zhang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Yuesong Pan
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Thanh N Nguyen
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Guangxiong Yuan
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Hongxing Han
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Wenhuo Chen
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Ming Wei
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Jiangang Zhang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Zhiming Zhou
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xiaoxi Yao
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Guoqing Wang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Weigen Song
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xueli Cai
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Guangxian Nan
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Di Li
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - A Yi-Chou Wang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Wentong Ling
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Chuwei Cai
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Changming Wen
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - En Wang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Liyong Zhang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Changchun Jiang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Yajie Liu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Geng Liao
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xiaohui Chen
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Tianxiao Li
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Shudong Liu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Jinglun Li
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Feng Gao
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Ning Ma
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Dapeng Mo
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Ligang Song
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xuan Sun
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xiaoqing Li
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Yiming Deng
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Gang Luo
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Ming Lv
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Hongwei He
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Aihua Liu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Jingbo Zhang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Shiqing Mu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Lian Liu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Jing Jing
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Ximing Nie
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Zeyu Ding
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Wanliang Du
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Xingquan Zhao
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Pengfei Yang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Liping Liu
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Yilong Wang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - David S Liebeskind
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Vitor M Pereira
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Zeguang Ren
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Yongjun Wang
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
| | - Zhongrong Miao
- From Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People's Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People's Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People's Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People's Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People's Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People's Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People's Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People's Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) - all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael's Hospital, University of Toronto, Toronto (V.M.P.)
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35
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Molad J, Honig A. Current advances in endovascular treatment. Curr Opin Neurol 2023; 36:125-130. [PMID: 36762653 DOI: 10.1097/wco.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Endovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients' selection and periprocedural management. RECENT FINDINGS Recent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability. SUMMARY The field of EVT is rapidly evolving. The results of recent trials have dramatically increased the indications for EVT, with many ongoing trials examining further indications.
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Affiliation(s)
- Jeremy Molad
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv
| | - Asaf Honig
- Department of Neurology, Soroka Medical Center, Beer-Sheva, Israel
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36
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, Riva R, Derex L, De Bourguignon C, Mechtouff L, Eker OF, Nighoghossian N, Berthezene Y. Assessment of three MR perfusion software packages in predicting final infarct volume after mechanical thrombectomy. J Neurointerv Surg 2023; 15:393-398. [PMID: 35318959 DOI: 10.1136/neurintsurg-2022-018674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV). METHODS This cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score. RESULTS Ninety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference -40.9 mL) and B (median absolute difference -67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference -118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99). CONCLUSIONS Automated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.
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Affiliation(s)
- Alexandre Bani-Sadr
- Neuroradiology, Hospices Civils de Lyon, Bron, France .,MYRIAD, CREATIS, Villeurbanne, France
| | - Tae-Hee Cho
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Hermier
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Andrea Filip
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roberto Riva
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Laurent Derex
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | | | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
| | | | - Yves Berthezene
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
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37
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Dhillon PS, Butt W, Podlasek A, McConachie N, Lenthall R, Nair S, Malik L, Bhogal P, Makalanda HLD, Spooner O, Krishnan K, Sprigg N, Mortimer A, Booth TC, Lobotesis K, White P, James MA, Bath P, Dineen RA, England TJ. Association between time to treatment and clinical outcomes in endovascular thrombectomy beyond 6 hours without advanced imaging selection. J Neurointerv Surg 2023; 15:336-342. [PMID: 35296526 DOI: 10.1136/neurintsurg-2021-018564] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/24/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6-24 hours) for acute ischemic stroke (AIS) patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-EVT treatment beyond 6 hours of stroke onset without advanced neuroimaging. METHODS Patients who underwent EVT selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging), between October 2015 and March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (<6 hours) and late windows with time analyzed as a continuous variable. RESULTS Among 3278 patients, 2610 (79.6%) and 668 (20.4%) patients were included in the early and late windows, respectively. In the late window, for every hour delay, there was no significant association with shift towards poorer functional outcome (modified Rankin Scale (mRS)) at discharge (adjusted common OR 0.98, 95% CI 0.94 to 1.01, p=0.27) or change in predicted functional independence (mRS ≤2) (24.5% to 23.3% from 6 to 24 hours; aOR 0.99, 95% CI0.94 to 1.04, p=0.85). In contrast, predicted functional independence was time sensitive in the early window: 5.2% reduction per-hour delay (49.4% to 23.5% from 1 to 6 hours, p=0.0001). There were similar rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 4.6%, p=0.54) and in-hospital mortality (12.9% vs 14.6%, p=0.33) in the early and late windows, respectively, without a significant association with time. CONCLUSION In this real-world study, there was minimal change in functional disability, sICH and in-hospital mortality within and across the late window. While confirmatory randomized trials are needed, these findings suggest that EVT remains feasible and safe when performed in AIS patients selected without advanced neuroimaging between 6-24 hours from stroke onset.
