1
|
Xie Q, Deng X, Xiao J, Chen X, He Y, Yang L, Liu S, Lai J, Cai Y, Sun J, Guo X. Protocol of the Development of a Core Outcome Set for Ischemic Stroke in Clinical Trials of Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:2649843. [PMID: 33082820 PMCID: PMC7556059 DOI: 10.1155/2020/2649843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 02/01/2023]
Abstract
Background. Ischemic stroke (IS) seriously impacts the quality of life of survivors. Chinese medicine (CM) has been developed for more than 2000 years and plays a key role in the treatment of ischemic stroke. Many Chinese medicine clinical trials have been conducted; however, the heterogeneity of outcome measurements and reporting limits implications of the findings in clinical practice and health policy development. Therefore, it is important to develop a core outcome set (COS) that should be used and reported in trials for ischemic stroke treated by Chinese medicine. This protocol describes the process of developing the IS-CM-COS. Methods and Analysis. The development of the COS will involve the following four steps: (1) A list of outcomes reported in the registered and published Chinese medicine trials of ischemic stroke will be extracted by conducting a systematic literature review. (2) An additional outcome list will be collected by semistructured interview to patients with ischemic stroke. (3) A two-round Delphi survey will be performed to prioritize and condense the outcomes. (4) In the consensus meeting, a final recommended COS will be developed. Discussion. The COS could improve the reliability and consistency of outcome reporting. We hope that this IS-CM-COS will be used in the future Chinese medicine trials for the treatment of ischemic stroke and improve research quality. Trial Registration. This study was registered with the Core Outcome Measures in Effectiveness Trials Initiative (http://www.comet-initiative.org/studies/details/1282).
Collapse
Affiliation(s)
- Qianwen Xie
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueyi Deng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingmin Xiao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueyin Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yihan He
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- EBM & Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lihong Yang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- EBM & Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Shaonan Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- EBM & Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jiaqi Lai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- EBM & Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yefeng Cai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingbo Sun
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- EBM & Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| |
Collapse
|
3
|
Abstract
BACKGROUND In 2003, Higashida et al proposed the Thrombolysis In Cerebral Infarction scale to evaluate angiographic intracranial flow. Our aim is to review how subsequently published studies define TICI. MATERIALS AND METHODS We used the ISI Web of Knowledge and SciVerse Scopus databases to search for "TICI" and "thrombolysis in cerebral infarction" and for articles that cited the original TICI paper from January 2004 through May 2012. Articles were categorized according to their definition of the TICI categories, typically grades 0-4, with grade 2 (partial reperfusion) subdivided into 2a and 2b, and rate of contrast entry to the perfused area. In addition, we catalogued the type of redefinitions of TICI subcategory 2 and additions of new categories. RESULTS Of 236 articles screened, 74 were included. Eight (11%) explicitly followed the TICI scale as originally defined. Thirty-seven (50%) cited Higashida but did not define their scale. Fifteen (21%) used and explained modified scales. Thirteen (18%) used the term TICI, but did not define the scale and did not cite Higashida. Eighteen (24%) specified a 2a subcategory. Nine defined grade 2a as <67% filling, 6 defined it as <50%, and 3 did not offer a percentage. Two studies added a 2c subcategory. Fifty-two (70%) used a cutoff level to define "successful reperfusion." Of these, 65% used TICI ≥2, 33% used TICI ≥2b, and 2% used TICI = 3. CONCLUSIONS There is substantial variability in the definition and/or application of the TICI scale in the literature. This variability could considerably impact our understanding of results of revascularization studies.
Collapse
|
4
|
Vajda Z, Schmid E, Güthe T, Klötzsch C, Lindner A, Niehaus L, Sperber W, Peters J, Arnold G, Bäzner H, Henkes H. The Modified Bose Method for the Endovascular Treatment of Intracranial Atherosclerotic Arterial Stenoses Using the Enterprise Stent. Neurosurgery 2011; 70:91-101; discussion 101. [DOI: 10.1227/neu.0b013e31822dff0f] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Balloon dilatation and deployment of a self-expanding stent is a safe treatment for intracranial atherosclerotic stenoses. The significant recurrence rate might be related to the high radial force of the Wingspan stent.