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Affiliation(s)
- Permesh Singh Dhillon
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK .,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Interventional Neuroradiology, Queen Elizabeth Hospital University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Anna Podlasek
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Norman McConachie
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | | | - Oliver Spooner
- Stroke Medicine, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - Kailash Krishnan
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nikola Sprigg
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.,Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Alex Mortimer
- Interventional Neuroradiology, Southmead Hospital North Bristol NHS Trust, Bristol, Bristol, UK
| | - Thomas Calvert Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, London, UK
| | - Kyriakos Lobotesis
- Interventional Neuroradiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, London, UK
| | - Philip White
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Martin A James
- University of Exeter Medical School, Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Sentinel Stroke National Audit Programme, King's College London, London, UK
| | - Philip Bath
- Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.,Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Mental Health and Clinical Neuroscience, School of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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38
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Dittrich TD, Sporns PB, Kriemler LF, Rudin S, Nguyen A, Zietz A, Polymeris AA, Tränka C, Thilemann S, Wagner B, Altersberger VL, Piot I, Barinka F, Müller S, Hänsel M, Gensicke H, Engelter ST, Lyrer PA, Sutter R, Nickel CH, Katan M, Peters N, Kulcsár Z, Karwacki GM, Pileggi M, Cereda C, Wegener S, Bonati LH, Fischer U, Psychogios M, De Marchis GM. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study. Stroke 2023; 54:722-730. [PMID: 36718751 PMCID: PMC10561685 DOI: 10.1161/strokeaha.122.039793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. METHODS Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. RESULTS Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02-2.10]; P=0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37-0.93]; P=0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P=0.63). CONCLUSIONS Two out of 3 patients with anterior circulation large vessel occlusion presenting in the late time window did not meet the DEFUSE-3 and DAWN inclusion criteria. In these patients, MT was associated with higher odds of favorable functional outcomes without increased rates of symptomatic intracranial hemorrhage. These findings support the enrollment of patients into ongoing randomized trials on MT in the late window with more permissive inclusion criteria.
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Affiliation(s)
- Tolga D Dittrich
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.B.S.)
| | - Lilian F Kriemler
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Switzerland (L.F.K.)
| | - Salome Rudin
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Anh Nguyen
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
| | - Annaelle Zietz
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Alexandros A Polymeris
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Christopher Tränka
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Sebastian Thilemann
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Benjamin Wagner
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Valerian L Altersberger
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Ines Piot
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Filip Barinka
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland (F.B., N.P.)
| | - Susanne Müller
- Department of Neuroradiology, University Hospital Zurich, Switzerland (S.M.)
| | - Martin Hänsel
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (M.H., S.W.)
| | - Henrik Gensicke
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland (H.G., S.T.E.)
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland (H.G., S.T.E.)
| | - Philippe A Lyrer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Raoul Sutter
- Department of Intensive Care Medicine, University Hospital Basel, Switzerland (R.S.)
| | - Christian H Nickel
- Emergency Department University Hospital Basel and University of Basel, Switzerland (C.H.N.)
| | - Mira Katan
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Nils Peters
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland (F.B., N.P.)
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, Switzerland (Z.K.)
| | - Grzegorz M Karwacki
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Switzerland (G.M.K.)
| | - Marco Pileggi
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
| | - Carlo Cereda
- Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland (C.C.)
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (M.H., S.W.)
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Rheinfelden Rehabilitation Clinic, Switzerland (L.H.B.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Marios Psychogios
- Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland (M.P.)
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
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Neurological Functional Independence After Endovascular Thrombectomy and Different Imaging Modalities for Large Infarct Core Assessment : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:21-29. [PMID: 35920865 DOI: 10.1007/s00062-022-01202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the rate of neurological functional independence (NFI) at 90 days in patients with large infarct core (LIC), which was evaluated by different imaging modalities before endovascular thrombectomy (EVT). METHODS PubMed and EMBASE were searched for original studies on clinical functional outcomes at 90 days in LIC patients who received EVT treatment from inception to 28 September 2021. The pooled NFI rates were calculated using random effects model according to different imaging modalities and criteria. RESULTS We included 34 studies enrolling 2997 LIC patients. The NFI rates were 23% (95% confidence interval, CI 15-32%) and 24% (95% CI 10-38%) when LIC was defined as core volume ≥50 ml and ≥ 70 ml separately on computed tomography perfusion, 36% (95% CI 23-48%) and 21% (95% CI 17-25%) when LIC was defined as core volume ≥ 50 ml and ≥ 70 ml separately on magnetic resonance diffusion-weighted imaging (DWI), 28% (95% CI 24-32%) and 37% (95% CI 21-53%) when LIC was defined as DWI-ASPECTS ≤ 5 and ≤ 6 separately, 23% (95% CI 19-27%) and 32% (95% CI 18-46%) when LIC was defined as NCCT-ASPECTS ≤ 5 and ≤ 6 separately. CONCLUSION Similar NFI rates could be obtained after EVT in LIC patients if proper LIC criteria were select according to the imaging modality.
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Broocks G, Meyer L, Elsayed S, McDonough R, Bechstein M, Faizy TD, Sporns P, Schön G, Minnerup J, Kniep HC, Hanning U, Barow E, Schramm P, Langner S, Nawabi J, Papanagiotou P, Wintermark M, Lansberg MG, Albers GW, Heit JJ, Fiehler J, Kemmling A. Association Between Net Water Uptake and Functional Outcome in Patients With Low ASPECTS Brain Lesions: Results From the I-LAST Study. Neurology 2023; 100:e954-e963. [PMID: 36414425 PMCID: PMC9990438 DOI: 10.1212/wnl.0000000000201601] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The effect of mechanical thrombectomy (MT) on functional outcome in patients with ischemic stroke with low ASPECTS is still uncertain. ASPECTS rating is based on the presence of ischemic hypoattenuation relative to normal; however, the degree of hypoattenuation, which directly reflects net uptake of water, is currently not considered an imaging biomarker in stroke triage. We hypothesized that the effect of thrombectomy on functional outcome in low ASPECTS patients depends on early lesion water uptake. METHODS For this multicenter observational study, patients with anterior circulation stroke with ASPECTS ≤5 were consecutively analyzed. Net water uptake (NWU) was assessed as a quantitative imaging biomarker in admission CT. The primary end point was the rate of favorable functional outcome defined as modified Rankin Scale score 0-3 at day 90. The effect of recanalization on functional outcome was analyzed according to the degree of NWU within the early infarct lesion. RESULTS A total of 254 patients were included, of which 148 (58%) underwent MT. The median ASPECTS was 4 (interquartile range [IQR] 3-5), and the median NWU was 11.4% (IQR 8.9%-15.1%). The rate of favorable outcome was 27.6% in patients with low NWU (<11.4%) vs 6.3% in patients with high NWU (≥11.4%; p < 0.0001). In multivariable logistic regression analysis, NWU was an independent predictor of outcome, whereas vessel recanalization (modified thrombolysis in cerebral infarction ≥2b) was only significantly associated with better outcomes if NWU was lower than 12.6%. In inverse-probability weighting analysis, recanalization was associated with 20.7% (p = 0.01) increase in favorable outcome in patients with low NWU compared with 9.1% (p = 0.06) in patients with high NWU. DISCUSSION Early NWU was independently associated with clinical outcome and might serve as an indicator of futile MT in low ASPECTS patients. NWU could be tested as a tool to select low ASPECTS patients for MT. TRIAL REGISTRATION INFORMATION The study is registered within the ClinicalTrials.gov Protocol Registration and Results System (NCT04862507).
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Affiliation(s)
- Gabriel Broocks
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
| | - Lukas Meyer
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Sarah Elsayed
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Rosalie McDonough
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Matthias Bechstein
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Tobias Djamsched Faizy
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Peter Sporns
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Gerhard Schön
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Jens Minnerup
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Helge C Kniep
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Uta Hanning
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Ewgenia Barow
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Peter Schramm
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Soenke Langner
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Jawed Nawabi
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Panagiotis Papanagiotou
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Max Wintermark
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Maarten G Lansberg
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Gregory W Albers
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Jeremy J Heit
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Jens Fiehler
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
| | - Andre Kemmling
- From the Departments of Diagnostic and Interventional Neuroradiology (G.B., L.M., S.E., R.M., M.B., T.D.F., P. Sporns, H.C.K., U.H., J.F.) and Neuroradiology (S.L.), and Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany; Departments of Clinical Neuroscience and Radiology (R.M.), Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Alberta, Canada; Department of Neuroradiology (T.D.F.), Stanford University, CA; Department of Neuroradiology (P. Sporns), Universitätsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (P. Schramm), University Hospital Schleswig-Holstein, Luebeck; Department of Neuroradiology (S.L.), University Greifswald; Department of Neuroradiology (S.L.), University Medical Center Rostock; Department of Neuroradiology (J.N.), Charité University Medicine, Berlin; Department of Neuroradiology (P.P.), Hospital Bremen-Mitte, Germany; Department of Neuroradiology (M.W.), MD Anderson, Houston, TX; Departments of Neurology and Neurological Sciences (M.G.L., G.W.A.) and Radiology (J.J.H.), Stanford University School of Medicine, CA; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany
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Tsai JP, Schaafsma JD, Sarraj A. Editorial: Management of acute stroke with large core. Front Neurol 2023; 14:1135886. [PMID: 36815000 PMCID: PMC9940731 DOI: 10.3389/fneur.2023.1135886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jenny P. Tsai
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States,*Correspondence: Jenny P. Tsai ✉
| | - Joanna D. Schaafsma
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amrou Sarraj
- Programs of Neurology and Stroke, University Hospitals Cleveland Medical Center – Case Western Reserve University, Cleveland, OH, United States