OBJECTIVE
To evaluate the procedural safety and stenosis recurrence rate by the use of a stent with reduced radial force (Enterprise).
METHODS
Two hundred nine atherosclerotic stenoses (189 patients) were treated (median age, 68 years; 132 male) in a single center. Lesion locations included internal carotid artery (n = 27), middle cerebral artery (n = 62), vertebral artery (n = 64), basilar artery (n = 55), and posterior cerebral artery (n = 1). Pre- and postmedication included acetylsalicylic acid and Clopidogrel for at least 12 months. Preprocedural and follow-up examinations included magnetic resonance imaging (MRI), neurological assessment, and digital subtraction angiography (6, 12, 26, and 52 weeks). Data registry included age, sex, normal vessel diameter, degree of stenosis, residual stenosis after stent, minimal in-stent diameter, and occurrence of ischemic symptoms during follow-up.
RESULTS
Median pre- and postprocedural stenosis rate was 65.4 ± 1% vs 25.1 ± 1%. Technical success rate was 100%. Major procedural complications occurred in 16 patients (8.1%). Combined neurological morbidity and mortality rate at 30 days was 2 patients (0.9%). In 174 stenoses (83%) angiographic follow-up was obtained (mean, 10.2 months). A restenosis (>50%) was observed in 43 (24.7%) cases after 4.2 months (mean) with 4 (9.3%) symptomatic lesions. Incidence of recurrent ischemia related to the stented artery was 2.2% during 10.2 months of mean follow-up.
CONCLUSION
Undersized balloon angioplasty and deployment of an Enterprise stent is safe and effective for intracranial stenoses. Follow-up results were equal to or better than those reported for bare-metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia.
Collapse
Affiliation(s)
- Zsolt Vajda
- Klinik für Neuroradiologie, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Elisabeth Schmid
- Klinik für Neurologie, Bürgerhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Thomas Güthe
- Klinik für Neuroradiologie, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Alfred Lindner
- Klinik für Neurologie, Marienhospital Stuttgart, Stuttgart, Germany
| | - Ludwig Niehaus
- Klinik für Neurologie, Klinikum Schloß Winnenden, Winnenden, Germany
| | | | - Jan Peters
- Klinik für Neurologie, Ostalb Klinikum Aalen, Aalen, Germany
| | - Guy Arnold
- Klinik für Neurologie, Klinikum Sindelfingen, Sindelfingen, Germany
| | - Hansjörg Bäzner
- Klinik für Neurologie, Bürgerhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Klinik für Neuroradiologie, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
- Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
| |
Collapse
|
5
|
Nguyen TN, Zaidat OO, Gupta R, Nogueira RG, Tariq N, Kalia JS, Norbash AM, Qureshi AI. Balloon Angioplasty for Intracranial Atherosclerotic Disease. Stroke 2011; 42:107-11. [PMID: 21071722 DOI: 10.1161/strokeaha.110.583245] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thanh N. Nguyen
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Osama O. Zaidat
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Rishi Gupta
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Raul G. Nogueira
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Nauman Tariq
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Junaid S. Kalia
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Alexander M. Norbash
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| | - Adnan I. Qureshi
- From the Boston University School of Medicine (T.N.N., A.M.N.), Boston, Mass; Medical College of Wisconsin (O.O.Z., J.S.K.), Milwaukee, Wis; Cleveland Clinic Foundation (R.G.), Cleveland, Ohio; Department of Neurology (R.G., R.G.N.), Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Ga; and Zeenat Qureshi Stroke Center (N.T., A.I.Q.), University of Minnesota, Minneapolis, Minn
| |
Collapse
|