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Fifi JT, Nguyen TN, Song S, Sharrief A, Pujara DK, Shaker F, Fournier LE, Jones EM, Lechtenberg CG, Slavin SJ, Ifejika NL, Diaz MV, Martin-Schild S, Schaafsma J, Tsai JP, Alexandrov AW, Tjoumakaris SI, Sarraj A. Sex differences in endovascular thrombectomy outcomes in large vessel occlusion: a propensity-matched analysis from the SELECT study. J Neurointerv Surg 2023; 15:105-112. [PMID: 35232756 DOI: 10.1136/neurintsurg-2021-018348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysis. Despite several studies, there is still a lack of consensus on whether endovascular thrombectomy (EVT) outcomes differ between men and women. OBJECTIVE To compare sex differences in EVT outcomes at 90-day follow-up and assess whether progression in functional status from discharge to 90-day follow-up differs between men and women. METHODS From the Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) prospective cohort study (2016-2018), adult men and women (≥18 years) with anterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery M1/M2) treated with EVT up to 24 hours from last known well were matched using propensity scores. Discharge and 90-day modified Rankin Scale (mRS) scores were compared between men and women. Furthermore, we evaluated the improvement in mRS scores from discharge to 90 days in men and women using a repeated-measures, mixed-effects regression model. RESULTS Of 285 patients, 139 (48.8%) were women. Women were older with median (IQR) age 69 (57-81) years vs 64.5 (56-75), p=0.044, had smaller median perfusion deficits (Tmax >6 s) 109 vs 154 mL (p<0.001), and had better collaterals on CT angiography and CT perfusion but similar ischemic core size (relative cerebral blood flow <30%: 7.6 (0-25.2) vs 11.4 (0-38) mL, p=0.22). In 65 propensity-matched pairs, despite similar discharge functional independence rates (women: 42% vs men: 48%, aOR=0.55, 95% CI 0.18 to 1.69, p=0.30), women exhibited worse 90-day functional independence rates (women: 46% vs men: 60%, aOR=0.41, 95% CI 0.16 to 1.00, p=0.05). The reduction in mRS scores from discharge to 90 days also demonstrated a significantly larger improvement in men (discharge 2.49 and 90 days 1.88, improvement 0.61) than in women (discharge 2.52 and 90 days 2.44, improvement 0.08, p=0.036). CONCLUSION In a propensity-matched cohort from the SELECT study, women had similar discharge outcomes as men following EVT, but the improvement from discharge to 90 days was significantly worse in women, suggesting the influence of post-discharge factors. Further exploration of this phenomenon to identify target interventions is warranted. TRIAL REGISTRATION NUMBER NCT02446587.
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Affiliation(s)
- Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Sarah Song
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Anjail Sharrief
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Deep Kiritbhai Pujara
- Department of Neurology, University Hospitals Neurological Institute, Cleveland, Ohio, USA
| | - Faris Shaker
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Lauren E Fournier
- Department of Neurology, Baylor Scott & White Health, Dallas, Texas, USA
| | - Erica M Jones
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colleen G Lechtenberg
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sabreena J Slavin
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nneka L Ifejika
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maria V Diaz
- Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Infirmary and New Orleans East Hospital, Metairie, Louisiana, USA.,Dr. Brain Inc, New Orleans, Louisiana, USA
| | - Joanna Schaafsma
- Medicine - Division Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jenny P Tsai
- Department of Neurological Surgery, Spectrum Health Medical Group, Grand Rapids, Michigan, USA
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Amrou Sarraj
- Department of Neurology, University Hospitals Neurological Institute, Cleveland, Ohio, USA .,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Yi TY, Wu YM, Lin DL, Lang FL, Yang YY, Pan ZN, Zheng XF, Hong GJ, Wu MH, Lin XH, Chen RC, Zeng L, Chen WH, Sui Y. Association of baseline core volume and early midline shift in acute stroke patients with a large ischaemic core. Front Neurol 2023; 13:1077824. [PMID: 36698883 PMCID: PMC9868771 DOI: 10.3389/fneur.2022.1077824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
Background Midline shift (MLS) is troublesome problem that may occur in patients with a large infarct core (LIC) and may be related to the baseline infarct core volume. The purpose of this study was to explore the relationship between baseline infarct core volume and early MLS presence. Materials and methods Patients with acute intracranial large artery occlusion and a pretreatment relative cerebral blood flow (rCBF) <30% volume ≥50 ml on CT perfusion (CTP) were included, clinical outcomes following endovascular treatment (EVT) were retrospectively analyzed. The primary endpoint was MLS within 48 h (early MLS presence). The association between baseline ICV and early MLS presence was evaluated with multivariable regression. Results Ultimately, 95 patients were included, and 29.5% (28/95) of the patients had early MLS. The number of patients with a baseline rCBF < 15% volume (median [interquartile range], 46 [32-60] vs. 29 [19-40]; P < 0.001) was significantly larger in the early severe MLS presence group. A baseline rCBF < 15% volume showed significantly better predictive accuracy for early MLS presence than an rCBF < 30% volume (area under the curve, 0.74 vs. 0.64, P = 0.0023). In addition, an rCBF < 15% volume ≥40 ml (odds ratio, 4.34 [95% CI, 1.571-11.996]) was associated with early MLS presence after adjustment for sex, age, baseline National Institutes of Health Stroke Scale score, onset-to-recanalization time. Conclusion In patients with an acute LIC following EVT, a pretreatment infarct core volume > 40 ml based on an rCBF < 15% showed good predictive value for early MLS occurrence.
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Affiliation(s)
- Ting-yu Yi
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yan-min Wu
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Ding-lai Lin
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Feng-long Lang
- Department of Neurology, Fushun Central Hospital, Fushun, Liaoning, China
| | - Yu-yan Yang
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Zhi-nan Pan
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Xiu-fen Zheng
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Gan-ji Hong
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Mei-hua Wu
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Xiao-hui Lin
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Rong-cheng Chen
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Lisan Zeng
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Wen-huo Chen
- Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China,*Correspondence: Wen-huo Chen ✉
| | - Yi Sui
- Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College, Shenyang, China,Yi Sui ✉
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Widimsky P, Snyder K, Sulzenko J, Hopkins LN, Stetkarova I. Acute ischaemic stroke: recent advances in reperfusion treatment. Eur Heart J 2022; 44:1205-1215. [PMID: 36477996 PMCID: PMC10079392 DOI: 10.1093/eurheartj/ehac684] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
During the last 5–7 years, tremendous progress was achieved in the reperfusion treatment of acute ischaemic stroke during its first few hours from symptom onset. This review summarizes the latest evidence from randomized clinical trials and prospective registries with a focus on endovascular treatment using stent retrievers, aspiration catheters, thrombolytics, and (in selected patients) carotid stenting. Novel approaches in prehospital (mobile interventional stroke teams) and early hospital (direct transfer to angiography) management are described, and future perspectives (‘all-in-one’ laboratories with angiography and computed tomography integrated) are discussed. There is reasonable chance for patients with moderate-to-severe acute ischaemic stroke to survive without permanent sequelae when the large-vessel occlusion is removed by means of modern pharmaco-mechanic approach. Catheter thrombectomy is now the golden standard of acute stroke treatment. The role of cardiologists in stroke is expanding from diagnostic help (to reveal the cause of stroke) to acute therapy in those regions where such up-to-date Class I. A treatment is not yet available.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Kenneth Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Jakub Sulzenko
- Cardiocenter, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
| | - Leo Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
| | - Ivana Stetkarova
- Department of Neurology at the Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady , Ruska 87, Prague 10 , Czech Republic
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Safouris A, Palaiodimou L, Szikora I, Kargiotis O, Magoufis G, Psychogios K, Paraskevas G, Spiliopoulos S, Brountzos E, Nardai S, Goyal N, De Sousa DA, Strbian D, Caso V, Alexandrov A, Tsivgoulis G. Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864221139632. [PMID: 36467113 PMCID: PMC9716457 DOI: 10.1177/17562864221139632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with Alberta Stroke Program Early CT Score (ASPECTS) 0-5 has not yet proven safe and effective by clinical trials. OBJECTIVES The aim of the study was to assess whether EVT in AIS patients presenting with low ASPECTS is beneficial. DESIGN Systematic review and meta-analysis of available studies in accordance with the PRISMA statement. DATA SOURCES AND METHODS We have searched MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 28 May 2022 with the aim to calculate (1) modified Rankin scale (mRS) score 0-3 at 3 months, (2) mRS score 0-2 at 3 months, (3) symptomatic intracranial hemorrhage (sICH), and (3) mortality at 3 months. RESULTS Overall, 24 eligible studies were included in the meta-analysis, comprising a total of 2539 AIS patients with ASPECTS 0-5 treated with EVT. The pooled proportion of EVT-treated patients achieving mRS 0-3 at 3 months was calculated at 38.4%. The pooled proportion of EVT-treated patients achieving mRS 0-2 at 3 months was 25.7%. Regarding safety outcomes, sICH occurred in 12.8% of patients. The 3-month pooled mortality was 30%. In pairwise meta-analysis, patients treated with EVT had a higher likelihood of achieving mRS 0-3 at 3 months compared with patients treated with best medical therapy (BMT, OR: 2.41). sICH occurred more frequently in EVT-treated patients compared with the BMT-treated patients (OR: 2.30). Mortality at 3 months was not different between the two treatment groups (OR: 0.71). CONCLUSION EVT may be beneficial for AIS patients with low baseline ASPECTS despite an increased risk for sICH. Further data from randomized-controlled clinical trials are needed to elucidate the role of EVT in this subgroup of AIS patients. REGISTRATION The protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO; Registration Number: CRD42022334417.
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Affiliation(s)
- Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, Piraeus,
Greece
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
- Aktios Rehabilitation Center, Athens,
Greece
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - István Szikora
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | | | - George Magoufis
- Neuroradiology Department, Metropolitan
Hospital, Piraeus, Greece
| | | | - Georgios Paraskevas
- Second Department of Neurology, Attikon
University Hospital, Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- Interventional Radiology Department, Attikon
University Hospital, Athens, Greece
| | - Elias Brountzos
- Interventional Radiology Department, Attikon
University Hospital, Athens, Greece
| | - Sándor Nardai
- Department of Neurointerventions, National
Institute of Mental Health, Neurology and Neurosurgery, Section of
Neurointervention, Department of Neurosurgery, Semmelweis University,
Budapest, Hungary
| | - Nitin Goyal
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, The University of
Tennessee Health Science Center and Semmes Murphey Neurologic and Spine
Clinic. Memphis, TN, USA
| | - Diana Aguiar De Sousa
- Stroke Center, Lisbon Central University
Hospital and Faculty of Medicine, University of Lisbon, Lisbon,
Portugal
| | - Daniel Strbian
- Neurological Research Unit, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valeria Caso
- Neurology Unit, ‘M. Bufalini’ Hospital-AUSL
Romagna, Cesena, Italy
| | - Andrei Alexandrov
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon
University Hospital, Rimini 1, Chaidari, 124 62 Athens, Greece
- School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
- Department of Neurology, The University of
Tennessee Health Science Center, Memphis, TN, USA
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Lu Q, Fu J, Lv K, Han Y, Pan Y, Xu Y, Zhang J, Geng D. Agreement of three CT perfusion software packages in patients with acute ischemic stroke: A comparison with RAPID. Eur J Radiol 2022; 156:110500. [PMID: 36099834 DOI: 10.1016/j.ejrad.2022.110500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare ischemic core volume (ICV) and penumbra volume (PV) measured by MIStar, F-STROKE, and Syngo.via with that measured by RAPID in acute ischemic stroke (AIS), and their concordance in selecting patients for endovascular thrombectomy (EVT). METHODS Computed tomography perfusion (CTP) data were processed with four software packages. Bland-Altman analysis and intraclass correlation coefficient (ICC) were performed to evaluate their agreement in quantifying ICV and PV. Kappa test was conducted to assess consistency in the selection of EVT candidates. The correlation between predicted ICV and segmented final infarct volume (FIV) on follow-up images was investigated. RESULTS A total of 91 patients were retrospectively included. F-STROKE had the best consistency with RAPID (ICV: ICC = 0.97; PV: ICC = 0.84) and Syngo.via had the worst consistency (ICV: ICC = 0.77; PV: ICC = 0.66). F-STROKE had the narrowest limits of agreements both in ICV (-27.02, 24.40 mL) and PV (-85.59, 101.80 mL). When selecting EVT candidates, MIStar (kappa = 0.71-0.88) and F-STROKE (kappa = 0.84-0.90) had good to excellent consistency with RAPID, while Syngo.via had poor consistency (kappa = 0.20-0.41). ICV predicted by MIStar was correlated strongest with FIV (r = 0.77). CONCLUSIONS F-STROKE is most consistent with RAPID in quantitative ICV and PV. F-STROKE and MIStar exhibit similar EVT candidate selection to RAPID. Syngo.via, for its part, seems to have overestimated ICV and underestimated PV, leading to an overly restrictive selection of EVT candidates.
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Affiliation(s)
- Qingqing Lu
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Junyan Fu
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Kun Lv
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Yan Han
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Yiren Xu
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China.
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Reasearch, Huashan Hospital, Fudan Universtiy, Shanghai 200040, China.
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Garcia-Esperon C, Bivard A, Johns H, Chen C, Churilov L, Lin L, Butcher K, Kleinig TJ, Choi PMC, Cheng X, Dong Q, Aviv RI, Miteff F, Spratt NJ, Levi CR, Parsons MW. Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core. Neurology 2022; 99:e1345-e1355. [PMID: 35803723 DOI: 10.1212/wnl.0000000000200908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular thrombectomy (EVT) is effective for patients with large vessel occlusion (LVO) stroke with smaller volumes of CT perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core volume >70 mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core volume ≥70 mL, hypothesizing that there would be a benefit from EVT for fair outcome (3-month modified Rankin scale [mRS] 0-3) after stroke. METHODS A retrospective analysis of patients enrolled into a multicenter (Australia, China, and Canada) registry (2012-2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core volume ≥70 mL was performed. The primary outcome was the estimation of the association of EVT in patients with core volume ≥70 mL and within 70-100 and ≥100 mL subgroups with fair outcome. RESULTS Of the 3,283 patients in the registry, 299 had CTP core volume ≥70 mL and 269 complete data (135 had core volume between 70 and 100 mL and 134 had core volume ≥100 mL). EVT was performed in 121 (45%) patients. EVT-treated patients were younger (median 69 vs 75 years; p = 0.011), had lower prestroke mRS, and smaller median core volumes (92 [79-116.5] mL vs 105.5 [85.75-138] mL, p = 0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% vs 13.9% in the non-EVT group; adjusted odds ratio [aOR] 2.1, 95% CI 1-4.2, p = 0.038). The benefit was seen predominantly in those with 70-100 mL core volume (71/135 [52.6%] EVT-treated), with 54.3% in the EVT-treated vs 21% in the non-EVT group achieving a fair outcome (aOR 2.5, 95% CI 1-6.2, p = 0.005). Of those with a core volume ≥100 mL, 50 of the 134 (37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% vs 8.7%; p = 0.908). DISCUSSION We found a positive association of EVT with the 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70-100 mL but not in those with core volume ≥100 mL. Randomized data to confirm these findings are required. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EVT is associated with better motor outcomes 3 months after CTP-defined ischemic stroke with a core volume of 70-100 mL.
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Affiliation(s)
- Carlos Garcia-Esperon
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia.
| | - Andrew Bivard
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Hannah Johns
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Chushuang Chen
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Leonid Churilov
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Longting Lin
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Kenneth Butcher
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Timothy J Kleinig
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Philip M C Choi
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Xin Cheng
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Qiang Dong
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Richard I Aviv
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Ferdinand Miteff
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Neil J Spratt
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Christopher R Levi
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
| | - Mark W Parsons
- From the Department of Neurology (C.G.-E., F.M., N.J.S., C.R.L.), John Hunter Hospital, New Lambton Heights; College of Health, Medicine, and Wellbeing (C.G.-E., F.M., N.J.S., C.R.L., M.W.P.), University of Newcastle; Hunter Medical Research Institute (C.G.-E., C.C., L.L., F.M., N.J.S., C.R.L., M.W.P.), Newcastle; Melbourne Brain Center at the Royal Melbourne Hospital (A.B., H.J., L.C., M.W.P.), University of Melbourne, Parkville; Melbourne Medical School (H.J., L.C.), University of Melbourne, Victoria; Prince of Wales Clinical School (K.B.), University of New South Wales, Sydney; Royal Adelaide Hospital (T.J.K.); Box Hill Hospital (P.M.C.C.), Melbourne; Eastern Health Clinical School (P.M.C.C.), Monash University, Melbourne, Australia; Huashan Hospital (X.C., Q.D.), Fudan University, Shanghai, China; Neuroradiology Section (R.I.A.), Department of Radiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada; and Department of Neurology (L.L., M.W.P.), Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Australia
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Huo X, Ma G, Zhang X, Pan Y, Tong X, Sun D, Liu L, Wang Y, Liebeskind DS, Wang Y, Pereira VM, Ren Z, Miao Z. Endovascular therapy in acute anterior circulation large vessel occlusive patients with a large infarct core (ANGEL-ASPECT): protocol of a multicentre randomised trial. Stroke Vasc Neurol 2022; 8:169-174. [PMID: 36137599 PMCID: PMC10176983 DOI: 10.1136/svn-2022-001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The benefit of stroke thrombectomy for large infarct core still lacks robust randomised controlled studies. AIM To demonstrate the design of a clinical trial on endovascular therapy for acute anterior circulation large vessel occlusion (LVO) patients with large infarct core volume. DESIGN ANGEL-ASPECT is a multicentre, prospective, randomised, open-label, blinded End-point trial to evaluate whether best medical management (BMM) combined with endovascular therapy improves neurological functional outcomes as compared with BMM alone in acute LVO patients with Alberta Stroke Program Early CT Score (ASPECTS) of 3-5 on non-contrast CT or infarct core volume range of 70-100 mL (defined as rCBF <30% on CT perfusion or ADC <620 on MRI) up to 24 hours from symptom onset or last seen well. STUDY OUTCOMES The primary efficacy outcome is 90 (±7) days modified Rankin Scale. Symptomatic intracranial haemorrhage within 48 hours from randomisation is the primary safety outcome. DISCUSSION The ANGEL-ASPECT trial will screen patients with large infarct core (ASPECTS 3-5 or 70-100 mL) through image evaluation criteria within 24 hours and explore the efficacy and safety of endovascular therapy compared with BMM.
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Affiliation(s)
- Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Xuelei Zhang
- Clinical Research Center, Capital Medical University, Institute of Brain Disorders, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zeguang Ren
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China .,Department of Neurology, Beijing Tiantan Hospital, Beijing, China
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Karamchandani RR, Yang H, Prasad T, Strong D, Rhoten JB, Defilipp G, Clemente J, Stetler WR, Bernard J, Asimos AW. Endovascular Thrombectomy Reduces Risk of Poor Functional Outcomes in Patients Presenting within 0-6 Hours with Large Ischemic Core Volumes on Computed Tomography Perfusion. J Stroke Cerebrovasc Dis 2022; 31:106548. [PMID: 35567936 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/02/2022] [Accepted: 05/01/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Patients presenting with large ischemic core volumes (LICVs) on computed tomography perfusion (CTP) are at high risk for poor functional outcomes. We sought to identify predictors of outcome in patients with an internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion and LICV. METHODS A large healthcare system's prospectively collected code stroke registry was utilized for this retrospective analysis of patients presenting within 6 hours with at least 50 ml of CTP reduced relative cerebral blood flow (CBF) < 30%. A multivariable logistic regression model was constructed to identify independent predictors (p < 0.05) of poor discharge outcome (modified Rankin scale score 4-6). RESULTS Over a 38-month period, we identified 104 patients meeting inclusion criteria, with a mean age of 65.4 ± 16.2 years, median presenting National Institutes of Health Stroke Scale score 20 (IQR 16-24), median ischemic core volume (CBF < 30%) 82 ml (IQR 61-118), and median mismatch volume 80 ml (IQR 56-134). Seventy-five patients (72.1%) had a discharge modified Rankin scale score of 4-6. Sixty-six of 104 (63.5%) patients were treated with endovascular thrombectomy (EVT). In the multivariable regression model, EVT (OR 0.303; 95% CI 0.080-0.985; p = 0.049) and lower blood glucose (per 1-point increase, OR 1.014; 95% CI 1.003-1.030; p = 0.030) were independently protective against poor discharge outcome. CONCLUSIONS EVT is independently associated with a reduced risk of poor functional outcome in patients presenting within 6 hours with ICA or MCA occlusions and LICV.
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Affiliation(s)
- Rahul R Karamchandani
- Department of Neurology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC 28203, United States, 734.883.7844.
| | - Hongmei Yang
- Information and Analytics Services, Atrium Health, Charlotte, NC, USA, 301.910.5966.
| | - Tanushree Prasad
- Information and Analytics Services, Atrium Health, Charlotte, NC, USA, 603.320.7556.
| | - Dale Strong
- Information and Analytics Services, Atrium Health, Charlotte, NC, USA, 410.940.9178.
| | - Jeremy B Rhoten
- Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 304.654.8820.
| | - Gary Defilipp
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 704.458.9612.
| | - Jonathan Clemente
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 704.604.4283.
| | - William R Stetler
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 205.542.1402.
| | - Joe Bernard
- Carolina Neurosurgery and Spine Associates, Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 704.618.4236.
| | - Andrew W Asimos
- Department of Emergency Medicine, Neurosciences Institute, Atrium Health, Charlotte, NC, USA, 704.804.9861.
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Sun D, Huo X, Raynald, Jia B, Tong X, Ma G, Wang A, Ma N, Gao F, Mo D, Miao Z. Predictors of symptomatic intracranial hemorrhage after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry. J Thromb Thrombolysis 2022; 54:558-565. [PMID: 35913684 DOI: 10.1007/s11239-022-02688-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/24/2022]
Abstract
Symptomatic intracranial hemorrhage (SICH) is a catastrophic complication of endovascular treatment (EVT) for large vessel occlusion (LVO). We aimed to investigate the incidence and predictors of SICH after EVT. Patients were selected from the ANGEL-ACT registry. We diagnosed SICH according to the Heidelberg Bleeding Classification. Logistic regression analyses were performed to determine the independent predictors of SICH. Of the 1283 patients, SICH was observed in 116 patients (9.0%). On multivariable analysis, admission National Institutes of Health Stroke Scale (NIHSS) > 12 (odds ratio [OR] = 1.86, 95% confidence interval [CI]: 1.11-3.11, P = 0.018), admission Alberta Stroke Program Early CT Score (ASPECTS) < 6 (OR = 2.98, 95%CI: 1.68-5.29, P < 0.001), general anesthesia (OR = 1.81, 95%CI: 1.20-2.71, P = 0.004), prior intravenous thrombolysis (OR = 1.58, 95%CI: 1.04-2.40, P = 0.031), number of mechanical thrombectomy passes > 2 (OR = 1.68, 95%CI: 1.10-2.57, P = 0.016), and procedure duration > 96 min (OR = 1.82, 95%CI: 1.20-2.77, P = 0.005) were associated with high risk of SICH, whereas SICH was negatively associated with underlying intracranial atherosclerotic disease (OR = 0.45, 95%CI: 0.26-0.79, P = 0.021). The incidence of SICH after EVT for anterior LVO was 9.0% in ANGEL-ACT registry. Our study identified some predictors, which may assist doctors in identifying LVO patients with a high risk of SICH and making the optimal peri-procedural management strategies for such patients.
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Affiliation(s)
- Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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